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

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#331

Post by stanley » Tue, Jan 30, 2018, 5:51 PM UTC

tmh79 wrote: post #299

lotsofpulp wrote: post #173

Earlier quoted context omitted.

It's rather entertaining to see the fallout of costs becoming more transparent in America's healthcare system. There is a reason why the medical field is so lucrative in the US, and it's because for decades it's been subject to extreme price obfuscation. This is great for the merchants (pharmaceuticals, doctors, hospitals, medical software providers, nurses, etc), especially for such inelastic goods such as healthcar…

Residency programs are more restricted by funding for residency spots, not by the AAMC. Funding is, very weirdly, provided by Medicare. It's all a tangled mess with lots of weird stakeholders, but saying "doctors are using rent seeking behavior to limit new entrants to the field" is a bit disingenuous. https://economix.blogs.nytimes.com/2013/12/17/how-medicare-s... https://www.aamc.org/advocacy/gme/71178/gme_gme0012.…

Doesn't the AAMC regulate the number of nurse practitioners? My understanding was that increasing the pool of nurse practitioners would help alleviate the cost of treatment for basic ailments, but that number is capped by an administrative body.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#332

Post by amelius » Tue, Jan 30, 2018, 5:51 PM UTC

_jal wrote: post #298

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've known two people who loved Kaiser until they had a serious issue. Not privy to a ton of the details, but it appears that they Kaiser is not immune to at least a divergence of interests with their patients when the figures get big.

Hence health insurance should be strictly separate from health care. A strong insurance body could even ensure proper competition in the health care space.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#333

Post by physcab » Tue, Jan 30, 2018, 5:53 PM UTC

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’ve been with Kaiser for over a year after having been on One Medical which is aiming to go in the opposite direction (many small satellite offices with good tech and more personal private care).

For simple, routine needs Kaiser really does shine. Easy appointments, quick, good staff. We recently had a baby through Kaiser and pre-natal and post-partum care as well as the actual delivery was a fantastic experience. Much more so than the experiences of my peers at other non-Kaiser hospitals. Cost is all covered in employee plan.

BUT as soon as you encounter specific issues, Kaiser breaks. I’ve had persistent GI issues and was never able to find consistent specialists on Kaiser. I also lost coverage to my therapist as Kaiser only does group therapy.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#334

Post by ethbro » Tue, Jan 30, 2018, 5:55 PM UTC

tmh79 wrote: post #299

lotsofpulp wrote: post #173

Earlier quoted context omitted.

It's rather entertaining to see the fallout of costs becoming more transparent in America's healthcare system. There is a reason why the medical field is so lucrative in the US, and it's because for decades it's been subject to extreme price obfuscation. This is great for the merchants (pharmaceuticals, doctors, hospitals, medical software providers, nurses, etc), especially for such inelastic goods such as healthcar…

Residency programs are more restricted by funding for residency spots, not by the AAMC. Funding is, very weirdly, provided by Medicare. It's all a tangled mess with lots of weird stakeholders, but saying "doctors are using rent seeking behavior to limit new entrants to the field" is a bit disingenuous. https://economix.blogs.nytimes.com/2013/12/17/how-medicare-s... https://www.aamc.org/advocacy/gme/71178/gme_gme0012.…

I explained it to someone recently as this: "This biggest problem with the healthcare industry is that incentives are terribly misaligned and patchwork. Because most of the market is formed by accreted law rather than naturally, even incentives for a given participant (e.g. an insurance company) are usually different than what you'd expect."

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#335

Post by taeric » Tue, Jan 30, 2018, 5:57 PM UTC

ams6110 wrote: post #274

lallysingh wrote: post #231

Earlier quoted context omitted.

I believe OP is talking more generally about insurance (not just health). Insurance covers you for unusual unexpected large-cost events at the cost of regular, predictable payments. They are useful in capping your risk exposure. But if the events are rather certain, then the insurer can only act as a payment plan on the events. The risk is 100%, so at least 100% is priced into your premium (profits, a overhead, etc t…

Except even the 100% risk is spread over the group. So if I have some known condition that will definitely incur $10,000 in medical expenses this year, it's still possible that my premiums total less than that, but everyone's premium is a bit higher than it would otherwise be, to cover my extra costs. Even covered wellness care probably comes out a bit less than it would otherwise cost, because not everyone uses it e…

This is why the poster called it a socialized system. You are literally spreading the costs to the society of individuals in the plan. That is not insurance.

