Kaiser is an interesting animal - almost all physicians and other staff who provide care to people with Kaiser coverage are employed solely by Kaiser and only take care of Kaiser enrollees. They operate in 8 (I think) markets around the country, and do well. However, I think they tried to expand into areas where they didn't own hospitals and found it to be pretty tough, pulling back. So, they have achieved a tight system by controlling all aspects of the delivery of care: the plan, the hospitals, and physicians. In some organizations, that could be a recipe for disaster, but they (from what I've seen and heard) are very patient and physician oriented. In order to prescribe a drug for a patient that's not on their formulary, their physicians simply have to check a box indicating they think it's medically necessary -- no arguing with a plan rep on the phone or changing the prescription when a patient gets to the pharmacy and it's not covered. Kaiser physicians do, though, get paid less than they could make working hard in private practice, but that's the tradeoff.
I agree that the incentives of health plans in employer-based insurance are convoluted. One positive note, though, is that some major employers have started to band together for health care reform -- look at the Leapfrog Group -- a group of major employers who sponsor research and standards for assessing quality of healthcare. Why? So their employees can hopefully get better care for their (and their employer's) buck, lowering costs and allowing them to be more productive. I'm all for informing the public, but I think larger organizations might be better placed right now to pressure the system for change...they can threaten to switch $XXX in business to another plan/hospital/network of physicians.
