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Amazon Health

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Re: Amazon Health

#91

Post by dx034 »

onemore2 wrote: post #72
aaavl2821 wrote: post #58

Earlier quoted context omitted.

The traditional economic view is that private, profit seeking enterprises actually offer better prices to consumers because of competition, while monopoly firms charge higher prices bc they have more market power, and government run enterprises yield lower quality products because they don't have incentive to compete on quality. India has a very competitive healthcare system that is largely out of pocket and while th…

It's relatively easy to keep the costs low in Europe: you pay in queues and cheap health care instead of money. That doesn't mean good-or-bad automatically. E.g. giving birth by C-section is a rare event in Europe but it's very common in the US, making the "born" event very expensive on average in the US. You usually get over-testing in the US and under-testing in Europe. If you have a suspicious mole, or a woman rep…

> If you have a suspicious mole, or a woman reports pain in the uterus, in Europe you might wait one or two years before a doctor sees you. And then you might get just an "everything looks fine" or a mild painkiller, and start again to look for another specialists or just go to the private health. It's known, but somewhat silenced, that a significant number of heart/liver/kidney patients just die before they get to see the specialist because the system is overloaded. This payment-by-queue drives costs down, but is obviously a bad thing.

Sorry but that's wrong. I've only used the health systems in the UK and Germany but in both countries, you can get an appointment either directly (if you're flexible with time) or within a few weeks. In urgent cases, all hospitals have specialised staff and will see you immediately.

Re: Amazon Health

#92

Post by dx034 »

annabellish wrote: post #89
vidarh wrote: post #85

Earlier quoted context omitted.

The average cost for vaginal delivery is not all that much lower than for C-sections, especially if someone needs/wants epidural etc.. Last US data I looked at showed average costs were something like 20% apart. The lower use of C-sections in most European countries is because it is only done if medically indicated - it has risks. People can, however, and do, do it privately in most European countries, and it is most…

>Maybe it happens some places Esoteric or non-physical things, mostly. The NHS really sucks at trans issues, for example, where a two year waiting list is not unusual. It's one of the few areas that US healthcare sometimes does better in, where the state is one which permits informed consent care.

To be fair, if you're willing to pay US prices you'll also get immediate treatment. There are enough private clinics with no waiting list that will treat you immediately. But insurances that cover those are not much cheaper than US health care.

Re: Amazon Health

#93

Post by noxToken »

chatmasta wrote: post #82
yarg wrote: post #47

Earlier quoted context omitted.

Premiums are as high as they are because health care is run as a for profit industry - health care in America is orders of magnitude more expensive than in other countries. If you remove the profit motive prices will drop down towards something more reasonable, in this situation it's not unreasonable to expect that the system could be maintained with employee premiums. The cost of initialisation of services will be h…

The US pharmaceutical industry is also one of the leading innovators and manufacturers of life saving drugs and medicine. The profit incentive, combined with 10 year intellectual property protection, is what allows pharmaceutical companies to spend enough on R&D to produce these drugs (which the rest of the world benefits from!)

When calculated as a function of GDP, the US isn't that much more innovative compared to other countries. Creating new molecular entities at a higher rate than other countries was the only argument I ever had against a single payer system, but research seems to say that we're not innovating (with respect to GDP) as much as we think we are. From this[1] comment about a 2010 study (and the first result in search about cost):

I don't know all of the ins-and-outs of funding, but this[0] study says that there are other countries developing NMEs at a proportionately faster rate than the US.

From the discussion section:

>Pharmaceutical innovation is an international enterprise. Although the United States is an important contributor to pharmaceutical innovation, we found that more than 20 countries contributed to the development of the 288 NMEs with patents at the time of approval. More than 171 companies were involved in the development of these NMEs, and the vast majority of companies were multinationals with facilities located in more than 2 countries. We also found that the United Kingdom, Switzerland, Belgium, and a few other countries innovated proportionally more than their contribution to the global GDP or prescription drug spending, whereas Japan, Spain, Australia, and Italy innovated less.

Granted I know that GDP isn't the end-all be-all for determining how drugs can be financed, but I think there is something to learn from the study and how other countries do business while continuing to innovate.

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/

[1]: https://news.ycombinator.com/item?id=15955818

Re: Amazon Health

#94

Post by icebraining »

dx034 wrote: post #91
onemore2 wrote: post #72

Earlier quoted context omitted.

