(sigh) If a doctor wants to try a cutting edge treatment modality, like bioidentical hormone replacement therapy, he likely won't be allowed to in a netowrk like Kaiser Permanente.  The ironc thing is, some of these treatments prove to be far less costly than "conventional" medicine treatments. I have been on low doses of progesterone and a tiny amount of testosterone for over 2 1/2 years. I am off six medications, down over 80 pounds from my high weight, no longer suffer from hot flashes or restless leg syndrome, and have more energy than I did when I was 30, and I am now approaching 51.  I know this topic is getting a lot of press coverage lately because Oprah is now on BHRT and singing its praises, but the truth is it has helped thousands of men and women lead healthier, happier lives.  Men and women of all ages can suffer from hormone imbalance, and sadly, too few doctors are able or willing to learn about complimentary medicine that can reduce costs and enhance lives.  

As a physician, trust me, doctors aren't ordering tests to get more money.  They are ordering unnecessary tests to attempt to avoid litigation.  They are searching for the "one in a billion" diagnosis that normally would be missed.  If there were caps on "pain and suffering" for malpractice cases and doctors were tried by a jury of their peers (like everyone else is) -- other physicians, the cost of health care would go down significantly.  

I have been Kaiser member in OR for more than 35 yrs.My experience has been almost totally satisfying.My internist is only dr. I've known who has called me at home periodically to see how I'm doing.Also he called me approx. 1 hr. after mammogram which indicated poss.breast cancer.Their techie programs mean everyone is wired in.Plus phone in prescription refills mailed to me.Oncologist,surgeon,radiation,dermatology,internal medicine,all my interactions very professional.

Are you saying that only salaried doctors practice evidence-based medicine?  That's insulting to all physicians currently practicing.  You also imply that doctors purposely order extra tests based on financial incentives.  I can't say this doesn't happen at all, but the actions of a minority of doctors should not be used to stereotype an entire profession.  I wonder...If doctor's will work for a fixed salary in the future, does that mean the government will pick up the entire tab for the education that goes into obtaining a medical degree?  Most doctors end up with debt that's well over $100,000.  Where will the financial incentive be for the best minds in the country to continue going into medicine?  If you think quality of care suffers now, just wait!

These programs may be "inviting for health reformers" but where are those reformers going to find doctors?  My brother (a physician) says most doctors in med school are not going into family medicine, so our family doctors are dying off, and no one is moving in to take up where they left off.  

I hope and pray that Kaiser never becomes
mandatory in the U.S.  When my wife was being
treated for a brain tumor, her doctors at the
Duke Brain Tumor Center in North Carolina, ordered
monthly MRI's while she was on experimental
medication.  Kaiser threatened to cease payment
for the MRI's because of the expense. This caused
extra stress and anxiety that my wife should not
have had to endure. Kaiser eventually paid, only
after my wife's doctor talked to Kaiser's Regional
Director.

I was a Fed employee at the time and was able to
switch to Blue Cross/Blue Shield at the next open
season.  Given free choice, I will never join
another HMO during my lifetime.  (My wife eventually
died of her illness.)

Kaiser Permanente?  Are you kidding?  I lived in the golden state for the 12 years up to the end of 2003.  I was a Kaiser P. HMO member much of that time.  They complained to my doctor about "this patient with multiple problems."  He warned me they were thinking of dropping me.  Kaiser did, in fact, drop a lot of folks in those years, got caught, and paid a hefty fine.  I'm sure that story was featured in some of your newscasts.
I'm going to suggest a MUCH better alternative.  You will find it in your "good news" email queue.

Dear Mr. Bazell

I have been forced to use Kaiser twice in my life and had I continued I would be dead now. Kaiser now has a three MONTH wait to see a specialist. If I were to have a heart attack or get cancer, by the time I could see a cardiologist or oncologist I would be dead. I would call that murder in the first. My wife currently has to have Kaiser and when the kill her I will become angry. When I complained to Kaiser they responded by putting me on the national terrorist list. This is not health care anyone can live with. Refusing to give health care to its members IS a great way of saving money but not lives.    

