Is Kaiser the Future of Health Care?

By , August 5, 2009

I was intrigued today by Steve Butler’s opinion column titled “Kaiser May Be Future of Health Care.” Perhaps it drew my attention because my next errand was to pick up a prescription at Kaiser Permanente.

As I read the column, I mostly agreed with his main points:

  • “Now that I think about it, I’m surprised that Kaiser hasn’t been mentioned much at all in this great debate on health care. … If Kaiser is what a government-run health care provider would look like, why hasn’t it been subjected to a barrage of criticism?”
  • Perhaps, Butler says, it’s because “The insurance and for-profit hospital systems set the cost bar so high that Kaiser can still make plenty of money after underpricing the rest of the market. . . . The HMO is operating in a market that is so inefficient and overpriced that it can offer a discount and still make a fortune.”
  • “If Kaiser is any example, a government-run health care service could probably price itself at 30 percent below current market and still ‘make a fortune’ for us taxpayers.”

I encourage you to read Butler’s entire column:Kaiser May Be Future of Health Care.”

I (Mark Welch) am not a huge fan of Kaiser Permanente, but I’m starting to like it.  Here’s my story:

Soon after I moved to California in January 1985, several of my new friends warned me to avoid Kaiser Permanente, and shared some horror stories.  Over the years, I heard more horror stories. As a new lawyer, I was appalled to learn how Kaiser deliberately abused an unfair arbitration policy to prevent dying patients from having their disputes heard regarding denial of potentially life-saving treatment.  I’d also learned, as a lawyer, that Kaiser rejects several mainstream treatments for mental-health issues (essentially, they don’t allow long-term therapy, and they push patients into self-help programs and group treatment instead of individual treatment).

But when I met my wife six years ago, she had a very different story, and prefers Kaiser over other health-care options.  I’ve generally been impressed by the care she’s received.  Last year, a great team of Kaiser surgeons performed her gastric-bypass surgery; fourteen years ago, she gave birth to her daughter in a Kaiser hospital; and a decade before that, she recovered in a Kaiser hospital after the terrible car accident.

Fast forward: Earlier this year, my Cal-COBRA coverage through HealthNet “timed out,” and I discovered that I would be forced to choose from a very short list of very expensive options — the cheapest of which would effectively double my cost (from $350 to $700 per month) while slashing my benefits (including imposing a $5,000 deductible).  Since my consulting income had shriveled with the recession, we weren’t sure if we could ever pay such high costs.

But after investigating my options, I discovered that because my Cal-COBRA coverage was ending and I could not get affordable coverage, I qualified for California’s Major Risk Medical Insurance Program (MRMIP), which my wife had also used seven years ago when she was denied other coverage because she was overweight.  California’s MRMIP program allowed me to choose from several different policies, but economically the only viable option was Kaiser Permanente, at $430 per month with a $500 annual deductible. (All other options imposed much higher premiums and much higher deductibles — substantially less coverage for much higher cost).  When I called, I was warned that there was a waiting list that might take six months — but when I applied, I was immediately accepted.

And so, in March 2009 (one month after my earlier health insurance coverage ended), I reluctantly became a member of a Kaiser Permanente health care plan.  I was somewhat hostile “going in” to the new program.  After a few months, I’m really quite satisfied, and pleasantly surprised. When I’ve needed an urgent appointment, I was seen the same day; my prescriptions are cheaper than ever before (I pay just $10 for a 100-day supply of each medication).  My main frustration has been with “waiting in line” (mostly for lab tests and for prescriptions), but even that has been reasonable.

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