I think the only reason people consider it a gold standard is because they market it really well (especially in the bay).

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.

The only advantage Kaiser has over many health care providers is price.

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.

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-s...

[2] https://health.usnews.com/best-hospitals/area/ca/ucsf-medica...

Here's an actual comparison of health care plans:

[1] https://www.fiercehealthcare.com/payer/ncqa-insurer-rankings...

[2] http://healthinsuranceratings.ncqa.org/2019/HprPlandetails.a...

[3] http://healthinsuranceratings.ncqa.org/2019/HprPlandetails.a...

[4] http://reportcard.opa.ca.gov/rc/HMO_PPOCombined.aspx

And here's some research showing Kaiser's outcomes quality: [1] https://www.ncbi.nlm.nih.gov/pubmed/26131607

[2] https://www.ncbi.nlm.nih.gov/pubmed/29625083

[3] https://www.ncbi.nlm.nih.gov/pubmed/30002140

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270203/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC64512/

> It’s certainly true that primary care visits improve health outcomes, but you offer no evidence that people get more primary care at Kaiser. Again, I worked with claims data where we could analyze primary care utilization and kaiser was significantly higher than most PPOs in our systems (and high in general). We specifically built an email targeting patients who did not visit their primary care doctor in the last year and Kaiser was at the bottom of numbers because of the high usage. There is definitely a lot more research you can find studying Kaiser's integrated approach and how it related to primary care usage. Kaiser is pretty good good at preventative care, primary care usage, and some chronic care management.

> 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. Again, I've outlined research showing outcomes and quality metrics showing Kaiser is pretty solid. Their primary care usage is higher than other health plans, and there are quality metrics and research showing they are pretty good at preventative, primary care, and chronic care management. There are definitely gaps, but from a population level outcomes, they perform at or better than many PPOs given their costs. If you take a step further and look at the economic ROI of their plans, they definitely outclass most PPO and HMOs.

It's not like they have that much secret sauce, the main advantages they have are the same ones a nationalized system has (being integrated aligns incentives better).

You moved the goalpost from “healthcare outcomes for tech workers” to “economic ROI given their costs”. This is what I mean by poor reasoning.

Sure, Kaiser is a good bargain. Lowering costs means more people get care vs don’t get care. It is not the “gold standard” when premiums and deductibles are not an object, like a tech workers company sponsored plan.

> OP and myself were discussing Kaiser as a health care plan. The ranking you showed was about hospitals not health care plans;

This is a bizarre retort as Kaiser generally locks you into their hospitals. Clearly we’re arguing different things.

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.