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Amazon, Berkshire, JPMorgan to Create Healthcare Company

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Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#211

Post by L_Rahman »

pc86 wrote: post #139
rocketpastsix wrote: post #122

Earlier quoted context omitted.

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.

People want to believe that their medical condition(s) are a special, one-in-a-billion mix requiring years or decades of rapport-building and conversations. That's not the case for the vast majority of people, even with very complicated medical histories and diagnoses. "Has seen me in the past" and "has my charts" are not indicative of medical efficacy. There are doctors I have rapport with, absolutely. I still have…

there is clinically proven evidence that seeing the same provider in the same setting improves outcomes:

https://www.newyorker.com/magazine/2017/01/23/the-heroism-of...

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#212

Post by maxxxxx »

mapgrep wrote: post #176

As some other people have mentioned below, the much lauded[1] vertically integrated health provider Kaiser Permanente started this way, as the health provider caring for the workers of an enlightened large employer, Kaiser Steel, which at the time was a massive shipbuilder for the Navy and others headquartered in California with a major presence in the SF Bay Area. I was briefly covered by a Kaiser plan, and have a l…

I had Kaiser for a while and loved it. One appointment and you get two doctor visits and blood tests done the same day.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#213

Post by weka »

fred256 wrote: post #149
weka wrote: post #116

Earlier quoted context omitted.

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).

Yep. And I elected ASAP. One of the first things I did starting new job.

But the I continuously got the "we have you down for this provider" when my COBRA admin told me that that provider could no longer give me coverage. I needed to AETNA to file me under a new provider.

Then I called AETNA and they still said "so and so" is listed as my provider. I told them to change it. "It's gonna be at least a week to update your information, sir."

Call back next week, "sir, you are still listed on 'so and so' provider."

It was exhausting.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#214

Post by cptskippy »

chimeracoder wrote: post #93
cptskippy wrote: post #54

Earlier quoted context omitted.

> One of the benefits a profit motive brings to insurance companies is pushing back on improper billing by providers And one of the reasons for the most complicated billing system in the world is for-profit Insurance companies.

> And one of the reasons for the most complicated billing system in the world is for-profit Insurance companies. Not really. In fact, Medicare is responsible for most of the current billing system, not private insurers.

Medicare is relatively simple compared to most insurance companies and their rules.

Insurance providers write custom lines of business for employers per state and allow those employers to customize the coverage however they like. This happens annually with revisions done to exclude or include coverage as the employer dictates.

Insurance companies, and employers, come up with byzantine rules for what's covered, when it's covered, where it's covered, who is allowed to provide care, prerequisites before approving coverage, what brand of products are permitted in treatment, and on and on.

The net effect is that the rules are multi-variant to the point that they cannot realistically be validated or tested by humans. There are entire industries dedicated to maintaining rules management engines specifically for validating policies, coverage, and claims.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#215

Post by joncrane »

mapgrep wrote: post #176

As some other people have mentioned below, the much lauded[1] vertically integrated health provider Kaiser Permanente started this way, as the health provider caring for the workers of an enlightened large employer, Kaiser Steel, which at the time was a massive shipbuilder for the Navy and others headquartered in California with a major presence in the SF Bay Area. I was briefly covered by a Kaiser plan, and have a l…

Kaiser Permanente has a huge presence in the Washington, DC area.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#216

Post by Someone1234 »

dawhizkid wrote: post #127

I strongly feel that what needs to be changed is employer-based healthcare itself. It is really kind of crazy, if you think about it, how closely the quality of our healthcare and the healthcare of our dependents is tied to the company we choose to be working for at the moment. If you or a dependent take a very specific expensive medication that isn't covered by a plan a new employer might offer, then you pretty much…

I have a choice of exactly two health insurance companies because that's who my employer selected for me. Both are for profit companies, with Aetna just posting record profits, and we see our premiums rise year upon year.

