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Amazon, Berkshire, JPMorgan to Create Healthcare Company

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Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#451

Post by wahern »

mbesto wrote: post #394
erispoe wrote: post #373

Earlier quoted context omitted.

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 insur…

I'm not discrediting that notion. My point was to echo the sentiment that a closed-loop healthcare system has it's downsides when it hits edge cases. For the record, I pay the same for healthcare from UHC now and it would cover the $25k cost for the specialist because they're in the UHC network.

Do you pay the same as an individual or through an employer?

When my wife left her job several years ago (but post Obamacare) and needed to get insurance on the open market, her Northern California Kaiser plan was roughly the same price as her employee group plan (inclusive of employer contribution). Not too long ago my sister purchased a Kaiser Mid-Atlantic plan on the open market, which was also reasonable with nearly identical coverage to the group plans I've had.

As far I understand, Kaiser is largely an outlier regarding rough cost parity between group plans and individual plans. I'd be surprised if UHC cost the same as Kaiser for the same coverage on the open market, but if you confirm then I'll have to update my assumptions.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#452

Post by tompetry »

I am continually surprised with the focus on attacking the "packaging" of healthcare at the insurance / network / reimbursement level. That isn't the problem that needs to be solved. The problem with healthcare costs is that there is a lack of competition of costly services provided by large hospital and clinics. In many areas, there is a single provider that runs unchecked. Two factors limiting competition are:

1) Huge barriers to entry. How do you start a new hospital or sizable clinic? Regulation, costs, training, etc make it prohibitively difficult 2) Science/data isn't good enough yet. There is not sufficient data to show which providers (hospitals/clinics/treatments) are better than others, enough to allow disruptive entrants into the system.

Only breakthroughs in biotechnology that displace incumbents in healthcare services will move the need. Re-shuffling the insurance / network / payment deck of cards aren't enough.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#453

Post by lttlrck »

IncRnd wrote: post #433
ceejayoz wrote: post #147

Earlier quoted context omitted.

Fulfillment centers are large enough that shipping them in individual boxes may actually be the cost-effective method at times. I've also heard they play a bit of a game of tetris to fill truck trailers in a way that completely stuffs them full enough that packages don't move around.

> Fulfillment centers are large enough that shipping them in individual boxes may actually be the cost-effective method at times. You missed half of what I wrote, "instead of in 20 oversized but mostly empty boxes." The context was in a single order from a single supplier, whose product was already at the warehouse, shipping on the same date, to the same address, for the same delivery date, using the same delivery ca…

It may not be incorrect. It seems that if it was significantly affecting their bottom line it’d be a low-hanging optimization that they’d have tackled by now. FWIW this issue infuriates me also - to a degree

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#454

Post by dragonwriter »

tompetry wrote: post #452

I am continually surprised with the focus on attacking the "packaging" of healthcare at the insurance / network / reimbursement level. That isn't the problem that needs to be solved. The problem with healthcare costs is that there is a lack of competition of costly services provided by large hospital and clinics. In many areas, there is a single provider that runs unchecked. Two factors limiting competition are: 1) H…

> The problem with healthcare costs is that there is a lack of competition of costly services provided by large hospital and clinics.

That doesn't seem to be the problem. Particularly, it is not a differentiator between the US and many systems with better cost-for-outcome profiles.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#455

Post by jugg1es »

I'm a lead dev at a small, but fast-growing healthcare IT company and I can say that healthcare is nothing like the markets that amazon is currently in. It is so incredibly fragmented and the laws vary state to state. In Maryland, where I live, we have a single, very competent and well-funded HIE called CRISP. California, in contrast, has like 20 different regional HIE's with not much support from the state AFAIK. I think they're going to be surprised how crazy the healthcare markets are.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#456

Post by wahern »

_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.

I've heard horror stories from all kinds of people with all kinds of insurers. For example, a neighbor of mine uses California Pacific Medical in Nob Hill. It's the hospital that caters to San Francisco elite. This past year his doctors mistook skin cancer on his eye for a sty for like 6+ months. He went back several times complaining before they caught their mistake. It's too soon to tell, but that serious issue may turn out to be a fatal one.

