As Bad As It's Been | to pdf >>
by David O'Grady

Helen Hunt's character, the mother of a boy with severe asthma and allergies, is sitting with her own mother at the kitchen table in their small Brooklyn apartment. Jack Nicholson's character, a curmudgeonly admirer of the boy's mother, has sent over a doctor to make a house call on the family. The doctor, a soft and gentle soul, tells them he is going to make sure the boy will get the care and testing he's been denied. "Those [blankety-blank-blank] HMOs," Hunt's character declares, to which the doctor responds, "Actually, I think that's the technical term for them."

You can imagine the response. Laughter and tears all around while the audience bursts into applause--the strongest reaction during the entire movie. I peer through the dark at an older woman sitting next to me, her head bobbing up and down in agreement with dozens of other viewers. Slinking down to the sticky floor and used gum under my seat, I feel alone and exposed, the butt of the joke.

In this era of HMO enmity, we all know to expect and prepare for the worst. But it's the little moments that still catch me off guard.

While flying to Oakland for a conference last fall, a kind-faced woman in country club casual wear and brassy hair struck up a conversation with me which rapidly veered into dangerous territory when she asked, "Whom do you work for?" I should have lied. "Oh, that's interesting," she coyly replied. "You see, I belong to a women's political group in the Bay Area that's trying to get your play Secrets* out of our Catholic schools."

Never mind that Kaiser Permanente has a moral obligation to provide health care and lifesaving information to saints and sinners alike; in these anti-HMO days, facts never stand in the way of the truth. Even in places--like on TV--where truth is always a casualty, there is no refuge. With shows like Chicago Hope and ER taking cheap shots at HMOs every week, the only programs safe to watch are cooking tutorials on public TV.

Many good ideas throughout history have been attacked or have received bad reputations through exploitation and greed. Scars from skirmishes with lawyers and regulators tell of our ability to heal and survive, to keep a good idea alive. But when my aunt in Chicago--a health care consultant and former cardiac nurse--called me up just to say managed health care has ruined her occupation, it's another one of those unguarded moments that crawl under my skin and take a swing at my psyche.

Fortunately, Kaiser Permanente has friends out there. Many of them are our members. When the Southwest Division was attacked in the media for protecting the confidentiality of patients and of the peer review process, hundreds of members wrote to us in support. A sympathetic neighbor of mine is a Kaiser Permanente member who stops by each week to share the latest negative story about us on the Internet. "They just don't understand, do they?" he says. "I think I get really good care, and the cost to me is minimal."

I nearly cried. Even As Good As It Gets nearly stumbles into understanding when Helen Hunt's character, after vilifying HMOs, suddenly asks, "How will I pay for it?" How, indeed? Most of us don't have curmudgeonly benefactors to buy our health care on the open market, visit by visit, test by test. That luxury never existed, but now it paradoxically springs to life in the fake nostalgia of popular culture, where only "popular" ideas survive market testing.

We know better. HMOs would never prefer multiple, unnecessary trips to an emergency room when a little preventive medicine can make asthma a manageable disease, thus dramatically improving the quality of life. We know that we can learn from our past experience, from our years of taking care of patients, and can develop better systems to provide health care.

If only people believed us. As Good As It Gets illustrates so clearly a fundamental conviction: Systems do not take care of people; people take care of people. Despite our best efforts to explain health care teams, preventive health care, and health education, the consumer still believes that health care equals doctor: nothing added, nothing subtracted.

Enter Permanente physicians. Use those hard-earned credentials outside the examination room to help educate the public about Kaiser Permanente's commitment to quality health care. Join your local medical association to meet your non-Permanente peers. Get involved with your governmental affairs department's efforts to make "house calls" on politicians and help them write better laws--or to preserve the ones we have already. Let your Division's communications staff share the good news from your practice. Volunteer for media training and the chance to speak to the public about quality health care. Your credibility is the message; your voice will be heard.

Every era has its villain: hospitals that overcharge, drug companies and their tyranny of product and price, the medical establishment's lax oversight of bad-apple doctors, and the profession's code of silence. Now, unfortunately, it's our turn--and critics lurk everywhere. Sometimes it's not so easy to stand up and be counted.

Strolling through my neighborhood the other day I ran into a man walking a mean-looking Doberman. The man and I seemed familiar to each other but couldn't place the connection. Then he asked, "Don't you work for an HMO?" The dog strained against its leash, snarling at me. I quickly checked my clothes for Kaiser Permanente logos and contemplated my reply.

*Kaiser Permanente's national award-winning educational theater program, Secrets, is a live theater production for high school students, focusing on HIV prevention.

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