Last week, the Mayo Clinic issued a statement lamenting the lack of delivery care reform in the health care reform bills moving through Congress. This morning, George Halvorson, chairman of Kaiser Permanente, one of the largest integrated care delivery systems in the nation, echoed that sentiment.

"We need to accelerate the pace of actual delivery reform in the package," he told a press briefing following his presentation to the second annual meeting of the Kaiser Permanente Health Care Institute at the National Labor College in Silver Spring, Maryland. Setting goals like those in the House bill is "directionally correct," but "we can get to those goals much faster," he said.

About a third of Kaiser's nine million enrollees are union members, and this year's conference is dedicated to promoting greater use of integrated care models. Both Halvorson and John Sweeney, president of the AFL-CIO, who jointly addressed the opening session of the day long meeting, backed using Medicare to drive greater efficiencies through the entire system and setting up a government-run commission like the Medicare Payments Advisory Commission to reorganize payment policy.

"Congress should be considering an independent process," Sweeney said.

I welcomed the opportunity to spend the day at this conference to learn more about the integrated models being jointly pushed by Kaiser, which eschews fee-for-service medicine in favor of salaried physicians, and organized labor, which tends to have expensive health insurance plans because unions represent older and often sicker Americans.

As Mike Leavitt pointed out in his comments to this morning's Washington Post (see my earlier post), a public plan that merely piggybacks on Medicare is a status quo prescription for rising health care costs. Delivery system reform has to be a major component of the package. Is Kaiser, which already insures about 5 percent of Americans with private health insurance, a model for the public plan?

Halvorson, who backs universal coverage even without major delivery system reforms, met with Blue Dog Democrats yesterday to discuss their objections to health care reform package, which have largely focused on the lack of cost controls in the legislation. After his presentation, one of the Congressmen present said "forget the public plan, I will just mandate the whole country become Kaiser," Halvorson said.

It was obviously a self-serving statement. But what fascinated me was that the more than 100 union officials and health care advocates present greeted his recollection of that Capitol Hill interaction with sustained applause. Unions who have those so-called Cadillac plans have no objection to getting their care from integrated systems with salaried physicians. Indeed, based on this limited sample of their leadership, they would appear to prefer it.