God Save Great Britain from Kaiser Permanente

["To reduce demand, a gate-keeper, usually a nurse, screens the patient's complaint and approves or denies access to a general physician who is expected to handle a far greater range of services than under the FFS system. A patient may consult a specialist only after a referral from the general physician (9). Patients may use only plan physicians and hospitals. Emergency room visits are discouraged by denying payment for 'inappropriate' use. Hospitalisations require pre-certification and many procedures require mandatory second opinion. Pharmaceutical cost containment is achieved by a restricted formulary (10). MCOs use case managers, usually nurses, to oversee care of high cost chronic diseases such as asthma, congestive heart failure and diabetes. Credentialing of physicians by MCOs extends beyond verification of training and certification to review of practice patterns, use of diagnostic tests, rates of subspecialty referrals etc. A system of incentives and penalties based on utilisation review 'encourages' physicians to regulate their use of tests, procedures, and specialty consultations (11, 12). Before laws prohibiting their use, many MCOs included 'gag rules' which restricted physicians to discussing only MCO-sanctioned treatments. Physicians are required to follow specific protocols limiting their clinical autonomy and are monitored for their compliance with practice guidelines. An MCO may also transfer some of the risk to the physician through a capitation arrangement under which the physician is expected to provide total care irrespective of the resources/effort required. This system came to be called 'managed care' as every aspect of medical care is managed.

To reduce costs, MCOs recruit younger healthier patients ('cherry-picking'), negotiate lower charges from hospitals and pharmaceutical companies and force physicians to accept lower fees. Costs are also shifted aggressively to other payers such as the Veterans Hospital Administration, and other insurers."]

Note: HMO's in this country generally do have co-pays. Often those co-pays make HMO use very expensive because there is a co-pay for everything from the visit to the doctor to drawing the blood, for every single x-ray, test or procedure. If you have all that done in one day you might be paying several different co-payments depending on how many departments or offices you are shuffled off to.

Often physicians under Managed Care are fed fear stories that all patients will sue them if they even cut a toenail wrong. Nothing could be further from the truth. However, what happens when physicians believe this stuff they become so concerned that they either intentionally for their legal protection over diagnose which forces the patient to pay for services with needed experts to learn that they really didn't have anything wrong with them in the first place. This costs the patient money each time they go through this.

What the physician doesn't see is that a corporation spreading fear stories is manipulating them into forcing the patient to spend more money. The truth is that unless the case is a slam dunk it is very hard to find any attorney to represent a patient, especially when the chances of recouping their actual business costs that have been extended for such suits are so slim.

In the above referenced article the Clinton proposed health plan is also mentioned. That was nothing more than a "hidden" Kaiser Permanente plan that they were caught trying to sneak in. Today it appears that preparations have been made to foist the same Plan, the same program on the public again in the next few years. False and misleading data is being publicized in an attempt to create the widespread belief that we are all uninsured and all suffering from lack of basic health care. It appears to be not much more than just another corporate marketing technique for the HMO to stay in existence now that they have been exposed and shown to be an overall disappointment. The elected officials, some of which certainly shall profit if this is allowed to happen are really doing nothing more than appearing to placate their constituents - a "let them eat cake attitude."

All HMO Plans, not just Kaiser, can and are often 'worked' for financial gain and to the detriment of the patient in need of true medical care. Just as some physicians deny care or downplay the severity of medical needs for their own personal financial gain there are those physicians that also create diseases on paper to steal outright from the various HMO's. It appears that once physician's become so ingrained in these money generating systems that they forget why they became doctors in the first place and end up only caring about how much more money they can make off of the system. Many physicians that become routinely involved in such scams end up with serious psychological problems because one day they do "wake up" and realize how many people they have harmed.

If everyone were honest then these plans could work. Unfortunately dishonest people are often controlling these plans. The "Evidence" that is touted about as so almighty isn't shown to the public and many doctors are so busy that they just blindly trust. Generalized, authoritative sounding statements are made about this so called "Evidence" by the self marketing HMO's, most commonly by Kaiser, but few really know what the entire truth is other than a great deal of it is actually manufactured and very inaccurate. All data can be miswritten. Much data is in error because it is based on billing and coding thus the prior statement that it is manufactured. If a person needs care and there is no code or available specific billable coverage for their need, sometimes, in fact quite often to help a patient doctors will find a way to use a code for billing.

As a very simplified example: If there is no code for billing for a patient with a broken arm but there is for a broken hip they are going to bill for the hip. That makes the "Evidence" inaccurate. The same thing happens with all data gathering. If the system is not set up correctly to begin with it isn't going to work. If the system is set up to collect data showing a predetermined outcome it isn't going to be accurate either. Often corporations are the ones paying for the data collection and they won't be doing it unless it benefits them.

A couple of years ago the US was supposed to have had an Asthma epidemic. During this time government grants and pharmaceutical contracts were awarded to corporations to study and produce data when they wanted to get some new drugs to market and boost pharmaceutical revenue. Pharmaceutical money in this country is often shared in some manner with corporations that prescribe their drugs and elected officials that accept their donations.

A lot of kids suddenly were labeled as asthmatic. As soon as the money stopped these kids suddenly were a cured. It appeared for a while while the studies for depression and ADHD were taking place that everyone had depression and/or ADHD and needed a prescription until people caught on to what was really taking place. That was pretty dishonest on the part of the HMO's and the doctors but they still did it. See the Kaiser Papers Behavioral Health Section for further information on that. http://www.kaiserpapers.org/tonyz.html

So people of the UK, check out the source of the "Evidence." Check out the actual data. Talk to the people in this country, not just the administrators and a few doctors over here. I think that you will find that the "Evidence" wouldn't stand up in a court of law if it were seen for what it really is.

