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Amazon, Berkshire, JPMorgan to Create Healthcare Company

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Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#281
post #236

Earlier quoted context omitted.

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.

Is there any private non-university health chain in the country that does mental health well? Every contact I've seen with any acute mental health care system --- except at the University of Michigan --- has been a catastrophe.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#282
post #201

Earlier quoted context omitted.

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 :-)

I don't think this is true at all. The doctors have to justify their costs and the insurance companies have to validate that they are worth covering. Neither of those seem simple unless the insurance companies simply said, "Whatever the doctor wants to do, and whatever they charge is fine."

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#283
post #228

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.

As a European I would disagree. We have helathcare for the purpose of keeping people healthy rather than for profit. It seems to work out a whole lot better than your system in the states.

And at least in Germany doctors still have very nice cars so there is still a good amount of profit.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#284
post #145

Earlier quoted context omitted.

"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 socializ…

Your comment seems to overlook the fact that insurance companies negotiate better rates on many (most?) services than an individual would get going at it alone. From that perspective, I think it's reasonable to say that in our current system, insurance can allow you to essentially avoid high prices even for things that are predictable/regular.

You can also negotiate on your own. I've occasionally had medical bills that for whatever reason were not covered. I call the provider and if I owe $1,000 I'll say I can pay $500 today to settle it. That's more than they will get selling the debt to a collector so they will take it.

You generally can't negotiate in advance though, because most providers seem unable or unwilling to tell you what anything is going to cost.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#285
post #116

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…

People feel that politics are tedious, but this is exactly the reason to pay attention. Look farther than your case and systematically review overall national stats of healthcare costs in the US vs other nations. We pay the most of any developed nation, double on average other developed nations, almost triple the best run healthcare of other nations. We not only pay much much more, people die sooner and go bankrupt more under this system for completely preventable reasons.

Edit: And great that there might be a new value conscious private competitor out there - but I'd note that all those other developed nations that are individually, collectively, and vastly outperforming our health system all have some form of government control on drug and procedure prices. And a single private company would be very hard pressed to replicate the negotiation leverage of a government. I'd also note that I'd trust JPMorgan about nil to be concerned about customer value over company profits. Other nations have a health system, and at the end of the day we have a health market.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#286
post #277

Earlier quoted context omitted.

>I think they're just pocketing the difference between the market rate and what their costs are. This is baseless and not really possible. Insurers must spend 80% of premiums (85% for large group plans) on providing care for their insured.

An allowance 15-20% overhead for health insurance seems like pretty low bar for the industry...

And yet, it was groundbreaking when it was signed into law. People received refund checks after it went into effect.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#287

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.

I tried applying to Kaiser and they rejected me for having a pre-existing condition which couldn't be helped given that I was born with it.

Good for everyone else, I guess. :/ I ended up moving back home where the government covers my treatments.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#288
post #75

I always think that it's only a matter of time before some company with vast capital (looking at you Apple) finds their own way to set up a city/country with their own ecosystem (healthcare, transport etc.), with less bureaucracy and more efficiently.

Company towns are not a new thing: https://en.wikipedia.org/wiki/Company_town Your idea was first attempted in the 1880's :)

This concept also seems appropriate (extrapolation): https://en.m.wikipedia.org/wiki/Corporate_republic

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#289

Earlier quoted context omitted.

Generally speaking, insurance companies profit if they don't have to pay out, which is why they sometimes pay for prevention. But this has other problems. Incentives are tricky.

Normally that would be true, but under ACA profits are capped at 25% of premiums. They can increase profits only by increasing premiums, which can be justified by rising costs. Private insurance companies in America have no incentive to lower healthcare costs.

Well, that's true if they hit the cap and have no competition. If they don't have a 25% profit margin yet, they can still try to increase profits by cutting costs. There is also the strategy of lowering prices to increase market share.

The downside I was hinting at is that as a patient, cutting costs isn't always what you want. If it means more prevention or paying less, it's good. Otherwise it'll probably mean worse service.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#290

Earlier quoted context omitted.

Hearing the report on Bloomberg news earlier today. Isn't this just for the 900k employees and isn't it just focusing on wearable tech? It sounded more like fitbit with cloud services than insurance.

>It sounded more like fitbit with cloud services than insurance. If there are healthcare providers involved giving direct healthcare, there will need to be systems and development around medical records. That could easily be sold as a product to hospitals and providers outside of the AMZN/JPM/BRK company down the road. Taking a "beginner's mindset" to me sounds like they plan on writing their own stuff, except for in…

"beginner's mindset" was my favorite line in the article. Classic Bezos. Yes, it might indicate building their own stuff. I also interpret it that sometimes the experts are too stuck in their ways.
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