Talk:Kaiser Permanente

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This is the talk page for discussing improvements to the Kaiser Permanente article.

Contents

[edit] Pre-Protection

The regions are important information. They should stay, don't you think? Also, the style of the most recent changes is a little informal. I might work on that latter. Any thoughts? posted by justen on 10 November 2005 at 16:12 PST

[edit] Edits

strange article. looks just like some kaiser-hate blogs

did the author compare permanente physican salaries with community standards? how many physicians that make there money from bc/bs or other private pay insurance companies retire as millionaires? do kaiser physicians really make more or retire with more? interesting. some majo holes in this article. looks like biased-junk to me. (This is from a Kaiser physician - see bottom of talk page. --Pansophia 18:42, 3 January 2006 (UTC))

also -- some very vague 'kaiser permanente harms patients' data. is this compared to bc/bs or other community standards? how about medicare? medicaid? interesting. some more holes. looks like the authors are comparing kaiser to itself or some imaginary ideal health care system. hmmm..

and the links--most are to similar sites? similar authors maybe? hmmmm


anonymous person wrote "Cotman68 writes: "someone keeps placing links to sites that have minimal factual information. is there a reason for this?"

The articles on one of the site links Cotman68 has deleted repeatedly are exclusively about Kaiser Permanente and are compiled from credible news sources, with links back to the original articles. Cotman is trying to supress legitimate criticism of Kaiser Permanente that is backed up with factual information and sources."



interestingly, recently I have not deleted the kaiser hate sites and have just added information to balance out the rather large critism section which is full of 2 things:

1. typical lawsuits filed against any large hmo or ppo or even medicare/medicaid 2. vague 'lawsuits' that didn't go anywhere 3. opinion pieces on 'why kaiser is bad' that are not based in fact

the person who has spent the most time on this article in the last few months has

1. only posted on kaiser entry, hmo entry (deleting kaiser as a type of hmo since no other examples are shown) and rankism--oddly enough was felt to be a useless enough entry that it was deleted.

(Insert: I didn't write the rankism article that was deleted. I did write the new one. --Pansophia 18:35, 3 January 2006 (UTC))

2. only posted criticism. and in fact added criticism to the history and intro sections! how odd (Untrue: I also added regional history to the history section. --Pansophia 18:39, 3 January 2006 (UTC))

cleary, I realize you hate kaiser. they probably 'did you wrong' somewhere' or at least you perceive that they did. but wiki pedia is NOT DESIGNED for your RANTS AGAINST KAISER.

from now on--I won't delete links. I don't care what you link too even though they certainly don't follow typical wikipedia link conventions and they all have a similar theme 'I hate kaiser'

I won't delete body of text unless it is completely ridiculous --like all kaiser physicians retiring as millionaires.

I will add counterpoint to your criticism. that is fair I believe.

Fair and not a problem. Two links that were deleted were to an advocacy site for Kaiser members in a specific region, and to a site that compiles legitimate news articles and complaints about Kaiser. While they may be critical, they cannot be criticized as not factual or not relevant.

It is also legitimate to include a criticism section in an encylcopedic entry about Kaiser, which is a magnet for same. It's all documented somewhere.

updated 1/2/06 - returned historical events to history section. These things are a matter of PUBLIC RECORD!

cotman68 is attempting to delineate opinion from fact. perhaps if said blogger above would edit his/her criticism section to contain less opinion then the criticism section would require less editing. the current criticism section contains much opinion that is mingled with facts creating logical fallacies that make it hard to interpret the data. the examples of kaiser criticism moved from the historical section to the cricism section represent true criticism and should (i.e. they are facts that are used as criticisms.) much of the rest of the critism section is fact muddled with opinion (which is not what an encyclopedia is all about.)

for example--it is fact that CURRENT kaiser practice is designed to overcode and make more money illegally? if that is the CURRENT kaiser practice as noted in the criticism section, then said blogger who has discoverd this should alert medicare of this fraud. this would be your duty to your fellow americans. or perhaps your would like to just post this data on a websight and keep the actuall proof to yourself?

also, the person that testified in front of the california legistlature DOES represent a group that falls outside of traditional medicine and that FACT should be INCLUDED on this site.

Cotman68 has repeatedly resorted to name calling and unsubstantiated accusations about editors who do not agree with him (see his edit summaries).

anonymous vandal continues to vandalize cotman68 edits.

More name calling and accusations when legitimate edits were restored. Legitimate Kaiser history from the public record has been deleted and moved. I haven't seen any bias or namecalling from anyone but Cotman68. I am not a vandal, and I haven't called any names.

please note that this kaiser wikipedia entry is the only HMO entry with any criticism at all. also note the similarity between the criticism section and the links below it. also note that the criticism section is full of opinion mingled with facts. also note that the criticism section is longer than the history section.

Cotman68 admits he is trying to supress valid criticism supported by historical documents in the public record.

so you admit that the records are criticism? note that I am NOT deleting them. I am just moving them to the criticism section--and since you admit they are criticism, then you should leave them there.

also note I made some factual addition (not subtraction) to the criticism section that you keep deleting. please leave that there unless you want bias.

I don't want bias from you or anyone else. You want to turn this entry into a Kaiser commercial. Is it not historical fact that Kaiser was fined $1.9 million for defrauding Medicaid and Medicare? Is it not historical fact that Kaiser was fined $200,000 for disclosing patient information on the internet. Is the Thrive campaign not a fact? I'd be happy to come to some kind of compromise, but you just want to call names and make accusations that aren't even true.

ok but listen to me. 1. you have a criticism section AND a history section--you tell me where criticism should go?


2. you have turned all sections into criticism

3. you also keep deleting my legitimate edits/rebuttals to your criticism.


4. no other hmo site even HAS a criticism section so this is far from a kaiser commercial. that statement is absurd--the criticism section is longer than the history section1

again--this is an ENCYCLOPIDIA not a dissection of kaiser. keep that on your blog.


There you go making false accusations again. I did not write the history section or the criticism section, and I am not the blogger you keep accusing me of being. I am not a bully. I am not a vandal. No one has called you any names.

Historical events belong in history. Kaiser's history of being fined and sanctioned for unlawful practices are part of the historical record.


congrats, you have won for now. you have turned and wikipedia the online encyclopedia into your own kaiser hate blog. good job. I'll be back though to continue to push the truth.

Cotman68: I edited some of your comments because they were false (see edit note). Also, I don't think you realize that the article that existed before the criticism section was added *was* a Kaiser commercial, written by a Kaiser employee ("Justen").



to anonymous user:

the only thing I know is that this site is ridiculous. why do you need to use the wikipedia for your own agenda? I don't have a problem with people criticising kaiser--all large coorporations need some checks and balances and that starts with the people they are here to serve. however, you have links to blogs/sites full of kaiser criticism that you include in your article. if I had the time (which I don't) I could break down every thing you say and offer quite a large discussion (including the autism junk--that has been studied ad naseum and certainly not just by kaiser!)

however, I don't have the time--I have family and work to think about. maybe I'll pass the torch to clean up this article to some of my friends/family. or maybe I'll work on it tomorrow.

but I will lleave you with this:

sure kaiser isn't perfect, but the entity as a whole isn't out to hurt you. in fact, most folks at kaiser that believe in delivering the best health care possible. to do that you need to focus on prevention and have deep care for your patients. you have taken kaiser and made it an anonymous bully--but I assure you that it is not. it is a composite of many people who care alot about patients and who worry about patients and strive to deliver the best health care possible to those patients. I can assure you that although some of your facts are truly facts, you have inserted many very hurtful and untrue comments into this article. that I know for fact.


To me it looks like the one with the agenda is Cotman68. Sounds like a Kaiser employee to me.

---

yes. my agenda is for the truth and a balanced discussion. you just added transcripts from some nixon tapes to a kaiser permanente section of an online encylopedia. I'll go check encyclopedia britannica and see if that tape transcript is there under 'kaiser permanente' or 'hmo'--cotman68

First, I'd like to say, I'm not the person you've been having the discussion with above. I did make the major changes in the Kaiser Permanente article, and I added the Criticism section. The original article I found was a Kaiser Permanente marketing instrument, planted by a Kaiser employee ("Justen"). I wanted to counterbalance what was originally a Kaiser ad. Because Kaiser is controversial, I thought it would be good to have a separate section labeled "Criticism".

I have deleted some of your recent remarks because they just seem to be contrarian. They don't add any substance, and a couple of them were just false. They don't belong in the Criticism of Kaiser section because you are criticizing the critics. Some of your remarks above suggest you are biased toward Kaiser and may work for them. I'm not going to contest any balancing contributions. Perhaps there should be a "Proponents" section?

Also, you're very mixed up about who you've been talking with. That's not the major editor of the article (that's me), and you've blamed them for a blog they say isn't theirs. By the way - I added some of the HARP link and comments, so those aren't the work of one person, either. You said I added extraneous Kaiser information to the HMO article when no other HMOs were represented: what I did there was take out a planted Kaiser ad in the middle of the text, when no other HMO was advertised there. You just have a lot of things wrong. I left a remark on your talk page so we could straighten some things out, and you chose to keep on pushing *your* agenda here.

When this is reviewed, I hope people take note of your "best health care" remarks and see your own bias here.

--Pansophia 01:38, 3 January 2006 (UTC)

I added transcripts from the Nixon Tapes because the discussion was about Kaiser and that was an historical moment that led to the HMO Act of 1973, and the beginning of HMOs in this country. Most people don't know the tape transcripts exist, but they are still a very important and valid aspect of Kaiser Permanente and HMO history. I have to say Cotman68, you are coming across as quite biased here. --Krandall


my best health care comment wasn't placed on the main page. also, it is an opinion of what kaiser employees would try to do. I didn't insert that into the front page.

also--you all have a TON of things wrong and as I try to edit them, you all delete them. you are running from balanced discussion.

I certainly didn't plant a kaiser ad. not sure who did that--I agree there should not be a kaiser ad here.

also-you deny the fact that this is an encyclopedia--not designed to prolifically critise the article. your links to that quite extensively.

note--I am not deleting. you are. I place facts, you delete them.

c--otman68

Ahhh. That explains a lot. Pretty sneaky Cotman68, after throwing all those accusations around.

who are you three? willing to answer? I didn't think so. because your sole weapon is anonymity. good luck with that. but is that who I really am? hm.

Your comment makes no sense. Ask a question...answer it yourself...make more accusations that are again unwarranted since two of the editors are not anonymous. Nice bedside manner, doctor. I hope that attitude doesn't turn people off to Kaiser when they see this kind of juvenile behavior from a Kaiser physician. They might be led to believe that is the kind of treatment Kaiser patients can expect, which would be a shame.

A look back to Cotman68's comment before he edited it again, reveals his statement that he "never denied it" about being a Kaiser doctor with a financial interest in Kaiser Permanente.

[Link to personal information removed. Please do not reinstate this. Mindspillage (spill yours?) 20:24, 4 March 2006 (UTC)]

He has tried to represent me as a vandal, when I have been nothing but civil to him. All attempts to discuss the edits were met with accusations and name calling. See above, and his edit summaries.

never denied but never accepted it. I also never said I was impartial. why are you trying to peronsally id me? I am not a kaiser physician. bottom line.

Not trying to personally ID you, I just think it's fair after all the accusations you have made about others that you accept the same kind of scrutiny. I quote from your comment a few up:

"who are you three? willing to answer? I didn't think so."

Why are YOU trying to personally out people?

I actually hope you are not a Kaiser doctor, because that would be downright scary.

He is a Kaiser doctor. I have a lock on it from multiple trails.

--Pansophia 03:48, 3 January 2006 (UTC)

Wow. I never realised, when I started this article, how awful it would become. (For the record, I didn't actually create the article, but what was here before was just a stub.) In any event, I'm a little offended to read on this page that I somehow biased the article or created just a "marketing tool," or what have you, for Kaiser Permanente. I do work for KP, but I wrote all that initial content for the article well in advance of coming to work for the organisation. (At the time, I was considering taking a job here, and decided there couldn't possibly be a better way to learn more about KP than to check out every book the Los Angeles Central Library had on KP and put together a Wikipedia article.) I don't think I have to defend what I wrote... Nothing was inaccurate, dishonest, or even sugar-coated, for that matter. It certainly didn't include all this content from Kaiser Papers (at http://www.kaiserpapers.org/) (a blog that posts anti-Kaiser news and info) and the like, but it did give a historical sketch of the KP timeline.

All of this being said, I'm sorry this article has evolved the way it has. I would like to clean it up, but I honestly don't have the will... It's so negative, so messy, and so disorganised now... I really hope someone who can't be tainted as "pro-Kaiser" (or "anti-Kaiser" for that matter) can work on it... I imagine that's why the disclaimers are at the top of the page... I just hope it happens soon, because the article in its current state is an incredible embarassment to Wikipedia...

Sorry.

Justen Deal 02:07, 12 January 2006 (UTC)


Justen: how can you be "offended" for your article being called a "marketing tool" while calling the changes that were made an "embarrassment to Wikipedia"? If you want everyone to take the high road and not belittle, then perhaps you should avoid stooping to that yourself. I would like to see the article be forged into a good encyclopedia issue, but expect any attempt to censor criticism of Kaiser to be challenged. By the way, I have nothing to do with the Kaiser Papers web site.
Ps. The Disclaimer at the top of the page is there because the Kaiser doctor put it there. He did that after I offered to talk it out, and he did it with a "ha ha" attitude. I don't know why you two think Authority amounts to being Pro-Kaiser. Luckily the Wikipedia process is democratic, and a good article will emerge the way it's supposed to: through discussion.
--Pansophia 08:28, 16 January 2006 (UTC)


I should clarfiy that my biggest concern at this point is the formatting of the article. There's an entire transcript right in the middle of the history section. There are paragraphs of historical information, followed by paragraphs of information regarding lawsuits. By all means, you can add whatever content you feel is appropriate (knowing that other Wikipedians might disagree, and edit that content however *they* feel is appropriate)... But don't walk away after adding your content leaving the article in the state it's in... Use section dividers and such. Rewrite the content to flow in the article, don't just plop in your criticisms here and there. If you do indeed want to promote a balanced look at KP, do so in a way that folks looking at Wikipedia will actually read, rather than have them turn away from the article because it looks like something on the Drudge Report, not from an encyclopædia.
I do personally believe that you (and, basically, only you) have plopped in a considerable amount of unsubstantiated content that isn't appropriate for an encyclopædia article. Like you, I do believe that, at some point, the revision process will allow an article to emerge that is of better quality than the current one.
Unlike you, I do believe the disclaimer is appropriate, and I doubt the Wikipedian ("Kaiser doctor," you say) who instituted the disclaimer was doing it with a "'ha ha' attitude." I'm not able to comprehend what you meant by "Authority amounts to being Pro-Kaiser," and I sincerely doubt you have ever known, nor will ever know, what I "think." Nevertheless, I do wish you well in improving the quality of the article.
Justen Deal 19:17, 17 January 2006 (UTC)
//transcript right in the middle// - I agree, and I've posted that transcript on Wikisource. I'm hoping Krandall will come back and delete the transcript from the article. I don't want to do it myself because of the whose delete controversy going on. As for your objection to the lawsuits, I'm wondering what was going through your mind when you posted the particulars of Kaiser's ad campaign as encyclopedia-worthy. IMHO, the lawsuits are more important - and I just chose a few representative ones. Also, your original "history" only included Kaiser's successful expansions, none of Kaiser's mistakes.
I also haven't "walked away". I'm here trying to figure out what to do. As for the folks "turning away", the big objection came from a Kaiser doctor and you, a Kaiser employee. Forgive me for not finding your claim to be speaking for the masses persuasive.
//"Kaiser doctor," you say// Here's my dilemma. I can name him and link to his Kaiser directory page, but that would be a breach of his privacy, and he's communicated all over Wikipedia that he's upset about this. If you have any respect for that doctor's feelings on the matter, I suggest you don't challenge me to issue my proof. By the way, my only objection to the POV tag is the attitude of the Kaiser doctor - how he treated other editors (demeaning), how he treated peer review like some sort of trump card after I offered to talk, and how he's obviously biased himself. I agree the article needs a lot more work to be up to Wikipedia standards.
That said, you obviously do believe that Authority amounts to be pro-Kaiser. You say I just "plopped" criticism in there: if you check the history you will see I originally put the criticism in the history section, but then made a special effort to extract it and label it as "criticism". I didn't add the transcript that you're complaining about. You also earlier complained about the "negative" tenor of the article. So to you the objective quality article to be admired by all Wikipedians would be "positive", or pro-Kaiser.
I'm sure this article will evolve considerably through editing, but I hope it doesn't do so through censoring criticism. And I certainly hope it doesn't include propaganda for Kaiser's leadership personalities and rehearsals of their ad campaign.
--Pansophia 23:45, 17 January 2006 (UTC)

It looks like all of the linked articles for Kaiser Permanenete are about legal actions against it and about personal accounts for when people have been wronged. I think in fair representation it should also be noted where Kaiser Permanente has given back to the community.

