Sometimes when I am having discussions with people, they raise important questions about why we are so focused on performance improvement at Kaiser Permanente, in the Coalition of Kaiser Permanente Unions and in the Labor Management Partnership. Sometimes it goes like this:

“You know, if we lived in a country where there was no profit, or health care was delivered by the government (i.e. a single-payer system), there would be less pressure to reduce cost. If we could eliminate profits in general, the high-profit insurance industry and wasteful administrative costs, our system would be much better and it could serve the entire population more efficiently.”

I don’t disagree. It is impossible to argue that the U.S. system is not burdened by these excesses. In the market-driven, employer-based approach to health care, the “free market” has allowed and fostered a lot of “freedoms” that have not worked for the majority of the population.

Profit and waste are huge burdens on the U.S. health care system!

Nonetheless, the issue of health care improvement and high performance are fundamental for all health systems around the world, whether the single-payer systems of Great Britain, Canada and Sweden or in most of the world where universal health care is delivered by a combination of public and private insurance and delivery systems.

In every nation, financial resources are limited, and the complexity and cost of delivering high quality, accessible health care is a huge challenge. In nations like Great Britain, Canada and Sweden, the national single-payer systems must operate within very strict budgets that have very little, if any, leeway. These are heavily taxed societies in which the citizenry has come to expect a great deal out of their vast public services. Nations that promise universal health care do so as a matter of national culture and pride. That is a very different environment—societies that have high expectations for their government!—than what we are used to in the U.S.

Indeed, governments can rise or fall based on the performance of national health care systems. Voters are not very lenient when it comes to the quality of their health care. Why should they be?

There is an international network of clinicians, health care administrators, government leaders and union leaders who collaborate regularly on how to improve performance in quality, service, affordability, and patient and workplace safety, as well as address the needs and future state of the health care workforce. Some of these networks are informal, organized on an ad hoc basis by universities and foundations. Others exist quite formally and on a huge scale such as the Institute for Health Care Improvement (IHI).

Leaders from single-payer nations are prominent in these forums, including the Swedes, the British and the Canadians.

And at the center of many of these forums are the not-for-profit Kaiser Permanente model of care and the Kaiser Permanente Labor Management Partnership. Along with colleagues from the coalition and KP, I have participated in many forums including the annual IHI National Forum, special conferences on health care improvement held at Cornell University, the University of Illinois-Chicago, the United Nations University in Maastricht, Holland, and at the International Labor Organization in Geneva. Unions in the U.S. have sponsored such forums in Pennsylvania, Chicago, New York, Providence, RI, and Los Angeles, just to name a few places.

Indeed the Kaiser Permanente Performance Improvement Institute brings together many practitioners from Kaiser Permanente as well as many other high-performing systems—all in search of best and effective practices and creating a learning environment for continuous improvement.

The challenge is this: Improving health care is difficult everywhere. The industry is hierarchical in nature; costs are escalating; available resources are always challenged by other forces; disease is becoming more complex; and expectations are rising.

So, our emphasis on performance improvement in health care is much more than meets the eye. It is as universal a need as the need for universal care. In fact, we will not achieve the one without the other.