Monday, May 2, 2011

Socialized medicine: an inside scoop

Kaiser Permanente is a non-profit health plan & medical group practice that gestated as a means to care for tens of thousands of workers streaming into Richmond, California shipyards as the U.S. geared up for World War II. The not-for-profit medical plan was formalized at the end of the war, as employment at the shipyards fell off. The organization is well-known for emphasis on preventative care and its public health orientation, and provides members with the convenience of making most services available at campuses that cluster medical clinics, labs, hospitals, and treatment centers in a single location. The numbers involved are large: over 8.5 million members in ten states; 35 hospitals; 15,000 doctors; $42 billion in operating revenue in 2009.

Kaiser's mode of managing health care, a product of industrial need and medical efficiency, has been tarred with the "socialized medicine" brush from the start. According to Rickey Hendricks in an article titled Medical Practice Embattled... published in the Nov 1991 Pacific Historical Review, "local medical societies rejected applications for membership from Permanente doctors who they implied were champions of socialized medicine."

I've been a member of Kaiser Permanente in Oakland since shortly after I graduated from college. I've been pretty fortunate, as these things go, to have required care only occasionally and in moderation. Over the course of several decades I've known dozens of others who are also Kaiser members, with a variety of health profiles. For all the fearmongering about scarcity of access under managed care plans, never mind the Tea Party whack-jobs fantasizing about death panels, I haven't heard a lot of complaints. I have none.

Well, okay, let's keep this fair and balanced.

There was one opthomologist I saw quite a few years ago following an injury -- some idiot-drunk high school kid tried to brain me with a wine bottle then kick my head off when I dropped to the sidewalk, because he thought I had disrespected his girlfriend (he turned out to be looking for somebody else ... idiot-drunk, like I said). The doctor I saw roughed me up a bit as he examined my eye to see if any glass slivers had lodged where they weren't wanted (luckily not) ... his examination hurt and he sure didn't seem to give a toss that I was squirming, in obvious distress ... but even there, a brusque chair-side manner might have seemed less caring than it actually was, exacerbated by muscle trauma he couldn't see despite a pretty awful mass of bruising. Believe it or not the guy's name was Dr. Yacht -- I am not making that up. Can you imagine going through life as a physician wearing that name tag? I didn't bear a grudge ... in the end, I was glad to know that high school kid from Gehenna hadn't cost me my eyesight.

But I'm telling you all this as preamble to last week. I'm not going to go into gory medical details, that would be yukky. This is a sanitized story:

I'd been feeling kind of crappy for a few days, but I really do try to avoid doctor visits unless I have an unavoidable need. My symptoms were getting worse, though, so I called in to what the folks at Kaiser call an "advice nurse." The advice nurse performs a sort of telephone triage. You tell what's going on, s/he asks questions, then s/he suggests that you take two aspirin and call if it doesn't get better; or gets your doc to write a prescription that you can pick up directly without an office visit; or instructs you to get to a doctor's office pronto. Depending.

I called the advice nurse number a little after three. The usual automated greeter put me on hold for two or three minutes. When the nurse to whom my call was routed came on the line I explained what was going on. She asked me to take my own temperature while she waited on the phone (I hoped she had a good book to read, or recordkeeping to catch up on). She must have asked me twenty questions, and in the end she said, look, it's late in the day but I'm going to have your regular doctor give you a call within the hour. If he doesn't call within the hour, call back and ask for me by name.

My regular doctor called in about thirty minutes. He said, why don't you just come in and we'll have a look. Not a long conversation. These doctors are scheduled by efficiency experts, I swear.

Traffic was crappy, parking was scarce, it took me a half-hour to get to his waiting room. That said, my doctor saw me within 10 minutes of when I sat down. He looked, poked, probed, palpitated, all that intrusive stuff doctors have to do, and then he said I'd better see a surgeon for a simple outpatient procedure. He could schedule me for the next morning, or call down to see whether they could squeeze me in right then, while I was at the medical center.

I voted for "let's get it over with" and the surgery clinic squeezed me in.

I hustled over to the building next-door and found my way to surgery. A medical technician called me back into the procedure room within 10 minutes of when I sat down in their waiting room (are you seeing the pattern yet?). They looked, poked, prodded, palpitated, prepped, all that intrusive stuff surgeons and surgical nurses have to do. Then they had me lie down on a table, shot me up with a local anesthetic, did the deed, and dressed the wound where they'd cut me open. It was five o'clock. They shooed me off in the direction of the pharmacy -- the one just down the hall -- to pick up meds before it closed. When I got to the counter the prescription wasn't in the system yet. After about half a minute of poking around the clerk exclaimed, O, there it is! Hot off the press. I had my little bottle of pills -- wait for it -- within ten minutes of walking into the pharmacy.

Did I feel processed? Molested? Crammed into a mold and shrink-wrapped?

Heck no. I felt as if I had called my medical provider at 3 pm with a minor problem I didn't quite understand, and within 2.5 hours I'd consulted with a nurse, seen my regular physician, been referred to a surgeon, undergone an outpatient surgical procedure, and picked up the medication I was meant to take in order to clear up my problem once and for all. Why did I feel that way? Because that's exactly what had happened.

Oh, and then there was the follow-up visit to the surgery clinic the next afternoon, for which an appointment slip had been scribbled out just before I left the procedure room. The ten minute rule? Still applied. Terrific nurse, funny, friendly, had a look at the scene of yesterday's scalpel-play and showed me how to change the dressing myself until the mess heals up. For good measure she gave me a fistful of gauze pads and a roll of surgical tape. They didn't even ask for a co-payment for that visit.

The moral of this story?

This is what I think of when I think of "socialized medicine": a medical organization funded by a community of members, and tuned for efficiency to respond appropriately to patients' needs.

Bring it on, I say.

And yes, I would be happy to pay more taxes to support provision of just this sort of socialized medicine for everybody who lives in my community.

Indeed, in October 2004, Steve Lohr of the NY Times asked Is Kaiser the Future of American Health Care? That wouldn't be the worst outcome possible in this member's view.

For a window into a much worse outcome, I refer you to Congressman Paul D. Ryan's plans for eviscerating Medicaid and Medicare (which I blogged about last month: G.O.P. proposes a death panel for health care ... the backlash has begun, says Associated Press -- let's hope it's got legs).

My thanks to Kaiser Permanente, and the dozen or so medical and administrative staff that made it swift and painless to get the treatment I needed last week.

Thanks to Coolcaesar and Wikimedia Commons for the image of an office tower bearing the Kaiser Permanente logo in downtown Oakland.

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