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Health Plan Rankings: the numbers speak for themselves
Written by Jeffrey R. Waggoner, MD   

I am not a great fan of rankings and statistics. They can be a bit irrelevant as Robert Boynton pointed out when he observed, “statistics have shown that mortality increases perceptibly in the military during the wartime.” Thus, it was with a jaundiced eye that I considered U.S. News & World Report’s recent ranking of American health plans (November 5, 2007).

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However, it does not require statistics to extract at least some truths from the study.

For example, out of the top twenty health programs, 16 are not-for-profit health plans. All of the top ten programs are not-for-profit. Secondly, out of the top 50 programs, there are only two that are not HMOs.

I don’t think a chi square test is needed to conclude that the best health care programs in America are not-for-profit. Common sense, a much underappreciated alternative to statistics, predicts that this might be so. When was the last time you heard a CEO of a for-profit corporation say, “I am acting in the best interests of my customers”? They don’t say that—they say, “I am acting in the best interests of my stockholders.” They’d get railroaded out of town if they put customers in front of stockholders—and served with a class action lawsuit just before they hit the city limits.

So, a CEO of a for-profit insurance company’s first allegiance is to his corporation’s stockholders, and recent history suggests they have done a darn good job in that regard. HMOs et al have ranked in the top 5 or top 10 for rate of return on investment for the past decade. (Fortune Magazine, annual ranking of America’s top 50 industries).

Unfortunately for patients, the flip side of this truth is that they are not the number one concern of a for-profit insurance company. It is difficult to serve two masters.

That’s why for-profit insurance companies rank high for engendering profit and low for program excellence. As I said, this is one of those anomalies where common sense is supported by statistical analysis.

I mention the business about HMOs—96% of the 50 programs are HMOs—as a sort of public service announcement.

As we all know, HMOs are a bit intrusive with regard to medical care. In short, they tell docs how, where, and when they can practice medicine. I have heard a great many doctors cry out in the night that America is on the brink of socialized medicine, fearful that doctors are going to be told what they can and cannot do.

My public service announcement is this: Hey docs—stop worrying. You are already being told what to do in 96% of circumstances. Whatever damage you think might be done by “socialized medicine” has already been done by HMOs. STOP WORRYING. If you want to grieve, then go ahead and grieve, but worrying about socialized medicine is, quite frankly, stupid.

So—there are my conclusions from the U.S. News and World Report study on health plans. It does make me wonder a bit. If we have an insurance system that puts patients second to profits and meets the criteria of socialized medicine, why aren’t we considering something else?

That’s probably a stupid question—statistically irrelevant.

About the Author

J.R. Waggoner, M.D. practiced family medicine for thirty years in Aurora, Colorado. He also worked as a consultant and herded cats as the managing general partner of a general partnership of physicians. Three years ago, he left his practice to study health care policy and write. During his time away from clinical work, he has written two books and worked as a Senior Clinical Content Specialist and freelance writer.

His current book Medical Metamorphosis: The three step cure for America's health care crisis is available at

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