@KW PNW Z8 I agree about traffic both in Seattle and Vancouver! And poor public transportation.Kaiser here does provide free transportation to services. Some things require travel to Tacoma, but they will take you. My hand surgery was in their out-patient surgical center there, but they require an adult to accompany you and stay in proximity until discharge. They won't release you to a driver, uber or taxi. So that's no help to people with no family or friends. My former daughter-in-law sacrificed her day off to take me.

My point was more that many places without a border have just as long or longer travel times for medical care. Good to hear you have great options in Vancouver, and Portland is right there if something else is needed.

@Olychick - my sister’s mother in law who lives in So CA has Kaiser & an Advantage Plan with them. It also provides the free transportation to services. I wonder if that’s a benefit of the Kaiser Advantage Plan & not a general Kaiser HMO benefit?

Jennifer, it sounds like your father was a wonderful, dedicated professional with values all can learn from. Pathologists provide an essential role in medical care.

One aspect of the specialty that many are unaware of is that pathologists rarely interact with patients. Both pathology and diagnostic radiology are specialties well suited for docs who prefer to have less or even no patient contact and they're chosen by many for that reason. It's not an exclusive trait for those who do that work but it is a common thread for many.

Or maybe they love Pathology.

Quoting myself from just above:

" It's not an exclusive trait for those who do that work but it is a common thread for many. "

As for the discussion on the Oregon/Washington border . . .

CMS has very specific adequacy and accessibility guidelines for Medicare Advantage plans that have to be met for each county or partial county in the US for a plan to sold in that geography.

Sadly for some geographies where the major population centers are just within the accessibility guidelines it makes access to care a PITA.

@Jennifer Hogan Thanks for chiming in with that piece of the puzzle. It does explain a lot!

ETA: The people I know here in Vancouver that have the Kaiser Advantage plan do not have free transportation to either any of the six (I looked it up) Kaiser clinics in Vancouver, WA or to the two hospitals (looked that up too) in Portland OR

" CMS has very specific adequacy and accessibility guidelines for Medicare Advantage plans "

I'm not sure what this means or its relevance to the conversation. Is the impact simply that insurers may not sell plans offering more comprehensive coverage (Medicare Advantage) in areas where the breadth of and accessibility to providers is inadequate for fulfillment of the enhanced benefits wishing to be sold? That seems like common sense and if my understanding is correct, I guess this is a consumer protection feature.

Edit to add:

Yes, I understand that Kaiser is a combination insurer/provider. I believe many feel that some of its problems are common to what's experienced in other countries whose national health systems work essentially the same way.

My dad’s original dream was to be an architect. However, before he even graduated high school, he was chosen by the military to train as a doctor for World War II. Through an accelerated program, he became a general practitioner by age 23, caring for soldiers deploying to and returning from the war. After the war, he chose to specialize in pathology. This pivot wasn't to avoid patient contact; rather, he believed he could make a far greater impact by studying disease diagnosis, transmission, and prevention than by treating everyday illnesses.

He and my mother were great community advocates, raising money to fund the newest and best hospital equipment, campaigning against smoking, and championing the polio vaccine even successfully navigating deep resistance within the local Amish community.

He also possessed deep empathy, frequently visiting families dealing with difficult diagnoses. When he passed, the community's love was undeniable. Despite the freezing winter weather, people waited outside for over an hour to come in and pay their respects. There wasn't room in the funeral home for all the people who came. He deeply loved his family and community, and that love was completely mutual.

Jennifer’s post about CMS was specifically relevant to the sidebar Oly & I introduced & the Advantage Plans I mentioned. It made me understand how Kaiser can have such a good sized clinic network here and not allow patients to use the nearest hospitals for anything except life threatening events. The further experience with Kaiser & hospitals happened to my next door neighbor. He had Kaiser as medical coverage through his employer - no Advantage Plan involved. He was hospitalized via ER at one of our local hospitals. When he was stable, he was required to be moved to a Kaiser hospital in Portland, OR which was @ 20 miles away.

