And, of course, they have no shareholders. So yes profit is part of the problem when it comes to costs because their costs are higher thus they need more money coming in per patient.

Not wanting to beat a dead horse, but in the past I offered KP HMO plans to groups and individuals. Their premiums were generally lower than competitors and benefits richer.

Of course the network was smaller and had strict rules about how to play the game without coloring outside the lines . . . and I explained this to everyone before taking the application.

Surprisingly (to me at least) my KP retention was considerably higher than PPO plans with other carriers. At that time, even folks who said they would never have an HMO changed their mind once they adapted to the system.

Their internal expenses may be higher but I have not seen evidence of that. That may have been abated by the fact they used a closed system (claims for example) and network which has the effect of LOWERING the cost of the product.

HMO plans by nature have lower costs by virtue of their managed care contracts.

I actually had a few clients who received services outside the network and the plan worked as if it were a PPO. One situation involved emergency treatment, transport and admission to non-network facillities. In that situation KP paid out roughly $80 to non-par providers.

Another incident involved a client that needed specific surgery and treatment at a hospital in TX. Not only did KP cover his treatment, they also paid air fare for him and his wife plus a hotel room near the hospital.

Providers and insurance carriers operate in a free market that is competitive. Providers and carriers do not exist as a monopoly or oligopoly where they are allowed to charge whatever they want.
 
I was Director of Sales for KP in New York State and then transferred to Texas. KP is one of, if not the best, run group model plans. Much of what you stated is true, they do keep costs in line. And their medical outcomes are some of the best in the business. One of the things that amazed me was the loyalty their members showed. I forget the exact numbers, but it was if a member stayed till the 3rd year, they stayed for a long time. This is why carriers in CA have always allowed a side-by-side with KP.
 
I was Director of Sales for KP in New York State and then transferred to Texas. KP is one of, if not the best, run group model plans. Much of what you stated is true, they do keep costs in line. And their medical outcomes are some of the best in the business. One of the things that amazed me was the loyalty their members showed. I forget the exact numbers, but it was if a member stayed till the 3rd year, they stayed for a long time. This is why carriers in CA have always allowed a side-by-side with KP.

My experience is you either love or hate the KP system (as a member). Much of my adult life was outside of KP. Then, for 4 years, I was "stuck" with KP as my insurance. I hated it. Had to drive an hour each way to see a specialist. Was hard to get an appointment with a specialist. And there's really no getting a second opinion since all the doctors are employed by KP. Was happy to finally leave them. But I have some clients who have KP and are near the big facilities with all the doctors, labs, etc and they love it.

On a side note, we can skip all the for profit medical providers and go to a nationalized system like Canada. Surely that means better care since any type of profitability is removed from the equation.

 
we can skip all the for profit medical providers and go to a nationalized system like Canada. Surely that means better care since any type of profitability is removed from the equation.

ROFL!!
 
My experience is you either love or hate the KP system (as a member). Much of my adult life was outside of KP. Then, for 4 years, I was "stuck" with KP as my insurance. I hated it. Had to drive an hour each way to see a specialist. Was hard to get an appointment with a specialist. And there's really no getting a second opinion since all the doctors are employed by KP. Was happy to finally leave them. But I have some clients who have KP and are near the big facilities with all the doctors, labs, etc and they love it.

On a side note, we can skip all the for profit medical providers and go to a nationalized system like Canada. Surely that means better care since any type of profitability is removed from the equation.


And you can die in USA from failure to get health care as well. In the states that didn't expand medicaid and people don't make enough for ACA care they can die due to inability to get health care. We are just trading who dies depending on the system used. I have lived in 5 countries with universal health care. Some systems were far better than others. The worst was the UK. If and only if you had the money to pay extra for the "better" level of health care did you have reasonable care. Otherwise the "standard" free version a real problem for many, but not all, issues. Dental and they only pulled teeth rather than do root canals, break your hand and they won't set it...
 
My town, up until a few years ago had probably 10 walk in clinics. Now? Zero.
What happened? Obamacare
Hidden in Obamacare was obscure language that provided higher reimbursement to clinics that served low income patients(Medi-Cal & Indians)
 
And you can die in USA from failure to get health care as well. In the states that didn't expand medicaid and people don't make enough for ACA care they can die due to inability to get health care. We are just trading who dies depending on the system used. I have lived in 5 countries with universal health care. Some systems were far better than others. The worst was the UK. If and only if you had the money to pay extra for the "better" level of health care did you have reasonable care. Otherwise the "standard" free version a real problem for many, but not all, issues. Dental and they only pulled teeth rather than do root canals, break your hand and they won't set it...

You can get health care in this country. Just show up at the emergency room. Paying for it is the issue. People aren't dying here because they can't get in to see a doctor. They are dying because they feel they can't afford to either self-pay or get insurance. The point being made in that prior post is all of those people (Canadians) have insurance (national healthcare), but they can't get in to see a doctor. I have a client who is originally from Canada. Her daughter still lives there. They are now removing primary doctors from people who are deemed "healthy". Now if they get sick, they have to just show up and hope they can get in. Her daughter had a rash on her arm. She got to the doctors office at 7 am. If my memory serves me correctly, she was 70th-80th in line. She didn't get to see the doctor that day. Had to go back the next day.

And prior to ACA, a family of 4 could get a decent insurance plan for $300 per month. Yet, many who didn't have insurance through their job still went without because "they couldn't afford it". Although they had a couple of nice cars, all 4 had cell phones, they ate out 4+ times per week. The list goes on. Now that family of 4, if they don't get a subsidy, has to pay $2k+ per month for health insurance. If they couldn't afford it at $300 per month, they sure as hell aren't affording it at $2k per month. Hell, even if they do get a decent subsidy, they would still pay well in excess of what they would have paid prior to ACA.

In my opinion, ACA really broke the system. It was a feature not a bug. And their answer is national healthcare because of course America can do it better than anybody else. Just like socialism, the only reason it hasn't worked anywhere else is because America hasn't done it yet. I'll pass.
 
national healthcare because of course America can do it better

Canada has a population of 40M
UK, 68M
Germany, 84M
Sweden, 10M

USA, 335M

The health care system may not be perfect but I don't know of another country anywhere near our size, that offers national health insurance/care.



In 2023, most people, 92.0 percent or 305.2 million, had health insurance, either for some or all of the year.

In 2023, private health insurance coverage continued to be more prevalent than public coverage, at 65.4 percent and 36.3 percent, respectively.

(Don't ask me why paragraph 2 adds up to 101%. I guess the phrase "close enough for government work" applies here . . .

Of the subtypes of health insurance coverage, employment-based insurance was the most common, covering 53.7 percent of the population for some or all of the calendar year, followed by Medicaid (18.9 percent), Medicare (18.9 percent), direct-purchase coverage (10.2 percent), TRICARE (2.6 percent), and VA and CHAMPVA coverage (1.0 percent).

 
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