I just got a free TB skin test at Kaiser.

I don’t get why Kaiser doesn’t get more love. Maybe I’m biased because I’ve been going there forever. But I’ve always been happy with it. It always gets high ratings (e.g., as of this writing, it was the highest ranked health insurance plan in California by U.S. News and World Report). In Atul Gawande’s important New Yorker article on the most expensive (and worst) health care in the country, Kaiser is mentioned as being one of the best. Still, despite its high ratings and reputations, a lot of my coworkers, when given the choice between Kaiser and something else (typically more expensive), they’ll choose something else.

To me, this points to another reason why free market principles can’t currently work with health care. One critical prerequisite for a working free market is information. And there’s simply not enough information about the relative effectiveness of different health care centers. In another fascinating article, Gawande writes about cystic-fibrosis, and about how for years, there was no way of knowing which centers were better in treating cystic-fibrosis, although when you looked at the data, some clearly were. Which hospitals in the Bay Area are best? I, for one, have no clue, because there’s no real data for me to compare.

Hospitals have good reason for not publishing data about their outcomes. It’s really hard to interpret. For example, if the 5-year survival rates for cancer patients is higher at one hospital than at another, it’s hard to tell if it’s because the first hospital is better or because the latter one gets more difficult or advanced cases.

In the absence of available data, Americans tend to assume that more is better when it comes to health care. They assume that more expensive plans must be better, even though there’s no evidence to support that (and some to support that there’s almost no link between spending and effectiveness). Americans hospitals do far more unnecessary tests, spend far more on unnecessary treatment and procedures, all based on the assumption that more must be better. But it’s not.

Anyway, I’m pretty happy with Kaiser. We’ve had good experiences. It’s universally highly rated by national publications (Gawande giving Kaiser a shout out in the New Yorker as being a model sticks with me). And it’s relatively cheap, which has mattered a lot since we gave birth to and are raising two kids. Not much to dislike about that.

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