
The History of Kaiser Permanente - perseusprime11
https://share.kaiserpermanente.org/article/history-of-kaiser-permanente/
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swasheck
Until very recently, and due to a job change, my family and I have had KP as
our healthcare provider. So many people derided managed healthcare, and KP
specifically, but we (my family, and I) loved it.

"It's like I'm a Walmart or Disney World for healthcare" is a comment that we
heard a lot. So? When pressed about the Walmart comparison, it had more to do
with availability than quality. I could never get a solid answer justifying
the Disney World comment, but I like Disney World and so does my family.

I also liked having everything in one clinic. I didn't have to drive across
the city to find a lab or a pharmacist. Friends would raise the specter of
prescription price-gouging, but when we'd compare prices on prescriptions that
we'd held in common, we paid quite a bit less than they had.

I also generally had the sense that the people employed there had genuine care
and concern for our health and well-being. Not that they shouldn't, and not
that they're better than other providers, but the notion that you're a piece
in a big machine (a common argument lobbed against KP) is ludicrous and
probably based more on personal bias than actual experience.

Yes, as an organization they're going to want to cut costs (another common
argument against KP and managed healthcare, in general). Yep. They do. That's
true. That never translated into a diminished level of care for us. It did
mean that they didn't order a bunch of unnecessary tests, but our PCPs always
listened to us and would suggest their course of action, and we'd negotiate a
course of care if there was any sort of dissonance between us about what we
wanted. This is similar to my experience in the broader "Family Practice"
world too.

I've now been on UHC for about 2 months. In that time, I've had to take 3
phone surveys, and fill out 2 Internet forms confirming that nobody in my
family has any other insurance. The proliferation of UC/ER pop-ups in
neighborhoods is evidence of the profiteering that occurs in our healthcare
industry (because of loose medical coding standards). I've always felt
insulated from that side of healthcare while with KP, but right now I honestly
feel very vulnerable and kinda regret taking an otherwise excellent job
because of this insurance transition.

~~~
lnanek2
I had the same experience with UHC when I was forced to switch to it for a
job. Numerous surveys, even by third party companies, that eventually resulted
in them denying to pay for treatment when they really were my only provider.
They kept claiming we had KP when we didn't, and claimed the claim had to go
through KP first even though it was an in-network UHC provider, which is
completely inapplicable to KP and would have no way to submit a claim to KP
anyway. So even if we had KP and KP was primary UHC would have still had to
pay, they just knew no one could successfully put the paperwork through to get
them to pay.

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linsomniac
What I think of when I think of the history of Kaiser is: They are pioneers of
making a profit off providing less healthcare.

For reference, see the taped conversation of Richard Nixon
[https://en.wikisource.org/wiki/Transcript_of_taped_conversat...](https://en.wikisource.org/wiki/Transcript_of_taped_conversation_between_President_Richard_Nixon_and_John_D._Ehrlichman_\(1971\)_that_led_to_the_HMO_act_of_1973):

And: Details about the deal Nixon made for his friend Kaiser:
[https://thecriticalaye.com/2011/08/31/skyrocketing-health-
ca...](https://thecriticalaye.com/2011/08/31/skyrocketing-health-care-costs-
thanks-president-nixon/)

~~~
Stratoscope
For another side of the story, a friend has stage 4 breast cancer which
metastasized to her spine, requiring back surgery and very expensive ongoing
treatment.

She was on a high-deductible, high-copay Bronze plan last year, and Kaiser
waived all the deductibles and copays for about eight months of treatment, up
through the beginning of this year when she could get on a plan more suitable
for her needs.

I'm not saying you're wrong, of course. I know little about the organization's
history. But I was favorably impressed with how they've treated her, both
medically and financially.

~~~
swasheck
I've never been anything but impressed with Kaiser.

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djrogers
This is particularly interesting in light of how much of an impact KP has had
on the US healthcare industry, and the recent announcement about Amazon,
Berkshire Hathaway, and Goldman doing the 21st century version of this.

~~~
tssva
What has been Kaiser's great influence on healthcare in the US? They were far
from the first HMO and have never been the largest? CIGNA has the longest
history as an HMO and before the HMO act of 73 was the largest.

Is it the model of owning coverage and delivery because that is a model that
even Kaiser doesn't completely follow in all the regions it provides coverage
in. And also one that has not spread widely in the US.

Maybe it is different in Northern CA and the rest of the Pacific Northwest
where Kaiser is strongest but in my region Kaiser has never had a great
reputation. It was the cheap insurance you bought when you were young and
hoped nothing really bad ever happened to you. It is known for poor access to
and quality of care. These days it is still known for that but premiums, co-
pays and deductibles now equal or exceed those of other insurance providers.

~~~
swasheck
I think that Kaiser's poor reputation is primarily driven by their managed
healthcare model (which you rightly mention isn't consistent outside of their
region). I don't have evidence to support why this is the case, but
colloquially it has to do with this fear of losing choice. People would rather
select their labs and pharmacies than just "go downstairs and wait for it to
be filled." Additionally, they feel like they don't have a choice in PCP when
they're just given a list of doctors at their nearest clinic.

~~~
maxxxxx
Based on what do people choose labs and pharmacies? I don't get that. When I
had Kaiser I loved the fact that all was in house and worked reasonably well.
Now I have a PPO and I have no clue how I would choose a doctor.

~~~
swasheck
I don't get it either, but it's what I hear (again, colloquial evidence). I'm
also at a loss with my recent transition.

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UseStrict
Back in high school I worked for a call center that handled follow-up surveys
and customer inquiries relating to recent medical claims made through Kaiser.
I would handle dozens of calls a day for post-rejection follow up. People
turned down for cancer treatment, heart surgery, etc. People telling me that
they were now condemned to die because of places like Kaiser. Whatever you all
are doing in the US for health care, it isn't working.

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oceanghost
I pay Kaiser 1.9k a month, it takes 3 months to get a doctors appointment.

The revolution can't come soon enough.

~~~
tezzer
Where do you live? I've never had a bad experience with Kaiser in northern CA.
Both of my children cost me $250 total for their entire pre-natal care and
birth, all preventative care is free of co-pays, any time I call for an
appointment there are multiple slots that day or in the next 3, prescriptions
are filled in the in-clinic pharmacy or mailed to you if you prefer,
consultancy can happen by phone, e-mail or in person... it seems way better
than any other insurance I've had.

~~~
oceanghost
So Cal. County of Riverside. Our daughter was seriously ill and the by phone
consultancy took over 24 hours to call us back. By that time, of course, we'd
been to the hospital.

It took 3 months to get a 10 min immunization appointment. The county
contributes ~9xx dollars as do we. Our medical care literally is 8x my last
car payment per month.