Now, it is common for "socialized" to be a scary word. So that people try and name it other things. But you aren't spreading the risk here. You are only spreading the costs.

Well, I'd also argue that you are spreading the benefits. Which is a good thing to me. Point being, though, it is not insurance.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#336

Post by ChuckMcM » Tue, Jan 30, 2018, 5:57 PM UTC

aero142 wrote: post #282

ChuckMcM wrote: post #244

Earlier quoted context omitted.

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."

How do you come to that conclusion? I've seen a number of articles and cases like [1] where a company decides to charge apparently "what ever it wants" and the insurance company said "fine" and paid it. This article[2] talks about the wide range of prices for the exact same procedure within the same area. Is it your understanding that each of those different doctors justified their costs and the insurance company validated them?

[1] https://www.law360.com/articles/940691/fla-compounding-pharm...

[2] https://www.usatoday.com/story/news/politics/2016/04/27/huge...

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#337

Post by stale2002 » Tue, Jan 30, 2018, 5:58 PM UTC

bbddg wrote: post #106

dekhn wrote: post #12

Here's what this is about. Large successful companies contract out their health insurance and care to external companies. Most of those companies are profit centers- they provide a service, but they take a very large profit on it. Much of that profit is just waste- it's money that goes to people who aren't innovating, or providing value, just acting as gatekeepers (note: this is just my opinion, not provable fact). C…

I'd call this liberal-communism. We just have to put our trust in benevolent billionaires to solve our problems for us with no oversight or democratic controls whatsoever. The idea that this is anything but an attempt to squeeze even more money out of the system for quite literally the richest people on Earth is naive. In Ohio, 10% of Amazon employees are on food stamps[1] while Bezos is worth over 100 billion dollar…

Squeezing money out of the system by paying less money to health insurance providers?

Are you really going to argue that for profit insurance providers are more deserving of that money?

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#338

Post by eanzenberg » Tue, Jan 30, 2018, 6:00 PM UTC

We’ve moved from trying to get to single-payer government provided healthcare all the way to tax cuts. This change of mindshare for the USA means more believe that health issues are more self-inflicted than random unluckiness.

There is truth to both sides, and I am in the single payer camp. However, I know that most doctors visits in the US are the result of obesity, lack of exercise, and lack of education. These things need to change much earlier down the funnel, but they don’t.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#339

Post by ethbro » Tue, Jan 30, 2018, 6:01 PM UTC

xapata wrote: post #232

weka wrote: post #209

Earlier quoted context omitted.

Not sure I get you. "But only for unpredictable, irregular events." But if I went into the Doctor's office without insurance, could they turn me away? The bill would be too high? We looked into ACA... but we thought that the process of switching over from AETNA to COBRA would be painless (weeks at most). So we just went through with it. We did not know it would end up like it has. The operations for insurance is a da…

I'd say that healthcare is just one of the fields where bureaucratic incompetence is horrifying. There are many others, like the legal system confusing two people with the same name in the same town.

The takeaway is that one shouldn't predicate success on lawyers creating a Borges-fidelity 1:1 mapping of the real world into law.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#340

Post by propman » Tue, Jan 30, 2018, 6:02 PM UTC

physcab wrote: post #333

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’ve been with Kaiser for over a year after having been on One Medical which is aiming to go in the opposite direction (many small satellite offices with good tech and more personal private care). For simple, routine needs Kaiser really does shine. Easy appointments, quick, good staff. We recently had a baby through Kaiser and pre-natal and post-partum care as well as the actual delivery was a fantastic experience. M…

Agreed. Kaiser does well for the vast majority of problems and for the averafe person, but anything specific, out of the norm, or challenging Kaiser fails. You sometimes need to see someone not in network and that's the main reason for insurance. Anyone really can help treat you for common ailments, but when something unique comes it's better to have the options to see the best in the field.