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That's Where They Get You: Kaiser Permanente

Updated on April 8, 2015

This is how they bring you in

The concept seems fairly innocuous, even advantageous, at first. The convenience of having your health insurance tied directly to your healthcare network is the major reason people tend to be drawn to the conglomerate. There's no need to worry about whether your doctor is going to be within a certain network. The deductible and copay systems are relatively straightforward and don't vary depending on which doctor or hospital you choose to go to. You are able to find the same level of care, no matter where you are travelling in the country, sort of like how you can always find a Big Mac anywhere in the world. Most everything is available to you online, which is actually a highly useful resource in this increasingly digital world.

The promise of convenience and top care are the main driving forces behind Kaiser's claim to distinguishing traits in the healthcare market. If you happen to need a specialist, you are assured they can provide one within your network, because they are the network. They seem to have extensive nurse hotlines available 24/7 to meet all of your potential health inquiries, even if you speak another language. Your health records and insurance policies are all kept neatly together, in case you or your doctor need to reference anything. All of this sounds great, until we take a closer look at what this interconnection really means for the economics of healthcare. As you will see, having your insurance company under the same roof as you doctor has distinct implications for your experience and pocketbook.

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This is where they get you

The fact that your insurance policy is held by the same company that offers you care means the doctors can't bill an outside insurance company. What that means is that every time they help you, they are losing money. They are billing themselves, every single time a cost is incurred. This phenomenon has far reaching consequences for the management systems responsible for providing you with healthcare.

One effect of this structure is that the managers will try to make overhead as efficient as possible. They will attempt to satisfy the greatest amount of insurance policies with the fewest amount of resources and investment they can reasonably manage. Simply put, the faster they can get you in and out while minimally satisfying your requirements for health, the more profitable the system is. Doctors are incentivized to diagnose and treat in the shortest amount of time, using the least amount of assets they can. This rationally has a deteriorating effect on the quality of care that the customer is ultimately receiving. If the doctor's office could simply bill a third party insurance company for time and other resources, this practice would be limited.

But wait there's more, and the prognosis is not great

Another thing they do in an attempt to minimize cost is to initialize a system that puts another step between you and a doctor's visit. Patients are encouraged to make appointments over the phone or online, where they are subjected to a preliminary screening process that attempts to weed out less than critical visits. What I have experienced, as a result, is that the nurse hotline takes forever and is very inefficient.

In order to get in contact with an actual doctor, one must first call in to leave a message, a nurse then takes notes of your dictation and sends it to the doctor in a special messaging system. This seems to be a very unnecessarily convoluted process, which may be an intentional effort to dissuade patients from actually making the trip to the office. This practice limits the amount of resources necessary for the company to satisfy a large amount of insurance policies, which they themselves hold.

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So now we have learned, it's all about the profit motive

From what I have seen, and what makes sense under this system, is that doctors will limit procedures and care to save money. This means sometimes attempting to recommend the patient seek an eastern or homeopathic remedy. Although it can sometimes be good to limit traditional western treatment, there seems to be an indisputable profit motive behind these suggestions. Another hidden incentive of this system is the limitation of access to pharmaceudicals. Drugs can be very expensive, and because you are covered for them, Kaiser is losing money every time you pop a pill. Again, if this cost was externalized to a third party insurance company, this phenomenon would not exist.

Another factor is that you have to see the your primary doctor for a chronic ailment, even if he/she is not who you initially got treatment from. This means you have to explain the entire ordeal all over again, and hope that your primary care physician comes to the same conclusion as the first person you saw. Since the doctor's time is structured to be exceptionally busy, being able to align your hectic schedule with the even more hectic schedule of a single doctor can border on impossible.

What can you do about it? You should try this instead

By definition, all healthcare insurance is designed to cost you statistically more money than you would be spending otherwise. That's the only way they make money. These companies are way better at estimating exposure than you are, and have the financial resources needed to absorb anomalously high costs of procedures and specialized care. They are selling peace of mind, because one day it could happen to you. After all, who do you think is paying for all those blimps and Peanuts royalties?

All that being said, you're probably better off going with an insurance company that isn't directly tied to your healthcare professionals. This will allow the invisible hand we've all heard so much about to at least partially reduce costs by providing competition in a more reasonable marketplace. Simply put, you have more options in the general market, and insurance companies are more inclined to compete for your business. This is a good thing for you.

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The key takeaway

The overwhelmingly most important factor is that you have access to a doctor that you know and trust to be competent. That being said, there are certainly more and less prudent means of going about this. The reason for bringing this to your attention is that I want you to be aware of the economical phenomena that exist in the specific case of Kaiser Permanente. You are free to make any decision you wish, but I believe you deserve all the relevant information before you do so. In closing, I would like to wish you all good health and happiness.

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