The American Kaiser Permanente model of healthcare is the acknowledged template for the controversial NHS and social care changes that are hitting Calderdale and Huddersfield, as well as the rest of England.
In this American model, so-called Health Maintenance Organisations (HMOs) provide relatively low-cost health services that are based on short hospital stays and cherry-picking patients with health care needs that are not too costly.
In 1971, when the Nixon administration was looking for ways to cut the costs of healthcare, White House domestic affairs adviser John Ehrlichman explained to President Nixon why he should promote the Kaiser Permanente system of healthcare:
“All the incentives are toward less medical care, because the less care they give them, the more money they make.”
This was enough to persuade Nixon that HMOs were the future for American healthcare.
Ehrlichman was later imprisoned for his role in the Watergate scandal.
Before resigning in 1974 to escape impeachment for obstruction of justice, abuse of power, and contempt of Congress, Nixon had time to promote the Kaiser Permanente system through the HMO Act of 1973.
One of the risks associated with HMOs is that they encourage “cherry picking” of patients – selecting patients whose health care costs are likely to be low, and leaving the rest without health insurance.
Michael Moore’s 2007 film Sicko contains a segment where a former Medical Reviewer at an American HMO testified to a Congressional Hearing that, as part of her job, she fatally denied treatment to patients in order to save her company money. This was rewarded by her rapid promotion and career success.
Lies, damned lies, and agnotology
The New Labour government strongly advocated the adoption of the Kaiser Permanente system in the NHS and set up Kaiser Permanente pilot projects in different parts of the UK – known as Kaiser Beacon Sites.
For instance, the 2006 South Devon Healthcare NHS Trust’s summary business plan for “Right Care Right Place Right Time: Securing integrated care for the South Devon community” stated that the Trust intended to deliver:
“a joint leadership development programme with Torbay Care Trust that [would] Build on the work undertaken with Kaiser Permanente and UK health communities.”
The so-called Kaiser Beacon Sites set up in the NHS under New Labour government (and enthusiastically promoted by Chris Ham) were based on advocacy of Kaiser “integrated care” in a 2002 BMJ article that used evidence later shown to be flawed .
An example of agnotology – the study and practice of how ignorance and doubt is spread in society.
Despite the change of government in 2010, the Kaiser Permanente system continues to be the template for cutting NHS costs in England and Wales.
Under this system, NHS specialist services – including A&E – are to be grouped into fewer hospitals, and A&E is to be reorganised into a two tier system, according to the recommendations of the Keogh Report.
If this goes ahead, people in Calderdale will have to travel longer distances to A&E in Huddersfield, which is the favoured location for the amalgamated specialist A &E centre.
Hospital stays will be much shorter. Patients will be discharged sooner. Elderly patients with complex health needs will be sent from hospital to Care Homes where telehealth gadgets will allow their vital signs to be monitored remotely by a “multidisciplinary team”. Other patients with chronic health problems will also be swiftly discharged and issued with telehealth gadgets for remote monitoring at home.
GP services will be grouped into “localities” that will share a variety of primary care services – not all GP centres/surgeries will have the full range of services. These locality-based GP services will include unplanned care, as the Calderdale CCG Governing Body meeting on 14 Nov 2013 made clear.
Patients will be encouraged to care for themselves at home using telecare and telehealth gadgets.
And so on. You can find out more in this Open Democracy article about the Calderdale and Huddersfield proposed NHS and social care shakeup:
The Coalition government never asked us if this is how we want our NHS and Social Care services to operate. It was not in either the Tory or LibDem manifesto for the 2010 election. There is no democratic mandate for what’s going on.
It will be interesting to see if the Calderdale Commission on health and social care takes a critical look at the Kaiser Permanente model that is being foisted upon us.
Updated August 2023 with info about Kaiser Beacon Sites and a reference to agnotology