24 hrs after admission for hip surgery, my 80 yr old mother/law was given wrong blood, medication and ESL "helpers" who dropped her, released her with pneumonia, bladder & surgery site infections and CDIF (an intestinal infection).  Kaiser health care has cost her at least 6 mos. at the very end of her life.  Kaiser health care has killed all of her roommates and will likely kill her.  It is the Auschwitz of health care.

Your story was an advertisment for KP.
It mentions lowering costs by not ordering un-necessary
tests, but fails to mention not ordering reasonable tests when they should. Sure looks bias to me.

More detailed reporting would be appropriate.  Questions to be addressed might include:  Does the Kaiser panel of available drugs include sufficient choices to effectively meet the needs of patients who have diagnoses that occur at low rates or call for highly specialized treatments?  Does Kaiser have sufficient rehabilitation benefits to maximize the long term outcomes of the people it insures when catastrophic central nervous systems occur such as stroke or brain injury or is the focus just on short term outcomes?  The producers need to provide more complete information before concluding that a health care system is more cost effective.  What are the long term outcomes for all groups?  What recourse do the patients have when something goes wrong?  Incomplete information is not helpful to furthering the National discussion on health care.

I think one problem people have with it is the idea of a private organization that is relied upon to do the right thing... while acknowledging that it has no financial reason to do so. While I understand that a doctor who is paid per test might be more inclined to order superfluous tests, an organization which saves money each time it denies care is more likely to reject applications for testing, experimental drugs, expensive treatments, etc.

I agree that this model may be one that we will have to rely on for many years to come - but it is an astoundingly flawed one, and not one that I will ever feel safe subscribing to.

Has anyone looked at the various states who have a high risk health insurance pool? The idea of the pools was to put all the high risk people in a pool to keep the costs down for the average person. It is obivous that it did not work for the average person when you look at their insurance rates. It sure did not work for those who are in the high risk pool, we pay 150% to 200% more than the average person. So what is happening is those who really need the insurance are going without it. Risk pools are another failure the government has invented and the risk pool insurance companies are making a unethical amount of money on.

NBC news once again presented a poorly researched story without giving any other views on the performance of Kaiser Permanante as far as patient satisfaction. If all physicians were employed in USA, it will lead to another disaster. Physician offices form the backbone of small businesses in USA. We employ millions of Medical Assistants, billing personal, all allied small businesses related to a doctors' office.
We believed in Wall Street and got our rear end kicked and no one is going to have pension in the near future. Now if we believe in CEO's and run health care like wall street, we will get in in the front end!!
Practice of medicine is not that simple and electronic medical records will not make everything go away.
malpractice reform has to take place in USA to curb excessive spending. Secondly Americans like to eat a lot and become obese and get all diseases allied with overweight like diabetes, hypertension and all related complications.
Public health, education and serious research on the consequences of adultrating our food supply with hormones, genetic manupulations need to take place. The USDA has not been a sincere advocate for the consumers.
In short NBC should not air one sided poorly researched stories in World News.

Kaiser's kidney transplant patients and their families in Northern California, and many other patients, dispute your report. Kaiser systemically violates the Americans with Disablitites Act by intentionally discriminating against disabled patients. Kaiser exited the State of Texas subsequent to the Insurance Department's report that the HMO's doctors' group had rigged its quality review process.  The Kaiser-Ohio doctors' group had a "gag clause" in its contract to interfere with truthful communication in the doctor-patient relationship.  Kaiser's electronic medical records system surreptiously alters documents provided to patients. Kaiser's  violation of federal and state law is systemic. Systemic reform of health care will begin in earnest with systemic investigation of Kaiser.

I saw the story tonight on the Kaiser model of health care. I felt that it was a one sided view.  I would be interested to see a follow up story revolving around those 'salaried' physicians and how they have 'no incentive to order unnecessary tests.'  

Physicians employed by insurance companies are often given incentives to do just the opposite.  I would like to know if they receive annual bonuses.  Also, what are those bonuses based on?  Likely answers may be the % of generic drugs written as prescriptions or ratio of lab tests to visits, etc.  What is sad and what is being advertised to America on your program is a vision of an unrealistic model where doctors are told by their employer how to practice the 'best' medicine.  