First, please remember to sign your remarks. Otherwise, I'm just looking at your Kaiser IP address (recorded on the History for this page) and assuming "marketing department". Second, this is Wikipedia - you're free to make the edits you feel are appropriate. Don't expect propaganda to slip by without scrutiny, though. Most corporations choose to "give back" for tax or publicity reasons. The question I have to ask is if Kaiser is so good-willed, why did they choose not to rectify the situations where they had wronged people? This makes all other good deeds look like mere photo ops. Pansophia 05:03, 2 February 2006 (UTC)
As long as you are naming off guidelines then should be reminded to focus on the contributions, not the contributers. As a contribution I offered the constructive remark that there were a lot of links related to this article that were Anti-Kaiser Permanente. I am a Kaiser Permanente Information Technology Professional and was making an observation of this article. I don't disagree with having a critism section for the article, but I do think that there should also be links given for beneficial things that Kaiser does for it's community. Kaiser Permanente may do these things on a corporate level for tax reasons, but that doesn't disregard that it is still factual information that should be presented in this article. Since you have gone out of your way and identified me as a Kaiser Employee then it is safe to assume that you will think that I am biased in this matter. So I will not be providing a link for this article. I will only be providing the contribution of constructive criticism. -Anonymous Kaiser Contribution 8 February 2006
Hmmm - well it's up to you whether you want to provide some links or not. Just to balance your perspective, I'm going to quote here another recent insert that another editor removed (and I agree with the removal): Kaiser is not an equal opportunity place. They selectivly hire and allow their co-workers to abuse other coworkers. Having them fired and causing chaos throughout the staff. Sick call line is not utilized correctly.The Manager will allow her LVN to have resourse to the sick call line, The LVN will allow her co-work(s) to have the number. everyone knows everyone business medical affairs. Blame the Managers and staff .Doctors pretend or careless about all the co-workers. Besides you make less. Advice get out while you are able. Maybe leaving or having to leave is the best for you, eventually the smaller sites will fold. like Occupational Health Clinics and other smaller facilities.
My point is that Kaiser spends a lot of money on positive propaganda, while the people who have a critical view of Kaiser are isolated and weak. Kaiser HR silences them by destroying all evidence, and there's no legal recourse since it's not illegal for employers to bully, lie, etc. I've read a lot of complaints (today I got one from Kaiser IT!) that never even make it to a public forum just because people are too embarrassed to talk about what Kaiser did to them or they fear speaking out will have adverse career consequences. This is why I'm going to do my best to defend the inclusion of critical views of Kaiser in public spaces. When someone gives me $40 million dollars to run my own ad campaign, then we can start talking about fair and balanced.--Pansophia 07:19, 20 February 2006 (UTC)

[edit] Talk page guidelines

Could editors please follow the talk page guidelines? Sign and date your comments, and indent them for clarity. Further, we should all focus on the contributions, not the contributors. It does not matter if editors are doctors, patients, janitors, or whatever. All that matters is the quality of the editing. Thanks, -Will Beback 20:58, 3 January 2006 (UTC)

[edit] NPOV and external links

I removed a lot of incendiary external links. Unofficial/unorganised criticism blogs are completely unacceptable as resources. Please review Wikipedia:External links on what constitutes a useful resource. Criticism of KP may be notable, but should follow rigid citation guidelines, many of which are not being adhered to in this article.

And along comes Ombudsman (talk • contribs), who has a track record for sneaking POV into articles through "see also" and "external links", and reinserts the garbage. Many users have tried to stop this, but Ombudsman tends to disregard any form of criticism as attacks on his holy philosophy (which is anti-medicine, anti-pharma, anti-vaccine and anti-basically-everything). JFW | T@lk 22:12, 15 January 2006 (UTC)

External links are not the same as cited references. What are the specific problems with each of these websites which violate Wikipedia:External links? Thanks, -Will Beback 22:22, 15 January 2006 (UTC)
There is a mounting problem afflicting a range of the Wiki's medicine related articles stemming from campaigns to delete content that questions mainstream medical dogma, sometimes with the explanation that only certain medical sources are sufficiently authoritative. Such posturing to assert mainstream medical pov primacy compromises the Wiki's credibility while seriously undermining certain articles. In the alternative, the addition of external links examining some of Kaiser's many advantages (e.g., its renowned brain surgery services and its relative affordability, which enables access to medical care for many who would otherwise be uninsured), would be very helpful in this particular case. It would be appreciated if JFW, et al, would please concentrate a little more on constructive contributions that add balance, rather than reliance upon deletions as an overly simplistic first course of remedy. Surely, it can't be that hard to ascribe more diligently to the collaborative ethos and logos that are the strength and promise of the Wiki, rather than succumbing to the pathos of deletionism. Ombudsman 06:37, 16 January 2006 (UTC)
I second this. Please consider balance and collaboration instead of name-calling and censorship. Thank you. --Pansophia 08:32, 16 January 2006 (UTC)

One need not confuse references and external links. The "mounting problem afflicting medical articles" is actually Ombudsman himself, but never mind. Witchhunting blogs such as presently linked to from this article are not contributory in any way, and could get Wikipedia into legally muddy water. Hearsay is not hard evidence.

Ombudsman, your lecturing on ethos and logos is not contributory to this discussion. Please stick to the topic. JFW | T@lk 17:33, 16 January 2006 (UTC)

JFW, your wholesale deletion of links is also not contributory to a balanced discussion or article because you have wrongfully lumped all of the sites into one category. Some of those sites have more information than others, and some do cite and link to legitimate news sources. As Will suggested, please give specific reasons each individual web site doesn't meet Wikipedia external linking standards. It's bothering me that the people doing the most finger pointing about the motivations of other editors have obviously come in here angry and with an agenda of their own.
Krandall 18:28, 16 January 2006 (UTC)

[edit] Nixon Transcript

Is there a way to put the Nixon Transcript on another page or in a collapsing section? It's good documentation, but I think it disrupts the flow of the History section where it is.

--Pansophia 09:41, 16 January 2006 (UTC)

Thank you Pansophia. I am the person who added the transcripts. I planned to do additional editing to improve the flow of the History section, but it got ugly in here at about that time, everything was being deleted, and I figured, why bother? I hope this will be the beginning of a civil discussion about improving the Kaiser Permanente article. Krandall 18:31, 16 January 2006 (UTC)
I agree with summarizing the Nixon Transcript. Source material does not belong in Wikipedia articles (that's why we have Wikisource). -Will Beback 20:48, 16 January 2006 (UTC)
I think the Nixon Transcript should be added here: http://en.wikisource.org/wiki/Wikisource:Historical_documents
I'm not sure how to add a page, though. The Help area just says to "post" it. --Pansophia 23:29, 16 January 2006 (UTC)
Perhaps you can add the proposed title here: [1], then click on the red link to create the page. -Will Beback 23:47, 16 January 2006 (UTC)
I created a stub here: http://en.wikisource.org/wiki/Transcript_of_taped_conversation_between_President_Richard_Nixon_and_John_D._Ehrlichman_%281971%29_that_led_to_the_HMO_act_of_1973:
I've just pasted what was added to the Kaiser Permanente entry: I don't know anything about this transcript, so I'm hoping someone else will edit. Also I haven't deleted the text from the Kaiser Permanente entry because I didn't want to stir up a "deleting" issue. I'm hoping the author KRandall will do that. --Pansophia 03:08, 17 January 2006 (UTC)
Thanks for doing that, Pansophia. I've added the Wikisource link to the page, so all that is left is to summarize the discussion. Cheers, -Will Beback 03:39, 17 January 2006 (UTC)
Sorry I didn't get back here for a few days. I actually don't have time right now to summarize the transcripts so please feel free. Otherwise I'll do it as soon as I can. I'm not seeing the full transcript at the Wikisource link you provided above though. Maybe I'm doing something wrong.
Krandall 16:36, 18 January 2006 (UTC)
The link above doesn't work, for some reason. But the link in the article, in a box towards the bottom, does work. -Will Beback 23:00, 18 January 2006 (UTC)
Terminal colon. Midgley 16:53, 18 May 2006 (UTC)
Krandall - I took the initiative to replace the transcript with the link to wikisource. Please take a look and let me know if what I did is okay. --Pansophia 05:04, 20 January 2006 (UTC)

[edit] Unattributed Sources

I reverted the page to restore the criticism that had been removed by FYCTravis, and then I went back and restored most of his minor edits. In regard to the problem with unattributed sources: does it resolve the matter if I add hyperlinks to my sources (for the parts I wrote)? --Pansophia 08:04, 20 February 2006 (UTC)

I removed those parts because some of it is just petty and stupid (60s songs? Come on. That's a joke.) and the rest is entirely unsourced. If and when you can source it and rewrite it to not make statements of fact, then you can put it back. FCYTravis 20:01, 20 February 2006 (UTC)
Why don't you try fixing the alleged problems, expanding with content defending Kaiser's well known abuses, and/or adding fact check tags rather than resorting to unwarranted wholesale deletions? Kaiser's systemic problems can be traced to a litany of political scams that have only festered without resolution over the years, so it might seem that the article was unduly harsh, but that doesn't justify the bald whitewashing of the article that has taken place. Ombudsman 22:18, 20 February 2006 (UTC)
Material that could be seen as patently libelous - such as the bald assertion that Kaiser is covering up medical information - may be and, in fact, shall be removed immediately until such time as the material is properly sourced and rewritten. It is not my responsibility to research your alleged facts. FCYTravis 22:24, 20 February 2006 (UTC)
If I remember correctly the specific example you cite in your edit summary comes from an academic article that's available online. I've offered to work on this with a request for guidance on sourcing. --Pansophia 07:29, 21 February 2006 (UTC)
This was the citation on controlling utilization: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10154631&dopt=Abstract
--Pansophia 07:43, 21 February 2006 (UTC)
The Dylan song actually caused quite an uproar, spawning a number of articles about the marketing of nostalgia. Here's one I could cite: http://www.msnbc.msn.com/id/9938335/site/newsweek/
--Pansophia 07:54, 21 February 2006 (UTC)

[edit] Why the protection

I've unprotected the article and we can attempt to build from here. My concerns come from an e-mail to the Wikimedia Foundation help-list, as well as my perspective that the article reads like a hit-piece in places and is not sufficiently written from a neutral point of view. There's far too much of the weasel wording like "critics say" or whatnot, and far too little specific wording. Let's see if we can work together to build a balanced article. FCYTravis 08:28, 22 February 2006 (UTC)

Hi, FCYTravis - I have a concern myself. I saw the request on your talk page from Kaiser employee Justen. Using someone else as a shield to make a change is just as biased as the Kaiser employee doing it himself.
My proposal is to revert to restore criticism. I am happy to work on reducing the "weasel words" and adding sources. --Pansophia 08:53, 22 February 2006 (UTC)
Please don't just blankly revert to the old version. I've rewritten the bit about Dylan, with source, as you can see. Take from the old version what you need and put it in the new one, but please don't just revert ;) I didn't respond from any Talk page notice - but rather, from an e-mail to the Wikimedia OTRS help-list. FCYTravis 08:55, 22 February 2006 (UTC)
Okay, will do. Please feel free to list what you feel needs sources. --Pansophia 08:58, 22 February 2006 (UTC)
I restored the criticism, and I think I left your changes intact (as well as tweaking a couple of things myself). I left your version of the Dylan thing alone and moved the thing about advertising fraud down to criticism. I realize that's one of things that should be sourced. Edit summary notes this as provisional, in anticipation of sourcing and critique of wording.--Pansophia 09:31, 22 February 2006 (UTC)

[edit] Post-Protection

[edit] 22 February 2006 edits, NPOV

So I've decided I can't just walk away from the article with the shape it's in.

I've tried to make some revisions to rephrase POV statements into NPOV statements. For the ones that I just couldn't figure out, I looked for references, and I couldn't find any... In those cases, I added citation needed requests.

I re-added the POV tag to the top of the article until these issues get worked out. Most people who have discussed the article here on Wikipedia agree it has POV issues... As such, I think the tag needs to remain.

I also added the citation check tag. Both of the current references have issues... One is an editorial (!) and the other is a link to a title of the reference, but it doesn't actually have any content. I think a single Newsweek editorial doesn't justify such a huge mention in this case, and I think the concerns for the PubMed reference are important, but they *do* need a valid reference.

That's about it for now. I hope you like the Infobox! I think it's pretty nifty.

Justen Deal 07:58, 23 February 2006 (UTC)

So much for that, I guess. All the changes except the addition of the Infobox were just reverted. I think the changes I made were going in the right direction, but, User:Ombudsman, I hope you will at least add the citation needed requests back into the article. And, I certainly hope, taking Wikipedia:AGF into account, that you didn't really mean to label my revisions "whitewash". Justen Deal 08:20, 23 February 2006 (UTC)
I do think your version is somewhat better. Not perfect, but closer to the ideal than the other version. Michael Ralston 08:32, 23 February 2006 (UTC)
... and I just noticed Ombudsman's edit was flagged as minor. Aye yi yi. Michael Ralston 08:43, 23 February 2006 (UTC)

[edit] Removal of external link

Is there any consensus on removing the external link to the "Corporate Ethics" LiveJournal? It is primarily just an aggregator for sites already listed in Kaiser Permanente#External links. It was originally added to the article by User:Pansophia, who is the owner of said LiveJournal blog... That's not a violation of Wikipedia policy, as far as I'm aware, but, given the redundancy of the link in the first place, it seems to eliminate any other gumption the link has for sticking. (No auto isn't policy, and it isn't direct, but it is interesting background reading for this.)

Thoughts? Justen Deal 10:50, 23 February 2006 (UTC)

Here's a thought for you Justen Kaiser employee. I can say with 100% certainty that the link wasn't added by a Pansophia sock puppet because it was added by me. I don't use Wikipedia much and didn't think it was necessary to create an account to add a few links, but to avoid any future false accusations (which is all the Kaiser employees who won't discuss the edits with civility can manage) I have created one now.
Please stop contradicting yourself. You chewed Ombudsman out for not assuming good faith when you've done the same thing, and more than once.
I have read the blog in question and your statement that "almost all" original content points to sites already linked to in external links is false. Some does, yes, but not "almost all." Your statement that Pansophia changed the title of the link to the "new title" of the blog in the January 16th edit is also false.
Your bias is showing and as a Kaiser employee you should consider removing yourself from editing this article.
Ngk3 18:23, 23 February 2006 (UTC)
Please check the IPs or whatever procedure you have. I've only posted to Wikipedia under Pansophia (or no screen name if I forget to log in). --Pansophia 19:16, 23 February 2006 (UTC)
When I added the links I did so anonymously so only my IP address shows up in the edit summary (the location of which clearly proves it couldn't belong to the same person who owns the CorpHQ blog because I'm in a different state). This doesn't fit the definition of sock puppet at all. It is just another false accusation by Justen to rile people up against you, which is what Kaiser employees do best. Ngk3 20:35, 23 February 2006 (UTC)
Livejournals are, per WP:NOR, not reliable sources, as a note. Michael Ralston 20:17, 23 February 2006 (UTC)
As Will Bebeck stated in the NPOV and external links section above, "External links are not the same as cited references." He also asked "what are the specific problems" but no one offered any, except for Justen, and the 'problems' he cited are false. Ngk3 20:44, 23 February 2006 (UTC)

I'm not quite sure how to handle what appears to be outright dishonesty, but User:Pansophia appears to be the author of the "Corporate Ethics" blog, and as User:Ngk3 claims to be the author of that blog, Pansophia appears to be Ngk3, too (who, like User:Pansophia, was formerly known as sock IP 66.91.71.172?). In every instance in which these other "users" have edited, so has Pansophia (within minutes or hours).

This Google cache of a Blogger user profile page for "Pansophia" clearly links to "My Web Page," the said LiveJournal, and an as-yet-unused blog on "rankism".

This Google cache of a "Committee to Protect Bloggers" comment clearly shows a user "pansophia" defending their "Corporate Ethics" blog.

Maybe it's time for Help:CheckUser?

