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Amazon, Berkshire, JPMorgan to Create Healthcare Company

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Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#241

Post by wolfgang42 »

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).

The way COBRA works is that they can just start giving you coverage whenever they feel like finally getting their act together?

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#242

Post by ataturk »

jawns wrote: post #7

> The three companies said they plan to set up a new independent company "that is free from profit-making incentives and constraints." I wonder if they will be setting it up as a health insurance cooperative, an organizational structure in which the primary goal is to serve its members, rather than to generate value for external shareholders: https://en.wikipedia.org/wiki/Health_insurance_cooperative It's not at all…

Most of the Blues are already "non-profits." That really isn't the issue. The biggest issue is regulation--I've worked in healthcare IT and it sucks due to the regulatory burden and fears that are associated with it. You can't innovate, management won't let you.

The second biggest issue is that they are using archaic technology such as AS/400 systems and trying to ship data around using "file drop." File drop--in 2018! They doubled down on stupid technology choices years ago and continue to fail because of it.

The third biggest issue is revenue. You can't even run a non-profit without revenue. Employees don't work for free!

A related problem is that the company I worked for failed to promote people like me who could solve some of their problems for them. I lost the political battle as a tech lead. Had I been someone with more clout, things might have gone differently. Companies promote all the wrong people, though.

BTW, cooperatives are bullshit--even grocery coops have to have revenue, it's not magic. Coops fail because there's "no one in charge" and without decisive action there is failure.

Credit unions work because they extend credit based on typical fractional reserve models. Members of credit unions own shares based on their deposits.

You can't do use a credit union model with insurance because of how insurance underwriting works. Just look at the healthcare costs of any small company--if one person gets sick, everyone's rates go up. There's no magic as to how this all operates. There's no pool of people size n where n is large enough to fix the problem--which is why universal or single-payer systems are merely an illusion of prosperity while taxes rise to 80% and up! It becomes punitive taxation! Which means no freedom for any of the people living under such a system, and eventually the resultant economic collapse--yes, even in Europe.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#243

Post by djsumdog »

Someone1234 wrote: post #216
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 becau…

This is what was talked about in the book "Redefining Health Care." The employer based model is totally broken.

What you're describing is more open capitalism in health care where everyone is on an open playing field. I use to really believe in this at one point years ago, even when working in Health Insurance.

Today, I'm not even for this compromise. I think it should be taken out of our taxes in single payer. Insurance would still be contracted out to those private insurers (cause America). We might even be able to create a system where people chose which insurance provider they use, but it should be payed for by taxes .. it's there for everyone and everyone pays the same proportion of income and everyone gets the same level of coverage. If something is in short supply, then it's going to need a needs based + lottery system (just like organ transplants currently).

For profit and _non-for-profit_ (not to be confused with non-profits; most health care companies are non-for-profits which is a weird legal area) have no place when it comes to public welfare services. People don't pay individually for private security/police. We don't pay for fire. We don't pay a fee to visit a city park (and I'm against fee based national parks actually). The general good should be paid for equally by everyone to their abilities.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#244

Post by ChuckMcM »

vobios wrote: post #201
ChuckMcM wrote: post #182

Earlier quoted context omitted.

This is not clear, in that "concierge doctors" or cash only doctors to some, seem to have rates that are lower than what the insurance companies claim they are billed for a service. That would suggest they are lousy negotiators.

For the doctor, a great benefit of being cash only is you don't have to do billing, a non-trivial task.

I don't disagree, but I observe that if the interests of getting the lowest cost were aligned with the insurance company, and if the complexity of billing was a significant cost factor, it should be well within the capabilities of the insurance company to simplify the billing (by simplifying the requirements) in order to lower overall costs. And yet here we are :-)

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#245

Post by bigtones »

seanwessmith wrote: post #238
bigtones wrote: post #219

Earlier quoted context omitted.

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.

I'm new to the area and have Kaiser. Are you talking about UCSF Medical Center at Mission Bay?

The Kaiser facility is very close to that UCSF facility next to the 101 on Owens street.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#246

Post by BadCookie »

optimuspaul wrote: post #144
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.

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.

Each rare disease is rare, but it is not very rare to have a rare disease. There are just thousands of rare diseases. For example, it is estimated that 6-8% of the EU population has a rare disease: https://en.wikipedia.org/wiki/Rare_disease#Prevalence

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#247

Post by superhuzza »

tonyedgecombe wrote: post #197
superhuzza wrote: post #151

Earlier quoted context omitted.

I bet that health outcomes are improved with longer term patient-physician relationships - Imagine having a new family doctor every year vs. a doctor who has known you for the last 15 years. edit: This (quite extensive and longitudinal) study would suggest that it's true. Check out the sources on the paper for other studies with similar findings: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226774/

I'd like to see some evidence on that because I can imagine staying with one doctor might result in some conditions not being diagnosed.

Updated my post - The introduction provides a decent overview of other studies (and and their limitations) suggesting the same results.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#248

Post by idlewords »

e40 wrote: post #236
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 is no longer a low-cost provider. They actually are quite expensive. We go through a very large group to get a better rate but it's still much higher than many of the other options that we have in our plan. When you look at how Kaiser is structured, they should be cheaper. I think they're just pocketing the difference between the market rate and what their costs are.

Cancer care at Kaiser was outstanding. They may be spending the money on extra staffing and facilities, not just pocketing it.

The only place where I believe Kaiser falls short and gives the impression of pinching pennies is mental health care.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#249

Post by all_blue_chucks »

bigtones wrote: post #219
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.

Is it an HMO? Because those can bankrupt you if you go out of network...

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#250

Post by everdev »

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…

Ditched my BlueShield PPO for Kaiser and costs went down dramatically. There's tons of costs to be saved in healthcare and glad to see the private sector making an effort.
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