Dump $1 trillion into Kaiser and push it out to all 50 states. I have it in Bay Area and it’s mostly been great for me. It’s not the best but it also gets 90% of things right.
Kaiser is the one thing I miss the most having left the Bay Area. It has sort of moved in here, but it took over an existing group and afaik, it's not really integrated like it was down there; there's no Kaiser hospitals here, so hospital care is going to be a mess, and I'm not sure if they have pharmacies either.
But, a lot of people don't like Kaiser. You have to be ok with getting good enough care, and not really be trying to seek 'the best' care. Integration is so nice though. I'm sure Kaiser never puts you in the situation where the Dr says I'm not sure which drug will be covered, let's try A, the pharmacist says A isn't covered, ask your Dr to write a script for B, and your Dr doesn't answer the phone so you have to decide to either pay $250 for A or wait over the weekend to start your kid's treatment.
There was a study comparing Kaiser Permanente with the UK's National Health Service (NHS) that found Kaiser achieved better performance at roughly the same cost.
If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape.
Eliminate other private health insurance and if people want above and beyond service they can negotiate directly with providers and pay out of pocket for that.
> There was a study comparing Kaiser Permanente with the UK's National Health Service (NHS) that found Kaiser achieved better performance at roughly the same cost.
The NHS does have serious problems, but it's a LOT worse now than it was a few decades ago, and the two significant things that have changed are a) funding (per capita and accounting for inflation) is far lower and b) a lot of privatisation has happened.
Politicians - mostly the tories but Blair's government take a lot of blame too - have defined "not privatising the NHS" as only meaning keeping it free at point of use. But in the background, NHS trusts have been forced to sell land and buildings that they used to own and rent it back from the new private owners, and many areas have seen both staff and equipment privatised, from agency staff (where instead of hiring cleaners or nurses or whatever, they instead hire agency staff, where the hourly cost to the NHS is double or more what an employee would cost with most of that increase going to the agency companies not to the workers) to private hospitals (where instead of investing in a new operating theatre, or whatever, they pay to have NHS patients operated on in private hospitals), etc.
The NHS is far from perfect, but the lesson we learn from those imperfections shouldn't be that nationalised healthcare is bad, but that underfunding it and then using that underfunding to justify privatising lots of stuff in the background is not a good way to run a nationalised health service.
The root problem is that many politicians would like to see the NHS fall to pieces so that an American healthcare system can create lots of opportunities for companies to make money, but because the NHS is hugely popular it would be political suicide to make that an official policy, so instead they've taken this approach which not only creates these short term opportunities for companies to come in and profit as mentioned above, but also gradually erodes the it's popularity with the long term goal being that eventually it won't be political suicide to say "Look the NHS is a failed experiment, we need to replace it with American style private companies and healthcare insurance".
The NHS is far from perfect (and was already far from perfect before the Tories spent a decade and a half making it worse) but given you -can- get private health insurance in the UK if you want it, IMO it's best to judge the NHS as 'universal basic healthcare' and accept that at that scale it's always going to suck sometimes but it's still better to have access to such a thing than not.
Kaiser in Oakland is without exaggeration the best medical care I’ve ever experienced. Aligning incentives between the care provider and the insurer, vertically integrating care and putting it all on a walkable campus (even with a pharmacy!!) was such an efficient and pleasant process.
I was never healthier. The other Kaisers in Oregon aren’t geographically collocated so there’s less of an effect and they’re far away from me so I don’t use them anymore, sadly
Psychology / Therapy: A horrible model that doesn't work properly. Limited to seeing patients once a month when they need it to be once a week, and constant fighting with the system by clinicians and patients. Overloaded schedules are ultimately unethical.
Doctors: It's like working for any other hospital; it's not bad.
I know Kaiser doctors. They mostly like it at least in Norcal. They said Socal Kaiser wasn't as good. My own Kaiser doctor said that Kaiser has been pushing more and more work on her like taking notes, etc, and it's frustrating but as far as I can tell it's a lot better than dealing with insurance companies. She gives me everything I request, like endoscopy, MRI, CT scan, blood tests, prescriptions, etc. The only time I was rejected was when I asked to see if blood sugar monitor could be covered but that was rejected because I'm only pre-diabetic and not diabetic.
But, a lot of people don't like Kaiser. You have to be ok with getting good enough care, and not really be trying to seek 'the best' care. Integration is so nice though. I'm sure Kaiser never puts you in the situation where the Dr says I'm not sure which drug will be covered, let's try A, the pharmacist says A isn't covered, ask your Dr to write a script for B, and your Dr doesn't answer the phone so you have to decide to either pay $250 for A or wait over the weekend to start your kid's treatment.