Amazon, Berkshire, JPMorgan to Create Healthcare Company • Hacker News Board

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#141

Post by remir » Tue, Jan 30, 2018, 3:33 PM UTC

adventured wrote: post #11

_m8fo wrote: post #6

I've always wondered what's stopping someone from creating a non-profit and just having people join it in order to give the non-profit ability to negotiate lower prices. I imagine there's a cost to set this up, but is that cost less than the marginal cost of each employee and the savings they would (presumably) receive if enough people joined?

The US healthcare system worked for the majority of people until roughly the last 15 years, and then it began failing gradually up the income ladder. So if you look more recently, the last ten years in particular, that would be the window where something like this would especially begin to matter. It wasn't done before, because it didn't make sense for large entities to bother; things have gotten bad enough that now…

I never understood the fear of public funded healthcare in America. An annual premium of $18,000 is insane. My mother in law spent 1 month at the hospital and she had two surgeries. Cost? Zero.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#142

Post by dawhizkid » Tue, Jan 30, 2018, 3:33 PM UTC

11thEarlOfMar wrote: post #53

It's not just the cost. It's the incredible inefficiency of the operations, and, the gerrymandering of coverage. Under the ACA, I had to choose between allowing my family to continue to see their lifetime care givers, or, paying in network rates, for the full year, because the insurance company I chose gave me incorrect information when they were trying to get my business (my wife is less kind in evaluating their mot…

But to be real here, the main motivation for creating this new venture is employer cost.

Some people might not be aware that the vast majority of large employers in the U.S. that offer health insurance are self funded (i.e. they collect premiums from themselves/employees and take on all the insurance risk), so anything they can do to lower any direct/indirect cost with plan administration, claims, drug cost (big one), healthcare utilization, etc. will save them billions easily.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#143

Post by pc86 » Tue, Jan 30, 2018, 3:34 PM UTC

coding123 wrote: post #109

WisNorCan wrote: post #107

Earlier quoted context omitted.

There is nothing wrong with “lining your own pockets” as a motivation. It is the fundamental driver of capitalism and the motivation for most entrepreneurs.

Just because it is a fundamental whatever of capitalism, doesn't make it 'not wrong'.

Doesn't it? America is unapologetically a capitalist nation with a few notable and infuriating exceptions (looking at you, ISPs).

I mean if you want to make an anti-capitalist argument on a message board owned by a venture capital firm, feel free. But by definition "profit = good"

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#144

Post by optimuspaul » Tue, Jan 30, 2018, 3:34 PM UTC

rocketpastsix wrote: post #122

austenallred wrote: post #117

Earlier quoted context omitted.

You’re right, but respectfully, in the long term, “I want this specific provider at any cost” is somewhat of an edge case. A lot of (most?) people just want good healthcare and a low cost. That’s a complex but solveable problem.

No, its not an edge case. If you have a rapport with a doctor/care provider, you would want to stay with them. I have a genetic disease and an endocrinologist who helps me manage it. I wouldn't want to leave that doctor, who has seen me multiple times, has my charts, understands what Im working with, and so much more.

I'm sorry but that does sound like the definition of an edge case to me. You have a rare situation that requires a unique solution.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#145

Post by rsync » Tue, Jan 30, 2018, 3:36 PM UTC

weka wrote: post #116

11thEarlOfMar wrote: post #53

It's not just the cost. It's the incredible inefficiency of the operations, and, the gerrymandering of coverage. Under the ACA, I had to choose between allowing my family to continue to see their lifetime care givers, or, paying in network rates, for the full year, because the insurance company I chose gave me incorrect information when they were trying to get my business (my wife is less kind in evaluating their mot…

I had the same unfortunate experience that in angers me to even think about it. - I leave my last employer on July 21, 2017 - My old employer rols me off system on last day of July 2017 - On June 2017, they switch HR providers from TriNET to Namely and now the payment processor is Discovery Benefits and the Dental/Vision are now in Guardian. (So it went from Aetna to Aetna/Guardian and two other companies). Since my…

"The whole reason we get insurance is to avoid those high prices."

But only for unpredictable, irregular events. Anything else is uninsurable. If someone sells you "insurance" for wellness checkups[1], regular, scheduled screenings ... or tires on your car ... you can be absolutely assured that they are taking from you as much, or more, in premiums than the cost of those services.

What you are looking for is socialized, state sponsored medical care. There is no problem in looking for that and I make no value judgement here on that.

