Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Brave Care Has Closed

bravecare.com

Post reply on HN
Print view View original

111–120 of 160 posts

Re: Brave Care Has Closed

#111

Post by jackcosgrove »

inferiorhuman wrote: post #108
jackcosgrove wrote: post #95

I have heard conflicting accounts of inefficiencies in the US healthcare system. One account is that the US has too many medical facilities in urban areas. In other words, there might be five hospitals each with its own radiology equipment. That equipment is idle some of the time, so you could close some of the imaging departments and leave just one or two for the metro area. That would obviously inconvenience some p…

I'm curious what the truth is regarding the number and character of brick-and-mortar healthcare facilities in the US: too many? too few? Because it looks like this company was opening physical clinics. Services are unevenly distributed and I wouldn't say there's too many providers in urban areas. Rural areas are underserved though (off the top of my head I can think of a movie and a TV series whose premise is rooted…

Just to be clear the "too much coverage" argument is about physical facilities and equipment, not personnel. I think everyone is in agreement that there is a shortage of medical staff.

As far as convenience vs efficiency, the argument was that to achieve the efficiencies found in other countries, which often have longer wait times for services than the US, you do have to sacrifice convenience. The US, by treating healthcare like a consumer good rather than a rationed utility, has built out excess capacity for the sake of convenience. This is, according to the argument, part of the reason we spend more on healthcare than peers. (Healthcare must always be rationed; the US does so on price rather than wait times.)

Re: Brave Care Has Closed

#112

Post by inferiorhuman »

doctorpangloss wrote: post #100
tptacek wrote: post #53

Earlier quoted context omitted.

Yes. I don't know if that's the primary factor that gives them their market power; it might be even simpler than that. But yes, they absolutely do. Unless you're Kaiser, in which case you're the insurer and most of the providers, which is the whole idea behind Kaiser. But every other insurer --- and overwhelmingly, Americans aren't on Kaiser --- is beholden to providers. And of course, Kaiser competes with providers…

Then why isn’t everyone on Kaiser? Because they’re stupid? Providers is also kind of vague. You show up at a hospital, does the nurse practitioner who does your intake set the price of your ER service? Who specifically sets the prices?

UnitedHealthcare operates in DC and all fifty states and has north of 26 million customers. Kaiser operates in eight states and DC and has around 12 million customers. It's safe to say plenty of folks use Kaiser when it's available.

The downside is that because Kaiser operates as an HMO, any specialists you need to see must be approved by your primary care physician (typically GP, ob-gyn, or uro). They have an abysmal record with mental health, and folks who need chronic non-routine care often struggle to get that care. If all you need are routine checkups, cheap prescriptions, routine immunizations, etc. they're quite competent.

  Who specifically sets the prices?
Kaiser is a vertically integrated HMO. Like other HMOs, to get coverage (with a few exceptions) you need to see a provider within the (Kaiser) network. As a vertically integrated HMO the providers in the Kaiser network are all employed directly by Kaiser. So Kaiser sets the its own employee compensation.

It's worth noting that all insurance companies are required to emergency care at any provider as if it were in network. If a Kaiser member were to go to a non-Kaiser ER they would see the same cost as if they'd gone to a Kaiser ER. Whatever Kaiser pays to the out of network hospital/staff is almost certainly negotiated beforehand.

Re: Brave Care Has Closed

#113

Post by inferiorhuman »

jackcosgrove wrote: post #111
inferiorhuman wrote: post #108

Earlier quoted context omitted.

I'm curious what the truth is regarding the number and character of brick-and-mortar healthcare facilities in the US: too many? too few? Because it looks like this company was opening physical clinics. Services are unevenly distributed and I wouldn't say there's too many providers in urban areas. Rural areas are underserved though (off the top of my head I can think of a movie and a TV series whose premise is rooted…

Just to be clear the "too much coverage" argument is about physical facilities and equipment, not personnel. I think everyone is in agreement that there is a shortage of medical staff. As far as convenience vs efficiency, the argument was that to achieve the efficiencies found in other countries, which often have longer wait times for services than the US, you do have to sacrifice convenience. The US, by treating hea…

It's not clear to me that wait times for e.g. imaging are due to insufficient staff. UC had two locations (for a city of 800,000) where I could've gotten an ultrasound. Getting waitlisted trying to find a GP isn't a staffing issue either. My solution was to patronize a medical practice that didn't accept insurance. I was able to make a same day appointment as a new patient. The lack of urgent care within the Kaiser network out here isn't a staffing issue. Kaiser simply hasn't built out clinics.

The lack of rural providers is largely a staffing issue, but once the staff go whole departments (e.g. obstetrics) get shuttered and it then becomes a larger problem than merely finding physicians.

Having been through the meat grinder a few times I don't think there's as much "convenience" as proponents of for-profit health care would like everyone to believe. Attributing the uneven distribution of care to convenience misses the mark. Profit incentivizes specialties that can charge higher prices and disincentives primary care. That's not convenience, it's profit. Again. St. Luke's.

