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Brave Care Has Closed

bravecare.com

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Re: Brave Care Has Closed

#131

Post by godisdad »

blindriver wrote: post #66
noitpmeder wrote: post #48

Earlier quoted context omitted.

What's the path forward? Where do we go from here?

Dump $1 trillion into Kaiser and push it out to all 50 states. I have it in Bay Area and it’s mostly been great for me. It’s not the best but it also gets 90% of things right.

Kaiser in Oakland is without exaggeration the best medical care I’ve ever experienced. Aligning incentives between the care provider and the insurer, vertically integrating care and putting it all on a walkable campus (even with a pharmacy!!) was such an efficient and pleasant process.

I was never healthier. The other Kaisers in Oregon aren’t geographically collocated so there’s less of an effect and they’re far away from me so I don’t use them anymore, sadly

Re: Brave Care Has Closed

#132

Post by tonyedgecombe »

mst wrote: post #126
tonyedgecombe wrote: post #117

Earlier quoted context omitted.

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.

The NHS is far from perfect (and was already far from perfect before the Tories spent a decade and a half making it worse) but given you -can- get private health insurance in the UK if you want it, IMO it's best to judge the NHS as 'universal basic healthcare' and accept that at that scale it's always going to suck sometimes but it's still better to have access to such a thing than not.

>given you -can- get private health insurance in the UK if you want it

You can but as soon as something gets serious they dump you back on the NHS.

Re: Brave Care Has Closed

#133

Post by [deleted] »

inferiorhuman wrote: post #112
doctorpangloss wrote: post #100

Earlier quoted context omitted.

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 abysma…

[deleted]

Re: Brave Care Has Closed

#134

Post by nradov »

IG_Semmelweiss wrote: post #122
jmye wrote: post #45

Earlier quoted context omitted.

You will still lose on the insurance front. If you’re on the exchange, you’ll get absolutely hammered by risk-adjustment. If you’re not, you’ll never be able to sell to anyone. You’ll have to lock up huge amounts of capital, which will grow as you grow, that you can’t invest or use. It will just sit in an account in case you can’t pay claims. You’ll have to accept horrible contracts with provider systems in order to…

I agree with your statement in general terms. But you can't enter into the industry as a startup, to get stuck in the general crud of status-quo. You are supposed to be disrupting things, right? The same applies to insurance. You can't take crap contracts that don't work for you, so maybe create a contract of your own based on 1st principles and going back to the definition of insurance.

That doesn't apply to health insurance. Due to HIPAA / ERISA / EMTALA / ACA and an alphabet soup of other federal and state laws and regulations a startup health insurance company would have very little freedom of action on creating new types of contracts. And this is an area where the laws are actually enforced.

Re: Brave Care Has Closed

#135

Post by nradov »

inferiorhuman wrote: post #109
jmye wrote: post #45

Earlier quoted context omitted.

You will still lose on the insurance front. If you’re on the exchange, you’ll get absolutely hammered by risk-adjustment. If you’re not, you’ll never be able to sell to anyone. You’ll have to lock up huge amounts of capital, which will grow as you grow, that you can’t invest or use. It will just sit in an account in case you can’t pay claims. You’ll have to accept horrible contracts with provider systems in order to…

Health insurance is undisruptable Medical practices that may charge an annual fee but don't accept insurance — so-called concierge care are a thing. Not accepting insurance means you can operate with a significantly smaller support staff. Patients with a PPO style insurance plan may even have some of the expenses covered.

Concierge medicine can be a good option for affluent people who can afford it. But it only works with relatively low utilization and won't scale up to address any of the systemic problems in the US healthcare system.

Re: Brave Care Has Closed

#136

Post by nradov »

tptacek wrote: post #75
inferiorhuman wrote: post #73

Earlier quoted context omitted.

What would insurer overbilling even mean? It would mean something like this: https://www.nytimes.com/2017/05/19/business/dealbook/unitedh... Or this: https://www.sacbee.com/news/local/health-and-medicine/articl...

Your second link is literally Anthem passing provider fees (in violation of their contract, sure!) through to customers. The bills were from providers. Fuck if I know what's going on between Medicare and UHC. It's a mess. Medicare Advantage is a hybrid Medicare/private system; once again, whatever fees were being passed to Medicare, they were coming from providers. Insurers can certainly inappropriately deny coverage…

Medicare Advantage is a capitated program. The provider fees aren't being passed through to Medicare.

Re: Brave Care Has Closed

#137

Post by NBJack »

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…

> That would obviously inconvenience some people, but the gist of the criticism is that the US duplicates medical capacity for the sake of convenience.

Or outright kill them due to a delay in a critical finding. This is more than a convenience factor, and moving patients between facilities is non-trivial.

Re: Brave Care Has Closed

#138

Post by blindriver »

doctorpangloss wrote: post #99
blindriver wrote: post #66

Earlier quoted context omitted.

Dump $1 trillion into Kaiser and push it out to all 50 states. I have it in Bay Area and it’s mostly been great for me. It’s not the best but it also gets 90% of things right.

Asking doctors about Kaiser will be an eye opening experience for you.

I know Kaiser doctors. They mostly like it at least in Norcal. They said Socal Kaiser wasn't as good. My own Kaiser doctor said that Kaiser has been pushing more and more work on her like taking notes, etc, and it's frustrating but as far as I can tell it's a lot better than dealing with insurance companies. She gives me everything I request, like endoscopy, MRI, CT scan, blood tests, prescriptions, etc. The only time I was rejected was when I asked to see if blood sugar monitor could be covered but that was rejected because I'm only pre-diabetic and not diabetic.

Re: Brave Care Has Closed

#139

Post by drannex »

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…

This is what happens when everything has to be privatized, ie, the general problem with capitalism, that the duplication of resources is far more than the system can support.

Re: Brave Care Has Closed

#140

Post by maxerickson »

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…

The prices charged for imaging have basically no relation to the equipment cost.

It's likely the other way around from what you are saying, with limits to market entry enabling the existing facilities to charge more than the efficient price for the service.

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