Monday, June 9, 2014
My Views On Kaiser, the VA, and the Health Insurance Market
My Views on Kaiser, the VA, and Group Practices My posting on Kaiser and the VA generated some negative feedback. I think it only fair to express my full opinions. Sadly, the traditional private practice of medicine is rapidly declining. Economics, insurers, and regulatory realities are driving medicine into managed care. Hospital groups are swallowing up groups of doctors. The private practitioner is an endangered species. I like the idea of being to pick and choose between an area’s best physicians and hospitals. Even before Obamacare, few insurance plans offered that flexibility unless you wanted to go “out of plan,” often an expensive proposition. The plans offered under ObamaCare are so restrictive of providers that often no practical choice exists. I don’t think Kaiser is the greatest innovation since sliced bread, but it is the best of the large managed care organizations, and insurance companies which purport to offer PPO’s and HOM’s, but are not true HMO’s. Group Health of Seattle may be excellent (we were members once for 6 months). I was also in Sound Health in Tacoma for three years and we were members of Medical West in western Massachusetts; neither of which do I think still exist. H.I.P. and some other true HMO’s may be wonderful, but only Kaiser operates in several states. The VA Healthcare System is a living testament to how bad the delivery of government healthcare will be. A common joke in Canada about the privately owned Canadian Pacific Railroad and the privately owned Canadian National Railroad is that the CP kept the CN efficient and the CN kept the CP honest. Kaiser faces competition in the healthcare market. The VA faces no competition. We were very concerned about the quality of healthcare as our children were growing up. The dynamics of the health insurance market in Springfield, Massachusetts and the alternative plans offered by both my previous employer in Springfield and my current employer in Orange County made HMO’s the obvious choice. In addition to the high quality of healthcare offered by Medical West and Kaiser, we were impressed by the dedication of the physicians and nurses. The HMO pediatricians were fantastic. So too were the family physicians at Kaiser who treated my mother in law during her final years. We also never had any billing disputes with the HMOs, but our limited experience with the major health insurance companies was often a billing nightmare. Unlike the United Healthcares, Aetnas, GIGNAs, and Blues, Kaiser has a cost advantage in that it is vertically integrated, including not only the physicians and nurses, but also the hospitals, pharmacies, rehab centers, and labs in the corporate structure. I regularly hear stories from my colleagues and friends who have to deal with these insurers. They range from great praise to horror stories. And that was when the really good hospitals were in the health insurance networks. If you like your current health insurance plan offered by your employer, pray your employer will not cancel the plan in the next few years as the new ObamaCare restrictions strike the group plans. I do not believe that any private insurer or managed care facility would have as good a chance of handling the VA patients as Kaiser. It has the capacity and expertise. You can trash Kaiser; it has made its mistakes, and will continue to do so. No doctor, no hospital, no insurer is infallible. All face cost pressures. Disputes with unions will become commonplace. Pharmacists came close twice in the past month to striking Kaiser in Southern California. The 200,000 unionized workers of the VA have to be scared of Kaiser or someone else stepping in. They have to be terrified at the prospect of privatization. They also know the status quo is unsustainable. For what it’s worth, Kaiser is unionized. For those of you who damn Kaiser, what is your alternative?