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

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#371

Post by maxxxxx » Tue, Jan 30, 2018, 7:01 PM UTC

neltnerb wrote: post #311

maxxxxx wrote: post #130

Earlier quoted context omitted.

To me he is a character like Gates, Rockefeller or Carnegie. Ruthless, ever greedy businesspeople who get as much as they can out of business at any cost. Then they give a big part of it away. The question is whether the health care thing is part of the making money activities or part of the giving away activities. You can always hope for the best so let's see what happens. Looking at the American health system I am…

Why do you think this? His public and private actions generally seem to support the idea that he is ethically grounded, and I'm unaware of questionable behavior at any point in his earlier career. But I'm not that old, so I don't know who he was in the 70s.

I have nothing against Buffet. I just think that you can't become a multi-billionaire by being a nice guy. You have to be ultra (pathologically?) competitive and ambitious to get that far.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#372

Post by learc83 » Tue, Jan 30, 2018, 7:06 PM UTC

kevin_thibedeau wrote: post #323

learc83 wrote: post #262

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.

> "There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is." When you can game the pricing you can always just slice 80% from an ever increasing pie.

That's not really how it works. The "ever increasing" pie would have to come directly from increasing subscriber premiums, not from cutting costs and pocketing the difference the OP indicated.

It doesn't matter how much they play with pricing on the back end, the company can't make more than 20% profit from subscriber premiums.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#373

Post by erispoe » Tue, Jan 30, 2018, 7:07 PM UTC

mbesto wrote: post #357

propman wrote: post #340

Earlier quoted context omitted.

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.

This happened to my family as well. My wife broke her ankle and is an avid amateur sports nut. She wanted to go see a top sports doctor (KP has none) and couldn't get KP to cover any of it. To pay out of pocket was anywhere between $20k-$30k. We ended up flying to the UK because it was cheaper and she had a trusted top tier sports injury surgeon she knew there.

Well that's how it works. If you want healthcare to work for everyone, you cannot expect that insurance will reimburse treatment from top doctors outside of rare conditions (where top doctors are the only doctors). Sport related injuries are extremely common. Why should an insurance reimburse an incredibly costly treatment when a normal treatment is good enough for most people? By definition, you cannot have an insurance that covers everyone but sends you to a top 1% doctor. What would the other 99% used for?

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#374

Post by kevin_thibedeau » Tue, Jan 30, 2018, 7:11 PM UTC

learc83 wrote: post #372

kevin_thibedeau wrote: post #323

Earlier quoted context omitted.

> "There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is." When you can game the pricing you can always just slice 80% from an ever increasing pie.

That's not really how it works. The "ever increasing" pie would have to come directly from increasing subscriber premiums, not from cutting costs and pocketing the difference the OP indicated. It doesn't matter how much they play with pricing on the back end, the company can't make more than 20% profit from subscriber premiums.

There is a whole lot of backscratching with the profiteers taking their cut of the 80%. That is why we get $30 Tylenol pills under the guise of "care".

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#375

Post by sxates » Tue, Jan 30, 2018, 7:16 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'm also a big fan of Kaiser, and can share a couple of anecdotes to illustrate why.

A few years ago when I was working for a startup and had insurance through United Healthcare, I came down with a high fever and then started seeing blood in my urine on a Saturday. My only option was to go to the ER, which I did.

In the ER I had blood and urine tests, which determined that I had an infection in my kidneys. I was treated with intravenous antibiotics, and sent home a couple hours later with prescriptions for a couple more drugs to take for the next week or two.

IIRC my total bill for the 2-3 hours I was there was around $6,000, of which my insurance covered about $1500 and I was left with a $4500 bill to cover out of pocket. I remember thinking at the time that such an event would be financially catastrophic for most people - I was fortunate that I could afford it.

My wife has been with Kaiser for many years. Last year my wife started experiencing chest pains, which turned out to be pulmonary embolisms (blood clots in the lungs). She was admitted to the ER as well, where they ran some tests and got her on blood thinners. This was followed up with lung capacity tests and a few other things. Like me, she was in the ER for just a few hours, then sent home with appointments for follow-ups.

Total cost for my wife was about $50 all-in.