Thanks for the explanation.

A graphic explaining my comment -

Blue - Large Metro - most densly populated county - members have to have access to a hospital within 10 miles of their home.

Orange - Step down to Metro - members have to have access to a hospital within 30 miles of their home

Two of the hospitals in the Large Metro Hospitals will cover the Medicare recipients in the Metro Area without the provider needing to contract the local hospital in the Metro County, but the metro hospital is too far to help cover the Large Metro 10 mile distance limits.

People in Jersey often have to travel into NYC - people in NYC are never asked to travel to Jersey.

Kaiser places their hospitals strategically so that they meet the guidelines with the fewest number of physical locations.

Source?

Assuming for a moment the veracity of this "policy" can be traced to a Kaiser source, let's think about it - why would it do otherwise? Isn't the statement a truism?

What business (and it is a business) would deliberately overspend on the number of sites and facilities it has beyond its needs for a fixed level and types of activity it needs to conduct?

Edit -

Sorry, I removed the Starbucks example as perhaps off topic. I mentioned that it found it had overbuilt in many areas, too many locations. It closed stores in overbuilt regions and found its business didn't suffer but its costs were reduced.

Both explanations & examples given in the two posts above for Kaiser / hospitals & Starbucks make sense to me from a dollars & cents business perspective. But, not any comfort to me when I’m needing my appendix removed in a hurry. If it’s a cup of expensive coffee I want, there are many other nearby choices to replace the Starbucks that just closed. Very fortunately for me, IRL I am equidistant between the two local hospitals available to me. And, I don’t have an HMO that restricts which one I can choose.

Jennifer, I seem to have missed your long post above addressing a number of things I said and singing the praises of Kaiser.

You're welcome to your views but I think it's clear that on many of these topics, you're not well informed. You responded to many of the facts I presented with your own opinions, not all of which are well founded. That's fine, we have no need to agree.

I’ll acknowledge Elmer’s post isn’t addressed to me but I did chime in with bits about the discussion of Kaiser down thread. I have a different take on Jennifer’s post & didn’t read it as ”…singing the praises of Kaiser.” My take is it’s not her opinion but simply quoting of data she has access to by virtue of her work with CMS. I don’t know much about the health care industry but I do think I know that CMS is a big driver in how things work in the healthcare world. There’s no need to agree with me either. I’m only stating my 2 cents - I’m not making my health care decisions based on any info I’ve read here. It’s only a KT discussion that’s an interesting topic of interest to most all of us. And, one that’s covered multiple aspects only tangentially related to the original topic! Good discussion!

I understand, KW PNW.

I thought I had provided sufficient caveats when describing the two recent Kaiser incidents involving people I know in California. I emphasized that they were recent examples, and I could have cited others from personal experience without doing any internet research.

My point is that whether magazine articles or even multiple academic studies are involved, any tidbits about this or about that should be always be viewed as evidence of possibilities, not as dispositive proof.

I sincerely hope Kaiser members have excellent experiences, but it's important to recognize that not everyone does. No number of favorable study cites can erase a lifetime of hearing of Kaiser malpractice and poor treatment situations involving people I've known.

This discussion reminded me of an incident that happened repeatedly during my childhood. My mother was an RN. One of her sisters belonged to Kaiser. Despite being financially comfortable, my aunt was extremely frugal. She regularly complained to my mother about problems she and her family experienced with Kaiser. Every few months she would call my mother with another story.

Eventually, my mother's patience wore thin. She would tell her, in essence: "Carol, these aren't medical problems, they're Kaiser problems. I've told you that before. When you pay less, you get less. Please stop calling me to complain about experiences I've repeatedly told you to expect. Why do you continue to use them?"

After hanging up, my mother would laugh and mention the irony of someone with reasonable intelligence repeatedly seeking advice, then ignoring it because it wasn't what she wanted to hear.

No animals were mistreated and no internet searches were done in the preparation of this comment.

If someone doesn't like Kaiser they shouldn't enroll. Beating a dead horse about something that doesn't affect you is just ridiculous.