Re: Brave Care Has Closed

#114

Post by llamaimperative »

robertlagrant wrote: post #105
thrance wrote: post #83

Earlier quoted context omitted.

Life expectancy is still lower in the US than in western Europe.

But engage with the point OP's making. That is despite spending far more on healthcare, so maybe the problem isn't the healthcare? Life expectancy in general in the US could also be due to the amount of gun violence, as well. Nothing to do with the quality of healthcare.

Managing chronic disease burden is a component of healthcare

The fact that Americans intuit that it’s not is a worrying sign of just how broken our system is

Re: Brave Care Has Closed

#115

Post by thrance »

robertlagrant wrote: post #105
thrance wrote: post #83

Earlier quoted context omitted.

Life expectancy is still lower in the US than in western Europe.

But engage with the point OP's making. That is despite spending far more on healthcare, so maybe the problem isn't the healthcare? Life expectancy in general in the US could also be due to the amount of gun violence, as well. Nothing to do with the quality of healthcare.

In western Europe, governments have a vested interest in the good health of their citizens, because a healthy citizen costs less to the healthcare system.

The US government does not care that much about obesity, gun violence and all that jazz because it is not the one paying for the damages it does.

All these factors contribute to the comparatively poorer life expectancy of Americans, which is, I agree, only a surface metric.

Re: Brave Care Has Closed

#116

Post by llamaimperative »

thrance wrote: post #115
robertlagrant wrote: post #105

Earlier quoted context omitted.

But engage with the point OP's making. That is despite spending far more on healthcare, so maybe the problem isn't the healthcare? Life expectancy in general in the US could also be due to the amount of gun violence, as well. Nothing to do with the quality of healthcare.

In western Europe, governments have a vested interest in the good health of their citizens, because a healthy citizen costs less to the healthcare system. The US government does not care that much about obesity, gun violence and all that jazz because it is not the one paying for the damages it does. All these factors contribute to the comparatively poorer life expectancy of Americans, which is, I agree, only a surfac…

The government does end up paying for this via Medicare and Medicaid but doesn’t have good levers to solve it directly.

The more important dynamic you’re pointing to is that private insurers don’t care because our insurance is tied to our employers and therefore is expected (by insurers) to churn every 4 years or so.

It literally makes zero sense for a private insurer to invest in an American’s healthcare results more than 3 or so years down the road.

Surprise surprise, we have best-in-class care for emergencies and complex acute cases, and absolutely atrocious management of early disease and lifestyle problems (which is when it’s most cost-effective to solve health problems).

Re: Brave Care Has Closed

#117

Post by tonyedgecombe »

swores wrote: post #106
tonyedgecombe wrote: post #91

Earlier quoted context omitted.

>If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape. It's hard to do that without turning it into the NHS.

As a Brit, that sounds like a positive not a negative, though I appreciate that in the US it might be a political negative.

I don't know, the experience with my mother in law over the last few weeks has left me wondering about that.

I certainly don't want a free for all system like the US has (and I suspect the Tories want) but it isn't great at the moment.

Re: Brave Care Has Closed

#118

Post by robertlagrant »

llamaimperative wrote: post #114
robertlagrant wrote: post #105

Earlier quoted context omitted.

But engage with the point OP's making. That is despite spending far more on healthcare, so maybe the problem isn't the healthcare? Life expectancy in general in the US could also be due to the amount of gun violence, as well. Nothing to do with the quality of healthcare.

Managing chronic disease burden is a component of healthcare The fact that Americans intuit that it’s not is a worrying sign of just how broken our system is

> Americans intuit that it’s not

Any evidence for this?

Re: Brave Care Has Closed

#119

Post by llamaimperative »

robertlagrant wrote: post #118
llamaimperative wrote: post #114

Earlier quoted context omitted.

Managing chronic disease burden is a component of healthcare The fact that Americans intuit that it’s not is a worrying sign of just how broken our system is

> Americans intuit that it’s not Any evidence for this?

GP’s comment? It’s predicated on separating “high chronic disease burden” from “poor healthcare system performance.”

I don’t think this is a broadly held belief, I think it’s the “eeehhrm actually…” contrarian belief that’s trying to discredit the consensus view that our healthcare system gets very poor results for the money. So it shows up in places like this exact HN thread.

Re: Brave Care Has Closed

#120

Post by Spooky23 »

inferiorhuman wrote: post #108
jackcosgrove wrote: post #95

I have heard conflicting accounts of inefficiencies in the US healthcare system. One account is that the US has too many medical facilities in urban areas. In other words, there might be five hospitals each with its own radiology equipment. That equipment is idle some of the time, so you could close some of the imaging departments and leave just one or two for the metro area. That would obviously inconvenience some p…

I'm curious what the truth is regarding the number and character of brick-and-mortar healthcare facilities in the US: too many? too few? Because it looks like this company was opening physical clinics. Services are unevenly distributed and I wouldn't say there's too many providers in urban areas. Rural areas are underserved though (off the top of my head I can think of a movie and a TV series whose premise is rooted…

Too much generally refers specifically to inpatient beds.
Post reply on HN