I think Wikipedia frowns on socks, but, unless they're used to promote the user's personal websites and to mislead the community, that seems to be veering outside the set bounds. I've never been dishonest about my edits, who I am, or how I edit. Every editor of Wikipedia likely has what you call "bias"; I have worked hard to make sure that I edit article from a WP:NPOV standpoint. I hope that other Wikipedians feel the same way. Justen Deal 21:15, 23 February 2006 (UTC)

[Justen] - The IP you list as a sock is not mine (To clarify, I'm not Ngk3, either). Period. Ask someone to run a traceroute and compare IPs. I hope other Wikipedians also frown on persisting in false accusations, particularly when they are being used as a prop in order to pull in other identifying information. I'd also like to point out that I went out of my way to show that I respected the Kaiser doctor's feelings when he was worried that I might name him. I doubt others who are relying on similar courtesies will appreciate your efforts to undermine that principle. --Pansophia 21:35, 23 February 2006 (UTC)
Justen, that is my IP as I have explained repeatedly, and I never claimed to be the author of the CorpHQ blog because I am not. Why would you make that up? I said I posted the links, not Pansophia. You are seriously out of line, and your behavior is typical of Kaiser employees. Your actions speak louder than any critic of Kaiser ever could. Ngk3 22:43, 23 February 2006 (UTC)
AND since you missed it the two other times I pointed it out (you should really bother to read what you are commenting on before you make a fool of yourself), that IP you're so fond of calling a Pansophia sock puts me in A DIFFERENT STATE THAN THE OWNER OF THE BLOG, who is clearly from Kaiserfornia. How you interpreted that as me claiming to be the owner of the blog is anyone's guess. You should be ashamed of yourself Ngk3 23:04, 23 February 2006 (UTC)
Please desist from attacking editors. Instead, please address only the edits. It does not matter if editors are in some way involved with the subject, only that they make good edits. If they don't then let's talk about the edits, not the editors. -Will Beback 23:08, 23 February 2006 (UTC)
I hope that is directed at Justen as well who has done most of the attacking. I have a right to defend myself against his false accusations. Ngk3 23:10, 23 February 2006 (UTC)
Yes, that is directed to the page at large. Let's all just avoid even mentioning each other's names, if we can help it. This shouldn't be personal. And vice versa, we should all try to leave our personal opinions behind when we log in. Our jobs, as Wikipedia editors, is simply to verifiably summarize reliable sources using the neutral point of view. We're not here to grind axes, even scores, re-write histories, or spin outcomes. And we're not here to draw our own conclusions either. Let's try to find a consensus over sourced material that includes all points of view. -Will Beback 07:42, 24 February 2006 (UTC)
Please take this suggestion at face value:-
  • consider moving the recent personal 'stuff' to personal talk pages
  • try to use personal talk pages for the personal 'stuff', leaving this talk page for discussion of facts and issues about Kaiser Permanente.
The personal 'stuff' can sometimes get a little heated, and it happens to everyone, so at least it will be more out of sight on the personal pages. This will make it much easier for newcomers to follow the main issues about the content of the main page Kaiser Permanente and more rapidly achieve a balanced text reflecting relevant POVs.
Talk - The Original Invisible Anon at 86.10.231.219 10:41, 1 March 2006 (UTC)

[edit] Infobox

Pansophia, please cease removing the infobox. It is not considered in any way an "advertisement," it is a standard feature of Wikipedia articles on corporations. See Apple Computer, US Airways and others. FCYTravis 19:33, 23 February 2006 (UTC)

Hi, Travis - is there anything you can do about the false accusation of sock puppetry above? Also, I just removed the logo and the CEO from the info box this time. Also, I think having the link to the corporate web site at the type is like an ad. Can we put a criticism link in the same area? --Pansophia 19:37, 23 February 2006 (UTC)
The logo and CEO are in the infoboxes for the examples he cited - why shouldn't they be here? I think that the logo of an organization is relevant in an article about that organization, no? As for sock puppetry, all he could (well, should) do would be to present some sort of disproof - deleting things from talk pages is generally considered a bad idea. Michael Ralston 20:23, 23 February 2006 (UTC)
Hi, Michael - What do I do to provide this disproof? Also, while I've been trying to avoid responding, I feel part of this has been trying to illicit identifying information. If I have to provide further identifying information, can I do this in private? --Pansophia 20:43, 23 February 2006 (UTC)
You shouldn't be bullied into disproving something Justen didn't prove in the first place, and I'm not sure why you would want to. *I* posted the link. Let me say it again for the hard of hearing: I POSTED THE LINK. Justen's accusations are contradictory because on the one hand he is accusing you of owning the blog while at the same time saying the links I added anonymously were added by you as well, when my IP identifies me as living in a different state from the person who runs the blog. Make up your mind, Justen. Ngk3 21:07, 23 February 2006 (UTC)
Actually, I don't think there's any sort of meaningful disproof you can present, Pansophia. An admin could use checkuser to show that, at least, you and anyone you're accused of sockpuppeting edit from different IPs. What I meant is that if you were asking FCYTravis to remove the accusation, that's not a good idea - if you were asking for someone to present evidence (of a sort that non-admin users cannot get directly) that the accusation is false, however, that would be okay. Michael Ralston 00:51, 24 February 2006 (UTC)
Well, I invite anyone to use the CheckUser process - I just wish they'd do it soon. I'm not concerned about the accusation, which should be easy to disprove, so much as Justen's elaborate attempts to construct my identity. This is affecting several people. --Pansophia 01:08, 24 February 2006 (UTC)

[edit] For-profit aspects.

Panosophia, do we really need to say that Kaiser benefits for-profit organizations on every line that anything relevant is mentioned? It seems redundant and messy.

Also, your edit summary makes me feel the need to remind you of WP:AGF. Michael Ralston 20:27, 23 February 2006 (UTC)

Hi, Michael - I agree, and I also want to gather some sources, but you guys are keeping me too busy with your criticism-deletes. Perhaps if you showed me a better way to present the not-for-profit/for-profit issue instead of just deleting it?
Ps. It's getting hard to WP:AGF because no one has addressed this sock puppet accusation.--Pansophia 20:52, 23 February 2006 (UTC)
I can't address that accusation, because I am not an admin - it would require an admin to use the checkuser tool to meaningfully address it. As for editing... I'm not simply deleting it. I'm deleting one of the references to it, because there were two sentences in different locations on the article that were almost identical. I removed one of them, again, not to remove the entire issue... but because I felt the other one was better, and that both were unnecessary. (The one I left seemed less judgemental, primarily by not citing irrelevant statistics.) Michael Ralston 00:54, 24 February 2006 (UTC)
What I would like to assure is that the challenge to Kaiser's not-for-profit status and the existence of critics remains in some form in the opening paragraph, since that encapsulates the whole thing. Also, I would appreciate some help with meeting the implied standards for statistics? The KaiserWatch (By the California Nurse's Association) was amazing, given how difficult it is for critics to access and consolidate that sort of information. --Pansophia 01:14, 24 February 2006 (UTC)
Okay. I think I'm going to try to completely rewrite the introduction - it's pretty crufty right now. I think that we should state there's a challenge to the for-profit status in the introduction, but not much more than that - the details belong in the article proper. As for statistics, mostly I mean that it doesn't matter how much money they're taking in for their profit/non-profit status - what matters is what they're doing with it. Michael Ralston 01:22, 24 February 2006 (UTC)
Sounds good. All I object to is this article becoming another arm in the Kaiser brand campaign. --Pansophia 01:29, 24 February 2006 (UTC)
Ps. Sorry for messing up the Infobox formatting. I can't figure out how to keep the text aligned.--Pansophia 01:37, 24 February 2006 (UTC)
By the way, good job on the intro, and thank you for removing the tags. I felt the only purpose they served was to assert one non-neutral point of view over another. --Pansophia 03:14, 24 February 2006 (UTC)
I'm glad the intro is an improvement - I may look at the rest of the article and try to consolidate various types of statements that are repeated, but for the moment I'm not touching it. As for the tags ... it's less POV now than it was. I still don't think it's truely NPOV, but I don't think we need a massive tag about that ... and the cleanup/copyedit tag, well, it's improving there for certain. Michael Ralston 03:21, 24 February 2006 (UTC)
I'd like to strive for NPOV just for the sake of being taken seriously. My thought is we should get there by adding info instead of just taking out the criticism, though. Thank you for taking that concern into account. --Pansophia 03:25, 24 February 2006 (UTC)
Well. There's a difference between taking out the criticism and refactoring it - if we throw a critical statement everywhere a positive statement might be made, we get an article that is, fundamentally, crap. Calling Kaiser a non-profit in a couple places, for instance, does not require us to bring up the criticism each time - as long as it's been clearly indicated already. Likewise, when we focus on the criticism, we don't have to leaven it with complementary prose at the same time.
In other words: There's a bit of a conflict between the basic principles of writing clearly and NPOV, sometimes, and we should try to focus on something that achieves both to a reasonable degree. Michael Ralston 04:47, 24 February 2006 (UTC)
Understood - that's part of why I created the separate criticism section in the first place. I doubt there's any such thing as true NPOV, though. It's sort of like Schroedinger's cat: it's either dead or alive once you look at it. I do think we can reduce loaded words on either side and work out a sort of balance, though.--Pansophia 04:56, 24 February 2006 (UTC)

(Resetting the indent. We're getting a bit silly at this point.) Oh, I agree. NPOV is something that can be asymptotically approached, but not achieved. At any rate... I'm pretty sure the two of us have a strong agreement both with one another and with WP as a whole as to what's desireable in an article - as long as we can keep that in mind, rather than looking at it as a platform for the advocacy of a position (which is a trap that is far too easy to fall into), we should be good. Michael Ralston 05:23, 24 February 2006 (UTC)

I'm thinking there should be a "I fought the Wikipedia Wars and Wikipedia Won" t-shirt. --Pansophia 05:29, 24 February 2006 (UTC)
Great, now my landlord's going to think I'm insane. You made me laugh out loud, quite literally. Good one! Michael Ralston 05:39, 24 February 2006 (UTC)
Heh, heh. Photoshop-powers activate! --Pansophia 05:45, 24 February 2006 (UTC)


Image:WikiWars.jpg



[edit] Infobox

Okay. We have a disagreement about the infobox. Let's try to work it out here, rather than edit warring over the article.

First off, let me present my position: This is an encyclopediac article, or at least it should be. As such, it should contain all significantly relevant information, and it should prioritize the information someone would want to find most easily. Kaiser's logo is relevant to anyone who wants to know about Kaiser, it seems Wikipedia considers the identity of the CEO of an organization relevant, and their website seems almost required - if someone, for instance, came to Wikipedia in order to find the website, they should be able to do so moderately easily; Kaiser's website should, in an article about Kaiser, stand out from all other links in some way.

Okay. someone who disagrees with me care to present your position on the situation?

I have mixed feelings about the logo. On the one hand, I see your point. On the other hand, a logo is a visual cue of something sponsored by a company. Here's a wild idea - perhaps balance the logo with some critical image?
My feeling about the KP web site is the same at the logo: putting it at the top and giving it priority transforms the article into a Kaiser ad. Maybe we should do a Pro vs. Con infobox instead of a corporate infobox?
As for the CEO, I continue to regard this as a vanity. It turns a role that Halvorson temporarily holds into something of historical significance. I actually think most of the "contemporary bios" on Wikipedia should be moved to a "Who's Who" instead of something serving as an Encyclopedia. --Pansophia 01:35, 24 February 2006 (UTC)
In reverse order first: Hmm. I see your point about the CEO, and while other articles on corporations list individuals who are less significant than the CEO as well... it's the least important disagreement on the infobox, and won't significantly harm the article if it's left out. So we'll do that, at least for now. If we want to revisit it later, say when more important disagreements are dealt with, we can, after all.
The website - we do the same for, eg, Apple Computer, and it's a simple fact that the most important website in regards to any organization is that organization's website itself - criticism may be noteable, but if a user wants to use this article only for very quickly getting some simple information about Kaiser, their website is quite likely to be one of those things - so I think it should stay, simply because it's more relevant to why they're in wikipedia than any other link on the article.
And onto the logo; I consider the website link a little more important, but the logo also matters. Again, I cite common wikipedia practice. Further, a logo is useful for identification, and presented independantly of any form of product significantly reduces the potential for "branding" to be relevant, so I don't really see it as indicating any sort of endorsement.
As for your suggestion about a pro v con infobox... I don't believe such an infobox exists as of now, and my primary stance here is that we should go for consistancy with how other articles on organizations are treated, at least as far as the infobox goes. Michael Ralston 01:52, 24 February 2006 (UTC)


Is there any standing debate on Wikipedia in regard to infoboxes? They really do strike me as an ad, especially with the logo at the top. I agree about the need to present quick-facts (maybe some other facts can go in there as well, such as fines levied?). All I want to do is prevent it from looking like an ad. --Pansophia 02:02, 24 February 2006 (UTC)
Not that I'm aware of. Now, if you were talking about *user*boxes ... but that's a completely different (and much worse) can of worms. ;) Michael Ralston 02:04, 24 February 2006 (UTC)
Also, thinking about it, if you want to get (corporate) infoboxes changed somehow... you should start here: [[2]]. Michael Ralston 02:23, 24 February 2006 (UTC)


Hmmm, I doubt my opinion would be very welcome there. It looks like the standard is being developed by business interests. :-/ --Pansophia 02:35, 24 February 2006 (UTC)
Well, it is by-default going to be developed by those with an interest in businesses. (A category, I note, that you seem to fall under). But as long as you present your opinion politely, I suspect you might find it can get more traction than you'd think. And even if not, I expect the majority will still be polite in response. Michael Ralston 02:39, 24 February 2006 (UTC)
Ok, I'll take another look at it to see if there's an opening for corporate-critical concerns. At first glance, it doesn't seem like a space has been created for that, though. :-( --Pansophia 02:55, 24 February 2006 (UTC)
I added my comment on the infoboxes here: http://en.wikipedia.org/wiki/Template_talk:Infobox_Company --Pansophia 03:01, 24 February 2006 (UTC)

In case this wasn't clear before: The presence in the infobox of the company logo and external link to their web page is entirely standard. Removing valid information from the infobox will be viewed as vandalism. Thank you, --MarkSweep (call me collect) 20:50, 25 February 2006 (UTC)

I view your continued reversion of my edits as a violation of the the Good Faith Assumption. I've repeatedly given my reason for removing the logo and personal-glorification of the CEO. These are extensions of Kaiser brand-building. I would regard it so in any context: I just don't have the energy to pursue it in regard to other company articles. I hope others will take another look at the propaganda affect of the Infoboxes and follow my lead on the subject, though. --Pansophia 01:05, 26 February 2006 (UTC)

The info box looks good "as is" (i.e. with logo and website) and appears to meet Wiki standards. I vote for keep. AED 01:30, 26 February 2006 (UTC)

I'm hoping others will join me in criticizing the Infobox, because it really does look like a classic magazine ad of a company. The people who developed the Wiki standard seem to be viewing this through the eyes of, say, stockbrokers looking for business information. Not everyone goes to an encyclopedia to further their business interest. Information featured in a special box should a) not constitute an advertisement (instant POV), and b) not consist solely of positive information. There's a lot of "warning" information that could be placed there, too. --Pansophia 02:49, 26 February 2006 (UTC)

You're the only one arguing for the removal of the company logo. The presence of the logo is entirely standard in articles about corporations. If you think it looks like an ad, you're reading too much into it. It's perfectly possible to write a positive, negative, or neutral article with that logo present (our task is #3). There is a consensus and precedent for keeping the logo. Your continuing removal against consensus is unjustified. --MarkSweep (call me collect) 04:57, 26 February 2006 (UTC)

Double or triple-teaming does not constitute consensus, your attempts to bully me in other ways (the WikiStalking and threats) are not serving as persuasion. I have offered my reasons for position on the logo, and I will listen with an open mind to people who show an interest in rational debate as opposed to bullying. --Pansophia 05:23, 26 February 2006 (UTC)
Ps. The slogan debate on the Infobox page suggests to me that Infobox policy as not as settled as you claim it to be. --Pansophia 05:24, 26 February 2006 (UTC)

[edit] External Links

In the interests of cleaning everything up a bit, I'd like to open a bit of discussion on the merits of each external link.

First: The Kaiser website. Per Wikipedia:External Links, we pretty much have to have it - and I don't think anyone disagrees.

Second: HARP.org. They're taking a critical stance, but they seem decently authoritative, and we should include links to the various POVs that are relevant - so, again, they belong.

Third: KaiserPapers and KaiserPapersHawaii. They're taking an extremely critical stance - I don't particularly like them, quite frankly; they seem rather polemical and biased. That said, I'm proposing ONLY removing the Hawaii one; it seems completely redundant, and where it's used as a source, I believe it's directly cited - thus, it's unnecessary.

Fourth: KaiserThrive. Also taking a critical stance, but of a specific issue. I say, for the moment, we should keep it.

Fifth, and last: Corporate Ethics. Critical, is on livejournal so it looks a little unencyclopediac to link to it, doesn't seem particularly objectively verified (so somewhat meets #1 of "links to avoid"), and seems to fall under #2 of links to avoid as well - I propose removing it, both for the reasons previously stated, and because the critical perspective is already significantly more represented than the other perspective, so it's redundant.