Olychick, I've previously responded positively and with understanding, acknowledging your very positive experiences. This comment is not a response to you or anything you've shared in this thread.

Are locations different? Are management and operations different? I don't know and you're right, it doesn't affect me. Good luck for some, bad for others. Does one only hear about the disasters? I dismiss that last one as an explanation, there have been too many and they're too frequent in my area for that to be the cause. Talking about the institution overall.

Every thread about healthcare morphs to you and your pontificating about your distaste for osteopaths and Kaiser. And it goes on and on and on. We get it. It's old news. Don't enroll in Kaiser, and don't go to an osteopath.

Many people, me included, do not make purchase choices based solely on cost. My personal preference with healthcare is to try to obtain the best available. An elusive objective and even unattainable sometimes but that remains. I don't shop based on cost.

The path I've followed has led me to using a lot of docs at medical schools. And following recommendations of real experiences. Not always. Sometimes it's going to a Grand Poobah somewhere that other docs admire and recommend. It's not more costly, they accept my insurance - that's what is paid that's more expensive. All of them are docs that Kaiser patients don't have access too. Ironically enough, even poverty level Medicaid patients (healthcare "insurance" provided by the feds and state at a safety net level) have access to many of these providers.

I've heard of and been influenced by many (anecdotal) experiences people have had with specific providers, and took that advice for a great outcome. Have you ever heard of anyone joining Kaiser or any other such organization because of the desire to see a specific doc? I haven't.

Stick with macro numbers. It'll isolate you from real people, real horror stories of delay and incompetence. Macro data from 30.000 feet doesn't tell a clear story. What's on the ground with individuals does.

We don't need to agree. I don't assault your personality, please return the favor.

(PS - if you think botched hip replacement procedures are common, then we very much have different standards and expectations of what constitutes quality care)

olychick, you've said on several occasions that you were going to ignore my posts. What happened to that? I'm not alone in having the belief that you would be doing readers a favor if you stuck to that practice.

Leg length disparity is not uncommon after hip replacement for the reasons stated, whether it’s considered ”botched” is a matter of degree.

My source is personal anecdotal knowledge which surpasses internet searches. 😉

Ditto, food, as to the info source

Elmer - Out of everyone I’ve personally spoken with who has had TKR, none come close to having experienced the pain I describe that I had from day one, when I was supposed to be discharged day of surgery rather than kept for four days, through the loooong recovery that I’m still dealing with 14 months later. My obsese landscaper was back to work three weeks following TKR, moving around like I cannot to this day. This is my anecdote.

The surgeon I chose was recommended by a doctor who himself sought out the best for his wife. The former chief of knee surgery at arguably the nation’s top orthopedic hospital, he has a stellar bio and reputation.

To this day I’ll occasionally find myself looking for anything negative about him, any reason to second guess my choice. I can’t find a thing, but still don’t plan to use him for my second TKR because of my own experience.

What would be more important to you if you were looking for a surgeon, my anecdote or all the accollades you’d find everywhere else?

FOAS, I am sorry you had such a difficult surgery/recovery. I think knees are the most difficult. Is that right. I pray you finally get through this nightmare.

Thanks murraysmom! It’s well short of a nightmare at this point, my new knee is generally better than my other knee which is the only reason I’m going for a second, but I’m far less than happy. I’m just trying to balance the odds by going to another surgeon. Despite my anecdotal experience, I consider switching doctors more of a psychological need than a rational decision.

FOAS I'm sorry you went through and are still going through recovery pain. Did you have any follow up visits to maybe see if there was something that might have caused the prolonged pain? I'm hoping the other knee is much easier for you.

Yes, and they say all is fine and put me on celebrex. I think it helps a bit but I’m not up for kidney damaging drugs for the rest of my life, so I limit taking it. They also want me to restart PT which admittedly I haven’t done. I split my weeks location-wise so it’s hard to schedule a routine. But I could be doing more on my own, and have started that.

