MEDICAL CARE: THE SOUL OF AN HMO

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"I think this system is robbing physicians of their essential goodness," says Dr. Roy B. Jones, a University of Colorado bone-marrow-transplant specialist who saw Christy deMeurers during her journey. "I think physicians are slanting the opinions they give based upon monetary considerations that in many cases they wouldn't have allowed to influence them before." Vincent Riccardi, a neurologist and expert on "Elephant Man" disease, says the issue of trust in California is already moot. He has gone so far as to establish a company, American Medical Consumers, that plans one day to dispatch "personal medical advocates" to negotiate for care on behalf of patients. People must be willing to confront their doctors, he says. "Since the trust is already gone, why not? You've got nothing to lose."

The matter of trust becomes especially vital for patients such as Christy deMeurers, unlucky enough to find themselves traveling the netherworld of extreme illness, where hope and trust may be all a doctor has to offer. When they're missing, "you feel just strangled," says Christy's mother, Joyce Nesmith, who lives in Oregon. "It's a secret-society type of thing. What you don't know, they don't want you to know."

Alan deMeurers became a Health Net subscriber in February 1989, when he began teaching kindergarten in Lake Elsinore, California, southeast of Los Angeles. Christy, formerly a K Mart manager, also became a teacher there in July 1992 and also chose Health Net, the least expensive of three options. They paid little attention to the nitty-gritty details of the plan. Alan says he did not even receive a copy of the full contract until well after signing. And when it did arrive, he says, "I just threw it in a pile with all the other papers."

In choosing Health Net, the deMeurerses selected neither the best health maintenance organization in America nor the worst, at least according to the primitive "report cards" just now becoming available. Indeed, debate within the industry and among consumer advocates rages over how even to define quality, especially since no valid measure yet exists to show which plans actually produce healthier people. Instead, companies tout their ability to satisfy voluntary standards. Last month, for example, Health Net received a one-year accreditation from the National Committee for Quality Assurance, an industry group whose blessings are coveted by health plans around the country.