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Brave Care Has Closed

bravecare.com

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Re: Brave Care Has Closed

#151

Post by pdpi »

helsinkiandrew wrote: post #102
IG_Semmelweiss wrote: post #17

Earlier quoted context omitted.

Most people outside of healthcare will have a hard time disrupting anything until they realize the goverment has tilted the rules in favor of status-quo. Healthcare insurance in the US is heavily subsidized, and no number of revolutionary care delivery models will put you on level terms with the behemoth of US govt insurance subsidies. Your only hope as a non-provider is to come in with your own a-la-carte insurance…

> .. they realize the goverment has tilted the rules in favor of status-quo Or is it that the Healthcare industry has tilted the government into making rules that favor the status-quo?

Both are true, but your phrasing shifts responsibility away from the government.

Ultimately, it is the government, not the industry, that sets the rules, and it is the government, not the industry, that is accountable to us.

Re: Brave Care Has Closed

#152

Post by amyfp214 »

HillRat wrote: post #142
IG_Semmelweiss wrote: post #17

Earlier quoted context omitted.

Most people outside of healthcare will have a hard time disrupting anything until they realize the goverment has tilted the rules in favor of status-quo. Healthcare insurance in the US is heavily subsidized, and no number of revolutionary care delivery models will put you on level terms with the behemoth of US govt insurance subsidies. Your only hope as a non-provider is to come in with your own a-la-carte insurance…

I don't know about "disruptive", since they were trying to enter, using conventional tactics, what is in general a mature market with pretty high barriers. Urgent care as a market combines a very small number of very large national chains (Concentra, MedExpress, etc.) with a lot of medium- and small-sized regional chains, about half owned by medical systems and half not. There's even an existing national-level pediat…

I agree it's not an easy market. Peds ER & pediatrician offices are already a thing catering to children, so I don't see the innovation there. Additionally it's long known pediatrics reimbursement and costs are just way less than adults. This also forks in with the immigration issue(s) in that demographically there are a much higher portion of not not non-documented peoples among children, which can introduce linguistic overhead/costs of time and money (mandatory requirement to speak all patients languages) as well as inability to pay beyond medicaid.

Children are an attractive selling point for a company in the same way as cancer of some altruistic goal. Though here, although elder care exists, to me that seems like the market to disrupt and minimize costs in.

Re: Brave Care Has Closed

#153

Post by missedthecue »

llamaimperative wrote: post #110
missedthecue wrote: post #63

Earlier quoted context omitted.

I don't think it's settled fact that the US has worse health outcomes. In fact, most data I see points to the opposite. Some people point out very lazy metrics like life expectancy while ignoring that 72% of Americans are overweight or obese according to the CDC. Rearrange healthcare/government insurance models all you want; it can't fix that.

Uhhhhh obviously managing chronic disease burden is a core feature of a functional healthcare system. One of the strongest levers we have to improve the “inputs” you’re describing is a better primary care system. America’s has been absolutely gutted over the last 20 years by interactions of various economic and regulatory dynamics including (notably) the anti-competitive vertical integration of pay-viders and pay-vid…

Yes managing chronic disease is good and important but there is no healthcare system that is so good it can outrun an obese population. The healthy population will always do better than infinity spending and care on a sick one.

Re: Brave Care Has Closed

#154

Post by addicted »

pdpi wrote: post #151
helsinkiandrew wrote: post #102

Earlier quoted context omitted.

> .. they realize the goverment has tilted the rules in favor of status-quo Or is it that the Healthcare industry has tilted the government into making rules that favor the status-quo?

Both are true, but your phrasing shifts responsibility away from the government. Ultimately, it is the government, not the industry, that sets the rules, and it is the government, not the industry, that is accountable to us.

Or, it’s the voters.

Even without the argument that ultimately voters are responsible for the government they get in a country with free and fair elections like the U.S., health insurance is a very direct example of voters explicitly opting for a worse option.

The ACA was being written in 2009 and 2010 and the argument was whether it constrained the insurance industry too much or not enough. The very specific policy proposal on the table was the public option which would have allowed the govt to offer an insurance policy that would have effectively set a floor to the quality of policies the healthcare industry could offer and a ceiling on the cost.

And the 2010 election fell right in the middle of the debate and American voters overwhelmingly chose the politicians arguing against the public option and for fewer restraints on the insurance industry.

Beyond that you can just look at every other developed country in the world, and all of them have better healthcare because their voters constantly vote for politicians who offer better healthcare policy, as opposed to the U.S. where voters choose the opposite.