The magic of Kaiser is that when the insurance and the provider are both the same company, there's no dispute over pricing. There are no fights over bills, and no surprise costs that weren't covered. We have deductibles with Kaiser, but almost all services are a low fixed cost, so we don't eat into those deductibles much at all. This is not the case with other insurance companies.

In my mind the Kaiser model is what the US should have as a national health care system, that's really good at covering the 95% cases at a reasonable cost, leaving people the option to go to other providers for specialty care if needed.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#376

Post by stale2002 » Tue, Jan 30, 2018, 7:22 PM UTC

FroshKiller wrote: post #369

stale2002 wrote: post #346

Earlier quoted context omitted.

Nobody opposes economies of scale. What we oppose is being forced by the government to accept a 1 size fits all plan, and not being allowed to buy the healthcare plan we want. It is the difference between everyone using Facebook because they like the product and the network effect, vs everyone using governmentBook because the government outlawed all competing social networks.

Everyone who says, "Why should I have to pay for poor people's health care?" is opposed to economies of scale.

If the US only allowed one grocery store to exist, that would have economies of scale as well.

Shouldn't we then give everyone "food insurance" which you pay for with taxes, and then are able to use that food insurance to get food from the store for free? (well, not really free, paid for by your taxes). You'd pay a predetermined amount of money no matter what you got from the store, but your options would be limited by the government food insurance committee.

If you don't support this single payer food insurance solution to all of your caloric needs, then my question for you is why do you hate poor people?

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#377

Post by dawhizkid » Tue, Jan 30, 2018, 7:26 PM UTC

greedo wrote: post #326

dawhizkid wrote: post #142

Earlier quoted context omitted.

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)…

Do you have anything to back this up? I work for an insurance provider, and this is not accurate in my experience.

back what up?

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#378

Post by astura » Tue, Jan 30, 2018, 7:26 PM UTC

greedo wrote: post #326

dawhizkid wrote: post #142

Earlier quoted context omitted.

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)…

Do you have anything to back this up? I work for an insurance provider, and this is not accurate in my experience.

http://www.benefitspro.com/2015/03/09/the-rise-of-self-fundi...

>Only about 26 percent of employers with between 100 and 499 employees self-insure, compared with more than 82 percent of employers with 500 or more employees, according to data from the U.S. Department of Health and Human Services.

That being said, they don't usually take on ALL the insurance risk, they typically purchase stop gap insurance for very large claims.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#379

Post by brazzledazzle » Tue, Jan 30, 2018, 7:30 PM UTC

spoiledtechie wrote: post #362

physcab wrote: post #333

Earlier quoted context omitted.

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…

You might be on the West coast. Kaiser does individual therapy on the East. Maybe your company isn't willing to pay for individual...

They do it on the west coast as well. You might be right that it's coverage related, but Kaiser in my experience let's you pay out of pocket for anything not covered. Could be that they don't do individual therapy for certain issues or simply can't due to staffing issues.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#380

Post by chimeracoder » Tue, Jan 30, 2018, 7:40 PM UTC

cptskippy wrote: post #341

chimeracoder wrote: post #239

Earlier quoted context omitted.

> Medicare is relatively simple compared to most insurance companies and their rules. As someone who's actually had to deal with this complexity and implement software to facilitate it, I can assure you that Medicare is not at all simple, by any stretch of the imagination. It's not even standard or consistent within Medicare within a geographical region , even if you limit the scope to Part A and Part B, excluding co…

It's not that Medicare is simple, it's not. It's that there are thousands of private insurance companies each holding thousands of lines of insurance each with their own set of rules comparably complex to Medicare. Medicare is by volume the larges provider but size is actually a benefit because it means that it's dealt with more frequently and is more familiar to care providers. A care provider isn't multi-regional,…

> A care provider isn't multi-regional, thus when they deal with Medicare it's mostly consistent. The interface is at least similar.

This is dead wrong. It's easier to deal with a small ha regional insurers than it is to deal with Medicare on the whole. And as I said in the original post, even within a region, Medicare is very heterogeneous.

> Medicare is by volume the largest provider.... Medicare isn't simple, it's just a small piece of a very big shit sandwich.

As you said yourself, it's the largest single piece of the sandwich. It also happens to be the core of it as well. Most of the complexity in the billing process stems from how Medicare structures and organizes its own billing, not the other way around.