The San Diego Union-Tribune

Jamie Court, that constant thorn-in-the-side of health maintenance organizations, has now adopted the World Wide Web as a weapon in his fight against managed-care abuses.

The full text of Court’s book, which documents the ills of HMOs he co- authored with Francis Smith — “Making a Killing: HMOs And The Threat to Your Health,” — is now available on the Web. And in interactive fashion, Court allows readers an outlet to submit their own horror stories for a possible updated version of the book.

The 230-page paper edition of “Making A Killing,” published by Common Courage Press, became available in October and to date has sold about 5,000 copies, Court said, half of what is needed before a second printing of the book will be considered.

“Sunshine is the antidote to HMO abuse and our indictment of corporate medicine’s offenses should not end with an arbitrary publication,” said Court, director of Consumers For Quality Care, a project of the Santa Monica-based Foundation for Taxpayer and Consumer Rights.

In a state where oversight of the multibillion dollar managed-care industry has long been criticized as lax, Court has become an unofficial ombudsman taking aim against a system he and many others say has sacrificed patient care for the bottom line.

HMOs view him with a mixture of frustration at his attacks and resignation that he may never be satisfied with the practices of health plans, no matter what they do.

“He’s not like other critics,” said Walter Zelman, president of the California Association of Health Plans. “His only goal is to make managed care look bad.”

Before taking on the insurance industry, Court was an advocate for the homeless. In 1994, after President Clinton’s health-care initiative was defeated, he and fellow consumer advocate Harvey Rosenfield founded Consumers for Quality Care, the health care watchdog project of the nonprofit Foundation for Taxpayer and Consumer Rights.

Court’s goal in making his book available for free on the Web: “The Internet site will allow readers to create a living history of HMO abuses and hopefully a chronicle of how HMOs were forced to change their behavior,” Court said.

In the introduction to the book Court and Smith write: ” . . . these companies have misled the public, swindled those paying the premiums, and grievously and fatally harmed patients in the process.”

And while other organizations have begun collecting HMO horror stories — and making them available on the Web — others question whether all the anecdotes of HMO abuses truly represent how managed care is doing or just skews the picture.

Zelman said there are as many stories of abuses in the old fee-for-service system as there are about managed-care abuses, but “I don’t hear Jamie Court saying anything about that.”

There is also the problem of trying to confirm the veracity of the stories. Aside from the complexity of many of the stories, patient-doctor confidentiality laws can get in the way of getting the full picture.

Earlier this year, Court said to The New York Times, “We tell the story in the patients’ own words, or from a parent. All we can do is report on what people tell us.”

Regardless, the Internet edition of the book can be viewed at http://www. makingakilling.org where viewers can submit their own stories by clicking on a link and filling out a form.