Talk:Kaiser Permanente/Archive 1

message: 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)
thread_title: Talk page guidelines

message: 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)
replies: text: 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)
replies: text: 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)

text: ... and I just noticed Ombudsman's edit was flagged as minor. Aye yi yi. Michael Ralston 08:43, 23 February 2006 (UTC)
thread_title:  22 February 2006 edits, NPOV 

message: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)
thread_title:  Infobox 

message: 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)
replies: text: 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)
replies: text: 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)

text: 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)
replies: text: 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)

text: 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)

text: (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)
replies: text: I pride myself in being a sweetie. :-) --Pansophia 02:10, 24 February 2006 (UTC)

text: 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)

text: 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)
replies: text: 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)
replies: text: 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)
thread_title:  External Links 

message: 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)
replies: text: 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)
replies: text: Sounds fair!--Pansophia 01:57, 24 February 2006 (UTC)
thread_title:  The West Wing 

message: 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)
replies: text: 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)
replies: text: 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)

text: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)

text: Suggestions? --Pansophia 20:58, 24 February 2006 (UTC)

text: 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)
replies: text: 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)

text: 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)
thread_title:  Changes 

message: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)

text: 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)

text: 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)

text: 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)
replies: text: 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)
replies: text: 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)
thread_title:  NPOV tag 

message: 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)
replies: text: Thank you. --Pansophia 06:28, 25 February 2006 (UTC)
replies: text: 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)
replies: text: 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)
thread_title: Tahoe/Bonds

message: 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)
replies: text: 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)
thread_title:  Three revert rule warning 

message: 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)
replies: text: 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)
replies: text: 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)
replies: text: 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)

text: Pansophia, the edit looks fine. Adding a new issue below although this section is getting unweildy. Antonrojo 17:31, 19 April 2006 (UTC)
replies: text: 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)
thread_title:  Treatment of Criticism of Kaiser 

message: 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)
replies: text: 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)
replies: text: 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)
thread_title: Wiki Links to Years

message: "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)
thread_title:  Kaiser, or America? 

message: ;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 babieshttp://www.kaiserpapers.org/meashots.html 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)
thread_title:  unreliable material 

message: "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)
thread_title:  Clarification: benefit 

message: " 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)
thread_title:  1942 motivation and encouragement 

message: 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  etc
Midgley 23:14, 13 May 2006 (UTC)
thread_title:  Tertiary care: kidneys etc 

message: 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)
thread_title:  Absent information 

message: * I am trying to make the article more impartial. Katomin 14:58, 15 May 2006 (UTC)
thread_title: Neutrality

message: 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)
thread_title:  Employee count 

message: "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)
replies: text: 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)

text: 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)
thread_title:  Texas: from that reference 

message: 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)
replies: text: "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)
replies: text: And reinserted, of course, unchanged, and still incredible and not fit for an article.  Midgley 21:23, 26 May 2006 (UTC)
thread_title:  North Carolinan response 

message: 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)
thread_title:  The strange thing the dog did in the night (glaring missing sections) 

message: 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)
thread_title:  Similarity of anonymous author's contributions 

message: http://www.consumerwatchdog.org/
Midgley 17:38, 17 May 2006 (UTC)
replies: text: 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)
thread_title:  Reliable source? 

message: 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.Jamie Court. "HMOs Stalk Patients' Rights." The Foundation for Taxpayer & Consumer Rights. June 10, 2002.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..
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)
thread_title:  Dispute Handling 

message: 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)
thread_title:  Union section (bizarre) 

message: Initiated:  http://en.wikipedia.org/wiki/Wikipedia:Requests_for_comment/Pansophia Midgley 11:23, 18 May 2006 (UTC)
thread_title:  RFC on Pansophia and this article and [[User:209.129.168.46]] 

message: 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)
thread_title:  NHS study (International reputation; principles of operation) 

message: 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)
replies: text: 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)
thread_title: Arbitration requirement

message: 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)
thread_title:  Regulation and comparison 

message: 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) 
* http://wonder.cdc.gov/wonder/prevguid/m0053391/m0053391.asp discussed strains of Measles etc in use at that and later times.
* Google cache HTML of LA Public Health report offers background and detail - excerprt below 
:;"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.
"
* http://www.infectiousdiseasenews.com/199611/measles.asp (requires registration, not read) reports on it.
* New Scientist 1996
: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.   (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 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)
thread_title:  Measles 

message: 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)
thread_title:  Pansophia's behaviour 

message: 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)
replies: text: 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)
replies: text: 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)
thread_title: Suggested Editing Approach

message: 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)
thread_title:  First?  Oldest? 

message: 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)
thread_title:  dumping  

message: User:Tafkargb collapsed all my beautiful citations for KP's history into a single giant blob at the bottom of the article.  Now it's impossible to tell which assertion goes with which page in the Hendricks book, which in turn violates Wikipedia:Verifiability.  I'm going to fix this in a couple of weeks, unless someone objects.  --Coolcaesar 05:29, 9 January 2007 (UTC)
replies: text: Giant concise blob or giant sprawling blob, that is the question.  :)  I'm asking some  people over on the style pages for some advice.  (Wikipedia_talk:Citing_sources#Many_citations.2C_single_publication.3F)  Do you mind seeing if they have any suggestions?  Let's hope there's some kind of happy happy middle ground.  Great work on digging up all those citations.  I just hope we can find a way to format them that doesn't take up several forests everytime somebody prints out the article!  Very few editors on Wikipedia can do what you've done and even fewer articles have the sort of citational depth that you've built into this one.  Be very proud!  Now let's just hope there's some Wikipedia style trick to make your truly beautiful work stylistically, as well as editorially, beautiful!  If we can't figure anything out, though, I completely would support your reverting the references back to the previous format.  In fact, I would be obliged to assist.  Tafkargb 06:12, 9 January 2007 (UTC)
replies: text: I would suggest a revert. Perhaps you can use a 2-column format to reduce the space taken up by the refs? Right now, however, the inline refs for A Model for National Health Care are useless because of the huge number of pages cited, and the book might as well be used as a general reference without inline citations. Λυδαcιτγ 22:40, 24 April 2007 (UTC)

text: Reverted to different refs for each block of pages. Not quite so many as before, though. Λυδαcιτγ 01:09, 28 April 2007 (UTC)
replies: text: Thanks, Audacity.  Also, Tafkargb, the vast majority of Wikipedia articles are not printed out.  Wikipedia is not a paper encyclopedia.  See official policy Wikipedia:What Wikipedia is not.  --Coolcaesar 17:47, 3 May 2007 (UTC)
thread_title:  Tafkargb made a mess of my beautiful citations 

message: I just wanted to mention that I think this is one of the most carefully balanced, well researched wikipedia articles I have seen on an organization. Kudos Joel s 18:20, 26 July 2007 (UTC)
thread_title:  Impressive article 

message: This article is currently of disappointingly poor quality, such that it fails to assert notability and is very poorly written.  On that basis, and as a disinterested party, I have nominated it and its currently associated picture for deletion.
One editor asserts that this is the first ever Kaiser hospital, albeit on a new site.  That assertion is presumably notable, but the article is poor and the assertion appears uncited.
Since it is an article on an associated topic to this one I feel it appropriate to ask editors active here to take that article and make it worthy of inclusion in WP, should this be possible.  Should this happen from here or any other source it will be appropriate to withdraw the AfD nomination for the article.  If the picture can be improved then the IfD can also be withdrawn.  Fiddle Faddle 15:51, 25 August 2007 (UTC)
thread_title:  [[Richmond Medical Center]]