Re: Brave Care Has Closed

#155

Post by jmye »

refurb wrote: post #80
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…

Upvotes for highly accurate summary. The providers have leverage and the ones with the most will screw you over unless you’re big enough to throw some weight around. I honestly don’t see much change unless the government comes in and sets new rules that actually make sense.

Yeah, agreed. It has to start from legislation. And that legislation has to also address education - we have to make it easier and cheaper to become a doctor or mid-level, or we have to start trying to import a ton of providers.

Re: Brave Care Has Closed

#156

Post by jmye »

noitpmeder wrote: post #48
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…

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

Vote and legislate. Doesn’t even have to be federal, since the exchanges are state run. But it’s a highly regulated industry (for good reason, this isn’t a place where deleting laws helps normal people), so you have to fix the regulation. The ACA killing pre-existing coverage denials was a great start, but you have to fix risk adjustment before anything else can happen, as it’s literally just a wealth transfer from new entrants to existing behemoths (I think it was well intentioned, and works well in MA, but is completely broken in the commercial market). Reinsurance fixes to address the fund lockup would also probably help, but they’d be tax-expensive and probably untenable.

But it all starts with voting for people who want to fix it, and not for people who just want to burn it down or maintain the status quo.

Re: Brave Care Has Closed

#157

Post by llamaimperative »

missedthecue wrote: post #153
llamaimperative wrote: post #110

Earlier quoted context omitted.

Uhhhhh obviously managing chronic disease burden is a core feature of a functional healthcare system. One of the strongest levers we have to improve the “inputs” you’re describing is a better primary care system. America’s has been absolutely gutted over the last 20 years by interactions of various economic and regulatory dynamics including (notably) the anti-competitive vertical integration of pay-viders and pay-vid…

Yes managing chronic disease is good and important but there is no healthcare system that is so good it can outrun an obese population. The healthy population will always do better than infinity spending and care on a sick one.

It seems like you’re either ignorant of some basic facts about healthcare or are willfully missing the point (true to the username I guess) so I’ll be more explicit:

Having access to doctors helps to manage disease.

Obesity is a disease.

In particular, having access to PCPs helps to manage obesity.

Our healthcare system yields poor access to healthcare.

In particular, it yields poor access to PCPs.

Ergo the obese population is in part an output of and not an external input into the design of our healthcare system.

Ergo changes to the healthcare system absolutely can — and in fact should have as a key goal to — yield changes to levels of obesity.

> “ Rearrange healthcare/government insurance models all you want; it can't fix that.”

This claim is false. The mental model of an obese population being exclusively an input into our healthcare system does not track with what we know about the relationship between healthcare and obesity.

Re: Brave Care Has Closed

#158

Post by dennis_jeeves2 »

noitpmeder wrote: post #48
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…

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

Will be consider mostly irrational, but I'll mention it:

Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons.

As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.

Re: Brave Care Has Closed

#159

Post by dennis_jeeves2 »

donw wrote: post #10
xyst wrote: post #4

Earlier quoted context omitted.

Very difficult to disrupt American healthcare when health insurance companies determine your rates, direct pay patients often the most vulnerable, and instead of focusing on patient care you have to focus on stupid administrative tasks to deal with different types of health insurance plans/pharmacy benefit managers/vendors. Thanks to decades of neo-liberalism (the idea of deregulation and "free market" economy). Amer…

... are you joking? Healthcare is one of the most regulated industries in the United States. Want to be a doctor? You've got the aptitude, the knowledge, the mindset, and the will, but a government-guaranteed cartel of medical schools won't let you in, so too damn bad. Learn to code. Want to open a clinic? You really only need about a half-million in hardware to operate at the level of a 1980s hospital, but regulator…

>Want to be a doctor? You've got the aptitude, the knowledge, the mindset, and the will, but a government-guaranteed cartel of medical schools won't let you in, so too damn bad. Learn to code.

Will be consider mostly stupid/irrational, but I'll mention it:

Learn medicine, and practice outside of of the mainstream clandestinely (a past real world example would be abortion clinics on ships). It needs a group of committed/smart people to pull it off, so not easy. Also it cannot be offered to the public at large for several obvious reasons.

As a general rule one cannot involve 'average' people in such an endeavor. All organization settle down to the lowest common denominator. When it come to large organizations in govt/health/etc. they are prone to increasing corruption and bureaucracy if average people are involved.

Re: Brave Care Has Closed

#160

Post by Projectiboga »

nradov wrote: post #135
inferiorhuman wrote: post #109

Earlier quoted context omitted.

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.

My wife's Doc tried that and quickly came crawling back to their patients who refused the $3,000 "concierge" fee here in Murry Hill Manhattan. If that model can't fly here I don't see where it could. Maybe affluent suburbs w fewer competitors?
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