If your mechanic lost money every time he found a problem with your car would you trust him to check your breaks? Of course you wouldn’t. That’s why your mechanic is paid by your car insurance. Now Moe doesn’t have to balance his beer money against the chances you don’t make it home for meat loaf.
How would you feel if your doctor had to personally pay for your treatment every time she found a problem? Need a discectomy to relieve crippling back pain? Well surgical facilities are expensive and Doc is going to have to take out a second mortgage. As Doc’s patient, are you concerned? You shouldn’t be as long as Doc doesn’t care about money. But if she does, you may find yourself in crippling pain for longer than you would like while she makes the numbers work.
That’s the problem with Kaiser. Kaiser decides what is wrong with you. But Kaiser also has to pay for the treatment for the conditions your doctors find. Now Moe has to think long and hard about whether new break pads are worth skipping the 7 p.m. pale ale pitcher with the boys.
How did we get here? Kaiser’s system is known as an “HMO”, or health maintenance organization. An HMO is an insurance group that provides medical services for a fixed annual fee. Kaiser’s system is different from a traditional arrangement where your health insurance is a different company altogether from your treating doctor, who instead submits the bills on your behalf to the insurance company.
Comparatively, with Kaiser, the treating doctors are with subsidiaries of the same corporate structure as the insurance company itself. Thus, when your Kaiser doctor finds a problem that requires expenses to be treated, it is Kaiser that will cover those expenses. The fact that HMO consumers pay fixed premiums does not cure the inherent conflict of interest of trusting the diagnosis and treatment of your health problems to the same company that will pay for the treatment.
Pay attention the next time Kaiser sends you to “group physical therapy” where you are lectured on posture with a group of strangers instead of providing you an immediate 1 on 1 session with a physical therapist. Is this decision in your best interests, or Kaiser’s?