Kaiser Permanente, a West Coast medical group, is encouraging an all-around healthy lifestyle, which may be a preview of all future medical care
I am not only a Kaiser Permanente member but a concerned healthcare consumer. I worry that the two options being floated for a National Healthcare system are both wrong, they being a) Democrats-free unlimited healthcare for everyone or b)Republicans-no healthcare for anyone. No one seems to be taking a very important subject into account, that lifestyle is a) a gigantic contributor to good health and b) very inexpensive. That is, no one until Kaiser came along and started promoting healthy lifestyle, presumably to help their profitability but also because it makes great sense.
I grew up in a small farm town and the local doctor later became my step-father. He told me once that everyone used to pay cash for medical services, and that they’d extend the farmers credit so that they could pay when their crops came in. In the 60s, there wasn’t a whole lot of medicine or procedures anyway (compared to today), so this system worked fairly well. Some people back then had medical insurance through their employers, but not many. More common was the “major medical policy” that kicked in if something catastrophic happened. These policies had high deductibles to make them affordable. This was actually a very good system, because of the following:
1) There were free vaccination programs through schools for things like smallpox, measles, diphtheria, pertussis, tetanus, and polio, paid for by programs like the Federal Vaccination Assistance Act.
2) At the basic health end, people didn’t bother the doctor unless they were really sick because it cost them out of pocket. Once they went to the doctor they negotiated prices to save money, and they tried to stay healthy.
3) There weren’t enough drugs or procedures yet to cost people a fortune.
4) If you were really sick, you died. There wasn’t enough medical sophistication to keep you on expensive life support for very long.
The problem with the Bernie Sanders style “free health care for all” is that it’s not free of course, and it implies unlimited medical care. It would need copays and deductibles to keep from running up taxes to unsustainable levels, plus there would be no disincentives for hypochondriacs, homeless, drug addicts, or non-citizens to not clutter and overuse the system. In addition, there may be the overuse of low-efficacy and expensive drugs and procedures, with the thinking that some medicine is better than none, thereby additionally overtaxing the system. Many have argued also that the current system uses Medicare as a loss-leader, making up the difference on the gouging of non-Medicare or insured patients, and that when there is Medicare for all, the Medicare per patient cost will thus rise to exorbitant levels.
Healthy, middle income tax-payers like myself, naturally, will be quite resentful and perhaps band together to stage a tax rebellion. After all, we tend to be responsible people who use the five basic tenets of good health, a) Don’t smoke, drink, or use drugs b) Exercise c) Love your spouse and kids d) Try to solve your own mental anguish using good habits, friends and family, and e) see the doctor as little as possible. Even though we pay our taxes and we advocate basic health for the rural and inner city sick (in the form of vaccinations), we may be tempted to quit paying taxes if you ask us to buy new livers for drug addicts. We may also quit paying if you start keeping lifelong smokers on life support with some expensive drug when they’re gonna die anyway.
So enter Kaiser. They stress basic lifestyle changes to promote good health. They promote a good diet that involves portion control, more fruits, veggies, and whole grains, less meat, eggs and dairy. They promote exercise and a happy outlook. They frown upon abuses of tobacco, alcohol and drugs. They are like Seventh Day Adventists or Mormons without the weird religious trips.
What I really love about Kaiser is how they address anxiety, depression, neck/back/joint pain, since somehow you know that chronic patients flood our medical care system with these things, which costs the rest of us a fortune. For mental health, Kaiser limits payouts for expensive therapists, and instead promotes “Cognitive Behavioral Therapy” which is basically helping you get your shit together. For aches and pains, they have only a partial payout for chiropractors, and instead promote physical therapy, which allows you to exercise your way out of the problem. This is good because the statistics and consumer reports show that beyond some back manipulations, chiropractors are largely show people prescribing expensive, ineffective procedures, while therapists can spend many fruitless, expensive hours with patients, dispensing pricey, barely effective pills that don’t always cure anxiety and/or depression. (Wheeler,2020),(Homola,2001),(Gots,2012)
Maybe someday, us healthy people that pay most of the costs will actually get a discount, but I doubt it (actually, the government currently regulates these “Association Plans”) Like in all insurance, they need us suckers to pay for all the dead wood that overload hospitals, those that drink, smoke, do drugs, beat their spouses and kids, are too lazy to work, get hurt in the rare instance they exercise, have a bad attitude, and use doctors and nurses to fill the holes in their miserable lives. This is already bad enough, God forbid it would be “free”.
I may speak for many Democrats when I say by all means free vaccination, prenatal health, legalize most drugs, or even free rehabilitation for drug abusers, since this helps society at large. But I see no benefit in crowding medical facilities with neurotic freeloaders who demand expensive procedures that barely work at the expense of hardworking, healthy taxpayers who barely need to see the doctor. Strangely, the cruel, stingy and short-sighted Republican system kind of mimics a better health care system by accident, the one in the 60s when we were forced to be healthier and pay less for care because we were afraid to get sick. Kaiser is now even training their own doctors and nurses to address shortages. Maybe Kaiser is evolving to be the medical system that marries sensible lifestyles with sensible medical therapies at sensible costs.