I understand pushing yourself with PT when you dont know if you are doing damage instead of building strength. When I went through it for my broken femur I had two people from the same place. One was an all out go for it sort of person who kept pushing me beyond good sense and the other was more cautious. My break was serious and not adding bone at a sufficient rate. Rebreaking the mend would be catastrophic as in losing my leg. Well...

FAOS I am sorry you are having issues with your knee replacement. I had 3 friends/family members get knee replacements last year - first 2 went smoothly then the 3rd had so many issues. Had a lot of swelling not only at the knee, but also his thigh and calf, he had a lot of pain He has exercised religiously his entire adult life - working out every day after work and did his PT religiously, but wasn't able to get to 90 and had to have MUA. He was out of work for 4 months and still has an unnatural gait and they are waiting to see if continued PT will fully stabilize the knee or if they will need to go back in and tighten some of the ligaments. (PT seems to be working).

It wasn't his doctor. The other 2 had developed knee issues in the past few years. He played football, basketball and ran track in high school and college and his knees were shot. Had damaged cartilage removed in his 20s, worked as a roofer for 20 years, continued to play basketball well into his 50s and was in a motorcycle accident a few months before he finally scheduled a knee replacement. After the motorcycle accident he was in serious pain constantly and couldn't put off the surgery any longer. The doctor had to correct a 10 degree bow that had developed over the years of walking on a bad knee. The other leg is also bowed (8 degree bow), so the gait is due to having one straight and one bowed leg. He should have the second knee replaced, but after this experience he is reluctant to have another surgery.

I don't expect that he will change doctors if he does get the second surgery. He has absolute confidence in his doctor's skills, but I would understand completely if he was reluctant to use the same surgeon after his experience.

@Elmer J Fudd

I debated if I should bother to respond to you or not, but I am not accustomed to laying down and letting others bully me into submission.

"Olychick, you've said on several occasions that you were going to ignore my posts. What happened to that? I'm not alone in having the belief that you would be doing readers a favor if you stuck to that practice."

What makes you think you speak for other readers? Why should Olychick sit back and let you dictate the narrative? Have you considered the option that you should stop responding to her posts, or do you honestly expect her to 'be a lady' and let the man have the last word?

"Many people, me included, do not make purchase choices based solely on cost. My personal preference with healthcare is to try to obtain the best available. An elusive objective and even unattainable sometimes but that remains. I don't shop based on cost."

No one suggested shopping for healthcare based on cost. You are arguing against a point nobody made to avoid discussing actual quality of care.

"Ironically enough, even poverty level Medicaid patients (healthcare "insurance" provided by the feds and state at a safety net level) have access to many of these providers."

Says who? Source? Just because Medicaid (or Medi-Cal in California) is an accepted insurance, it does not mean that Medicaid patients have the same access to care as others. Hospitals take care of those who enter through the emergency department because they are state-mandated to do so as a public institution. But getting an appointment to see an Orthopedic Surgeon about getting hip replacement surgery at UCLA or any of the UC hospitals is a completely different story. The UC system has virtually no specialist appointment slots open to Medi-Cal patients.

"Stick with macro numbers. It'll isolate you from real people, real horror stories of delay and incompetence. Macro data from 30,000 feet doesn't tell a clear story. What's on the ground with individuals does."

When you purchase a new car, do you look at the repair history for that make and model? That is macro numbers. Finding ways to improve healthcare outcomes requires looking at comprehensive claims data and every reported complication. Far from removing us from the horror stories, macro data provides a complete look at the full picture. It isn’t just about one isolated story of a knee replacement gone wrong. It is about deep-diving into the history of every patient with a complication to study the commonalities and determine the root cause of the issue.

"I don't assault your personality, please return the favor."

Really? How many times have you brought up that I don’t have children of my own and claim I have no right to an opinion on parenting issues?

How many times have you insinuated that my knowledge comes strictly from Google searches?

Why are my references to peer-reviewed studies dismissed as 'opinions,' while labeling your secondhand stories from friends and family 'facts'?