In summary: I want to remove Corporate Ethics and KaiserPapersHawaii as being redundant, and would like to see at least some sort of "response to their critics" or something else that's "pro-Kaiser" to help balance out the representation of the two POVs. Michael Ralston 01:42, 24 February 2006 (UTC)

I vote OK to removing the Hawaii site. I'd like to see Corporate Ethics stay (which again, I am NOT the author of), but I won't put up a fuss if I am out-voted. Ngk3 01:48, 24 February 2006 (UTC)
I don't think either link should be removed (and just to make my role in this clear - I think HARP was the only one I added). First the KaiserPapers one is extremely volatile: it gets taken down from time to time. However, the original KaiserPapers should remain because it offers humongous resources. The KaiserPapersHawaii one is, however, more stable, better organized, and contains additional material. As for the blog, it's not redundant to any of the above other than the fact that it's critical. Besides, many Kaiser employees post in the comments. I have no objections to adding another Pro-Kaiser one for balance, though.--Pansophia 01:52, 24 February 2006 (UTC)
Ps. I would factor who is doing the voting before bowing to a seeming majority here. There are at least three Kaiser employees who have posted on this talk page, and despite Will Beback's plea for editor neutrality, I feel they have formed an interest-bloc to extract the criticism from the article.--Pansophia 01:56, 24 February 2006 (UTC)
Okay. We'll leave the links as is for now, I guess; if I could add a Pro-Kaiser link, I would - but I don't know of one, offhand. So I'll just leave this as an open request to someone (Justen, perhaps?) who does know of one. Michael Ralston 01:54, 24 February 2006 (UTC)
Good points from Pansophia. Corporate Ethics does link to credible sources for the most part except when items are purely opinion, but then they are clearly identifiable as such. It focuses mainly on the problems Kaiser employees are having, which makes it not redundant in my opinion. I think I can find a pro Kaiser link Ngk3 02:01, 24 February 2006 (UTC)
(Post edit-conflict): Also, about the "who is voting"... can I point out that the two "votes" so far are among those OPPOSED to Kaiser? ;) My intention, right now, is to make no controversial edits to this topic at all - I'm presenting my logic in the hopes I can change the minds of those who are currently opposed to what I'm considering doing. Even if twenty people weighed in and said we should remove them, I wouldn't do it, as long as you and Ngk3 continue to disagree in a reasonable and polite fashion. (Admittedly, I wouldn't stop someone else from doing it either, but...) Michael Ralston 02:03, 24 February 2006 (UTC)
I pride myself in being a sweetie. :-) --Pansophia 02:10, 24 February 2006 (UTC)
I couldn't find a site that is dedicated to pro-Kaiser issues, but what about this article from MSNBC: Kaiser Permanente bucks the HMO trend? Ngk3 02:18, 24 February 2006 (UTC)
Good idea. It certainly indicates clearly what good Kaiser is doing/can do - which, I note, is (it seems to me) almost completely unconnected to the criticisms, which is probably a good thing - since that's not merely taking a "he said/she said" attitude. I'll go put it in now. Michael Ralston 02:35, 24 February 2006 (UTC)
No objection to the link, but as an aside I'm wondering if the decrease in cardiac-deaths can be related to Kaiser's success in recruiting younger members, particularly through employer-sponsored insurance deals...? --Pansophia 02:52, 24 February 2006 (UTC)
By the way this is the explanation I got for Kaiser's claim to lower cardiac deaths: "Kaiser achieved this only by talking 25% of the patients out of intensive care so that this group of the sickest and oldest of the patients were counted as Dead at the Scene when they died in the hospital." Does anyone have a source for that? --Pansophia 00:39, 25 February 2006 (UTC)

" KaiserPapers.info - The Kaiser Papers (personal accounts, news, etc.). Critical of Kaiser." Comparing that to WP:EL and WP:RS which of the points on why not to link to such sites does it not score on?

"KaiserPapersHawaii.org - Kaiser Papers Hawaii: Help for Kaiser Permanente Hawaii Members, member of Managed Care Watch. Critical of Kaiser." This doesn't reach various standards for medical websites, and doesn't seem a clearly reliable soruce - that being what WP should be based upon.

"MSNBC - "Kaiser Permanente bucks the HMO trend" " News coverage. Is it likely to be ephemeral? I'd think there are at least a couple of better analyses - helath economics publications for instance.

"KaiserThrive.org - web site that offers criticism of Kaiser's Thrive campaign, member of Managed Care Watch. Critical of Kaiser. " Very meta - about an advertising campaign. Also ephemeral, and less than obvious in its basis.

"Health Administration Responsibility Project - anti-HMO organization. Critical of Kaiser." This meets the usual standards for eg a Honcode site AFAICS, and seems to me to meet the bar for admission. WHether it is useful is another matter, and whether it should be a referecne for the HMO article rather than for a KP one is another question. But it isn't clearly dud. Midgley 22:59, 13 May 2006 (UTC)

[edit] The West Wing

While I agree that there's no way to prove Kaiser hired Alison Janney to suggest the White House, is there anything I can do to research the marketing strategy issue and present it in a way that meets Wikipedia standards? --Pansophia 01:53, 24 February 2006 (UTC)

Well, I can envision a couple ways it COULD be proved, at least to our standards. What I'd suggest doing, for the moment, is to research the issue and bring it up here; after all, if we discuss edits before they happen, it'll be a lot harder for them to be problematic, neh? Michael Ralston 01:56, 24 February 2006 (UTC)
Sounds fair!--Pansophia 01:57, 24 February 2006 (UTC)

[edit] Changes

I put the logo back into the infobox, as well as the link to kaiserpermanente.org. No valid reason to leave out simple facts from this article. I removed the blog link and HARP.org. Blogs should rarely be used as links, and HARP.org didn't seem to have much specific info about Kaiser Permanente. I also separated the criticism in the external links section, the official website should be the first thing we link to from a company's article. Rhobite 18:26, 24 February 2006 (UTC)

Hi, Rhobite - if you read all of the above, you can see we finally got a productive editing process going on here. Please consider participating in the negotiations toward an NPOV article instead of just making deletions. All matters above are being discussed. --Pansophia 19:12, 24 February 2006 (UTC)
You are the one deleting the company's logo, putting a livejournal as the first external link (above KP's official site), and putting in incorrect revenue numbers. Please discuss why you feel a blog should be linked from the article instead of KP's official site. Rhobite 19:21, 24 February 2006 (UTC)
I strongly oppose linking to a Livejournal site from a Wikipedia article. And I see no reason to deny readers certain factual information, such as the company's logo and the list of key people. Rhobite 19:29, 24 February 2006 (UTC)
I didn't add the infobox in the first place and don't know anything about the revenue numbers - feel free to change those. The oher issues are all discussed above, in the name of using Talk pages to avoid edit warring. We came to a compromise after much work yesterday. Also, since you're also showing an interest in the Rankism article, I'm wondering if your actual problem is with me? --Pansophia 19:38, 24 February 2006 (UTC)
Pansophia, your edit summary said "please see discussion" when you removed the corporate logo, but not a single user on this talk page has agreed with your decision that the logo should be removed. Every other company article on Wikipedia shows the logo, lists key people, and links to the company's home page. Why is Kaiser special? Rhobite 19:40, 24 February 2006 (UTC)
The agreement was to talk it out here, and we came to some agreements by doing things that way. On the advice of Michael Ralston, I submitted my problem with the infobox on the infobox page. I don't believe Kaiser is special in this respect: I don't believe Wikipedia should be running corporate ads at all. --Pansophia 19:47, 24 February 2006 (UTC)
It looks like you were discussing the links (I still don't think a Livejournal blog has any business in a Wikipedia article). I don't see any other user who agreed to remove the company's logo, or the list of officers, from this article. Also, Albert Brooks is a humorist. An Albert Brooks column does not equal "controversy". Rhobite 19:59, 24 February 2006 (UTC)
Look further up, for that one. As for the livejournal being the first external link, that was me - I sorted alphabetically. Michael Ralston 20:36, 24 February 2006 (UTC)
Hi, Michael - the 3R rule is only being applied to me, but not Rhobite or MarkSweep. I can only make really major changes. I don't mean to efface your changes. Hopefully we can edit it back down later. --Pansophia 20:46, 24 February 2006 (UTC)

(Indent reset) Yipes. This is definitely returning to being an edit war. Making massive changes for the sake of avoiding 3RR doesn't seem wise - I think most people would say that still constitutes a 3RR violation. That said, MarkSweep, you should know better! It's not simple vandalism, and Pansophia is and has been talking on this page! All that said ... people, can we try not to make disputed edits repeatedly? We could at least talk about them first. Michael Ralston 20:54, 24 February 2006 (UTC)

Suggestions? --Pansophia 20:58, 24 February 2006 (UTC)
By the way Rhobite also went to the other page I try to look after, so I think he just dislikes me. --Pansophia 21:03, 24 February 2006 (UTC)

Pansophia, I removed the "What to do if a loved one is harmed by Kaiser" section because I think it belongs in another article, perhaps for victims of HMOs in general. If we're working toward neutrality I don't think that was heading in the right direction. Ngk3 22:55, 24 February 2006 (UTC)

I agree on the neutrality goal, but I'm not sure what else to do here. Rhobite and MarkSweep made unilateral changes, avoiding the talk process we were working on yesterday. Whenever I bring provocation up (the false sockpuppet accusations, other people's violations of 3RR and AGF, the Wikistalking), the admins just ignore me. What I'd like is for someone who really is neutral to come in and reinstate the process we had yesterday. Other than that, all I can do is add a lot of new stuff and hope the editing process pushes it in a neutral direction. --Pansophia 00:14, 25 February 2006 (UTC)
Okay, I removed the Tahoe and Bonds stuff because I don't think I'm going to get around to editing it tonight. Still object strongly the Kaiser logo. --Pansophia 01:40, 25 February 2006 (UTC)

[edit] NPOV tag

Due to Pansophia's anticorporate muckraking I've placed a NPOV tag on the article. There is far too much opinionated text about the nonprofit status, the Dylan commercial (a handful of blog links are not a controversy), the evil bonds, etc. Rhobite 20:50, 24 February 2006 (UTC)

There needs to be some balance to the Pro-Corporate infobox. And since I can't appeal to the 3RR rule, this is all I can think of. --Pansophia 20:57, 24 February 2006 (UTC)
An infobox is just raw data, it cannot express an opinion. How is it opinionated to note that KP is based in Oakland, or that they have 145,000 employees? Rhobite 21:02, 24 February 2006 (UTC)
The main thing is the logo makes it look like an ad. I'm ok with quick facts at the top, though I wish there were some critical ones. --Pansophia 21:04, 24 February 2006 (UTC)
Editors were already admonished for getting personal and asked to avoid mentioning each other's names when discussing the edits. Can you please respect the progress we've been making in the discussion? Otherwise it will be impossible to come to any kind of agreement. Thanks. Ngk3 21:37, 24 February 2006 (UTC)

The NPOV concern is justified. Please do not remove these tags unless there is agreement that the article conforms more closely to the NPOV policy. --MarkSweep (call me collect) 04:52, 26 February 2006 (UTC)

The tag-mongering is being used as a weapon to impose a particular editorial stance, which goes against the very spirit of NPOV.--Pansophia 07:16, 26 February 2006 (UTC)
I think the article is looking significantly less POV now than it has in the recent past. There are a few issues, yet, but quite frankly I think we need a cleanup tag and not an NPOV tag, at this point. Michael Ralston 07:20, 26 February 2006 (UTC)
I agree that the article has come a long way towards NPOV, especially with User:Pansophia's recent edits to improve the article. Nevertheless, the article still has not achieved NPOV. I think the tag needs to stay, for now. (Afterall, the tag itself says the neutrality of the article is "disputed", and I don't believe anyone here would argue that there isn't an ongoing and substantial dispute as to the article's POV, even with the most recent edits.) Justen Deal 07:37, 26 February 2006 (UTC)
An article with a substantial critical component and stripped of propaganda value will never be neutral from the Kaiser pov. For instance, do you see yourself arguing it's not "neutral" unless it has the Kaiser logo featured in a prominent place? --Pansophia 07:51, 26 February 2006 (UTC)

[edit] Tahoe and Bonds sections

I'm not sure if I've seen a more opinionated group of words ever appear on Wikipedia. "Both were millionaires" and "making...profit...[during]...the depression"? And "the flow of money" has "been kept as secretive from the public as the missile launch codes of the President"? I can't even begin to dissect the Bonds section...

Of course, the POV is a big deal, but it is also quite remarkably poorly written. It actually doesn't appear to have been written, but merely translated from jotted notes or something. These sections need to be removed until they can be written NPOV and with proper grammar and syntax. Justen Deal 00:16, 25 February 2006 (UTC)

As I said in the edit summary, it was a stub which I was working on. I will work on it a bit more on a scratch pad first. Also, I'm still waiting for your apology for the false accusation of sock puppetry. --Pansophia 00:21, 25 February 2006 (UTC)
The Arbitration Committee has ruled that, for the purpose of dispute resolution, when there is uncertainty whether a party is one user with sockpuppets or several users with similar editing habits they may be treated as one user with sockpuppets. See WP:SOCK. The editing habits between User:Pansophia and User:Ngk3 were, and continue to be, remarkably similar. The edits continue to be intertwined (although they have become intriguingly more conversational since I raised concerns about WP:SOCK). And it continues to be the case the User:Ngk3 claims to have added the link to User:Pansophia's blog, a link which User:Pansophia later modified on several occassions, and a link which, to date, has only been supported by, not surprisingly, User:Ngk3 and User:Pansophia. "Both" user(s) may feel free to submit their request to Help:CheckUser if they're looking for some sort of "exculpatory" evidence, as the CheckUser Policy states: It is allowed to check an editor ips upon his specific request, when this user wants to publicly prove his innocence. I believe this can be accomplished by contacting an person on the CheckUser permissions list. (I should clarify that I'm in no position to require, and do not demand anyone to do this... Regardless of what IP addresses User:Pansophia and User:Ngk3 have edited under recently, the other evidence clearly indicates, WP:SOCK, in my opinion. Justen Deal 02:53, 25 February 2006 (UTC)
So, if two or more different people disagree with you (and particularly that you represent the neutral point of view) they must be "sock puppets"? Moreover, you seem to be saying both that our editing patterns are similar, but that I have modified the edits of those other people? (Not to mention, they've edited me). All you've been doing here has been trying to push your edit as the "neutral" one. I've already asked for the CheckUser (via email complaining about your ongoing false accusations). You owe me an apology. --Pansophia 03:22, 25 February 2006 (UTC)
Ps. By your theory Rhobite, MarkSweep, and yourself must be sock puppets for all promoting the Kaiser logo and "intertwining" to try to make me an administrative problem for opposing your edits.--Pansophia 03:47, 25 February 2006 (UTC)
Justen your accusations are ridiculous and I feel no need to prove anything to you. YOU can believe what you want to believe and the only thing I'm requesting is that this conversation about the sock puppet issue stop because it detracts from the issue at hand. I'm requesting this of both you and Pansophia. I'm going to explain something one more time for the benefit of other editors who may be misled by your patently false claims and then I won't be defending myself again.
My IP is known from my early anonymous posting of the links. Justen has posted what he believes to be some sort of proof that Pansophia is the author of the blog in question. A simple check into the hostname and location of my IP proves it is a residential cable account that I couldn't forge or access from 2500 miles away from the author of the blog, whose location is documented. I'm not being specific because I think enough personal information has been revealed here to last a lifetime, but anyone who wants to spend 5 minutes looking could figure it out for themselves.
If Pansophia would like to exonerate herself that is her business, but will you please take it out of here and onto your talk pages. I can't imagine that the other editors would disagree. Ngk3 03:31, 25 February 2006 (UTC)

[edit] How to Add to Info Box?