Bob Crane a Director with the Kaiser Permanente Institute for Health Policy has a document

on the NHS web site at: http://www.natpact.nhs.uk/uploads/BobCrane.ppt. The actual document is broken down to images within this web page and placed neatly near the bottom so that you can view the actual presentation without having to have power point installed on your computer.

I don't think that Mr. Crane intended on showing so clearly that the Kaiser Permanente's intent is to manage those with chronic (expensive) conditions out of the system altogether.

Let us start with Bob Crane's Brief History of Kaiser Permanente to critique as it clearly shows what this entire web site is about and what every single person that works with us already knows:

1948: The Permanente Medical Group founded - After the war California was flooded with people from all over the country that did not have much in the way of a job or money to pay for a doctor. Kaiser went public to survive as they were already on the verge of bankruptcy because war time contracts had ended. It was a solution that temporarily appeared to fix a problem but it was flawed because it operated on the same socialist principles set up originally by Garfield.

1955: The Tahoe agreement, roles of PMGs and KFHP set - The Tahoe Agreement which took place one weekend at Henry Kaiser's estate in Lake Tahoe, California happened only because the doctor's were going to walk. They knew that they could make more money and have more freedom in private enterprise and were fed up with being taken advantage of by a company that was using them up. The Tahoe Agreement was for the sole purpose of placating the physicians. At that point, if this meeting had not taken place Kaiser Permanente would have been out of business and hundreds of thousands if not millions of lives would have been spared.

1958: Hawaii added as 4th region - Again military contracts made this possible. We should all remember that it is very important to cultivate relationships with those in places of power on the golf course and cocktail parties because that is where personally lucrative business deals are made - when people are not thinking clearly
they often will do exactly what you request without thinking things through.

1969: Colorado and Ohio regions added - Colorado is not a very progressive state and the majority of the population does not have any insurance nor can they afford it despite what news reports show us about the elite vacationing at Aspen. It is also a small Kaiser patient population in that state. Anyone with the right amount of money could get a license to set up any shop in Colorado because they are a poor state and that is
all Kaiser did. Kaiser doctors in Colorado make more money than any other region because they can get away with it.

As for Kaiser Ohio, it is basically only in the Cleveland, Ohio region that Kaiser is operating and only a minute segment of that population. That is just one single town. Again Kaiser is overstating itself with bragging about Colorado and Ohio. - Mr. Crane failed to mention the sections of the country where Kaiser was asked and ordered to leave. In some of these former Kaiser regionsKaiser was given the opportunity by the states to leave quietly or be heavily fined thus receiving greater negative publicity. That was cost effective for the state to somewhat correct the problems and less expensive than fighting the Kaiser team of attorneys that would drag on matters for years. Those are important things to learn about as it brings all of this into perspective.

1985: Georgia region started - Again Kaiser is only in Atlanta, Georgia a very small patient population in one single town.

1997: The Labor Management Partnership (LMP) was forged and ratified by 26 AFL-CIO unions. It is the largest and most complex health care partnership in the United States - both operationally and in scope. - From the number of complaints we receive and the number of employees working with us we believe that this "Partnership isn't working out as billed."

1998 Care Management Institute started - On the surface this really sounds good, as if they were reforming but unfortunately it was just a government contract and a lot of taxpayer money that the public had no say in giving them that created the Care Management Institute.

1999: Commitment to implement common automated medical record - In theory this is possible, in reality the system is based upon archaic computer programs that are piggy backed one upon another. Also that little problem with getting people to actually put accurate information into the database keeps cropping up. Then there is the pesky problem of people not wanting to be part of a national and international database to track their physical problems and genetic uniqueness as it is reminiscent of Adolph Hitler and his techniques. I hope by this point people of Great Britain that you all are remembering that it was originally the insurance companies and IBM, a computer company that made everything Hitler did possible. It is better to get a copy of your own medical records and carry them with you on disc or cd and have control over who has access to them.

Over the 1990s, managed care grew dramatically. - It is true - our government freely handed out large sums of money to just about anyone that asked for it if you invited an elected official over for dinner. They didn't check out what they were being sold because the reasoning was that their friends wouldn't lie and cheat them would they? Especially when many of them got what is called referral fees or kick backs. That is why we have today numerous Enron type problems in this country today. Creating a crisis on obtaining medical care in the media by paying for the articles sure helped with this illusion as well.

Chronic Illness Drives Medical Care Costs - So. Why is that surprising? Being sick costs money - but it doesn't have to cost all of your money and at Kaiser you pay a separate co-pay for your blood work, your x-ray your doctor visit, anything that you do so it probably overall costs more than just having the work done at a regular doctors office. What if you have everything almost done and run out of money for that last test - the one that will determine if you will live or die? Oh well - you ran out of money is what Kaiser probably will tell you.

KP Members Clinical Area with this Condition - for States and then took a tax write off for it made possible by creative accounting methods. Those that have attempted to have their misinformation which This section isn't exactly true. All of the following is flawed data. Kaiser had to make a case to get continued Federal Money to push their national computer database program. Thousands of people were labeled as having Asthma, Diabetes, Chronic Pain, etc. when they did not have it. For a while many patients with any medical condition were labeled depressed. It was the Kaiser way to making a case for continued Federal funding that again the public has no say in giving away their tax dollars. In some cases Kaiser took the Federal money and set up Disease RegistriesKaiser placed in these registries corrected have found out that they will refuse to do so. It is impossible they are told to make a correction in these flawed databases. The databases are also sold to universities that share the information with local medical associations. If you think that you can avoid telling your doctor that when you were fifteen you had a social disease tough luck.