Kaiser apologists of every flavor can not figure out how I can willfully display the unmitigated gall to decry their shoddy care. “Look how they’ve brought costs down!” they say. “Their quality scores are competitive!” they crow. “They’re not for profit!” (as if) they cheer.
There are a few (I can count them on one hand) things I think Kaiser does well. I love, love, love their phlebotomists. Billing is certainly easy (although I’d go back to 20 hours a week of fighting insurers to actually get help when I contribute to “cost sharing”). Having everything in one building is a convenience, and can expedite labs and imaging.
None of this can overcome their most glaring failure: the time available for office visits.
A section of this most excellent post, quoting what appears to be a most excellent article, explains why.
Of course for the vast majority of humans out there, a few minutes of face time with a doctor isn’t going to make a bit of difference. They come to the doctor for physicals, immunizations, births, tests, sprains and colds. For those commonplace medical needs, Kaiser is quite acceptable (mostly). In fact my favorite internist shared with me a quip whispered by his colleagues: Kaiser is great… if you’re healthy.
But what if you’re not? Eventually you are a product of attrition, by one method or another.
So what does that leave us? Health coverage for the healthy (Kaiser) and health coverage for the sick (Blue Cross? Medicare? Wealthy Uncle?)?
What happens to affordability, if the healthy are all covered under one cheap system, and the sick under another?
What happens when the premiums for that cheap system become more expensive, and in spite of the…. narrow coverage, can’t compete with more comprehensive coverage?
What happens to the patients caught in the middle? What happens to medical ethics? What happens to the knowledge gained through hundreds of years of medical enlightenment? When medicine is by assembly line, and any one physician sees only a narrow view of any given patient, what happens to our generalists? Our diagnosticians? Who can identify and mange the complex, multi-system diseases and disorders?
My problems with Kaiser go far beyond my personal care. Their model of practice is like a cancer that has spread far beyond it’s original confines. While some may disagree, Wal-Mart certainly has it’s place, things it excels at. But Wal-Mart will never be Macy’s.
Just because some things can be done quickly, cheaply, efficiently, does that therefore mean we want all measures of efficacy reduced to the lowest common denominator?
