The main reason is that the "success" these articles highlight is based on efficiency and cost savings - key indicators for business success. For example, the Economist article explains how Kaiser's integration of fixed-price health insurance with treatment using its own hospitals and clinics allows it to achieve efficiency gains that make it one of the cheapest healthcare providers in most regional markets in which it competes. The LA Times article similarly highlights aspects of Kaiser's structure that help it reduce cost - consolidating billing and administrative functions for physicians, using advanced technology to conduct electronic consultations, and centralizing access to electronic medical records. The LA times article was primarily focused on how Kaiser was able to continue growing its business in the midst of a troubled economy, keeping costs down and margins high.

Quality of health care is mentioned in these articles, but only briefly and in a very narrow sense. The Economist noted that Kaiser's approach achieves good health outcomes as well as good financial ones, but the focus was clearly on preventive care. The health care strategies and outcomes praised - wellness programs, early diagnosis of breast cancer, and the use of medical technology to facilitate healthy lifestyles and early diagnosis - all relate to prevention. This is important because for providers, like Kaiser, that have an integrated health care and financing model, prevention is directly linked to financial success. Keeping people healthy and catching illness early keeps costs down. In fact, the LA Times article highlighted Kaiser's "cradle-to-grave emphasis on prevention" as key to its financial health. It makes perfect business sense then that Kaiser focuses so many of its resources on prevention, and I think it is fair to say that prevention is one of Kaiser's strengths.

Unfortunately, two very important factors are missing in this analysis of Kaiser's "success": access to care and quality of care for the sick patient whose illness could not be prevented and who may need expensive, on-going care. People may suffer from illnesses that are not easily or inexpensively treated, such as certain kinds of cancer, heart problems, or diseases that require expensive surgery, like transplants. Many people also have chronic or disabling conditions, such as autism, that require long-term or regular care that can become very costly over time. Indeed this is a critical function of insurance and the reason many people purchase it - to ensure access to care which would otherwise be prohibitively expensive, and to avoid the severe financial consequences (like bankruptcy or homelessness) of medical catastrophe and exhorbitant health care bills.

In these cases, the financial interests of Kaiser (or any other insurer) are not clearly aligned with their health care obligations, and in fact are often viewed as conflicting. This can lead insurers to deny care or employ strategies to discourage treatment in order to reduce cost, and we've seen countless examples of this. It is precisely because of this strong financial incentive to prioritize cost over medical necessity that we have laws prohibiting bad faith denials by insurance companies and requiring independent medical reviews of insurance denials. Yet, stories about Kaiser's transplant program, autism discrimination, and patient dumping show that this conflict continues to infect our health care system, especially when the financing and delivery parts are integrated.

While I don't want to devalue the importance of Kaiser's specific successes in the areas of prevention, technology, and other forms of cost reduction, I think that before we start using labels like "success" or "model for reform," we need a more complete story that asks how well Kaiser treats the very sick, people with disabilities, and the chronically ill.
Moreover, we need to be careful about what information we use to generalize about patient satisfaction and outcomes. For example, it's not clear from the article in the Economist where it got support for its statements about the good health outcomes and patient satisfaction at Kaiser, and there are significant challenges to measuring quality of care through patient satisfaction surveys. One challenge is that disatisfied people who can leave plans often do, and surveys that only go to current enrollees may miss this group. In fact, the LA Times article reported that Kaiser lost 30,000 members in 2008, but we don't know why: Did people choose to leave because they were disastisfied? Or did people leave for other reasons, such as unemployment or children aging out of their parents' plans?

Before we can determine whether the Kaiser model is one that should be emulated, we need a more comprehensive assessment of its overall "success." While Kaiser is most certainly a business, it is a "health care" business, with statutory, professional, and contractual obligations to deliver quality care in a timely manner to all of its members. Its business success cannot and should not be measured without looking at how well Kaiser performs this "health care" piece. Only then can we learn from Kaiser's successes and failures, and integrate these lessons in our future health care reform efforts.