Kaiser Permanente: the Wall Mart of Healthcare

So I got a new job this year, and along with the new employer comes a new HMO.

The old guys bought coverage through a company called United Health Care, who let you see whatever doctor you wanted.

I picked a family practitioner near my favorite hospital.

(important: when my wife was sick I spent a lot of time hanging around various hospitals, and learned a lot. Avoid the ones staffed primarily by well-intentioned yet not terribly bright volunteers. If someone is going to bungle your treatment, order extra tests, neglect to clean out the bedpans in a timely fashion, then force you to pay over $150 for a small disposable basin and plastic cup they should at least *appear* to be well paid and competent. On a similar note avoid hospitals staffed primarily by students. Yes, they're very enthusiastic, optimistic and attentive. They can also kill you.)

Anyway, private practice. Clean, quiet waiting area. Ultra modern equipment. I was receiving medial advice from a man who lived in the future.

The new folks use an outfit called Kaiser. These guys are the Wall Mart of health care... and I mean that with equal parts admiration and disgust.

Let's talk about the disgust first.

The place is grimy. And worn. And the waiting area is massively chaotic and crowded. Until you actually get to the doctor you're a number and a slip of paper, which is handled with extreme efficiency.

Which is where the admiration comes in. Someone optimized the crap out of their processes, but they didn't seem to cut unimportant corners.

Once I had a confirmed appointment -- okay, rewind, they lost the first appointment between the call center and the check-in desk, and my secure web account isn't active yet, so I got logged in the walk-in queue, then saw a nurse, who made another appointment for me, then I came back a few hours later.

The key to that long sentence is that it was annoying dealing with the bureaucracy, but they *were* able to put me into two appointments in the same day without breaking a sweat. The other doctor would have made me come back in a week. Like I said, terrible and admirable.

So, once I had a confirmed appointment I slid right into the doctor's office. Check in, zip the card (who carries cash these days?), put the right paper in the right basket, then they call you up. The nurse who lead me back took my vitals -- literally -- as I walked past the scale/thermometer/pulse station. It took 12 seconds flat. Amazing, but scary fast.

I was on an assembly line, it was ugly but it worked.

The doctor was a nice guy, with an affable bedside manner. He listened well, turned down opportunities to run extra tests (I think some of my previous doctors were trying to fill up their MRI/X-ray/pharmacy punch cards -- 10 referrals and you get a free putter...) and the back office nursing staff was enthusiastic and friendly. The exam room was small, and somewhat worn, but all of the important bits of the experience went well.

Plus the lab operates on a walk-in basis, seven days a week. So that's a plus -- again, having watched my wife deal with regular 9:30 am workday lab visits (no vacation for us that year...) I can appreciate this.

So what does it mean?

As I walked out of the huge cement building someone else walked in. I pulled my car out of the crowded lot and navigated traffic past wall mart and the occasional cingular outlet to my office. Gas is over $3/gallon, so when it stops raining I'm going to ride the motorcycle everywhere. It's insured by Progressive -- I bought the policy online. We had dinner at Olive Garden.

It wasn't bad, but it wasn't great.

This should be chiseled on the average guy's tombstone.

I mused about living in a benign 1984, one sans civilian torture, and with a killer marketing department. Millions of people plowing along, no experience being particularly beautiful, but everything seems to work.

I got home, parked my car. Ants have taken over our parking lot -- dozens of new hills pile up through the cracks in the asphalt. A surging vein of them leads to a dead wasp. Did they enjoy the hunt, or do they just cut it up and drag it underground. Do ants sleep? Do they dream?

You tell me.