For example, if your boss asks you not to make personal phone calls at the office, most people would comply.  Well, doctors in these 'staff' model insurance plans follow the same idea.  If their boss/employer/insurance company tells them not to give certain medicines to patients based on cost, the doctor will likely comply.  There are health plans all over the country similar to Kaiser, in these plans, patients have to wait weeks to get in, don't get all available options, and are generally dissatisfied.  

It will be a sad day in the United States when our physicians no longer have an incentive to provide the best and most cutting edge health care to patients.  In the Kaiser model, they are just collecting a paycheck and maybe a bonus if they cut costs for the insurance company.  

As a medical provider, I have not heard positive assessments regarding the care provided within the Kaiser system.  Those comments come from both patients and fellow providers who are employed by Kaiser.  Kaiser physicians often report mandated patient volumes, constrained treatment options, and limited professional autonomy.  The freedom from concern for the business side of medicine is appealing to most of us, but corporate medicine also has severe downsides.  NBC needs to provide a more balanced report of the advantages and disadvantages (which are substantial) of the Kaiser model.

I suffer the Kaiser Permanent "care". In order to cut costs only generic medications are available,chronic conditions, or deteriorating conditions are "treated" by painkillers (saves on treatment) and anything "new", say if it was used successfully in Europe for 15 years, is experimental and not available.
I had lived under 4 other healtcare systems, what Kaiser has to "offer" will make the nation very sick indeed.

OMG!!!!  If Kaiser Permanente, the health plan from hell, is to be used as a model for health care reform and the lack of health care rationed to the extreme by Kaiser Permanente we are all better uninsured.  This is the health plan that sent my father home with a CVA - no studies were done.  Three days later I dragged him back to the facility with right hemiparesis begging for at least home health since the health plan did not hospitalize for CVAs.  Well, he was admitted to the hospital at that point.  Seven years later this same man was inapproprairely discharged from KP hospice only to expire a week later and less than 24 hours on service with another hospice.  Please, oh please, don't let this be an example of what Americans should expect as health care.  The health care I have received from this same plan has been so bad in terms of access the past two years I have decided not to obtain anymore.... which excludes preventice care.  It isn't worth the stress.

Most health care providers take care of patients because it gives us purpose and great joy in our lives. Unfortunately our current medical system rewards procedures(not lab tests) and those who perform the procedures. We have incented a group of motivated people to choose procedures over primary preventative care. Knowing that, it is easy to understand why so few young physicians choose primary care (few proceedures =less income). This country needs to reward preventive care, patient involvement in care including cost and carefully scrutinize new/expensive proceedures and medications for their value. There is a whole lot of room for improvement.

Suggested Health Care Plan

• Everyone with a valid social security number is enrolled in Medicare; anyone being issued a social security number for the first time is enrolled in Medicare when the number is issued.

• Medicare is funded in its entirety each year by the premiums participants pay.

• Premiums paid by individuals are based on gross income.

• Premiums paid by employers for individuals are based on the company’s gross revenues.

• Medicare supplemental insurance will be expanded to include several additional tiers; premiums will depend on the level of the tier.   The lowest tier will be the same as the current plan F (pays everything Medicare does not pay up to what Medicare allows).   The highest tier will pay everything Medicare does not pay up to what the doctor or hospital bills.

• Insurance supplements will be offered by private companies.  Participation will be voluntary but benefits in any individual tier will be mandated.

• No advertising of prescription drugs, medical procedures or medical providers will be allowed.

• All punitive damage judgments in medical malpractice cases will be payable to the state; no judgment or costs to the plaintiff or their attorneys.

Thank you for offering an important perspective which has been validated by articles in the New England Journal of Medicine among other scholarly journals.  We need align doctor and hospital financial incentives to keep people well. --- Davis Liu, MD - Author of Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System

YES. Care from Kaiser Permanente in Northern California is AWFUL.

Having insurance with Kaiser Permanente is as good as having no insurance.  My friend got her dental insurance through work, and brung her son into the Vancouver, WA, office for treatment.  He has multiple sclerosis.  His other dentists always gave him general anesthesia so he'd be still for treatment.  Kaiser refused.  She pleaded with them.  They refused.  She asked them what good is it to have insurance for her son if he can't get treatment.  They told her not to call back.

