So that we do not unintentionally violate copyright law I have to ask you to refer to the photograph of the Permanente Map at the below referenced page. Under the map replicated for instructional purposes is a clear and concise explanation of what all included images represent.
1. The very, most left hand beginning of The Permanente Map” (aka – Permanente Medicine) is the “group ethic,” which is Kaiser’s attempt to all but replace the Hippocratic Oath; suddenly the “group” of physicians have to watch out for each other financially and the “group” of patients are supposedly willing (uninformed consent) to sacrifice individual high cost care to the purpose of keeping each individual’s premium down;
2. The Japanese attack on Pearl Harbor resulted in a need to build a new Pacific Fleet, and Henry Kaiser liked a challenge and offered speed of building; the workers poured into the Kaiser shipyards and had the single choice of Kaiser clinics, the latter built by the Navy and given as a gift to Kaiser at the end of the war;
3. Kaiser is represented in the next pictures as a series of fairly independent Permanente ships with the steering compartment enlarged to show the dependence on “Clinical Guidelines” – really rationing documents hoping to avoid the 80% of medicine which is not proven because the specialists simply agree that it works well; [the independence of the Permanente groups is more of a legal defense against outside legal experts, as in reality this is a single fleet joined by the Admiralty command in Oakland including Permco (the venture arm), The Care Management Institute, the physicians having veto power over the plan, the taxing of Permanente groups to form new groups, the unity of legal counsel, the adoption of the same “Clinical Guidelines” of restricted care, etc].
4. Note that utilization and costs are always high (revenue lost) against the low revenue income dial – the message being that the only hope for the fleet is to decrease utilization of services and keep the patients mildly confused about what is going on (tolerably satisfied);
5. Off to the side is the total loss of fee for service, that is to say private medicine (otherwise portrayed as the proud but almost extinct, lone eagle); other IPAs (Independent Physician Associations) are trying to copy Kaiser but do not have the right size ships;
6. The “Industry Shakeout Whirlpool” is really the concession that the purchasers – like Pacific Business Group and CalPERS – will be watching the services given out (CalPERS not even agreeing to arbitration); and thus the seniors and the poor are the ones from whom services must be most drastically withheld;
7. The “Current of Evidenced-Based Medicine” is the substitution of Kaiserized research that achieves the substitution of real expertise in the outside world; for example, the middle group of pneumonia patients which the world evidence would say should be admitted because of a 2% risk of death, Kaiser chooses in its version to send home since most sick ones will return in time;
8. “Body Part Legislation” is annoying – this might relate to regulators trying to come in and – now successfully – fine Kaiser $1million for wrong care of an area of the body – the ballooning and breaking of patients’ aortas which Kaiser thought did not deserve a paramedic ambulance;
We have inserted the “cyclops” in the place of government regulators because that is how Kaiser views the government. “The cyclops was the ugly giant who killed part of Ulysses crew in the Greek novel (by Homer) of voyage on the sea. The cyclops was blinded by the clever captain (e.g. Dr. Crosson now who heads the Permanente Federation) but the giant tossed huge boulders out on the sea to stop the captain’s escape. Kaiser infiltrates government at all levels to make sure that the regulations passed are HMO friendly and will help them in their greedy voyage toward millionaire retirements. You can be sure that as Kaiser tries to insert itself in a state and national health plan it will be for the pleasure of the captain and his mates. One small step forward for man; one step back for mankind.” CP
9. “Any Willing Provider” is a risk because government might force Kaiser to be open to any good physician and thus not able to find those who will trade their oath for the “group ethic” of the for profit Permanente groups; and yet, Kaiser maintains to the IRS – for a $5 billion tax savings – that it is an open, community chain of hospitals;
10. The details of the sails of each Permanente ship are shown in the right hand, lower corner – “Group Responsibility” is one of the front flags – this is a restatement of the obligation of each physician to see himself or herself as a business unit ordering tests, the latter which ultimately decrease the general group’s share of the risk pools of money that can be unspent if at all possible;
11. The “Labor and Management” support to the captain is actually the “gag clause” put on the labor unions in exchange for benefits, e.g. don’t report Kaiser’s mischief to patients; this is why the California Nurses Association never agreed to “partner” with Kaiser;
12. If the ships can sail through the dangerous waters, waiting ahead is a great Silicon Island information system – perhaps $2 billion by the time it is done – for organizing patient records (but more importantly, for tracking each and every professional in the Kaiser system against business – not medical – targets – “a robust set of performance measures”);
13. Finally, there is the “Sea of Superior Care,” which really means that if it isn’t proven care it will not be given out regardless of the line of experts calling it the best standard approach used in the community;
14. At the end of the “Sea of Superior Care” is the KP Promise Land with “Investment Capital” and “Our SUSTAINABLE FUTURE,” which means that anyone who cannot join the chorus is dooming the existence of the choir; more simply each doc must either latch on or launch out.
15. In summary, this is the Kaiser culture in which both physicians and patients must be Kaiserized to accept that the unknowing enrollee is really paying only for a wellness program of easily treated illness, like appendicitis; If a real illness strikes, it is simply a patient’s invitation to hospice on the way to Heaven.
16. I begin to wonder if Heaven is simply the absence of fraudulant HMO schemes. Dr. Chuck Phillips – 11/16/02 – Former Kaiser Physician for 18 months
Jon Stewart, Associate Editor of the Permanente Journal wrote an article in the Winter 2000 / Vol 4, No 1, Permanente Journal in the Section Entitled Health Systems. It is titled Permanente Medicine: The Permanente Medicine Map
The Public may view it at:
recently removed from the following location at:
mirrored for historical purposes at: https://businesspractices.kaiserpapers.org/the-permanente-medicine-map/
In the event that the above referenced article disappears in the near future we have saved copies of it for interested members of the public.
Supporting Permanente Literature – A Conversation with Jed Weissberg, MD, On Defining Permanente Medicine:
mirrored for historical purposes at: https://businesspractices.kaiserpapers.org/a-conversation-with-jed-weissberg-md-on-defining-permanente-medicine/
For best printing of The Permanente Map use the pdf version – just click on this highlighted link
Permanente Staff quote:
“We all felt a need to get our arms around the concept as a unified whole rather than as a series of discrete principles. We wanted to “see” how all the pieces related to one another and to the historical, professional, and industry environment that helped shape them. Hence, the Permanente Medicine Map.
The map grew out of a series of discussions and focus groups led by Tomi Nagai-Rothe, a graphic artist/facilitator from Grove Consultants, International, of San Francisco.” “This, then, is the story of Permanente Medicine, the conceptual vehicle (or fleet, in this case) that we depend upon to carry us to a sustainable future.”