The central league stopped using non-profit status a while ago. Even back when it did, it was appropriate - they distribute any net income to the teams, who probably have additional tax dodges but are not non-profits.
As for Kaiser Permanente, it’s what I have now and I like it. My wife has had them her whole life except for a few years when we moved and is elated to be back.
My most problematic insurance company was Blue Cross. They refused to acknowledge I had hit my out-of-pocket maximum during cancer treatment. I couldn’t continue to pay the co-pays for the mail-order drug, so I had to stop early (I finished 5.5 months of a year long plan).
Absolutely true that experiences vary. You see the same thing every time someone asks for recommendations for computer brands. Some were very happy with a particular brand while others had all sorts of issues.
Mrs Cad has had many tests over the last 5 years showing very high levels of inflammation. But the test haven’t pinpointed WHAT is causing the inflammation (blood tests can only show so much) so they won’t let her be treated for the inflammation. She gets the run around like
She has Hashimoto’s so they send her to the endocrinologist that confirms the test and doesn’t deal with the inflammation.
Her knees hurt all the time, so she has to go to the orthopedist to x-ray her knees. Nope they’re structurally sound. No pursuit of why they are inflammed.
Etc.
As I noted above, Kaiser is fine for basic medical treatments like dealing with a sinus infection or a minor injury, and as long as you don’t have any underlying conditions having everything ‘together’ can be quite convenient. They’re also well recognized (in California) for oncology treatment; not at City of Hope, Cedars-Sinai, or the UC system hospitals in terms of cutting edge treatment, but as long as you have a cancer with pretty standardized treatment protocol they seem to provide good care. But if you some with some issue requiring specialized expertise that they don’t have in-house, need mental health services, or get caught of in one of their apparently comment billing errors that they refuse to resolve even when presented clear and incontrovertible evidence that they are at fault, you are stuck in a grinder and don’t really have any options other than to spar with their “Member Services”. Cost control is one of their major focuses, which would be great if they actually used their integration to control costs and make treatment costs transparent, but oddly they really don’t seem to do this much better than any other combination of insurance company and medical services except by denying treatments in the manner described by the o.p.
As for the various iterations of Blue Cross and Blue Shield (I’ve been on three different ones; again, constantly changing plans through work), I don’t have particularly good things to say but at least I have options about where I go and who I see, and at the PPO level at least if I want to see a specialist I don’t need to beg a GP for a referral. A BCS network urgent care used a lab that was out-of-network, and somehow I was supposed to be aware of that even though I asked and was assured it was covered, and the lab billed me for $1200 (for a test the insurance company would have paid at most $150 for) that BCS refused to cover, so they suck donkey balls, too, but that just illustrates the larger problem with a barely regulated for-profit health system that is largely organized along state lines even though the states are minimally involved in overseeing insurance companies, and the utter lack of transparency, equity, and accountability for a system that is supposed to benefit the ‘savvy medical consumer’ who shops around, notwithstanding the lack of access for anyone who doesn’t have medical insurance through a corporate employer.
According to the PCP, it’s because rheumatology won’t treat her if the cause isn’t already known. I listened to the phone call and it came across as, “I’m annoyed you’re making me do my job.”
More likely it is that “the Kaiser diagnostic flowchart is telling me to short stop this issue because it will probably require an outside referral that will eat into their earnings.” To be fair, generalized inflammation is a frequent condition in which no specific diagnosis is too often the result, but that doesn’t excuse not referring the patient to a specialist who is familiar with specific knowledge and access to tests that a GP may not have.
I think the second part is the issue. The Rheumatologist is the logical one to make the diagnosis, if the GP can’t. But to just shrug, we don’t know, and move on like there isn’t an issue. I would be getting a new doctor.
I have found it’s feast or famine with them. We had the worst doctors in the world with my daughter’s seizures. With one of them, when we asked about side-effects of the medicine he wanted to put her on, he told us to shut up and blindly do what he said since he was the doctor. But then her last two doctors were phenomenal and the last one sat down with us and explained why he was recommending medication, and he did so in a way that was respectful to us (not treating us like idiots).
My PCP was the best before he retired. He ran tests, talked with me, explained metabolic disorders to me - again like I did have a brain and together we worked on a plan to get my body on the right path. But then again I went to Kaiser when I had covid like symptoms but the test came back negative. His treatment was to tell me I probably had covid anyways and I should be tested again. You notice a similarity to Mrs. Cad’s situation. Let’s determine the cause and ignore the symptoms until we know. What? We don’t know the cause? Then we can’t help you. Go home and suffer.
Excellent points, thank you. As for Kaiser specifically, it’s the insurance group only that is considered non-profit; the hospitals group and medical services group are all for-profit. In any case, some putative “non-profits”, such as some Blue Cross member organizations, have been some of the most egregious abusers and deniers of health care coverage in the industry.
Sure, but that’s a ridiculously misleading generalization without proper qualifiers. Single-payer systems may not be perfect to the extent that all organizations are imperfect, but their problems tend to be very different from those of private insurers. In particular, they are structured to automatically pay for all covered services, so the traditional huge problem with private insurers – denial of coverage for essential health care, or selective or incomplete coverage, or meddling in the doctor-patient relationship in any way – are virtually unknown in public health insurance systems. It’s just a completely different payment model.