I'm trying to add the number of OSHA Violations since 2000 (with source footnote) to the Infobox, but I can't figure out how to add a new item. Does anyone know how this works? --Pansophia 00:54, 25 February 2006 (UTC)

That isn't (and shouldn't be) a supported parameter of the infobox. It isn't of interest to the vast majority of encyclopedia readers, and it isn't relevant to many companies. It is also a very U.S.-centric thing to add. I understand that you're on a major quest to add every bit of information which reflects negatively on Kaiser Permanente, but Wikipedia isn't the right place to do it. Rhobite 01:06, 25 February 2006 (UTC)
You seem to be assuming that the vast majority of encyclopedia readers are interested in management or shareholder information as opposed to employee-relevant information?
I could certainly add a lot more if I wanted to include "every bit" of negative information on Kaiser Permanente. I've only added some highlights. All I'm trying to do here is to keep this article from becoming Kaiser propaganda. That doesn't belong on Wikipedia, either. --Pansophia 01:15, 25 February 2006 (UTC)
Pansophia: I think you would be wiser, right now, to look for citations supporting the criticism section (and maybe copyedit it a bit), than to edit war over the infobox. To get a change on the first is easy, to get a change on the latter is not likely to happen, and almost certain not to happen the way you're doing it. Michael Ralston 01:15, 26 February 2006 (UTC)
I don't wish to edit war, but it's an issue I feel strongly about. With all the other focus on NPOV, how can people be missing that privileging the corporate logo in a special box constitutes a free advertisement? I honestly don't understand why there's so much support for these Infoboxes. From my perspective, it also looks like people are acting just on hostility toward me [for instance, FYCTravis making a revert back to a crappy page just to undo my own revert that actually worked in his favor].
I hadn't considered the issue at all before the past few days - my current suspicion is that people don't view it as being any more of an ad than the simple existance of an article, and they figure that as it's simple verifiable facts, there isn't a POV to it, and people who look merely at the infobox don't care about criticism anyway. Michael Ralston 03:34, 26 February 2006 (UTC)
I've added to my argument on the Infobox page - but so far the response has been from people with a vested interest in the Kaiser article. :-( --Pansophia 03:54, 26 February 2006 (UTC)
I am open to hearing your "other ways" of being heard on this issue. I don't think it's going to get a hearing on the Infobox page you pointed out because those are all people with an interest in developing the Infoboxes. Is there an existing Infobox protest movement? --Pansophia 02:55, 26 February 2006 (UTC)
As to that ... I honestly don't know. I'm just certain that edit-warring over something like this is not going to accomplish anything, except maybe to get yourself removed from the encyclopedia. Michael Ralston 03:34, 26 February 2006 (UTC)
What I also don't get is why the "edit war" and 3RR comments are focused on me (except the one at the bottom of the page, which for once is stated neutrally). Other people are making their edits, too - including a lot of reverts. Today at least there was a significant advantage on the Kaiser logo side - so in aggregate the 3RR is on the other side. Moreover, Rhobite and MarkSweep, are following me to another page. While I have raised the potential bias of Kaiser employees, I've never called to ban them. In short I feel like the Wikipedia rules are being used to block me specifically instead of being applied equally to all. This isn't fair. --Pansophia 03:52, 26 February 2006 (UTC)

[edit] Tahoe/Bonds

I'm not going to keep use up reverts on this and be accused of 3RR later. I don't think people want the unedited Tahoe/Bonds thing in there. I'm probably not going to get around to editing it. I deleted it on request. Unless you're just restoring it just to set me up in some way, please revert back to an edited version. --Pansophia 06:18, 25 February 2006 (UTC)

Thank you. --Pansophia 06:28, 25 February 2006 (UTC)
Idly, if you'd like some help working on this, I'd suggest sticking it on a subpage of your userpage and asking for some editing help. Michael Ralston 05:31, 26 February 2006 (UTC)
Probably not anytime soon. What I mainly wanted was to have something to work on while I was waiting for the 3RR 24 hours to go by, and I wanted to add my own stuff so people would have to work on the critical aspects and Rhobite and MarkSweep wouldn't just get away with ruining our agreement to talk it out here. However, they did get away with it, so there's no point in clogging up the article with stuff it would take me forever to edit all by myself. I'm taking their ability to just undo our agreement to heart, though. --Pansophia 06:59, 26 February 2006 (UTC)

[edit] Lack of citations

RE: "Kaiser's policy of forcing patients with malpractice claims into arbitration has been highly controversial. In 1991, Wilfredo Engalla died after waiting six months just to have an arbiter appointed. The California Supreme Court found that Kaiser had a financial incentive to wait until after Engalla died; his spouse could recover $500,000 from Kaiser if the case was arbitrated while he was alive, but only $250,000 after he died. Patients and attorneys continue to fight for the right to sue." These things may be true, but I would like to see some sort of verifiable reference or link for these assertions: 1) that Kaiser unduly forces patients with malpractice claims into arbitration, 2) the Wilfredo Engalla story, and 3) the California Supreme Court's rulings. I would also like to see some clarification about what is meant by "fighting for the right to sue". Since when do people not have the right to sue? AED 01:26, 26 February 2006 (UTC)

A quick google turned up what I, at least, would consider confirmation for the Wilfredo Engalla story (and related supreme court rulings), by the way. [[3]] and [[4]], for instance. As for the "right to sue", don't look at me on that one. And for the arbitration... those two indicate that Kaiser's agreements somehow compel arbitration instead of simple lawsuits, at least in certain situations. Michael Ralston 02:04, 26 February 2006 (UTC)
Thank you for going through this trouble. The "right to sue" issue does refer to Kaiser putting forced Arbitration into its member contracts. This is one of the biggest criticisms of Kaiser. Is there a better way of putting it? --Pansophia 02:43, 26 February 2006 (UTC)
Source it. Source it, source it, source it. If we have several citations per sentence, well... that's ugly, and we'll want to remove some, but it becomes hard to argue with simple inclusion at that point. Michael Ralston 03:30, 26 February 2006 (UTC)
Also, this is a sample lawsuits. I have many other examples: does it count as better sourcing of the generalization to add more? --Pansophia 02:45, 26 February 2006 (UTC)
Source them individually - maybe in references. But in general, the more reliable sources you provide, the better. Michael Ralston 03:30, 26 February 2006 (UTC)
Ballpark number? --Pansophia 03:32, 26 February 2006 (UTC)
Arg! I lost all the lawsuits I've been working on for the last hour in an edit conflict with AED. :-( --Pansophia 04:56, 26 February 2006 (UTC)
Michael Ralston, thanks for the references. RE: The California Supreme Court found that Kaiser had a financial incentive to wait until after Engalla died; his spouse could recover $500,000 from Kaiser if the case was arbitrated while he was alive, but only $250,000 after he died[4]. Not being a lawyer, I have difficulty interpreting the Court's opinion to determine whether they think Kaiser intentionally delayed. Anyone? AED 05:22, 26 February 2006 (UTC)
Engalla was one of the citations I was trying to put in when I lost all my edits. :-( http://www.fos-adr.com/engcasup.html --Pansophia 05:26, 26 February 2006 (UTC)
By the way, Pansophia, do you happen to have a link to the trial court's second decision? That would be slightly better than the Calif Supreme Court, primarily because the CSC did toss it back to the trial court for some findings of fact. Michael Ralston 05:34, 26 February 2006 (UTC)
Haven't figured this out yet, but there's an interesting left turn from this case to a corrupt lobbyist: http://www.consumerwatchdog.org/corporate/nw/?postId=3674&pageTitle=Attack+On+Big+Business

RE: "Notable recent lawsuits include Gary Rushfords attempt to use proof of a physician lie to overturn an Arbitration decision [5] and Chant Yedalian's lawsuit based on unfair business practices.[6]" Filing a suit and winning a suite are two different things. Unless these people have won their suits, neither are notable or worthy of inclusion. AED 06:09, 26 February 2006 (UTC)

Chant appears to have been at least partially successful - his suit was settled [[7]]. Haven't looked up Rushford's, yet. Michael Ralston 06:12, 26 February 2006 (UTC)
There are many reasons why suits are settled. It looks bad, but settling doesn't mean nor tell us that Kaiser was at fault. AED 06:20, 26 February 2006 (UTC)
I've talked to all these people personally, so I'd like guidance to satisfy the sourcing requirement and get as much on the table as possible. Part of the problem with Kaiser settling these suits is then no one ever knows what happened. Also, I'm not sure what to do about citation for the union issue, since the specific complaints came from private communique with union steward. I can probably find a general reference to Kaiser/union strife. --Pansophia 06:26, 26 February 2006 (UTC)
Can't really help you here. Personal communication inserted into the article is equivalent to original research. Doctors and hospitals make mistakes, so settling in the case of malpractice isn't unique to Kaiser anyway. Settling to cover-up business practices unique to Kaiser is more interesting, but then you need evidence of a cover-up. AED 06:35, 26 February 2006 (UTC)
Well Kaiser's Labor Management Partnership is a novel business practice, so it's important to address it. All of Kaiser's propaganda is laudatory, but all I hear about it are employee complaints about Labor Leader Management Collusion... --Pansophia 06:43, 26 February 2006 (UTC)

RE: "Kaiser, along with other HMOs, have come under fire from advocacy groups such as HARP and Kaiser Papers for an alleged policy of withholding information about costly medical services in order to control costs.[4]." The citation is for an article in the Journal of Healthcare Marketing, but it is not clear what specific statement it is actually referencing. Does the article state "Kaiser is withholding information about costly medical services in order to control costs" or does it state "Kaiser, along with other HMOs, have come under fire from advocacy groups such as HARP and Kaiser Papers for an alleged policy of withholding information about costly medical services in order to control costs"? In other words, does the article actually mention HARP and Kaiser Papers? If not, the statement needs to be changed. AED 05:50, 26 February 2006 (UTC)

I see. The citation needs to go at the end of the paragraph. It's the source of the HMO cost-containment strategies. I'll fix it. --Pansophia 05:59, 26 February 2006 (UTC)
AED I've spent a substantial portion of my night gathering more sources for you, and now you decide that pointing out the specific lawsuits are now "POV"? That doesn't wash at all. I'm starting to question your POV as a physician (ophthalmologist?) is coming into this. --Pansophia 08:24, 26 February 2006 (UTC)
Gathering sources for me? First of all, you should be doing it for the good of the article. Secondly, as I mentioned above (we're posting in the wrong part of the thread if we're discussing your Rushford link), filing a suit and winning a suit are two different things. Thirdly, stick to the article, play nice, and please don't stalk me. AED 08:46, 26 February 2006 (UTC)
You are the one who placed all the "fact" requests. I've been working all night to fulfill them. I don't see how now opposing their removal is "stalking". Furthermore, even if the Rushford's lost their case, they are an important instance of finding a way to challenge Kaiser in court despite Kaiser's attempt to force arbitrations. --Pansophia 08:49, 26 February 2006 (UTC)
Firstly, I don't believe I was the one who put all the fact requests up, but I certainly agree that unsubstantiated assertions shouldn't be allowed to go unchallenged. Secondly, simply because you put some effort into looking up a link that you think is appropriate, doesn't necessitate that the link is appropriate in context. Thirdly, that we disagree what should be in the article isn't stalking, but looking up things about me or my interests might be. Finally, the critique that Kaiser's arbitration policy isn't liked has been made...and made...and made...and made. (By the way, you're welcome for the effort I have put into formatting your links properly.) AED 09:00, 26 February 2006 (UTC)
I apologize for attributing all the fact requests to you - some of those were from Michael Ralston. And thank you for formatting the links in some preferable way.
As for looking you up: there was a request for Mediation for this article - I looked up everyone who might be involved to determine whether such Mediation would be fair. I haven't followed you around or messed with your edits elsewhere. I'd like to note however, no one has frowned on MarkSweep for doing the same to me. I feel like a lot of "weasel wording" has been used (mostly in NPOV-posing) to suppress my efforts to maintain the criticism article: notice how you are merely "challenging" while I must be doing something administratively, philosophically, or inherently wrong for maintaining my own challenge? These are unfair tactics, and it makes it hard for me to see people as acting in good faith when they use them. --Pansophia 09:14, 26 February 2006 (UTC)
I did add some, yeah. I figured it was probably necessary - sources help. And this way, I have somewhere to start looking for if and when I go to expand some of those paragraphs, which could probably use expansion; they tend to read like a giant list of All That Kaiser Can Do Wrong, which doesn't mean they're invalid - but does mean they're not yet as well-written as they could be. Michael Ralston 19:14, 26 February 2006 (UTC)
This List o' Wrong effect is partially coming from separating out the criticism. I'm starting to think this was a bad idea. Any thoughts on that? My thought is the Kaiser people who hang out here can always add accomplishments. However, a lot of the accomplishments Kaiser claims in the media are open to challenge (I listed the critique of the cardiac "progress" on this page, though I haven't added it to the article). If someone lists an accomplishment that's just Kaiser propaganda, I feel obliged to add the criticism. This is why I feel like the NPOV thing will go on forever. --Pansophia 20:04, 26 February 2006 (UTC)
I get the List o' Wrong effect not from the separated critism - but because a lot of the criticism gets maybe a sentence. If there was, say, a paragraph per piece of criticism, I think it would be clearer, indicate a bit of the nuance that's probably there, and generally sound less like a mudslinging list and more like reasoned criticism. Which is better all around, yes? Michael Ralston 20:40, 26 February 2006 (UTC)
Okay, I'll try to add to it. I just came across another "separate criticism" concern, though. In the links, the critism is cordoned off in a special section. However, the pro-Kaiser link is given "neutral" status under External links. That doesn't seem right. I think the links should be re-combined, but we should identify the critical ones in the link description. --Pansophia 20:50, 26 February 2006 (UTC)

[edit] Three revert rule warning

To all editors: Please do not keep undoing other people's edits without discussing them first. This is considered impolite and unproductive. If you continue, you may be blocked from editing Wikipedia under the three-revert rule, which states that nobody may revert an article to a previous version more than three times in 24 hours. (Note: this also means editing the page to reinsert an old edit. If the effect of your actions is to revert back, it qualifies as a revert.) Thank you. ≈ jossi ≈ t • @ 03:23, 26 February 2006 (UTC)

Hi, Jossi - thank you for covering all editors with this. The problem is there is a fundamental agreement about infoboxes, and so making edits back and forth is the only thing people can do. Discussion has occured, but it isn't helping. I have offered the compromise of a modified infobox, but no one finds that acceptable. --Pansophia 03:30, 26 February 2006 (UTC)


[edit] Treatment of Criticism of Kaiser

Cases where I think it would be appropriate to keep critical items are listed below and I'd be interested in adding to the list. Otherwise I think that criticism should be moved to the appropriate areas of the Criticism section. Codifying this sort of rationale should help greatly with editing this page. Antonrojo 19:42, 6 March 2006 (UTC)

Reasons for keeping critical statements outside of the Criticism section (a working list):

  1. Major landmarks (such as government reports, notable penalties)... Antonrojo 20:32, 6 March 2006 (UTC)
    1. Criteria for major include the event or report being reported in a major news source or that a fine, case, etc. would be considered notable by a legal, etc. expert in that area Antonrojo 20:32, 6 March 2006 (UTC)
  2. Doing so is justified in proportion to the extent that the critical view is believed by people who know about Kaiser, in keeping with [WP:NPOV:Undue Weight] Antonrojo 20:32, 6 March 2006 (UTC)
  3. When the statements are supported by 'Good Research' by a consensus of page editors [WP:NPOV:Good Research] Antonrojo 20:32, 6 March 2006 (UTC)

WP also includes the suggestion not to delete critical statements outright [WP:NPOV:Deletion]

Also, I had added what I thought was relevant information about criticism of Kaiser's quality of patient care: a recent survey of HMOs by Consumer Reports which ranks Kaiser as having the top patient care in most categories. I have readded this link since I think it is relevant. Comments on Talk explaning why this might not be the case and/or criticisms of the Consumer Reports study within the article are welcome. Antonrojo 20:32, 6 March 2006 (UTC)

Hi, Antonrojo - My concern about the Consumer Reports link is that it doesn't seem to say what you think it does. If I'm reading it correctly, Kaiser mainly got high scores for its customer service representatives, not on issues surrounding medical care. The medical stuff is all average. Even if we were to translate "average" as "satisfied", I'd want to ask a few questions about who was polled for the survey. While I don't have any big statistics database at my disposal, I've been following the complaints about Kaiser for quite some time. My own experience as a patient at Kaiser was quite bad - mainly because the doctor dawdled around before considering the expensive diagnosis (and it was quite obvious that Kaiser policy is for doctors not to diagnose at all if they can help it, since any statement of fact will pin Kaiser down on something. Moreover I have permanent scars from a botched procedure right before I lost my coverage. If this were just me it would be one thing, but these same compaints are repeated over and over and over again. Kaiser offers a lot of conveniences if you're not actually sick or if you have a chronic condition that Kaiser can run through an automated cycle of "medical management", but the doctors are not proactive or creative when it comes to dealing with individual patients. I can see where Kaiser's administration is mostly responsible for that, but it's not helping anything to deny it. Kaiser should stop complaining about "hit pieces" and scrambling to manipulate public perceptions and start using the criticism as a touchstone to make progress as a health care provider. --Pansophia 02:22, 12 March 2006 (UTC)
Ps. Thank you for going through all the work of codifying the rationale for criticism. I'm also going to look into the Consumer Reports survey and may add it back myself. My main objection is that it was placed in such a way that it made it look like patients were satisfied with medical care. --Pansophia 02:26, 12 March 2006 (UTC)
Just a quick response (I may add more later): I think it's important that both criticism and praise be put into context. I'm sure all large companies have lawsuits, OSHA violations and displeased customers. In my mind, focusing on detailed cases is important but I'd also like to know how they compare to other companies in their industry and and of similar size. The conclusion I draw from the report I cited is that the majority of enrollees are generally satisfied with their plan and the mostly routine care they received (also my personal experience as a plan member in the past for about 15 years). A nonbiased survey focused on patient care and/or non-routine procedures would of course be more useful, although for various reasons including confidentiality issues and a lack of data sharing among medical institutions, I doubt this exists. Antonrojo 14:21, 14 March 2006 (UTC)

(tab reset) A little more detail on survey methods used by the Consumer Reports survey: the surveys are based on random samples of their customers. They are generally noted for being one of the best sources of unbiased product and company ratings. Again, other patient survey data is welcome and see above for my reasons on why I don't think good publically available data on patient care can be found. Antonrojo 13:52, 31 March 2006 (UTC)

  • Hi, Antonrojo - If you swing back by, check out my revision of the Consumer Reports survey to see if it's an acceptable compromise. Again, my only objection was that the survey seemed to indicate satisfaction with customer service. I wish there were more details about what this entailed, because I'm not sure whether they are talking about call centers, building concierges, waiting room environment, or whatnot...--Pansophia 02:02, 9 April 2006 (UTC)
Pansophia, the edit looks fine. Adding a new issue below although this section is getting unweildy. Antonrojo 17:31, 19 April 2006 (UTC)
  • Mentioning criticism of nonprofit status in heading section:

I don't think this belongs here for the numbered reasons above. Also, I think the header is meant as a 'who, what, where, when, why' type of description unless there is strong consensus regarding both positive or critical opinions related to the def.

