One of the very best is the Hawaii Kaiser Permanente Medical Care Plan with some 190,000 customers. Readers of Consumer Reports magazine rated it high in 1991. I love it as a satisfied user for most of the years since it opened here in 1958.
Kaiser nationally has over 7 million members. It considers itself a health-care provider rather than an insurer. It plans to work more with communities to promote general health consciousness. This outreach is consistent with its self-interest in encouraging people to stay well since it provides full care - just about whatever the problem may be - for fixed, prepaid fees.
Kaiser is non-profit whereas about 60 percent of today's 600 HMOs in America are for-profit. Either can be good but some are accused of stinting on care in a nation long used to being overtreated by fee-for-service providers.
Many of the accusations are just, particularly those against HMOs that gag their doctors from discussing alternative treatments with their patients - something Kaiser doesn't do.But it also is true that medical advances have made hospitalization so much less necessary that half today's hospital beds may become surplus.
Rather than replace its 40-year-old hospital in Portland, Ore., Kaiser is consolidating with a new, modern "competitor" hospital in order to retain the critical mass of bed usage needed to support quality staffing.
Kaiser's top executives from Oakland, Calf., visited Hawaii in late May and held a round of meetings.They endorsed the need to provide more information for customers to evaluate competitive health plan offerings - data on coverage, doctor choice, outcomes, etc. In 1994 they began issuing annual report cards on themselves.
They cited the need for a structure to see that HMOs and related prepaid providers meet adequate financial and care standards. The state insurance commissioner voiced a fear that some future HMOs may go bankrupt by promising more than they can provide. The industry should try to head this off, he said, or lose consumer confidence.
Help may come from the relatively new National Committee for Quality Assurance, which so far has reviewed about half the nation's HMOs for accreditation based on outcomes of the care they provide. Its list can be obtained by phoning (202) 955-3515 or on the World Wide Web at http://www.ncqa.org.
The limits on what an HMO will provide are a major issue nationally. Hawaii has minimum coverage requirements set by law, but plans can go beyond that to offer choices ranging from Chevrolets to Cadillacs.
The public should be aware that some of the HMO criticism comes from sectors that in the past have profited by overtreating to the point of driving American per capita health costs well ahead of other countries with good health outcomes.
THE debate is turning demagogic. We consumers should try to become as informed as possible. When we do I think HMOs that hew to the late Henry Kaiser's original dream dating back to the 1930s will look very good.
The famous industrialist moved to Hawaii in "retirement" in the mid-1950s. He then founded and initially developed Hawaii Kai. He also brought here - against stiff opposition from Hawaii doctors of the time - the pre-paid health service plan he had started in Oakland in 1945. He personally made the rounds of Hawaii newspapers to help sell it.
He said his mother died in his arms for lack of adequate health care when he was 14 and he wanted his health plan to be his and her main memorial after his death.
Good HMOs can keep America healthy and customers satisfied at a fair price. Bad HMOs need to be prodded to shape up. Consumers need the information to judge comparatively what they are offered - Chevrolet, Cadillac or lemon.