The first step would be to stop mischaracterizing this as "insurance". It's not. It can't be.

[1] Yes, certainly wellness checkups and things like them can be enormously economically beneficial for the provider since they spend up front preventative dollars instead of emergency, acute dollars later but it still doesn't change the fact that those are not underwriteable as they are regular, on-going expenses - very much like the tires on your car.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#146

Post by pc86 » Tue, Jan 30, 2018, 3:37 PM UTC

nojvek wrote: post #136

Spoom wrote: post #115

Earlier quoted context omitted.

I think in healthcare, there is a problem with profit as a motivation, at least insofar as the ability to receive care. I think healthcare professionals should be paid, and paid well. But a for-profit company (or whether or not one can pay the premiums or deductible of any insurance company) should not be a gatekeeper to whether or not one can receive care at all. Inevitably, someone will be left out in the cold, or…

Single payer healthcare is the best soln. Agreed, However I can’t see it working more than a presidential term. America is too politically unstable. What i’d love to see is a commercial business having vertical integration. Insanely cheap basics like X-rays, mris, and other checks. Heavy use of AI based diagnosis confirmed by doctors, and a big insurance pool where profits go back into scaling healthcare. Basically c…

Who is going to develop AI-based diagnosis platforms if there's no profit to be made?

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#147

Post by ceejayoz » Tue, Jan 30, 2018, 3:37 PM UTC

IncRnd wrote: post #124

samfriedman wrote: post #59

Earlier quoted context omitted.

I think it would be irresponsible at best for Amazon to tackle the medical supply/device market before they can get their counterfeiting problem under control.

It would be irresponsible at best for Amazon to tackle the medical supply/device market before they can learn to ship 20 items from the same fulfillment center on the same day in the same box instead of in 20 oversized but mostly empty boxes.

Fulfillment centers are large enough that shipping them in individual boxes may actually be the cost-effective method at times.

I've also heard they play a bit of a game of tetris to fill truck trailers in a way that completely stuffs them full enough that packages don't move around.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#148

Post by JoeAltmaier » Tue, Jan 30, 2018, 3:39 PM UTC

pc86 wrote: post #143

coding123 wrote: post #109

Earlier quoted context omitted.

Just because it is a fundamental whatever of capitalism, doesn't make it 'not wrong'.

Doesn't it? America is unapologetically a capitalist nation with a few notable and infuriating exceptions (looking at you, ISPs). I mean if you want to make an anti-capitalist argument on a message board owned by a venture capital firm, feel free. But by definition "profit = good"

A venture-capitalist firm that's doing studies in Basic Income and its effects. So give them a little credit.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#149

Post by fred256 » Tue, Jan 30, 2018, 3:41 PM UTC

weka wrote: post #116

11thEarlOfMar wrote: post #53

It's not just the cost. It's the incredible inefficiency of the operations, and, the gerrymandering of coverage. Under the ACA, I had to choose between allowing my family to continue to see their lifetime care givers, or, paying in network rates, for the full year, because the insurance company I chose gave me incorrect information when they were trying to get my business (my wife is less kind in evaluating their mot…

I had the same unfortunate experience that in angers me to even think about it. - I leave my last employer on July 21, 2017 - My old employer rols me off system on last day of July 2017 - On June 2017, they switch HR providers from TriNET to Namely and now the payment processor is Discovery Benefits and the Dental/Vision are now in Guardian. (So it went from Aetna to Aetna/Guardian and two other companies). Since my…

That's the way COBRA works though: you have 2 months to elect it, but if/when you do, you have to pay premiums starting from the moment you lost your original coverage (and have retroactive coverage).

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#150

Post by sixdimensional » Tue, Jan 30, 2018, 3:41 PM UTC

_m8fo wrote: post #6

I've always wondered what's stopping someone from creating a non-profit and just having people join it in order to give the non-profit ability to negotiate lower prices. I imagine there's a cost to set this up, but is that cost less than the marginal cost of each employee and the savings they would (presumably) receive if enough people joined?

Actually, I'll go one step further. Why don't we set up a non-profit/cooperative to aggregate people to get all the group benefits that full time employees receive (e.g. Retirement, Health and other insurance, and other discounted perks)?

Heck, we could even create a HN-cooperative that any of us could join, sign up and pay a nominal membership fee. Then we could off and all be independent contractors etc. without fear of losing benefits.