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> The gold standard is probably Kaiser for CA residents. I love your post but I almost shat myself when I read this. Kaiser is convenient but not top ranked in

> The gold standard is probably Kaiser for CA residents. I love your post but I almost shat myself when I read this. Kaiser is convenient but not top ranked in much. The gold standard is a PPO that lets you go anywhere (else) you like incl. top specialists + a membership primary care network like OneMedical for convenience. (By the way, I support Medicare4All. Good healthcare shouldn’t just be for wealthy FAANG engineers and even for us the system still sucks.)

almost_usual 7y ago
Kaiser is also terrible for mental health.
- conanbatt 7y ago
  Kaisers mental health services are mostly used by Kaiser staff. Its a fun industry secret.
mbesto 7y ago
I was going to say the same thing. Kaiser (KP) is a "full stack" healthcare provider, which means they save money by being vertically integrated (healthcare payer + provider). The downside is that it means you get very little choice of your doctor, the hospitals you use, etc. I had both KP and UHC, and UHC was far better (more specifically UHC + the providers I chose). I think the only reason people consider it a gold standard is because they market it really well (especially in the bay).
nostrademons 7y ago
Kaiser varies significantly based on which center you end up in. I've heard very good things about the Redwood City location and very bad things about Santa Clara. There're probably similar variations among its other hospitals. YMMV. I've been on various Anthem PPOs of varying quality (Google's covered basically everything with zero copay or deductible, their individual plan wouldn't even cover my PCP, my wife's plan was in the middle but getting progressively worse). There's a convenience/flexibility tradeoff. With Kaiser you know that they'll take care of you but you don't have a lot of flexibility or recourse if your particular needs don't meet what they offer. With a PPO you have a lot of flexibility to choose the best providers available, but you have to fight with the health insurance company for a lot of things, and the administrative hassles can be a huge burden.
- chaostheory 7y ago
  I’ve heard bad things about both their Santa Clara and Redwood City locations. I’ve also experienced bad things in their RWC location. For example, I was always exhausted and I requested a sleep study. What I got from Kaiser was a crappy take home gadget that detected no abnormalities in my sleep. When I switched to PAMF, I got a real sleep study in a lab. They were able to diagnose breathing and snoring issues within 30 minutes. There are more stories from both coworkers and friends. Save yourself a headache, pay more for a better provider The only advantage Kaiser has over many health care providers is price.
oarabbus_ 7y ago
Kaiser is awful. Sutter and Palo Alto Medical Foundation IME are far superior. I've used these 3 systems.
- geoelectric 7y ago
  Thought PAMF was a part of Sutter Health? Anyway, I agree with you. Kaiser is convenient, but the standard of care of HMO-nominal (i.e. poor). I've used PPOs with PAMF for lots of years now, and it's been far better than Kaiser no matter who my actual insurance provider was.
  - oarabbus_ 7y ago
    You're correct, PAMF is sutter.
sdnlafkjh34rw 7y ago
For actual healthcare outcomes, Kaiser will outrank most PPOs. Because Kaiser is an integrated health system, they are highly incentivized to actual improve outcomes. PPOs might feel better to you (because they let you have choice and freedom) but I strongly suspect that from a purely what's best for public health is systems like Kaiser. A patient's sense of satisfaction with their healthcare is rarely correlated to outcomes. For example, I worked with healthcare data and we were developing quality metrics and we found for a lot of providers had a negative correlation in metrics to their review scores. I.e there are tons of doctors with high reviews who actually perform quite badly in terms of outcomes. We strongly suspected these are doctors who have good communication and empathy skills but weak clinical skills. I remember looking at malpractice studies and seeing something similar. As a doctor, the probability of getting sued for malpractice is driven by your bedside manner and NOT your clinical outcomes. Essentially, we've found that a doctor with bad clinical expertise but great bedside manner will get sued more than an amazing clinician who has bad bedside manner. It's a slipper slope if you think your anecdotal satisfaction with your medical provider is a metric of how well the system takes care of you. Unless you are looking at outcomes at a population level it's really hard to see what's going on. I will say (as others have noted) that Kaiser's mental health support is terrible, but there outcomes outside of that are very strong (if not best in class). They were frequently studied in my partner's master of public health, because of their strong outcomes. Also don't underestimate the power of primary care in the heaths system (patient's tend to skip primary care visits in PPOs). Many of the life threatening issues my partner sees were caught only due to a primary care visit which exactly why systems like Kaiser are effective.
- abalone 7y ago
  This type of post is a pet peeve of mine because you use terms like “data” and “anecdotal” but it’s actually a poorly supported argument. This happens too often on HN. It’s certainly true that primary care visits improve health outcomes, but you offer no evidence that people get more primary care at Kaiser. Meanwhile the most significant rankings are not only patient opinions but rather systematic reviews of outcomes, expert analysis and objective metrics. Newsweek did one such ranking that put Kaiser behind 4 other hospitals.[1] US News puts UCSF ahead of Kaiser in many aspects and specialities.[2] When you need a brain surgery or cancer treatment, you’re definitely going to “feel better” having “choice and freedom” to go to the best. [1] https://www.mercurynews.com/2019/04/03/ucsf-medical-center-stanford-hopsital-kaiser-santa-clara-ranked-among-top-hospitals-in-u-s/ https://www.mercurynews.com/2019/04/03/ucsf-medical-center-s... [2] https://health.usnews.com/best-hospitals/area/ca/ucsf-medical-center-6930043 https://health.usnews.com/best-hospitals/area/ca/ucsf-medica...

