The History of Kaiser Permanente | Hacker News Reader

The History of Kaiser Permanente

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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.

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.

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...:

And: Details about the deal Nixon made for his friend Kaiser: https://thecriticalaye.com/2011/08/31/skyrocketing-health-ca...

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.

I've never been anything but impressed with Kaiser.

My experience has been similar, KP paid out $250K when I was run over biking to work, most of it out-of-network, and were very reasonable during the settlement process - they recovered only half what they'd paid. Now, day-to-day, for smaller health issues, I would say that they don't always shine quite as bright, but overall they have been fine.

These are very interesting reads and I can see how they can certainly color a conversation against KP. This is a bad look for the origins of KP, but hopefully we can allow that companies, like people, can change from their questionable origins (VW?).

Jeremy Hunt - health sec of the UK has been visiting to see if their model can be applied to the UK.

Before being in charge of health he wrote a book about how health should be privatised, since he has been in the position the NHS has been in almost constant crisis.

We've already seen increased independent sector provision.

Drug and alcohol services got taken out of the NHS and given to public health. Local authorities had to run competitive tendering. Some of them sent the work back to NHS providers, but many are now provided by community interest companies like Change Grow Live, or private for profit providers like Priory Group.

At the moment one third of patients detained under section of the mental health act are in independent sector hospitals.

We have organisations like LivewellSW (they're very good) providing healthcare across a large region.

People don't really understand how far along we are with privatisation.

Jeremy Hunt caused the crisis as a stepping stone to privatisation which is why he's the most disliked frontline politician in the UK: https://www.independent.co.uk/news/uk/politics/jeremy-hunt-i...

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.

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.

I'm no expert in this field, but with my CA based employer the co-pay/deductible via Kaiser is quite significantly less than the other insurance options my employer offers. I switched to Kaiser two years ago and have found no material difference in the standard of care for my family's medical requirements, aside from having significantly more money in my own pocket.

That's interesting; I wonder if it is a regional difference as you mentioned. I'm in Northern California, and I remember 30 years ago people here did view Kaiser as a second-rate option.

It doesn't seem that way today; my friends who are on Kaiser speak very highly of their experience with them.

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.

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.

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.

You can choose your pharmacy. You can get scripts and take them to any pharmacy (e.g. Costco) to be filled.

I'm missing why an external lab would be preferable.

Kaiser used to have a bad reputation but they seem to have changed a lot. Most people I know who are in their system like them now. I don't go to the doctor much but my personal experience has also been very good.

I think it was JP Morgan, not Goldman.

Interesting cognitive dissonance.

How is incorrectly recalling the name of a company with its competitor cognitive dissonance?

I was referring to my own thoughts when I read it. I could not identify the mistake which means Amazon and Berkshire stick but not JP Morgan for some reason.

He probably meant Freudian slip.

Ah yes, when you say one thing but mean your mother.

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.

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

The revolution can't come soon enough.

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.

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.

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