Mr Bazell,
This comment is not intended to be published.  However, now 3 months after your article, I am interested in your followup.   Recently the Economist cited KP Northern Calif (where I practice) as one of several model systems.   I think a critical look at the systemic use of  physician staff HMOs nationwide as a plausible way to ensure competition and cost savings with evidence based practice is needed.   Journalists need to provide detailed portrayal and critique for Americans as to what this new system would look like.  Congress and the President have failed so far to illustrate such a health market.

I was born at Kaiser and have had care there for 43 years excepting a 12 year time period that I lived "out of area". My care at Kaiser has been very thorough and I have always had excellent relatinships with my doctors.
In my Blue Cross coverage years, I felt I was using the yellow pages to find a doctor. So random.
Plus, filling prescriptions at local drugstores was always a problem (losing, can't find insurance info in computer,etc.)

Obviously with any "system" there will be navigation issues and people need to advocate for themselves.
Sometimes we blame the system for health issues that a doctor anywhere can't fix - I know that sounds harsh but step back and think about it.

We need to cover the unemployed (I am paying out of pocket now $1200 for a couple), the poor and the lower middle class.

To Eric Frommer, MD,

journalist these days have limited knowledge or interest in providing information. They are hired on the base of connection and price while "news" gets published in order to attract advertising.

Manipulation of information by big business is now well documented by the disaster that cooperation among Wall Street Finances, Real Estate Developers, politicians at all levels and media brought to the country during and after the housing bubble- which still continues under strict cover of silence.

It is the same with heath care at al levels, from none for 20% of working Americans, through the the financial medication hole in Medicare, to the lack of quality care and disability "insurance" that is actually not available to majority of working people who get disabled- the conditions to receive SS disability are set in a way that precluded qualification.
Naturally, single payer program is most cost effective, covers everyone- thus preventing disasters with communicable diseases- and, having taken profits out, provides the best care.
The arguments leveled against it all come from profiteers. The insurance companies who take people to bankrupcy while rewarding themselves with billions in profits, from for profit "health institutions: that refuse to treat "under insured" or simply sick patients while reporting millions in profits and from those doctors who entered the profession to profit, not to heal.
It is good for any health care to eliminate profiteers.Contrary to what profiteers trumped out as "information" once profits are limited you get the best care because the people providing it want to provide care not to enrich themselves.
But profiteering is an accepted way of thinking and life- the aggressive lied, cheat, steal and are honored because they are rich. The caring and hard working are never mentioned.
Changing health system is also a tiny step in direction of better society- and bandits are not interested in better society.
Linda Winsh-Bolard

I too was born in a Kaiser hospital in Northern CA and have had wonderful care, including 9 surgeries that saved my life.  My father suffered from multiple grave illnesses for over 20 years and was treated exceptionally well costing Kaiser millions of dollars. On occassion he was sent at Kaiser's expense to other hospitals specializing in his strange intertwined diseases. All that plus no bills to us!
That said, you really have to understand how Kaiser works to be comfortbale with their treatment regimes.
Word about Kaiser "killing" patients - if all of the hospitals that accepted Blue Shield insurance were named Blue Shield Medical Center everyone would say Blue Sheild was killing their patients too- it's just a simple stero type.
Kaiser does make mistakes, however as a patient you have to actively particpate in your health treatment to receive the best from your doctors.  

We have had Kaiser for over 30 years.  I had 3 children at Kaiser and am a diabetic.  I always have had the best care at Kaiser.  I love the process of elimination before a Dr. justs jumps into a surgery situation.  It does take some time and is a bit frustrating if you are hurting but in the long-run it is much better than jumping to conclusions.  You can get a bad Dr. anywhere.  At Kaiser you have many choices.  I feel it is an excellent model for the government to look at.

I have been a Kaiser Northern CA member since I was 15 and I am now 70. I think it's a wonderful program. My Dad lived to be 94 after Kaiser replaced his pacemaker 7 times and performed valve-replacement surgery when he was in his 80's. He died of a problem that was not even heart related. I was sent for a heart-stress test & a cardiologist watched the test and had me return that very day for more tests. He found a problem and has since been monitoring my heart on a regular basis. I can contact him anytime by email and ask him questions. I don't understand the complaints frm folks who say they have to wait to see a specialist. That surely has not been my experience.