almost_usual 7y ago

Kaiser is also terrible for mental health.

conanbatt 7y ago
Kaisers mental health services are mostly used by Kaiser staff. Its a fun industry secret.

mbesto 7y ago

I was going to say the same thing. Kaiser (KP) is a "full stack" healthcare provider, which means they save money by being vertically integrated (healthcare payer + provider). The downside is that it means you get very little choice of your doctor, the hospitals you use, etc. I had both KP and UHC, and UHC was far better (more specifically UHC + the providers I chose). I think the only reason people consider it a gold standard is because they market it really well (especially in the bay).

nostrademons 7y ago

Kaiser varies significantly based on which center you end up in. I've heard very good things about the Redwood City location and very bad things about Santa Clara. There're probably similar variations among its other hospitals. YMMV. I've been on various Anthem PPOs of varying quality (Google's covered basically everything with zero copay or deductible, their individual plan wouldn't even cover my PCP, my wife's plan was in the middle but getting progressively worse). There's a convenience/flexibility tradeoff. With Kaiser you know that they'll take care of you but you don't have a lot of flexibility or recourse if your particular needs don't meet what they offer. With a PPO you have a lot of flexibility to choose the best providers available, but you have to fight with the health insurance company for a lot of things, and the administrative hassles can be a huge burden.

chaostheory 7y ago
I’ve heard bad things about both their Santa Clara and Redwood City locations. I’ve also experienced bad things in their RWC location. For example, I was always exhausted and I requested a sleep study. What I got from Kaiser was a crappy take home gadget that detected no abnormalities in my sleep. When I switched to PAMF, I got a real sleep study in a lab. They were able to diagnose breathing and snoring issues within 30 minutes. There are more stories from both coworkers and friends. Save yourself a headache, pay more for a better provider The only advantage Kaiser has over many health care providers is price.

oarabbus_ 7y ago

Kaiser is awful. Sutter and Palo Alto Medical Foundation IME are far superior. I've used these 3 systems.

geoelectric 7y ago
Thought PAMF was a part of Sutter Health? Anyway, I agree with you. Kaiser is convenient, but the standard of care of HMO-nominal (i.e. poor). I've used PPOs with PAMF for lots of years now, and it's been far better than Kaiser no matter who my actual insurance provider was.
- oarabbus_ 7y ago
  You're correct, PAMF is sutter.

sdnlafkjh34rw 7y ago

For actual healthcare outcomes, Kaiser will outrank most PPOs. Because Kaiser is an integrated health system, they are highly incentivized to actual improve outcomes. PPOs might feel better to you (because they let you have choice and freedom) but I strongly suspect that from a purely what's best for public health is systems like Kaiser. A patient's sense of satisfaction with their healthcare is rarely correlated to outcomes. For example, I worked with healthcare data and we were developing quality metrics and we found for a lot of providers had a negative correlation in metrics to their review scores. I.e there are tons of doctors with high reviews who actually perform quite badly in terms of outcomes. We strongly suspected these are doctors who have good communication and empathy skills but weak clinical skills. I remember looking at malpractice studies and seeing something similar. As a doctor, the probability of getting sued for malpractice is driven by your bedside manner and NOT your clinical outcomes. Essentially, we've found that a doctor with bad clinical expertise but great bedside manner will get sued more than an amazing clinician who has bad bedside manner. It's a slipper slope if you think your anecdotal satisfaction with your medical provider is a metric of how well the system takes care of you. Unless you are looking at outcomes at a population level it's really hard to see what's going on. I will say (as others have noted) that Kaiser's mental health support is terrible, but there outcomes outside of that are very strong (if not best in class). They were frequently studied in my partner's master of public health, because of their strong outcomes. Also don't underestimate the power of primary care in the heaths system (patient's tend to skip primary care visits in PPOs). Many of the life threatening issues my partner sees were caught only due to a primary care visit which exactly why systems like Kaiser are effective.

abalone 7y ago
This type of post is a pet peeve of mine because you use terms like “data” and “anecdotal” but it’s actually a poorly supported argument. This happens too often on HN. It’s certainly true that primary care visits improve health outcomes, but you offer no evidence that people get more primary care at Kaiser. Meanwhile the most significant rankings are not only patient opinions but rather systematic reviews of outcomes, expert analysis and objective metrics. Newsweek did one such ranking that put Kaiser behind 4 other hospitals.[1] US News puts UCSF ahead of Kaiser in many aspects and specialities.[2] When you need a brain surgery or cancer treatment, you’re definitely going to “feel better” having “choice and freedom” to go to the best. [1] https://www.mercurynews.com/2019/04/03/ucsf-medical-center-stanford-hopsital-kaiser-santa-clara-ranked-among-top-hospitals-in-u-s/ https://www.mercurynews.com/2019/04/03/ucsf-medical-center-s... [2] https://health.usnews.com/best-hospitals/area/ca/ucsf-medical-center-6930043 https://health.usnews.com/best-hospitals/area/ca/ucsf-medica...