I think a good example is the Slobodan Milošević article header does a good job of this by focusing on formal charges and indictments rather than the (well founded and widely supported) view that he is in fact a war criminal. While it might not be appropriate to allow his untimely death to allow this question to remain open in the definition, there is a strong background of international consensus that he is a war criminal. For Kaiser, I don't see a strong consensus for the view that they should not have non-profit status or any institutional action against them. Evidence that Kaiser channels funds to for-profit orgs in ways that violate non-profit laws is essential and I don't think this Kaiser Papers citation [8] provides it. Antonrojo 17:31, 19 April 2006 (UTC)


Arg! I'm kicking myself right now. I just saw a great article about the confusion between patient satisfaction scores and quality of care - and the fact quality of care criteria contradicts the subjective reports of satisfaction. I meant to save that for you! I'll try to find it. As for Kaiser, I hope you're following the whole Kidney Transplant debacle. --Pansophia 04:53, 7 May 2006 (UTC)

[edit] Wiki Links to Years

I'm curious if there is a policy for linking citations for years and for that matter months + days. This article, like many, is a mixed bag. For example, Ford links years and not, dates like December 2 and not. How are these links useful other than by making them jump out at readers? Antonrojo 19:59, 6 March 2006 (UTC)

If I understand the policy, years should not be linked in this article although it's widely done in Wikipedia. Antonrojo 18:25, 13 March 2006 (UTC)
That is the correct interpretation. We link full dates (March 13, 2006) but not years. We only link full dates because then the user preferences can re-arrange the date elements. -Will Beback 20:35, 13 March 2006 (UTC)

[edit] Status?

There was a request for mediation made. Argument appears to have calmed. -Ste|vertigo 04:03, 31 March 2006 (UTC)

  • Whatever the status, I don't think the argument could be resolved through mediation because there wasn't a balanced panel of signees. There are significant issues that remain to be addressed. For instance, I still feel that the infobox with the corporate logo amounts to Kaiser branding. --Pansophia 01:59, 9 April 2006 (UTC)
After reading over the request, it looks like maybe 25% of these are dead issues. I think that an outside POV on the remaining issues would be useful for the article so I added myself to the mediation request. A peer review might be more appropriate to get this input and at least the request should be edited or resubmitted.
Pansophia: what do you think a balanced panel would look like? I think the only requirement is that there be a representative sample of major contributors. Antonrojo 16:26, 19 April 2006 (UTC)

[edit] Labor

This text:

  • Kaiser union members have criticized Kaiser's Labor-Management Partnership (LMP) as an arrangement that's disadvantageous for workers. Union leaders bargain with management, and then present the outcome to workers as a non-negotiable fait accompli.[9]

Does not seem to be supported by the provided reference. Can someone please point out where this criticism is included? Thanks, -Will Beback 01:48, 9 April 2006 (UTC)**

    • The problem is that I'm personally familiar with this situation through massive "plea for help" emails, but I'm not sure how to convey this point, which is important from the perspective of the people experiencing it, in the encyclopedia article. I chose that document because it includes criticism of LMP as an aspect of the worker's survey. I'm open to ideas on how to improve this section while making sure that what many people experience as the truth doesn't get suppressed.--Pansophia 01:57, 9 April 2006 (UTC)
Here's how I look at it. Our job is to verifiably summarize reliable sources using the neutral point of view. It is not, much as we'd often like it to be, the job of expressing the Truth with the support of sources. Now in this instance, let's say hypothetically that this source contains a survey which says that 10% of workers are unhappy with benefits, 12% are unhappy with working conditions, and 9% are unhappy with their pay. It would be inappropriate for us to write, "Many workers are unhappy with their benefits," even though it is perfectly verifable and seemingly NPOV. If workers say they are unhappy about three things then to pick out one for special treatment is unbalanced and gives a false appearance it being the leading cause of unhappiness.
That doesn't mean that we don't have the ability to emphasize what we, as informed editors, think is an aspect that has more information available. So we could correctly say about our hypothetical company, "Surveyed workers have said they are unhappy about working conditions, benefits, and pay. Pay has not been raised in five years." OTOH, we should not say that, "The company has been fined for working conditions, leading employees to rank it their number one concern." That makes a connection which is not established or verifiable and so is original research.
Getting back to this real company, I'm not sure what you were looking at in this long source document - a page number would help. As for the aspect of how contracts are voted on, that seems fairly verifiable. There must be some publications which cover Kaiser's labor relations. Is there a union newsletter, a nursing organization magazine, a local newspaper? That'd sure help. The problem is also why LMP deserves a paragraph and section of its own. If we're going to emphasize it then we need more info and context. Is this peculiar to Kaiser? However this is hard info to get. Instead manybe we should just tack it on to a paragraph about labor relations. -Will Beback 06:31, 9 April 2006 (UTC)


I do understand (and agree with) yout point. I'm trying to find a better source. --Pansophia 19:49, 16 April 2006 (UTC)

[edit] Intrigued? Or impressed?

Or even better, cited. Did he say that he was intrigued? Interested maybe, impressed seems more likely, some might say convinced, but describing a CEO/owner as organising his workforce's medical care on the basis of being interested in whether something might work needs a bit of a citation or reference to hang it on.

I suspect if of being one of those words people toss into a sentence to make it spicier, whereas unless we know the reason for a decision, it is encyclpaedic to simply record what was decided or done. Midgley 11:49, 23 April 2006 (UTC)

Midgley, I'm not sure what you're comment is referring to.
The information on international reputation you wrote adds an interesting element regarding what the world thinks of Kaiser and by extension the US HMO model. I think for the information on international reputation to be wikipedia-worthy we'd need to show either than 1) concrete action occured due to the British gov. examining KP (for example, who met with whom?) or 2) that high-level officials have taken the model into serious consideration. Absent either of these, I don't think the section should stay--for example as written it the section could mean simply that a low-level researcher read a few papers on the subject. For now, I'm just adding a fact tag and suggest you develop the section with more detail. Antonrojo 14:03, 23 April 2006 (UTC)
1. "Intrigued by the concept developed by Hatch and Garfield in the Mojave Desert, Henry Kaiser persuaded Garfield to open a prepaid practice for his construction workers building the Grand Coulee Dam in Washington state in 1938." Midgley 17:10, 23 April 2006 (UTC)
2. [10]

Meetings between dept of health and KP[11] Official DoH site. speech by HM Secretary for State (John Reid, Health) Eight primary care trusts have been working with KP[12] annual report of the chief medical officer[13] "The American organisation Kaiser Permanente is partnering eight primary care trusts to share lessons about how to develop integrated and co-ordinated ..." etc etc all official DoH stuff dating from 2003 to present.

one BMJ item; National Electronic Library for Health: health-management: "Kaiser (a U.S. non-profit health care organisation) is committed to a whole system approach to healthcare in which primary and secondary care are closely integrated. In the Kaiser system, there are close links between GPs and hospitals and specialists, supported by electronic health records. Patient self-education is a priority, especially in Kaiser’s approach to the management of chronic disease. Significant features of Kaiser hospitals are the relatively short lengths of stay, careful care planning and quite aggressive approach to discharging patients. (1)

The main lesson from Kaiser is its ability to minimise the use of hospital beds through integrated service delivery. (2)

Eight PCTs - in Torbay, St Albans, Taunton Deane, Northampton, East Sussex, Eastern Birmingham, Blackpool and Lincolnshire South West - are running pilot projects which adapt key components of the Kaiser model. (3)"[14] "Guardian Unlimited | The Guardian | Plan to cut hospital stays the ... The partnership with Kaiser involves sending teams of clinicians from NHS hospitals and primary care trusts to learn techniques used in the US to improve ..."[15] Midgley 17:10, 23 April 2006 (UTC)

[edit] Kaiser, or America?

"Patient Dumping

Kaiser and other hospitals in Los Angeles area has been involved in a recent scandal involving discharging indigent patients to Skid Row.[8]"

That isn't very encyclopaedic, it isn't durable - no date - and it isn't particualrly about Kaiser so its presence here looks more POV. It sounds like the view of AMerican healthcare we tend to get from this side of the Atlantic, whcih I assume is a bit of a caricature, but unless there is some reason why Kaiser should do better with this than anyone else in LA or the US, it should be in an article on the problems of a capitalist healthcare ssytem. Midgley 10:06, 2 May 2006 (UTC)

[edit] Reliability of source

http://www.kaiserpapershawaii.org/ doesn't look to me as if it fulfills WP:RS. Does anyone feel it definitely does? One area I know something about is IT in healthcare, and the section on the front page on the Kaiser automation seems to me to be rubbish - large healthcare IT systems should be made of old well-sorted legacy apps tied together with clever string, not newly written from scratch. Any system offered is going to be just that, a system, not a single monolith, and "new" systems are largely rearrangements of existing modules. As they should be.

The financial diagram pointed to as a reference doesn't seem to me to actually make the case that KP whose tax status is as a not-for-profit is illegally making and distributing profits. If I were writing accusations of tax fraud I'd want to be backed up by something stronger than that, particularly if the treasurer might regard it as personal. Midgley 11:51, 4 May 2006 (UTC)

In what way does it not fulfill WP:RS? To my eye it is hard to tell. Much the material seems to be reprints of material published in newspapers, etc. For RS, one of the main determinants of reliablity is having more than one person involved in writing and editing the material. I can't tell how many people are involved in that website. -Will Beback 20:32, 4 May 2006 (UTC)
That would be it ... in medical websites the Honcode applies - that it should be clear who produced and controls and edits the site - that site looks like a rather generic attack site, and the default assumption is that it is produced by one person with a grudge, and perhaps a few assistants. IE in order to fulfill RS, surely it has to be apparent from the site that it fulfills RS? Material published in newspapers would be sourcable from the newspaper, and better so than via a changeable aggregator. Midgley 20:55, 4 May 2006 (UTC)
Often the news stories are unavailable elsehwere and an aggregator is the only source. -Will Beback 22:20, 4 May 2006 (UTC)
Barring libraries and the files of the newspaper, of course. That one isn't a site that conveys a feeling of reliability to me.Midgley 23:21, 4 May 2006 (UTC)

The NHS view of Kaiser makes a virtue of some of the things that seem to be complained of by at least some. None of it is an unmixed blessing, but the impression gained from here is that KP is relatively cheap and gets relatively good outcomes, by running a process that most people find acceptably good. Writing an encyclopaedia article by listing all the complaints people can find against th subject probably doesn't produce a good one that is useful to readers who want to know eg "How does KP handle arthritic hips?" A discussion of their approach to integrating in an out of hospital care does. Midgley 23:21, 4 May 2006 (UTC)

The links removed and then replaced do not meet WP:RS and should not be in the article. Midgley 23:00, 5 May 2006 (UTC)


Midgley, have you seen this BJM article? http://www.pnhp.org/news/2004/june/feachems_kaiser_stu.php
It isn't a BJM or even BMJ article, it is a Br J General Practice article. And yes. Hence my reference to the reaction to the BMJ editorial in the body of the article.

WP:NPA

Regardless, this last edit [16] by Pansophia appears to revert past the contributions of many editors without any substantive explanation. (In fact, it appears to revert all the way back to the last time Pansophia edited the articel, April 9 [17]). I've going to revert it. Please explain the specific reasons for removing entire sections, etc. -Will Beback 05:24, 7 May 2006 (UTC)

(refactored)

Yes, sorry I did that. There were a whole lot of edits, and I didn't have time to read them all. WP:NPA reverting back to myself was a shortcut. However, when I look at the article now, many edits have deleted criticism. I'm currently trying to restore what had previously been agreed upon. Even reading through it, it looks like I'll be replacing a lot. --Pansophia 04:28, 13 May 2006 (UTC)
I'm glad you are sorry that you acted as you did. I suggest we revert ot the status quo ante, and then if there are edits you feel a need to make you can eitehr make them one at a time, or propose them here. I'll revert. Midgley 19:59, 13 May 2006 (UTC)

[edit] unreliable material

Medical experimentation

Critics have also accused Kaiser of exploiting patients for medical experiments. Kaiser, along with the Los Angeles County Department of Health and the CDC, injected over 1500 mostly minority babies[1] with unlicensed experimental vaccines with fraudulently-obtained consent from the parents between 1989 and 1991.

That reference really won't do for supporting that statement. See WP:EL and for that matter WP:RS Midgley 23:08, 5 May 2006 (UTC)


tax status.

When the challenge is taken up by the tax authorities, is the time to take note of it.

How about some outcome data which is the sort of thing that is importnat about healthcare orgs. Not what people who don't like them say. Midgley 23:13, 5 May 2006 (UTC)

[edit] Clarification: benefit

"They also provide infrastructure and facilities that benefit for-profit medical groups."

Does that mean they rent facilities to for-profit medical groups, and if so are those exclusively the PMGs? Midgley 22:29, 13 May 2006 (UTC)

[edit] 1942 motivation and encouragement

" In 1942, Kaiser established health plans for workers and families at shipyards in Richmond, California and Vancouver, Washington, and at a steel mill in Fontana, California."

I recall seeing it suggested that there was national encouragement for this as the shipyards were a significant part of the war effort. In the UK around then developments in the Emergency Medical Service (EMS) and the later emergence of the NHS in its original 1949 state would have some resonance with that. Midgley 22:34, 13 May 2006 (UTC)

[edit] Tertiary care: kidneys etc

It does look as though something could be made of this passage:-

"In 2006, Kaiser shut down its start-up kidney transplant program after less than two years of operation because administrative problems and failure to communicate with regulatory agencies knocked patients off the organ list and created long delays for transplant surgery. During the transplant program's first year, only 56 transplants were performed (with around 2000 people on the wait list) and twice that number of people died waiting for a kidney. At other California transplant centers more than twice as many people received kidneys than died during the same period. Kaiser suspended the program after being hit with a series of lawsuits."

From the standpoint of a health service organisation tertiary care services will either be provided within the organisation, if it is larg eo r if they are part of its share of overall provision, or by commissioning the service from anotehr healthcare org. It seems unlikely that KP simply decided to not treat end-stage kidney failure, or that before their start-up programme they didn't provide such treatment, so one would assume it is bought in. Focussing on "the kidney disaster" does not necessarily produce the best or most encyclopaedic article. KP offers 60 documents which include "renal transplant" and points members toward analyses of both survival and cost/benefit ratio of transplant vs dialysis. A narrow focus on transplantation is not encyclopaedic, a discussion of the size required for a transplant programme to be effective is. see [18] etc

Midgley 23:14, 13 May 2006 (UTC)

[edit] Absent information

One of the justifications of HMOs is economy... so where is the discussion of cost vis a vis other systems of care in areas in which KP operates. Midgley 23:15, 13 May 2006 (UTC)

[edit] References

Removing the reference to the editorial in the BMJ is actually bizarre. Adding back in the references to blogs and unattributable axe-grinding sites which are not WP:EL or WP:RS requires that this article be marked as both unverified and NPOV. I think this use of references by Pansophia will have to go to RFC. Midgley 02:18, 15 May 2006 (UTC)

Pansophia, could you explain how this graphic conveys any information? Reliable sources are things like newspaper articles, studies, etc. Kaiserpapershawaii.org appears to be filled with anecdotal evidence, appeals to emotion, and a pervasive sentiment that it's evil for companies to try to make a profit. I do not think it meets the requirements of Wikipedia:Reliable sources in any way. Rhobite 02:49, 15 May 2006 (UTC)

I placed a simple accuracy tag on this article, due to my concerns about kaiserpapershawaii and other sources. One minute later Pansophia removed the tag, saying "we agreed to remove tags. See talk page." I don't see any such agreement here - I didn't agree to ban all tags from this article, of course. I don't believe that kind of agreement is possible on Wikipedia. There's no way to predict future disputes. Rhobite 02:53, 15 May 2006 (UTC)

Rhobite - That graphic is compiled from a lot of sources, in an attempt to help people understand the for-profit elements of Kaiser. Normally this process is buried behind Kaiser's claims to be a "non-profit". I see no harm in presenting information in a simplified way people can understand. Also, I believe you're the one who insisted on the logo. I've let the logo remain despite my strong feelings about it. Please keep that it mind WP:NPA. --Pansophia 02:59, 15 May 2006 (UTC)
You didn't actually respond to my question. I'm putting the accuracy tag back. Please don't violate the Wikipedia:Three revert rule. Can you name the "lot of sources" where that graphic came from? All your references seem to be anti-capitalist, anti-HMO sites with mostly anecdotal evidence. Rhobite 03:04, 15 May 2006 (UTC)
Hopefully it will be construed as a minor edit trying to get you to see why the tags were taken off in the first place. It will take me a while to gather some sources for you, but start by looking in the Structure section of the article itself. --Pansophia 03:07, 15 May 2006 (UTC)
I think that was 3RR was it not? Pansophia, I suggest you take a rest, and consider some of the advice on your talk page. Urgently. Midgley 03:09, 15 May 2006 (UTC)
Midgley - trolling doesn't count toward 3RR. I pointed out the complaint about you.


