

Controlling Health-Care Costs: Another American way - marcamillion
http://www.economist.com/business-finance/displaystory.cfm?story_id=16009167

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stretchwithme
I think the reason we don't have more alignment of the interests of caregivers
and patients is the insurance model our government has chosen to subsidize.

Can you imagine if government subsidized employer-provided housing or food by
25%? What limited options would you have then? What more do you then have to
worry about when you lose your job?

Can you trade affordability for convenience and safety? No, but you can pick
between housing option A or housing option B. And be ready to move if you get
laid off.

That's just one among many issues subsidizing things creates.

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stretchwithme
and if you lose your job, you'll actually be conditioned to want to get right
back into the same limited housing options because you won't be paying full
price.

and the irony is that you are paying full price, just not paying all of it
directly. you the taxpayer are paying the difference between the employer paid
option and the open market option.

but that's all hidden from you, because, if nothing else, this system thrives
on deception.

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dadkins
Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. And the
reason that he can … the reason he can do it … I had Edgar Kaiser come in …
talk to me about this and I went into it in some depth. All the incentives are
toward less medical care, because … the less care they give them, the more
money they make.”

President Nixon: “Fine.”

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jbarciauskas
Americans consume enormously wasteful amounts of medical care. Kaiser
Permenante seems to have excelled by reducing not medical care in general but
specifically that care which does not improve outcomes, as its record as
having the best outcomes in the regions it serves proves.

The quote above was considered a "smoking gun" illustrating the depravity of
the health insurance industry by Michael Moore in SiCKO but now is an
incomplete summary of how KP has become a model of success.

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dadkins
More recently (from Wikipedia):

"In 1999, a number of groups successfully sued Kaiser Permanente in regard to
its In the Hands of Doctors advertising campaign. The lawsuit revealed that
doctors at the organization were not fully in control of decision-making and
that there may have been persuasion to limit care with financial bonuses."

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slapshot
My personal perspective: I am a Kaiser member (California) and I love it. It
is extremely simple to deal with: if I ever feel sick, I show up at a Kaiser
facility and pay a $10 co-pay. If I need tests, I walk down the hall and pay a
$20 co-pay. There is no billing, no headache, no mess. Everything is in one
facility and integrated. The doctors, nurses, and NPs seem competent, if
somewhat busy.

That said, I've heard that people with rare and specialized conditions have a
harder time navigating the Kaiser system, but I'm not sure that it's any worse
with other healthcare systems.

Overall, it has made me a believer in the HMO model when properly executed.
And it appears that it takes complete integration for it to work right: the
joy of Kaiser is having everything in one building and managed through one
system.

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ars
Um. Isn't this an HMO? Didn't the insurance industry try really hard to make
these, with no success and tons of consumer backlash?

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ippisl
"Many health systems, including Britain’s National Health Service (NHS), have
tried unsuccessfully to implement comprehensive computer systems; patients and
doctors often hate them."

When was doctor and patient satisfaction was the most important thing in
medicine? is getting better treatment more important ?

