[mcntsh]

When I worked in the US I had “Kaiser Permanente” which seemed to be something like an all-in-one system. You have specialists, GPs, labs and pharmacy all in one building covered by one insurance. Could something like that scale to the whole country?

[btreecat]

> When I worked in the US I had “Kaiser Permanente” which seemed to be something like an all-in-one system. You have specialists, GPs, labs and pharmacy all in one building covered by one insurance. Could something like that scale to the whole country?

We can't even scale out broadband to the entire US.

[dghlsakjg]

It can scale to a whole province of 5 million people.

I had Kaiser Permanente when I was in the US. Now that I'm in BC, Canada, it is very similar. I walk into any hospital in the province and every doctor and specialist in the building are part of the same system (technically they are broken up into three geographic subunits, but to the patient it basically doesn't matter). If I need some sort of treatment that hospital doesn't offer, they can immediately refer me to the correct hospital. For emergency cases the provincial ambulance service will transport you to another hospital by road or air at no cost.

There are still independent specialists and doctors outside of the hospital system, but they have access to the same records systems and the billing is so seamless that I suspect that most people don't realize it is happening since it never involves the patient outside of providing your ID.

[monknomo]

I think the answer is a "yes, and"

Of course the approach works, we can see it work at various scales. I think what prevents it from working is that it works best when it is the only option. I don't think we could support 5 kaiser permanentes. And that feeds into insurance - there are a lot of insurance plans, and each of them would likely only support their specific kaisers

So ideally there is one insurance, with one provider that has vertical integration everywhere and then indies outside the network you can go out of pocket for, and oops I invented single payer

[vel0city]

Organizations like this have existed in some places in the US as well. I remember growing up in Houston we would go to the Kelsey-Seybold clinic. They had a lot of GPs but also a ton of specialists all under the same network and sharing the same building.