Rhobite - here's an article that explains the Bond issue: http://www.kaiserpapers.info/kpbonds.html --Pansophia 03:21, 15 May 2006 (UTC)

This is a great study of Kaiser by the California Nurse's Association. I believe it's already cited in the WP article. If not, it should be: http://www.kaiserpapershawaii.org/kaiserwatch.htm --Pansophia 03:29, 15 May 2006 (UTC)

Here's an article about Kaiser's excessive reserves: http://www.consumerwatchdog.org/healthcare/pr/?postId=4461 --Pansophia 03:31, 15 May 2006 (UTC)

I am trying to find the truth behind Kaiserpapers links and replace them with newspaper articles. As an example, you claimed that Kaiser "fraudulently-obtained consent" from parents to inject 1500 babies with the experimental measles vaccine. The word "fraud" is a legal term, which implies a court finding. Fraud involves intent to deceive, and monetary gain - proven based on a preponderance of evidence. These elements were almost certainly not present during the experiment. Thus the paragraph was factually inaccurate in several ways. The figure was also incorrect. Although 1500 babies were involved in the test, only 900 were injected before the test was halted. I am sure that many other paragraphs in this article are still inaccurate, due to your exclusive use of biased sources, so I wish you would leave the tag on the article. Anyway, you've been reported for your 3RR violation. You should expect to be blocked from editing soon. Rhobite 03:37, 15 May 2006 (UTC)


Rhobite - I restored your edit before you made this comment because I agree about weasel wording there. Shame on you for trying to help Midgley in his harassment of me! Have you read what he's been doing? (See the ongoing saga on my talk page: http://en.wikipedia.org/wiki/User_talk:Pansophia)
By the way, you seem to have an interest in business. Could you explain to me how this 1800 Harrison Foundation fits into Kaiser's financial picture. http://www.guidestar.org/pqShowResults.do;jsessionid=9D5A3F3C18EE6E9626A7656A96FB4C3A.web03Worker.web03Worker?type=guidestarIt&partner=guidestar
--Pansophia 03:44, 15 May 2006 (UTC)
Now I see Midgley actually asked you to join on: http://en.wikipedia.org/wiki/User_talk:Rhobite#RFC_needed --Pansophia 03:55, 15 May 2006 (UTC)
I observed the edit war on my watchlist. You'll see by the timestamps that I added the accuracy tag [19] before Midgley left me a message [20] (not that it matters). Please stop reverting. You're way past the 3RR limit. What you're doing now can only be described as generating evidence for a future arbitration against you. Rhobite 04:40, 15 May 2006 (UTC)
A month ago we had a nice "talk it out" policy on this page that resulted in a number of compromises. That was the right process for Wikipedia, which would gradually lead to an article everyone could live with. Ganging up to get someone in 3RR trouble for trying to prevent the deletionist approach while simultaneously trying to fend off a troll (who went to tell you to join in while he set me up for 3RR) is not good Wikipedian behavior. It's bullying and trying to game the system. Please consider that the diplomatic approach might be more effective. I'm now regretting all the other times I've deferred to your wishes. --Pansophia 04:49, 15 May 2006 (UTC)
  • Sounds all too familiar, these tactics, which seem to be affecting an ever widening swath of articles, perhaps simply as a result of the Wiki's rapid growth, or perhaps because entities like Wal-Mart have realized they can participate here, too. Like the article on Wal-Mart]], the vaccine critics, Andrew Wakefield, and biological psychiatry articles, to name a few, have similarly deteriorated in terms of npoving. There is a serious and escalating problem with what might be called dangerous editing zones, which for some reason bring to mind Three Mile Island and Chernobyl. There seems to be a tendency for medical articles to succumb to coordinated activity by a minority of editors from the rigidly authoritarian medical community, who seem to veer a wee bit too much toward over use of intricate procedural tactics and blunt political skills. Two things that stick out from a quick perusal of the two versions is the statement that KP is 'admired', and that the National Health Service was 'impressed' by KP. The phrasing just looks like propaganda. Calton, who has done some good work uncovering some problems related to misrepresentations in the past, will hopefully help bring this matter back down to a simmer from the boiling point after taking a closer look at what is going on. Ombudsman 07:52, 15 May 2006 (UTC)

[edit] Neutrality

  • I am trying to make the article more impartial. Katomin 14:58, 15 May 2006 (UTC)
    • You are a good person. Midgley 18:41, 15 May 2006 (UTC)

[edit] Measles

What is the context of this?

"Experimental" is probably a bad choice of word - it would imply that someone could say what the experiment was, among other things. Was there a Measles vaccine with a US licence at that time at all? Was there a specific reason to offer Measles immunisation at that time? Midgley 15:01, 15 May 2006 (UTC)

I found the St. Petersburg Times article in LexisNexis.. I can e-mail it to you and Pansophia if you want. Basically the Edmonston Zagreb vaccine was approved in other countries, and the CDC (along with LA and Kaiser) was testing whether large doses of it were more effective than the current U.S. measles vaccine. Although measles is under control in the U.S., it is not eradicated. Underserved (low income and minority) communities are the most likely to contract it. Anyway, the CDC didn't obtain the proper consent from parents, and they stopped the trial when unrelated foreign trials of the same vaccine resulted in some deaths. I agree that "experimental" carries a negative connotation. Clinical trials happen all the time, and they are preceded by many years of research and animal testing. To call it "experimentation" wrongly suggests unethical or even torturous behavior on the part of doctors. I also want to point out that most of the blame was placed on the CDC, who apologized immediately and accepted responsibility. Rhobite 15:20, 15 May 2006 (UTC)
So, "a clinical trial conducted for (under the aegis of?) the CDC, of a preparation licenced elsewhere to determine if it had advantages over the existing standard was terminated when adverse events occurred elsewhere. Defficiencies in CDC process were also identified, for whcih the CDC apologised."

The next question is whether that is actually about the CDC or about KP, (or about the variant of Measles vaccine for that matter) and the one after that is whether there is any reason other than malice for the inclusion of even that NPOV and accurate phrase, never mind the existing one in this article - IE is it interesting. I'd say it isn't, actually. Not encyclopaedic.

I suggest it be rephrased as above so as to be in the history, then removed and kept out of the article. Midgley 18:40, 15 May 2006 (UTC)

I agree that this incident is marginally notable, if at all. People who attempt to use Wikipedia to disparage an organization frequently develop laundry lists of negative events and minor stories, basing them on biased web sources. Not every news item about Kaiser Permanente deserves to be mentioned here.
I can't agree more Katomin 05:08, 17 May 2006 (UTC)

SO we are going to change that, by concnesus, yes? Midgley 13:16, 17 May 2006 (UTC)

[edit] Employee count

This is given as 134000 and 145000 within the first section. Elsewhere it is given as 80 000 union members, and 145 000 total. Midgley 15:05, 15 May 2006 (UTC)

[edit] Texas: from that reference

"Bomer said that revocation of Kaiser's license as a Texas health maintenance organization never was an issue except in the context of the company's financial condition." TO what extent does that bear out the interpretation given in the text? Midgley 17:30, 15 May 2006 (UTC)

It doesn't. Here is th eexcised text, whcih is not really encyclopaedic either:-

" where reported problems had become so severe that Kaiser directed its lawyers to attempt to block the release of a Texas Department of Insurance report. This prompted the state attorney general to threaten to revoke the organization's license. "

Midgley 17:57, 17 May 2006 (UTC)

However this has been repeatedly shifted back to a version whioh doesn't reflect either the cited material, nor how such agencies work. It has been reasonable in the past and should be reverted to that. Midgley 21:18, 26 May 2006 (UTC)

[edit] North Carolinan response

That looks a bit odd as well. I'm not a US national so whether the unions reporting on healthcare is unusual is unclear to me, but I doubt that something that happens 4 years afterward is "in response" to that report. More likely intepretation woudl be that the unions were among those noting it was not going well, and eventually it was withdrawn from or floated off or contracts were not renewed. Midgley 17:57, 17 May 2006 (UTC)

"The Industrial Union Department of the AFL-CIO issued a 1996 report critical of Kaiser's quality." fascinating stuff, but unreferenced, and it is not clear that this lead to the closure 4 years later. KP withdrawing from NC in 2000 is established and encyclopaedic, but to assert that it was due to ("in response to this") a single cause it would be necessary to show a credible reference. It isn't believable actually, and it probably isn't interesting. Removed. Midgley 09:27, 18 May 2006 (UTC)
And reinserted, of course, unchanged, and still incredible and not fit for an article. Midgley 21:23, 26 May 2006 (UTC)

[edit] Man bites dog (and half of doctors are below average)

"It appears that the quality of patient care differs by region."

Lets turn that round and try

"It is known that the quality of patient care is absolutely identical in all regions."

Which one is remarkable? Lets lose the bit about variation, unless it can be made definite, and the degree of variation shown to be remarkable. (The NHS talks a lot about "post-code prescribing" (bad) and "local determination of priorities" (good) and I assume there is some of that in the USA, and within Kaiser. ... Midgley 22:24, 15 May 2006 (UTC)

Detail

Looking at the reference given to support that section... "Kaiser's Northwest and Southern California region plans received average ratings ..." is what the article says, turn to the reference and you find that overall, the top HMO out of all of them with a score of 84/100 is KP Northwest. The article text does not adequately reflect the findings of the survey which it uses as a reference.

You can dig into surveys and metrics like that (or like Dr Foster in the UK) and apart from small differences (6% given in the survey itself) being insignificant, the usefulness of a single figure, or even half a doz. categories as figures of merit for the breadth of surgical and medical specialties needs not to be exaggerated. If you go looking for control charts on specific activities and outcomes then you are beginning to get a little hotter. Midgley 22:53, 15 May 2006 (UTC)

Presidents and Acts

I've reworked it, removing the example of what not to wrrite straight out of WP style and weasael words ("some say"... name someone who said it...)

It seems highly unlikely that a president, signing an Act on HMOs, would not have considered the largest HMO. Whether that means that having considered the other HMOs and non-HMO orgs he then chose to drive through an Act which disadvantaged all except that one, and for that purpose, seems unlikeley. If anyone wants to suggest it was, then it needs something more than that transcript, no?

"Some say the President had in mind the longest highway when he sgned the Long Highways Act regulating long highways". Hmmm Midgley 23:04, 15 May 2006 (UTC)


I see the President was reverted. WP style offers examples of what not to write, one of which is "some say". I've taken that out. Arguably this is about federal regulation rather than being strictly history, so I've moved it tot the bottom of that section with a sub-heading on that. The reference asserted to be to a transcript backing up the assertion that a discussion took place does not actually work - there is no document there. It would be more useful to fix that than to repeatedly revert the text to a version which is not encyclopaedic and directly contrary to style guidelines. Midgley 09:42, 18 May 2006 (UTC)
Badness of refernece
That reference doesn't work as a link. THe colon at the end of it seems to be the cause, can anyone get that fixed?
The content as given doesn't justify it's title.
Interestingly, the only hold-out was the vice-president (would that be Spiro Agnew?).
Although KP is mentioned, the context looks to me as though it is not specific to KP, but applies to all HMOs. As it should. While it might form part of the article on the HMO Act, I don't think it informs the reader of an encyclopaedia about KP in particular, and in fact I am unconvinced of a reason for having it in the article in any form. I suspect the implication was that if Erlichman had talked to Mr Kaiser about a bill affecting KP that this was some improper influence, whereas actually it would be crazy to produce legislation affecting 8 million people's healthcare without talking to the people running it, and no case is made that KP had different access to the cabinet than any other HMO. (If they did, that is more probably useful in the article on the Act than on KP, and if we want to say that KP was consulted on the act then lets say that KP was ocnsulted. Provided that a citeable reference can be made. Midgley 10:38, 18 May 2006 (UTC)
The insight into American politics is interesting, even if it leaves a slightly queasy feeling, but I'm not convinced that

[edit] The strange thing the dog did in the night (glaring missing sections)

Core values. The article as yet doesn't refer (except the reference I added to the founder's Sci. Am. paper on provision onf healthcare) to what the core values are. In an organisation the size of many national health services which is unlike the majority of American healthcare, is that surprising? Midgley 22:30, 15 May 2006 (UTC)

As a doctor I'm interested in the conditions of work for doctors in KP. A rumour I heard was that doctors in KP organisations don't also have posts outside them. True? Midgley 22:30, 15 May 2006 (UTC)

Costs... what is the sub? And are there metrics for comparisons with other HMOs, and with non-HMO care for the better-off 85%? Midgley 22:30, 15 May 2006 (UTC)

[edit] Similarity of anonymous author's contributions

http://en.wikipedia.org/wiki/Special:Contributions/209.129.168.46

Anons with a single interest are somehow less convincing than named users. Midgley 17:21, 17 May 2006 (UTC)

[edit] Reliable source?

http://www.consumerwatchdog.org/

Midgley 17:38, 17 May 2006 (UTC)

It's an anti-HMO site. It is a good example of anti-HMO, pro-universal-care activism. Typically, most of its arguments seem to blame insurance companies and pharmaceutical companies for being profit-making entities. It should not be used as a factual reference. Rhobite 14:30, 20 May 2006 (UTC)

[edit] Dispute Handling

THis looks like a significant topic - it is significant for all healthcare orgs, and it is not best addressed by picking a few disputes and describing them.

Procedures have reasons for them whcih should be brought out, and documented if possible.

THis material:-

, and Kaiser has recently attempted to roll back the gains made in patient rights.[2][3].

Is not supported by the references given. It isn't "recent" now either.

Discussion of capacity - eg for emergency rooms - could reasonably form a topic - it runs into rationing, which is an NHS debate as well.

Midgley 17:48, 17 May 2006 (UTC)

Thanks Midgley for injecting some sanity into this article. Kato 18:49, 17 May 2006 (UTC)

[edit] Controversial edits

I've noticed a lot of controversial edits made by an anonymous ip which touch on a lot of open issues without explanation despite the fact the majority of the talk page seems to be dedicated to requests for more information regarding criticism of Kaiser. Unless these edits to the article are discussed and evidence is provided addressing the open questions above, I don't think most of them belong in the article. Antonrojo 03:29, 18 May 2006 (UTC)

However, mass blanking of the contributions does not appear to be the most effective means of collaborating for the purpose of bringing about an optimal degree of npov. A lot of good faith work obviously went into refining the material in question that has been posted, and simple deletions seem to go against the grain of encouraging respectful agreements to disagree and the sort of esprit de corps within the Wiki that should prevail. Ombudsman 06:16, 18 May 2006 (UTC)
Actually it seems obvious that much of the material added to this article has been in furtherance of a personal grudge against some particular part of Kaiser. That is not a suitable use of WP and adding unreliable or unsatisfactory (WP:RS WP:EL WP:V - remember... ) material is not an acceptable use of WP or way to construct an article. What is "obvious" to Ombudsman is often not obvious to others. Is there really much doubt about who the anonymous editor is here? Removing material which fails the simpler tests to the talk page is exactly the best way to encourage discussion, and if it persists then yet another RFC followed by arbcom and blocking may be the route. Lastly, the quality of the contributions is not such that it appears that "a lot of" work regardless of its faith has gone into it. WP deserves proper research. 08:36, 18 May 2006 (UTC)
Ombudsman, I agree that blind reverts aren't the best way to handle content dispute issues and I don't doubt that some of these edits would add value to the article after undergoing normal editor review. However, I've seen an extended pattern of requests to provide more evidence for many of the criticisms by several editors. Rather than addressing these issues, substantially the same edits are made regularly without explanation.
I could be wrong but I don't think that the edits need to be reverted individually with comments in the talk page until these issues are addressed. If evidence from legitimate news sources or regulatory agencies could be provided I would probably support many of these edits as long as they don't clutter up the article (no article on a large company should list every attempted lawsuit or allegation or it would be unreadable). For example, allegations that Kaiser has violated their non-for-profit status do not address 1) whether any for-profit activity violates the law (I don't know the law here but it's quite likely that a large corporation can have both for profit and nonprofit divisions under the same umbrella) and if so 2) whether there has been governmental investigations into this. Instead, a graphic from a critical website is provided...a style of evidence that could support nearly any claim that someone with a domain name and access to Photoshop want to make). Antonrojo 11:17, 18 May 2006 (UTC)

[edit] Union section (bizarre)

I've chopped this out. It is not about KP, and is not encyclopaedic anyway. It is about the unions involved, but looking at it, it really belongs under man bites dog, doesn't it. Unions exist largely to carry out collective bargaining of their members with employers. That a small minority of union members disagree with the policy of their union is neither surprising (except in so much as why they are in a union if they think they would be better off out of it) nor a matter for this article. If KP refused to employ anyone who was not a member of a specified union - a "closed shop" - then this would be worth noting, but still fails to be a criticism, I'd say, but is rather a condition. Midgley 10:22, 19 May 2006 (UTC)

[edit] References

  1. ^ http://www.kaiserpapers.org/meashots.html
  2. ^ Jamie Court. "HMOs Stalk Patients' Rights." The Foundation for Taxpayer & Consumer Rights. June 10, 2002.
  3. ^ The Foundation for Taxpayer & Consumer Rights. [http://www.consumerwatchdog.org/corporate/pr/?postId=3560&pageTitle=State+Auditor+Should+Investigate+State+of+the+State "State Auditor Should Investigate State of the State Consumer Group Calls for Audit of Governor's Use of Private Lobbyists to Write Public Policy."] News Release. January 8, 2003.

