Dr. Kenneth E. Bell is bullish when it comes to the Clinton health care reform package. As a top executive for Kaiser Permanente, the nation's largest health maintenance organization, and as a clinical professor at the UC Irvine School of Medicine, Bell welcomes big changes in the health care system. Bell also recently established the first private residency program for primary care physicians in Orange County--at Kaiser's Anaheim Hills facility. That program begins next summer. He recently spoke with Times staff writer James M. Gomez.
What is your general opinion about the Clinton health care reform package?
Looking at the Clinton plan, there are a number of things we at Kaiser Permanente like a lot. There are also some things that we think would be problematic. Most importantly, we support universal coverage, subsidies (to small businesses) and employer mandates. Comprehensive benefits is something I think is important.
Although I do like the idea of health alliances, I do have a problem with the size of the groups that go into them. I think that 5,000-employee organizations should not be part of health alliances. I am much more in favor of alliances made up of small groups and individuals.
How well do you think the California Health Insurance Purchasing Cooperative, which went into effect in January, has worked?
Kaiser is very supportive of it. It is based on work that some of our folks have done. We think it is important and we like the idea of employee choice. We are very supportive of community rating and portability.
How important is the so-called health care report card provision in the Clinton health plan?
It's very important. It is my belief that expert opinion is much less important than measurable outcomes. We need decent measures like that and so we are strongly in favor of outcomes research.
What exactly is outcomes research? Since the term is used often in the medical profession, can you define it?
Well, everybody always deals in anecdotes. "I like Dr. Joe. He's a good doctor." Well how do we know he's a good doctor? Well, he went to good schools, or whatever. That is all very good. But what is really important is how Dr. Joe and the hospital where he works are performing. If you go to that physician or to that hospital, what are your chances of getting the best outcome? Those things are measurable. So outcomes research deals specifically with measured circumstances. Outcomes research also includes how people feel about their care.
All the controversy aside, do you think the health care system really needs fixing?
Yes. I am very clear on that in my mind. A couple of years ago, I spent three months at Harvard in a business program. And half the folks were from around the world and half from the United States. The ones from outside the United States were laughing at us when it came to health care. It was just becoming a hot topic at that time. They were laughing at us. They told me there were two countries in the world without universal health care, two developed countries: The U.S. and South Africa. They asked how it could be possible in this rich, wonderful country.
What are some of the incentives in health care reform that you feel would make reform work?
My incentive is to keep the patient well. I do well if you are healthy. If you are not healthy, the cost of care goes up. So I benefit by keeping you healthy. In addition to that, if I don't give you enough care, you're going to get sick. So it is very important for me to keep you healthy and prevent you from getting sick. And if you do get sick, to do everything possible to get you well again.
Preventive medicine seems to be a key concept in health care reform. How does it work to lower costs, since it appears you are actually seeing patients more often?
For example, we have a major program called the pediatric immunization program. We also give mammograms. We are big believers in women having mammograms when they are in the at-risk age groups. One of our regional goals is to get every woman in the high-risk group to get mammograms. It is less expensive to do mammograms and find early cancer than to take care of people who are dying of cancer. We know that in women 50 to 74, there is a 40% decrease in mortality if they get mammograms every two years.
Why do you think it is important to have universal health insurance?
If you look at the uninsured in this country, the uninsured have a 25% higher mortality, for all age groups, than anybody else. That is craziness. It is bad for the country. It is certainly bad for the uninsured people. And it is an expensive thing to happen if you just want to talk about costs. We want to keep people healthy and we don't have the health care system to adequately do that.
Why are primary care physicians so important an issue in regard to health care reform?