It’s not just a different payment model; it is an entirely different service model. Single payer systems exist to provide a service whether is is ‘profitable’ in the fiscal sense because there is recognition of both the social good and societal responsibility to provide a certain threshold of health services regardless of financial status of the patient. It is the same model as public education, and (indirectly) public streets, parks, et cetera. Of course, we can choose as a society to not take on that burden and live in a country like India where the wealthy are well cared for and everyone else lives in scrabbling poverty but I don’t think that is a healthy example of what we should aspire to be as a society.
Essentially every modern industrial nation has adopted some form of subsidized or single payer system because having people going into endless debt to pay for routine medical problems or to pay for insulin is not a good look. Of course, some systems work better than others, and may be a ‘better fit’ depending on the size of the nation and the particulars of its social philosophy but I feel morally certain that the United States—“The most powerful nation in the world!”—could come up with a suitable system that would provide for everyone without “death panels” or depriving people of their pillows and still be sufficiently individualized to not turn us all into mindless socialist drones like those Scandinavian people should we exert the political will to do so.
I fall into the category of mostly good experiences with Kaiser. But I’ll note I have a “better than you can buy on the open market” Kaiser plan through my employer and I haven’t had to have major surgery (yet - though I was once hospitalized for a few days). My step-brother DID have an emergency (internal burst tumor that was bleeding out) cancer surgery and came out fine, but he has his wife who is a Kaiser surgical nurse looking out for his better interests.
But I remember once they wanted to sleepwalk me into an emergency appendectomy based on CT-scan, which quickly turned into a non-event on consultation (I apparently have a larger-than-standard-size appendix). And I’m certainly glad my father got his particular type of cancer surgery at a state-of-the-art facility at UCSF with a widely recognized expert rather than at Kaiser.
But as HMO’s go IMHO they’re overall okay. Not great, not awful, with many individually varied complaints and praise. More affordable than Blue Cross/Blue Shield but potentially weaker care in certain areas. I have choices in health plans and go with Kaiser because it the best combo of inexpensive, comprehensive and conveniently all-in-one maintenance care. But I might very well switch at retirement to a far more expensive option like Blue Cross just to cover the extra oddities of geriatric medicine. But I dunno - for me it would be a lot more expensive.
You might try asking for a second opinion (outside of Kaiser). Also you can try writing (via KP messaging) to Member Services to complain. If you need to make some mild, vague legalistic threats to Member Services. It’s pretty much all that they respond to.
No, it is not, and I do not see any reason for you to attack me like this. Sure, things like the NHS do not have the billing and payment issues we have here, but they have issues like the OP.
They have plenty of written complaints just for the NHS:
So yeah, a UHC system would be wonderful as far as the money goes. No worries about not being able to afford it, no worries about losing your job and your health care with it, and so forth. In that regard, it is wonderful. America should have something like the NHS.
But of course there are still complaints about long waits, doctors not wanting to do tests, doctors doing too many tests, and what not. If there are doctors, there are complaints about them. Kaiser, NHS, Blue cross, whatever.
The point is, although I am sorry the OP had his experience, his complaint is an anecdote, one data point. Not worthless, but since I was able to show that the vast majority of patients prefer Kaiser over any other similar medical plan, that outweighs one persons anecdote. Kiser consistently ranks at or near the top, year after year.
So yeah, that one Doctor may be a goof, sure. I am willing to accept that. Kaiser has thousands of them. But to say "Kaiser is Fking worthless" based upon a single data point- now that is a ridiculously misleading generalization.
Yes, it is, and I’m not “attacking” you. I’m explaining why your assertion is wrong.
If the NHS has issues “like the OP”, it’s because the NHS happens to be an integrated health management organization much like Kaiser is essentially an HMO – that is, the NHS employs doctors and manages hospitals. This is incidental and irrelevant to how a single-payer or equivalent public health insurance system fundamentally works. The systems implemented in Canadian provinces are a typical model for how most such systems actually work around the world. Doctors in private practice are self-employed or part of independent partnerships, and most hospitals are independently managed.
Thus the role of the single-payer public insurance system is simply to pay the bills. With very rare special-case exceptions, they do so unconditionally, with nothing like “pre-approval” or any kind of scrutiny or clinical meddling involved. The patient is completely removed from any financial interaction at all, and neither patient nor provider have any concerns about whether the service will be covered. This is completely different from how any kind of private insurance works, and is absolutely fundamental to why single-payer is successful and efficient. Put simply, the only precondition for a specialist referral and for the referring PCP and the specialist to get paid for consultation and treatment is that the responsible physicians deem it to be medically necessary.
I had Blue Cross through work once. My wife is a freelance writer covered by my insurance, and before they paid for any of her care they had me certify that she didn’t have her own insurance.
Three times.
Are you sure you don’t have insurance?
Are you really sure?
I must not have been the only one, since my very large company dumped them the next year. UHC was far superior.
And, speaking of single payer, Medicare has been best of all.