[edit] RFC on Pansophia and this article and User:209.129.168.46

Initiated: http://en.wikipedia.org/wiki/Wikipedia:Requests_for_comment/Pansophia Midgley 11:23, 18 May 2006 (UTC)

[edit] NHS study (International reputation; principles of operation)

http://www.networks.nhs.uk/39.php is informative - at least in terms of the assessment of one health service (KP) by another (the NHS).

The PDF on the principles of KP's operation (as seen from here) looks to me like a foundation for a section of the article. A relevant comparison would be with other USA HMOs, and with USA non-HMO care such as Medicare and straight fee for service ad hoc medical service. That would need to be done by someone who has some exposure to or experience of those things I think. Comparing the VHA with KP might also be informative. Midgley 11:29, 19 May 2006 (UTC)

Is the basis of KP's operation as given below so similar to other US HMOs and non HMO care that it is not at all notable?

"Kaiser (a U.S. non-profit health care organisation) is committed to a whole system approach to healthcare in which primary and secondary care are closely integrated. In the Kaiser system, there are close links between GPs and hospitals and specialists, supported by electronic health records. Patient self-education is a priority, especially in Kaiser’s approach to the management of chronic disease. Significant features of Kaiser hospitals are the relatively short lengths of stay, careful care planning and quite aggressive approach to discharging patients. (1)

The main lesson from Kaiser is its ability to minimise the use of hospital beds through integrated service delivery. (2) "

From the NHS perspective it seems remarkable, and I suspect the NHS is remarkably integrated, centrally controlled and socialised for American eyes. There is no comparison of KP's operation with other HMOs in the article at present, this is a clear omission. Midgley 22:49, 26 May 2006 (UTC)

[edit] Arbitration requirement

I think this statement from 'dispute handling' needs supporting facts and to be restated: "Some cases proceed to court and one argument is over whether the requirement to go through dispute resolution is enforceable".

It is a very general statement...who is making that argument (I'd guess patients lawyers)? Has there been any evidence of the outcome of these challenges? If all we can say is that 'the argument has been made in court' this provides little info to the reader. Antonrojo 12:34, 20 May 2006 (UTC)

It isn't useful, of course, but it is also repeatedly added back in by Pansophia or assorted IP addresses making identical edits. A pointer to arbitration or to "dispute resolution in health services" might be useful there, and support a paragraph relating to the effect of legal costs on provision of services, but this would not serve Pansophia's purpose of damning the organisation I assume fired her. Midgley 15:03, 20 May 2006 (UTC)

[edit] Regulation and comparison

THe state regulatory department reports at http://www.opa.ca.gov/report_card/ on their view of KP and other HMOs in California. THis does appear to be a reputable source, being official, and it would be amazing that it was not already referred to were it not for the transparently malicious eiting that accounts for most of the detail on performance or problems. KP is given stars which are not surpassed for the various aspects, in particualr, given that the early guiding principle of KP is preventive care, they score 2 stars there, higher than the others. THis is a better source than newspaper articles about particualr problems or the blogs that keep being re-inserted intot eh links despite being clearly outside WP policies on RS and EL. Midgley 15:34, 20 May 2006 (UTC)

[edit] Research

THis is a heading that should appear. "Experimentation" is not a good word for a clinical trial, the reference given neither deals particualrly with LA and KP, nor is it of a sort that will support anything. References from the CDC might, as well as references to papers published in peer-reviewed journals, which if the clinical trial on the Edmonton strain of Measles which was abandoned with no iniation of harm having occurred to any patient treated by KP is actually encyclopaedic must have occurred would not just be approproate, but would actually give more information than one expects in an article here.

KP does a considerable amount of research, as you would expect from the care system and doctors in it for 8 million people. It publishes its own journal, and publishes in other journals. The text I added on this was reverted by Pansophia/sock/anon and should be reinstated as this section. Midgley 13:08, 21 May 2006 (UTC)

[edit] Measles

Acceptable references to this - primary sources rather than tertiary or quaternary sources as given - are not difficult to find:-

The research is anemd as the Edmonston-Zagreb Mealses Vaccine Project (a telling omission from the repeated insertions)

"EDMONSTON-ZAGREB MEASLES VACCINE PROJECT
BACKGROUND
In the first few months of life, maternally derived measles antibody serves to protect the
infant against measles infection; however, it also may be responsible for the failure of that
infant to respond to live measles vaccine. Therefore, measles vaccination must occur after
the infant’s maternal antibody titer has subsided. Since 1963, when measles vaccine was
introduced in the US, the recommended age for vaccination increased from 9 months to 12
months in 1965, and then to 15 months in 1976 (although in some areas, including LAC, the
recommended age has been changed back to 12 months). These changes were
implemented because of higher seroconversion rates at older ages, and because younger
infants are considered to be protected by maternal antibodies. Most women of childbearing
age in the US now have measles immunity from vaccination, rather than natural infection.
Because vaccination results in lower antibody titer than does natural infection, these mothers
are likely to pass lower levels of antibody to their infants. Recently, outbreaks in
unvaccinated preschool-aged children, including children under 15 months (the
recommended age for measles immunization in most parts of the US), have raised concerns
that infants may be losing protection from passively acquired antibody at a younger age
"

and

"A vaccine that would induce long-lasting immunity in young infants despite elevated maternal
measles antibody levels is of particular interest because of the 1991 measles epidemic in
LAC and other parts of the US. Many of the cases in these epidemics were infants less than
15 months of age (30%-40% in LAC). Until this project, no studies comparing the EZ measles
vaccine with Moraten measles vaccine (the only measles vaccine currently licensed for use
in the US) had been done in an industrialized nation.
Page 2
Chapter from Special Studies Report 1995
Los Angeles County, Department of Health Services, Acute Communicable Disease Control
2 / 2
Since 1990, the Acute Communicable Disease Control Unit has collaborated with Southern
California Kaiser Permanente in a Centers for Disease Control and Prevention (CDC) funded
clinical trial among Kaiser enrollees comparing immunologic and clinical differences among
infants vaccinated with high- or standard-titer Edmonston-Zagreb (EZ) measles vaccine and
infants vaccinated with the standard Moraten vaccine.
"
Is misrepresented in the repeating text. It is actually pointed at the US government and its agencies, not at KP, and makes it clear that the CDC ran the trial and was obliged to apologise. From the beginning:-
"THE ethical standards of clinical trials sponsored by the US government in inner city areas are under question.

Last week, the Centers for Disease Control and Prevention (CDC) in Atlanta was forced to apologise to parents who in 1989 were not informed that their children were given an experimental measles vaccine.

In 1989, the CDC and Kaiser Permanente, a California healthcare organisation, launched a measles vaccine trial among some 1500 children in Los Angeles, mostly from poor black and Hispanic families. The parents were told that some children would receive a vaccine different from the one used normally in the US. "This vaccine has been shown to be effective in younger children," a brochure stated. But the parents were not told that this alternative vaccine—known as the Edmonston-Zagreb vaccine—is not approved for use in the US. About 900 of the children in the study received the EZ vaccine. ...
"

*  A chapter "Live Vaccines" in the book New Vaccine Technologies Ellis, Ronald W. ISBN: 1-58706-050-7 probably refers to this.   I've not read it. 
* A subscription newsletter NewsRx notes that the trial organisations also included Johns Hopkins University and extended to  Haiti and more than a dozen other Third World countries.  [http://www.newsrx.com/newsletters/Medical-Letter-on-the-CDC-and-FDA/1996-07-29/0729961364648347DC.html] (introduction read)
* A Los Angeles Times editorial (June 20, 1996) noted that none of the 1500 children in the (LA arm of the) trial was harmed.  
* Markowitz LE, Albrecht P, Rhodes P, et al. Changing levels of measles antibody titers in women and children in the United States: impact on response to vaccination. Kaiser Permanente Measles Vaccine Trial Team. Pediatrics 1996; 97:53–8. Looks relevant [http://en.wikipedia.org/w/index.php?title=Talk:Kaiser_Permanente&action=edit&section=53 Pubmed link] 
* Also relevant at least as background are going to be several of teh references to this paper http://www.journals.uchicago.edu/JID/journal/issues/v190n1/31792/31792.html unfortunately it isn't open on the Web but it will be in libraries. 
* http://www.biomedcentral.com/content/pdf/cr-ir2213.pdf is an overview - mentioning the use of the initial Edmonston strain

I'd suggest that the LA Times reference is the one to go looking for, if anyone has access to its back files.

Midgley 15:19, 21 May 2006 (UTC)

[edit] Pansophia's behaviour

Has moved from looking vindictive and unbalanced to looking ill. I think edits should be reverted, not an effort made to build them into something more sensible. Otherwise it is simply impossible to build an article that improves. Midgley 13:10, 21 May 2006 (UTC)


[edit] Suggested Editing Approach

I think that the best approach to editing would be to 1) add changes gradually providing reasoning and evidence for any issues deemed controversial in the Talk page and in turn 2) not reverting edits in bulk as long as changes are added gradually and with an attempt to defend them in talk and/or the edit summary.

In the last edit by Panasophia I saw a fair amount of both grammar and substantive additions that I think would add value to the article. I don't think that editors should have to go through the effort of separating them out from criticisms of Kaiser where there is still consensus that more evidence is needed or that they add more detail than belongs in a wiki article. (Panasophia--your approach to editing earlier today seemed to follow this model). A list of issues editors think are controversial would be a good place to start (and maybe archiving most of the talk page since it's getting unmanageable). Antonrojo 17:12, 26 May 2006 (UTC)

I've re-read the talk page. The reason for archiving talk page content is not the size of it, but that the issues in it are dead and dealt with. However here the issues that were live at the beginning are still live. I suggest leaving it out there, otherwise the arguments will all go on as if they were new, rather than as if the history was ignored. There is also an active RFC involving this page, so lets leave it until that concludes. Midgley 21:31, 26 May 2006 (UTC)
Antonrojo - just to make position clear: I found no success using the talk page because very few people were using it. I was under the impression that you were one of the people willing to make proper use of the talk page (hence my willingness to negotiate with you), but then I saw that you were assisting Midgley. I continue to be harassed by Midgley, and all I see here is people willing to look the other way because the bully happens to be serving their purpose. In regard to this support of bullying, it's hard for me to believe that the Talk page is a good faith tool: only a place to relegate people when you don't like their edits. This is the last comment I'm leaving here until the Midgley situation is addressed. This is not an ultimatum addressed at you: what I'm doing is leaving a comment here to respect your continued efforts to use the Talk page. The Midgley situation makes it impossible for me to participate in the way you'd like because I'd have to spend all my time addressing Midgley's smears, spurious RFCs, and malice-edits. This is wearing me out, and I'm simply not going to subject myself to it anymore. --Pansophia 23:18, 31 May 2006 (UTC)

[edit] Surveys

I expect there are lots - but what do they add to the article? Unless they demonstrate marked differences from other healthcare providers they don't really seem to advance it. It is quite clear that most people are satisfied with their healthcare provision, most of the time for most things, and searching for a list of instances where someone is not is not helpful (unless you simply wish to be nasty about KP in public, of course). Outcome data would be interesting, and cost (and other input data). There is a great lack of material on how they differ from anyone else, and why they do things, and what the result is. Midgley 18:00, 1 June 2006 (UTC)

I agree that we're reaching the point of having too much survey information (and in fact may have passed that point). A good criteria for deciding what to keep is whether it adds unique, useful and valid information. I think non-trivial patient surveys by non-interested parties fall into this category because this data is so rare and because the debate over whether HMOs are a good model is very far from settled (as would Kaiser improvements in more recent versions of the patient survey). Outcome studies would round out this gap in information.
Also, I think that stating that Kaiser 'was rated lower' in this survey may not be a strong enough statement (to pick a ridiculous example, since the prior statement ranks Kaiser as the best HMO, I could interpret this as 'another survey said they aren't the best'). What is newsworthy about the article (if consensus is reached that it is) is that several Kaiser hospitals got the lowest possible satisfaction ranking from a large sample of patients (in statistics, a sample of as few as 30 people can be enough to draw a conclusion about a large group and 35,000 is pretty impressive).

[edit] First? Oldest?

Was there an actual HMO established before KP? Is there an HMO so established still in operation? If not, then this might figure in the first line? If so, thenmentioning it may be in order. Midgley 10:22, 2 June 2006 (UTC)

[edit] dumping

http://en.wikipedia.org/w/index.php?title=Kaiser_Permanente&curid=477362&diff=61042373&oldid=60992809

THis is clearly a social problem rather than one related to any particualr HMO or hospital... in addition it is boring to a reader who wants to know something about the topic of the article. Midgley 20:21, 28 June 2006 (UTC)

[edit] quality of care

Just because it is in the newspaper does not mean it is true. The patient who was supposively "dumped" had an admitting diagnosis for which all normal patients get discharged home. My friend who works there stated that since the patient did not have insurance and follow up could not be arranged (one other thing was going on but I can't mention it do to privacy), the patient was admitted and the specialist saw the patient in the morning. Subsequently, placement was obtained and unfortunately, the taxi dropped the patient off at the wrong spot, and the patient was not the sharpest knife in the kitchen and didn't know exactly where to go. So much for dumping... a diagnosis that ordinarily costs about 100 buck to make turns into an admission that results in the cost of about a thousand dollars. Kaiser trys to do the right thing and then the media gets a hold of this story and kaiser capitulates and apologies when there was absolutely no reason to do so! The funny thing is now kaiser has a policy that it does not discharge homeless patients...eventually costing people who pay insurance probably more than a few million a year... all with ZERO benefit towards society. ER MD 01:42, 30 June 2006 (UTC)

I agree with the comment in the margin of this edit--as written it is a vague allegation and needs to be rewritten (literally saying that they dischared poor people where they live). The reason it is worthy of mention is that the applicable federal regulatory body found it met the formal definition of dumping which are well defined standards for providing proper care to the poor.
I don't double that you have insights into whether and how often dumping occurs and if the laws are effective. For the former I think Wikipedia:No_original_research applies (I don't think we can cite your friend :) and for the latter the efficacy of the law is an interesting question outside the scope of the article. Since the poor are the least likely to show up in patient satisfaction surveys and the most likely to receive poor or no care due to a lack of insurance, I think this is penalty is worthy of note. Also, I think that the fine process falls outside of the typical court system (regulatory bodies have their own set of laws) so hospitals, companies, etc. often have no recourse against judgements other than not paying a fine--the reason I mention this is that as I understand the process, the only role that Kaiser can play in the process is to offer formal evidence against the claim, so that it's unlikely that bad PR played a role. Antonrojo 02:19, 30 June 2006 (UTC)
Section is better written, but it need not be under "quality of care"--it could be under a different section. The case mentioned in the LA Times as far as I know never progessed to a "dumping" case (i.e. violated EMTALA). Patient received both a medical screening exam (MSE), appropriate (actually excesive) treatment, and discharge. The care of members and nonmember patients however is set up in a POV manner. ER MD 07:50, 30 June 2006 (UTC)
I read the link provided and these are settlements--not necessarily judgements or "fines". Also added a new section since "care of 'unregistered'" (where that term was created i don't know) is implicitly pov. ER MD 08:01, 30 June 2006 (UTC)
There is a lot of history behind the present appearance and layout... I'd suggest that the American healthcare systems and care of the uninsured and indigent is possibly an encyclopaedic topic, ("The American healthcare system is an aberration" BMJ leader today) but that it is not actually part of this encyclopaedic topic - KP - whereas there is considerable material that has found no place yet which is. Midgley 09:59, 30 June 2006 (UTC)

[edit] fines versus settlements

Read the webpage--it says settlements. It is vague, but that is the term. ER MD 16:08, 2 July 2006 (UTC)

Concur. The department involved is at pains to make it clear these are agreed. One could go on about the State reclaiming costs of care and it being ontractual rather than anything else but that would start to sound like socialised medicine. IE out of context. Midgley 18:38, 2 July 2006 (UTC)
'Settlement' is technically accurate, however the heading of the page is 'Civil Monetary Penalties' and I think penalty and fine are essentially the same thing, especially since every case listed was handled in the same way. To my mind, 'settlement' has two meanings: a formal legal meaning (which may or may not involve payment of funds) and a common meaning of 'to resolve'. Readers have to pause and figure out which meaning applies and/or follow the link.
So the term is somewhat misleading--when reading that a hospital had allegations of patient dumping my first question would be 'were they found guilty?' (e.g. is there verification of the allegations) and the second would probably be 'was there any punishment'. I agree that we can't answer the first but to say in response to the second question 'there was a settlement' is vaguer than saying 'they paid penalties' (better yet would be to list the $ amount). In the latter case, I know that the law has teeth and that the case was serious enough to warrant actual penalties rather than just, for example, an adminstrative warning.Antonrojo 19:43, 2 July 2006 (UTC)
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