But beyond me, the fact that someone working minimum wage, unemployed, or at a startup using the Obamacare exchange pays more than an executive at a fortune 500 makes no rational sense. That's because the market has been silo-ed by employer instead of each individual insured.

The US would be in a much better state if everyone had to get their insurance from the exchange. One of the two political parties is constantly drumming the "competition" drum as a magical solution, but they're too scared to actually make the market competitive.

- Give everyone in the US a HSA (health savings account).

- Increase HSA contribution maximums significantly ($20K/year or more)

- Allow employers to give money, tax free, to employees via their HSA

- Allow employees to pay their insurance premiums via the HSA

- Ban employers from directly picking the employee's insurance or providing the insurance

- Employees (and everyone else) would pick insurance from the health insurance marketplace

- Medicaid would pay 100% of premiums, but Medicaid recipients still pick their own insurance

- The VA would move to a mixed model, help pay for regular insurance (via the HSA), and offer bespoke services specific to former enlisted personnel. Most common services would be received at regular healthcare providers, not VA hospitals.

Now instead of employers paying $1000/month for your health insurance they put that $1000 into your HSA, you then go onto the health insurance marketplace find insurance, and use your HSA to pay your premiums. Don't like your insurance company? Change. This is how you spurn competition.

Additionally if your employer doesn't help you with health benefits, you can contribute to your HSA yourself tax free and you won't be further punished (i.e. pay the same overall premium, with same tax benefits, as someone with a better employer, unlike now).

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#217

Post by sehugg »

austenallred wrote: post #117
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…

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.

The OP reports the insurer misrepresenting their in-network coverage. I've had this experience with BCBS -- the list of in-network doctors on the website was wrong. Hard to prove incompetence vs. malice, but there seems to be zero accountability for this sort of thing.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#218

Post by pjdemers »

23443463454 wrote: post #125
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…

It's a bit of an aside, but this whole issue, the bare knuckle fight about health care brings about an interesting deeper rooted issue that clearly and uniquely differentiates the two primary perspectives; one side always tends towards the heavy handed, imposing, authoritarian approach to force things they deem self-evident as desirable or have determined to be "good" and are thereby inherently inefficient and wastef…

If my employer buys health insurance for me, neither they nor I pay taxes on the premium cost. If I buy the exact same policy for myself, it is fully taxable to me. The amount of taxes is not small, about $1000 per month. So, the government is already imposing a very strong centrally planning effect on how health care works by tax policy.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#219

Post by bigtones »

mapgrep wrote: post #176

As some other people have mentioned below, the much lauded[1] vertically integrated health provider Kaiser Permanente started this way, as the health provider caring for the workers of an enlightened large employer, Kaiser Steel, which at the time was a massive shipbuilder for the Navy and others headquartered in California with a major presence in the SF Bay Area. I was briefly covered by a Kaiser plan, and have a l…

I'm with Kaiser Permanente (switched from a PPO) and have been for two years and I absolutely agree with your comment - in SF they have brand new world class facilities in the dog patch neighborhood near me and I can book and see a doctor and orthopedic specialist and get an xray and scan in the same day and in the same building, and be about $30 out of pocket all in. That is awesome health care.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#220

Post by ihsw2 »

013a wrote: post #83
ihsw2 wrote: post #72

Earlier quoted context omitted.

Vanguard took decades to gain any traction and it was managed well enough to ensure it didn't prematurely burn out, and not only that but Jack Bogle spent his entire life evangelizing low-cost in an environment where "cost is no object" was a common mantra. Not only that but the healthcare industry has extraordinarily high financial and legal barriers to entry.

> Managed well enough Unlike Amazon and Berkshire, two of the best managed companies humanity has ever created? > Extraordinarily high financial and legal barriers to entry Unlike financial companies?

There are extraordinarily high expectations in the finance industry but the only barriers are regulatory compliance (with regards to fiduciary duty) and convincing people to throw money at you.
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