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Just now I called the phone number on the Kaiser ad that dropped out of yesterday's newspaper (December 6, 2005) where it has snuggled with the other ads.  The two sided ad is called "Call the Experts at Kaiser Permanente Senior Advantage for Answers."  "With our more than 60 years experience listening to and caring for members, you can count on us to guide you through the changes in Medicare.  Empowering people to make informed health care decisions.  That's just one more way Kaiser Permanente Senior Advantage can help you thrive."  Then the Kaiser logo - now joined with the Thrive logo.
 
I called 1-877-288-4335.  It would appear by the tape recording that those members already in the Kaiser Senior Advantage Program - a subcontractor to Medicare - they are automatically enrolled in the Medicare Part D program without making any new choice.  And they are warned that if they sign up for any other Medicare Part D program, they will be dropped from Senior Advantage.  
 
I went on to wait for a live voice.  I asked if the physicians at Kaiser worked for profit.  The answer from a very assured young lady was that "Kaiser is absolutely non-profit."  As the Kaiser physician contract with Kaiser, they are also "non-profit."  She was "absolutely" sure of this.  The physicians just "work for Kaiser."  
 
No wonder everyone in the ad from the pictured telephone operator to the seniors at the tennis court who just won a trophy (thriving) are smiling - here are physicians just working for salary who could not be influenced by profit.  Talk about trust.  Hippocrates would be proud.
 
On the other hand, there is the truth.  The Permanente physicians were originally organized for profit.  I have the original TPMG articles of incorporation. And Kaiser has been profitable for 58 of 60 years - half going to the physicians.  Last year the physician split $900,000,000.  This was above salaries which with benefits are worth $250,000 a year.  The Permanente partners are the top average IPA earners in the state - if you ad in the profit bonus (cushioned into a comfortable "corridor" flow).
 
Kaiser is linked to HMOs, which people hate.  So they try to lean on the term "Kaiser Permanente" so they can "fly the Permanente flag."  But it is handy to try to shift the Kaiser Plan - not-for-profit with the physicians as the most important ad "tag line" in the organization.  The Permanente partners own stock by which they can split stock dividends - most hidden into glorious retirement schemes.  (Hint - the FBI should start by looking for numbered accounts in Mellon Bank.)
 
Now senior confusion over the Medicare Part D plan - about as clear as the tax code - is used as the invitation to join Kaiser and let your worries be over.  Both political parties hope more seniors will join HMOs - though all of the politicians voting have the right to sue for mistreatment.  For the vast majority of seniors, HMOs cannot be sued.  That "patient right" to go after organizational corruption got lost in the stampede to look for individual physician error.  
 
Ad lies will be called puffery in court.  Wrong information on the phone will be called an operator's bad hair day.  Poor care once the senior is stuck inside the HMO will be called the "rational" use of precious resources to keep premiums down.  You know - the "best evidence"!  
 
The only good news I can add as that the nation is gradually stepping away from HMOs.  Someday it will only be a bad idea - a form of greed tied to governmental entrepeunerial fraud.   
 
                                                     Chuck Phillips, MD
 
 


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