Controlling Health-Care Costs: Another American way | Hacker News Reader

Controlling Health-Care Costs: Another American way

economist.com

24 pointsmarcamillion9 comments

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.

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.

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.”

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.

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."

On the other hand, it would sound just as perverse if they said "the more care we offer, the more money we make" (as opposed to trying to actually heal the patient).

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.

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?

"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 ?

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