I have been with Kaiser since 1976. For people who take some responsibility for their own health, I think it is an excellent option. Though I have never had a major health issue, those times when tests indicated that there might be a problem, my caregivers acted quickly and efficiently. In one case I was sent to an outside specialist.  When I was busy working, I appreciated that my medical records were easily available without me having to remember what and when. I love that I can go online and make appointments, or ask an advice nurse whether my symptoms merit an appointment.  For people who are proactive about taking care of themselves, it works fine. I also appreciate that Kaiser offers programs in weight loss, yoga, etc. I appreciate a plan that suggests that drugs are the last resort rather than the first. I'm sure not all Kaiser programs are equal.I know ours in Colorado generally gets high ratings.

My  personal experience with Kaiser has been very good.  In fact, the neurosurgery units at Kaiser Sacramento saved my wife's life and made it possible for her to have an amazing recovery from something that kills most people.

My only issues with Kaiser are about the financial aspects of the medical plans and how they treat appointment co-pays.

And I've been interested to read anecdotal stories about what constitutes an 'office visit' in some place (not necessarily Kaiser).  It's not necessarily what you think.  We don't even have a clear understanding of what an office visit with a doctor really is. Like the guy who visited his doctor, had 7 questions to ask, and the doctor told him that to have more than 3 questions answered he'd have to schedule another office visit with another visit co-pay.  Interesting.  Nothing is what you think it is.

I live in San Francisco, I have Kaiser, and live just blocks away from a Kaiser emergency hospital and Kaiser medical office on Geary Ave.  The coverage is great, the facilities are great and the medical staff is excellent.  I'm very happy with it.  

First of all, I don't think that Kaiser, Northern California, has a Medicare supplement.  It only does an HMO, under Medicare Advantage.  There is a big difference in the way an HMO gets paid vs. a Medicare supplement.  Second, individual stories can be useful, but what we want is the big picture.  I have never seen anyone do a big picture on Kaiser as an HMO in Northern California, for example.  What does it do well?  What are its failings?  How does it match up to competitors?  The story above is like looking into the fishbowl at the fish.  It does  not tell us much of anything.  

As a physician who worked at Northern California KAISER for several years, I thought it is my duty to talk a little about my work experience as medical doctor while at Kaiser.

My busy patient schedule was in a way that I was not allowed to spend more than a certain time with a given patient, no matter how much the case was complicated, upon elapsing the time, I had to move on to the next case. Over time, this gave me a bad feeling of like  brushing off my patients; not adequately listening to them due to the funny time constraint. Then,I thought this ultimately could jeopardize both patient care and my hard-earned state medical license. In addition, at times, I noticed failure to request necessary tests or failure to refer patients with serious medical conditions to appropriate specialists on its right time. Why? I think mainly for the sake of cutting down on expenses and skyward increasing the organization profitability. For example: I saw cases with complete torn meniscus or tendons but they were still straying back&forth in physical therapy department! dictated by Kaiser's guidelines that only orthopedic doctors can order MRI of knee or shoulders! ,whereas in most such cases it took quite a time for patient to see the specialist and many other instances....

In fact, over time, I came to the conclusion that Kaiser was not a right place for me in order to render a QUALITY service to my patients. So, I decided to move out of its system to the current my private clinic. I think this was a reasonable decision in my career life , this time I know that I keep my patients happy with my service not my well-off supervisors!.

Another part of the Kaiser story: its rehab services in San Francisco. After suffering a painful pelvic fracture, I was sent by SF Kaiser to a nursing home for rehab. The place was disgraceful--ill-trained staff, confusion as to med orders between shifts, lack of empathy toward patients, many of whom had dementia. As for me, I ended up hallucinating with a bladder infection that had resulted from a catheter left in too long. When my frantic daughter asked for help from staff, one of them said, "Oh, THEY get confused." Thank heavens she was there--as I was rushed to the hospital with a life-threatening blood infection. The rehab facilities (there's one that I hear is even worse than the one into which I was placed) in SF are appalling. Complaints to Kaiser have gone unanswered. Is this any way to treat a 75-year-old patient--or any patient for that matter?

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