It's relatively easy to keep the costs low in Europe: you pay in queues and cheap health care instead of money. That doesn't mean good-or-bad automatically. E.g. giving birth by C-section is a rare event in Europe but it's very common in the US, making the "born" event very expensive on average in the US. You usually get over-testing in the US and under-testing in Europe. If you have a suspicious mole, or a woman rep…

> If you have a suspicious mole, or a woman reports pain in the uterus, in Europe you might wait one or two years before a doctor sees you. And then you might get just an "everything looks fine" or a mild painkiller, and start again to look for another specialists or just go to the private health. It's known, but somewhat silenced, that a significant number of heart/liver/kidney patients just die before they get to s…

Hell, even in my poor Southern European corner you might wait a couple of months for a scheduled appointment; I've never heard of waiting years for a GP consultation. An year is what my brother waited for surgery for a minor shoulder problem, not to see a doctor!

Re: Amazon Health

#95

Post by losvedir »

watertom wrote: post #26

I think these 3 will no longer provide health insurance for their employees, they are going to create a new more affordable framework and they will allow any other large company to participate. The goal will be keep the cost of insurance the same for the employees, while eliminating the cost for the companies entirely, which is why this will take off. It’s crazy to have employers paying for healthcare, this I believe…

I'm incredibly excited to see what they come up with, but if it's just some tooling that further entrenches healthcare-via-employers then I'm going to be disappointed (for the reasons you point out about how crazy and stupid that system is).

These are all very smart people, so I have to assume that they have realized that insurance is a fundamentally flawed mechanism for providing the kind of health care we want, without a universal mandate - which, as private companies, they're not able to issue.

If they instead tackle health care via some other mechanism than insurance - say trying to drive down prices to make it more affordable via transparent pricing in a competitive marketplace (e.g., like the diagram in the article where doctors, pharmacies, etc, list their services) then that has a potential to be a huge, positive change.

That said, they're still operating in our regulatory framework, so they still do need to provide insurance to their employees. So I hope they're able to dual-band it - provide a high-deductible, low-premium HSA with contributions from the company, and let the employees shop on this marketplace from their HSA, while still being covered in the catastrophic case by the insurance plan.

Re: Amazon Health

#96

Post by dredmorbius »

chatmasta wrote: post #82
yarg wrote: post #47

Earlier quoted context omitted.

Premiums are as high as they are because health care is run as a for profit industry - health care in America is orders of magnitude more expensive than in other countries. If you remove the profit motive prices will drop down towards something more reasonable, in this situation it's not unreasonable to expect that the system could be maintained with employee premiums. The cost of initialisation of services will be h…

The US pharmaceutical industry is also one of the leading innovators and manufacturers of life saving drugs and medicine. The profit incentive, combined with 10 year intellectual property protection, is what allows pharmaceutical companies to spend enough on R&D to produce these drugs (which the rest of the world benefits from!)

And yet outcomes measures hardly moved inn the past 50 years, most of that from access, not technical improvements. Life expectancy, QALYs.

Contrast infrastructure and public health measures.

https://object.cato.org/sites/cato.org/files/wp-content/uplo...

Re: Amazon Health

#97

Post by dredmorbius »

dba7dba wrote: post #52
watertom wrote: post #26

I think these 3 will no longer provide health insurance for their employees, they are going to create a new more affordable framework and they will allow any other large company to participate. The goal will be keep the cost of insurance the same for the employees, while eliminating the cost for the companies entirely, which is why this will take off. It’s crazy to have employers paying for healthcare, this I believe…

This is how Kaiser Permanent got started. A major US rail company found it was cheaper and better to hire own doctors to take care of employees.

Water projects. Colorado River Aqueduct, Grand Coulee Dam.

https://news.ycombinator.com/item?id=16274478g

https://share.kaiserpermanente.org/article/history-of-kaiser...

Re: Amazon Health

#98

Post by dredmorbius »

pinot wrote: post #35
aaavl2821 wrote: post #5

The article makes the point that the companies have complementary business competencies that could help them deliver a better healthcare experience (tech, logistics and customer service at amazon; reinsurance at berkshire; capital at JPM), but there is another advantage to these three companies working together: scale. amazon and berkshire are in the top 10 employers, and JPM is in the top 25. while most of the talk…

Isn't this basically how Kaiser got started?

https://news.ycombinator.com/item?id=16281893

Re: Amazon Health

#99

Post by walshemj »

kalleboo wrote: post #75
watertom wrote: post #26

I think these 3 will no longer provide health insurance for their employees, they are going to create a new more affordable framework and they will allow any other large company to participate. The goal will be keep the cost of insurance the same for the employees, while eliminating the cost for the companies entirely, which is why this will take off. It’s crazy to have employers paying for healthcare, this I believe…

> every employer wants to drop that overhead cost One thing I've always wondered is why aren't the large unionized companies heavily lobbying for socialized healthcare and pensions, with a clause sneaked in there absolving them of their preexisting liabilities?

Yes struck me as odd too, one of the few times that the CWA and the motor manufacturers would be singing from the same hymn sheet.
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