Doctors aren't magicians, and they make plenty of mistakes. More to your point, no respectable doctor is going to ignore the cost and time element. Nor should he. There's no such thing as a cost-free diagnostic or procedure, even when money is no object. Even the very best doctor the world has ever seen is working with scarce time and resources; namely, his own. There's no avoiding conflicting interests and goals of some sort or another.

At the end of the day people should be choosing healthcare based on objective criteria. More importantly, our social policies should be built around objective criteria. By objective criteria Kaiser is one of the very best hospital systems in the country. There's plenty to complain about, but it's the nature of things.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#457

Post by ceejayoz »

IncRnd wrote: post #433
ceejayoz wrote: post #147

Earlier quoted context omitted.

Fulfillment centers are large enough that shipping them in individual boxes may actually be the cost-effective method at times. I've also heard they play a bit of a game of tetris to fill truck trailers in a way that completely stuffs them full enough that packages don't move around.

> Fulfillment centers are large enough that shipping them in individual boxes may actually be the cost-effective method at times. You missed half of what I wrote, "instead of in 20 oversized but mostly empty boxes." The context was in a single order from a single supplier, whose product was already at the warehouse, shipping on the same date, to the same address, for the same delivery date, using the same delivery ca…

Hard to say without knowing the supplier's volume, the nature of the products, etc., but it's entirely possible given the nature of Amazon's warehouses that those "almost identical items" could be scattered all over.

They could have arrived from the supplier in small batches (or even one-by-one) over time if it's a low-volume sort of thing. Amazon might intentionally spread them throughout the fulfillment center in some situations to expedite packing and reduce the distances their robots have to travel.

They might have just needed twenty boxes to finish the tetris puzzle to send a truck out the door.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#458

Post by sumedh »

maxxxxx wrote: post #371
neltnerb wrote: post #311

Earlier quoted context omitted.

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.

> I just think that you can't become a multi-billionaire by being a nice guy.

Berkshire is a holding company, all the not so nice decisions are made by the CEOs of the companies Berkshire owns.

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#459

Post by vanderZwan »

visarga wrote: post #325
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…

> distributism Thank you for giving a name to something I have been pondering a lot. I have come to this conclusion by thinking about automation and technological unemployment. If people own land, or productive tools, they can be self reliant and exist without jobs from corporations, or help from the state. Naturally people would organise as a cooperative or a market of services, exchanging services for services, bec…

> Distributism (also known as distributionism or distributivism) is an economic ideology that developed in Europe in the late 19th and early 20th century based upon the principles of Catholic social teaching, especially the teachings of Pope Leo XIII in his encyclical Rerum novarum and Pope Pius XI in Quadragesimo anno.

> According to distributists, property ownership is a fundamental right, and the means of production should be spread as widely as possible, rather than being centralized under the control of the state (state capitalism), a few individuals (plutocracy), or corporations (corporatocracy). Distributism, therefore, advocates a society marked by widespread property ownership.

> Distributism has often been described in opposition to both socialism and capitalism, which distributists see as equally flawed and exploitative. Thomas Storck argues: "both socialism and capitalism are products of the European Enlightenment and are thus modernizing and anti-traditional forces.

https://en.wikipedia.org/wiki/Distributism

So not to be snarky, but how is this anything more than simple "Marxism, minus the parts that don't work with Catholic religion, plus Catholic religion"?

Re: Amazon, Berkshire, JPMorgan to Create Healthcare Company

#460

Post by maxxxxx »

sumedh wrote: post #458
maxxxxx wrote: post #371

Earlier quoted context omitted.

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.

> I just think that you can't become a multi-billionaire by being a nice guy. Berkshire is a holding company, all the not so nice decisions are made by the CEOs of the companies Berkshire owns.

And the guy on top is a nice guy who washes his hands clean from all unpleasantries. I don't think that's how it works.
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