You explicitly stated that I am not well-informed on these topics—entirely dismissing my 20 years of professional experience in studying healthcare outcomes (while providing zero evidence of your own expertise).

please return the favor. . .

I assume the 'personal attack' you are referring to is my observation that you are incapable of admitting when you are wrong. That wasn't a personal attack—it was an objective observation based on your posting history. It is also a matter of record on this forum, where numerous other participants in current and past threads have pointed out your habit of playing the self-proclaimed expert on every topic."

"PS - if you think botched hip replacement procedures are common, then we very much have different standards and expectations of what constitutes quality care"

Yet another one of your deflection techniques—twisting the words of others. I never said botched hip replacements are common. I said that a hip replacement surgery resulting in a leg-length discrepancy is not uncommon, and it does not mean the surgery was botched. There is a massive difference between a known clinical variable and a botched procedure.

“or do you honestly expect her to 'be a lady' and let the man have the last word?“

Yes, yes he does!

Quote from one of his posts,

eta, The whole thread is quite lengthy. I said we’d have to agree to disagree. He was having none of that. He can be very persistent to have the last word.

Here's a hint: no matter how outrageous the comment, DO NOT RESPOND. Nothing. If you think it's a personal attack, report it. Do not reply directly, and do not bring up what that person posted. Don't reply to his topic. Please, have mercy on all of us and do not reply. Let it die.

not responding is NOT giving you permission to send personal emails to women here. It is predatory and creepy.

Disagreeing does not give you permission to make predatory and creepy comments about me in public as you do repeatedly.

I had to turn off my private messaging about a month ago to stop Elmer from sending me harassing private messages. I told him to stop and he ignored my request to stop. I told him that continuing to message me privately when I'd asked him to stop is harassment. He wanted to argue with me about it and said he wasn't harassing me. I told him that once I'd told him to stop and he continued, that that is harassment.

He doesn't understand that no means no. Classic narcissist bully.

So ladies, beware of his private messages. He's just making his harassment private.

I am happy to also provide screen pics of the number of times I told him to stop and how I had to explain the definition of harassment. Finally, I just turned off my private messaging.

I wasn't going to put this out there publicly but decided to forewarn you when I read his comment to Sushipup about responding offline.

Predatory and creepy indeed.

If Emily happens to read this and wants to see his harassing private messages, I am happy to provide. I'm sure others have similar private messages they could share. It's his pattern of behavior.

Please drop it.

please clarify, drop what, sushi?

And dang, sephia!

Some people simply cannot take 'no' for an answer, it seems.

FWIW, the definition of bullying we use with our elementary campers is when someone asks you to stop doing something to them and you keep doing it.

Not sure who this is addressed to, but if to me, I have deleted nothing.

Elmer wrote: I respect sushipup's suggestion and will respond offline. I hope that won't trigger a public outrage from the recipient.

Can anyone who's welcomed Elmer's private messages please speak up?

@feathers11, not sure why you would be asking this. The issue is not those who may be ok with getting uninvited messages from him, it’s that many of us object to it and even when told to stop, he persists. That is predatory behavior. No means no!

Sort of in defense when I got a private message and explained I did not do that he did stop but I also made a comment on the forum here at the same time. I keep my messaging open for the occasional personal comments on my health issues and such. I prefer to keep all comments on topics public. I prefer to take my criticisms if people disagree with me. I like to be told if I have inadvertantly offended or been irritating. How else do we learn acceptable social norms?

The only person who I ever felt harassed me behind the scenes is dead now. Correlation or causation?

Foas, i think I know who you mean; she got me too !

Causation. A manifestation of karma.

I’m not sure if it’s karma. This thread’s ending (among similarly numerous threads) shows when someone acts a certain way, it tends to shape how others respond back to them. Over time, patterns emerge: trust builds or erodes, cooperation increases or collapses, reputations form. So it’s really feedback loops in human behavior and memory, not a moral mechanism like karma manifesting in the universe.

Does anyone else see something strange about Elmer begging people to stop doing something after he repeadly refused to stop sending private messages when asked?