My new Aussie puppy reminds me of the dog-training book, "Good Dog, Bad Dog." Meanwhile, the flood of e-mail after my column on Kaiser Health suggests that it's time for a book "Good Kaiser, Bad Kaiser."
If you want to see the fur fly, say something good about Kaiser.
Plenty of people were quick to disabuse me of the thought that Kaiser was vastly improved as a result of all that money they have been making. Several pointed out instances of sloppy, inattentive care and misdiagnosed illnesses. A few of these stories sounded horrendous and inexcusable.
In the same vein, others pointed out that Kaiser has several different benefit levels which can leave people in some situations with an unlimited amount that they might have to pay. Prescription drugs, in one example, were covered up to a limit which meant that the patient had to pay for everything over that limit. In the individual insurance market, Kaiser, of course, requires that applicants prove their insurability by having no pre-existing conditions.
One especially important arrow in Kaiser's quiver, in theory at least, is the practice of preventive care. Unlike most other insurance programs, an HMO like Kaiser has an economic interest in early detection and prevention of illnesses. HMO, after all, stands for Health Maintenance Organization.
A few people wrote to tell me that those physical exams were woefully inadequate, the worse they had ever received by one account.
Examples? No coughing check for hernia or PSA test for starters. In one case, a new Kaiser enlistee, disgusted with what experience told him was a second-rate physical, asked for another Kaiser doctor at another location. He came away extremely pleased and said, "You just have to do your homework."
Kaiser is having no trouble filling doctors' jobs. One e-mail noted that doctors coming out of the nation's medical schools have selected Kaiser as one of the most popular possible job options. A recent top job had two finalists â€” one from the Stanford Medical School's faculty and another from Harvard's. They picked the Harvard guy.
One wonders why we haven't heard more about the Kaiser model as part of the debate on national health care. After all, their patient record-keeping is 100 percent computerized while the rest of the industry is at less than 10 percent. Computerization is supposed to be the key to holding down costs. The answer was supplied by yet another e-mail as follows: A portion of Kaiser is an insurance company like everyone else. They belong to an association of similar insurance companies that they don't want to antagonize. Throughout this national debate on improving a dysfunctional system, the HMO has remained largely below the radar.
I would offer a more cynical reason. The longer the rest of an inefficient industry continues to raise prices in their regional oligopolies, the greater the advantage for Kaiser. The status-quo is serving them well, so why would they step up to the plate and offer to solve problems on any kind of national scale? Why step right into a buzz saw?
What I would like to see is a collaborate effort on the part of private industry to offer health care to everyone with no proof of insurability. This would solve the major problem for early retirees and the unemployed who find themselves without coverage and at risk of losing everything in the event of even a minor illness.