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Brave Care Has Closed

bravecare.com

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Re: Brave Care Has Closed

#61

Post by llamaimperative »

Aurornis wrote: post #56
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…

> Very difficult to disrupt American healthcare when health insurance companies determine your rates, This isn’t unique to America. In countries with government healthcare, the government determines your rates. Typically government rates are lower than private insurance rates in the US, too. For as much as Americans like to complain about insurance companies, we actually get a lot more care and pay higher rates to pr…

What on earth

We get a lot more care, pay higher rates, and have worse outcomes.

That last bit is why people are pissed.

Re: Brave Care Has Closed

#62

Post by devonkim »

llamaimperative wrote: post #61
Aurornis wrote: post #56

Earlier quoted context omitted.

> Very difficult to disrupt American healthcare when health insurance companies determine your rates, This isn’t unique to America. In countries with government healthcare, the government determines your rates. Typically government rates are lower than private insurance rates in the US, too. For as much as Americans like to complain about insurance companies, we actually get a lot more care and pay higher rates to pr…

What on earth We get a lot more care, pay higher rates, and have worse outcomes. That last bit is why people are pissed.

I think we should add that the outcomes are worse at _all_ socioeconomic levels. The rich get screwed over as well in this system as well. It's unfortunate that so many of them have better overall outcomes and/or myopic experiences that many are emotionally invested in being _able_ to pay exorbitant amounts for more personalized care - regardless of the societal consequences - as an interpretation of "freedom."

But hey, it's not like the US is a democracy exactly given that public opinion generally doesn't translate into policy changes anymore.

Re: Brave Care Has Closed

#63

Post by missedthecue »

llamaimperative wrote: post #61
Aurornis wrote: post #56

Earlier quoted context omitted.

> Very difficult to disrupt American healthcare when health insurance companies determine your rates, This isn’t unique to America. In countries with government healthcare, the government determines your rates. Typically government rates are lower than private insurance rates in the US, too. For as much as Americans like to complain about insurance companies, we actually get a lot more care and pay higher rates to pr…

What on earth We get a lot more care, pay higher rates, and have worse outcomes. That last bit is why people are pissed.

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.

Re: Brave Care Has Closed

#64

Post by AtlasBarfed »

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?

So my four pigs analogy, where insurance companies, drug/device companies, doctors/hospitals, and lawyers all feed at the trough, increase costs and point to someone else (although I will admit lawyers are probably the smallest cost component and the most blamed by the other three).

There is a fifth one that imposes costs: our comprehensively unhealthy food, health, and lifestyle in America that capitalism feeds upon with addictive high-margin food and drink, with overworked workers that can barely have time to raise kids (our healthy demographics are due to immigration) much less a healthy lifestyle. The entertainment complex certainly doesn't help either.

Providers: you need comprehensive family care to avoid specialist care being needed, an increase in supply of doctors, decreasing their educational loan burden (which strongly incentivizes specializataion, and a system that involves specialists). I think advanced AI systems can do much more day-to-day tracking and diagnosis/information, but of course that is a personal information nightmare. Actually I don't mean advanced. I think current AI is plenty good enough. Unfortunately only insurance companies will employ these systems or pay for them.

Insurance: Probably need a medicare-for-all option. We were close to this with Obamacare but FUCKING JOE LIEBERMAN killed it. Exhibit A in why the Democrats with full control of government will never get anything done.

Drug/Device companies: reduce patents, I don't know, maybe allow price negotiation (which is just mind blowing in a "free market" economy), reform the FDA to make bringing drugs to market cheaper.

Lawyers: caps caps caps so there isn't costly malpractice insurance. Maybe would also necessitate a federal review board to weed out "bad doctors".

But the biggest is probably governmental direction to actually get people to be able to eat and live active lives. Maybe GLP-1 will help, but the quiet time bomb of increasing obesity in Americans each decade is probably a sneaky large amount of our costs.

Otherwise, on the nihilistic side, keep doing whatever our society is doing which is causing men to kill themselves in huge rates (soma ... uh... I mean opioids were also doing this as well) before they reach their ultra-expensive late stage of life.

Anyway, none of that is happening (except, sadly, the nihilistic solution is the most realistically happening).

Maybe setup huge provider networks across the border in Mexico and Canada served by high speed transit, so large portions of the world get health maintenance in functioning health care systems, and only do hospitalization and emergency care here?

Re: Brave Care Has Closed

#65

Post by donavanm »

ipaddr wrote: post #33
skissane wrote: post #19

Earlier quoted context omitted.

> Healthcare is one of the most regulated industries in the United States. And yet other countries have even more regulation, and manage to deliver cheaper and more equitable healthcare overall, with better public health outcomes when measured at the national level For example: in Australia, the federal government is a near-monopsony purchaser of prescription drugs, so it has enormous negotiating power with the pharm…

Most Americans don't want equitable healthcare they want the best they can afford and they want the newest treatments available. The waiting for the patent to expire and buying in bulk keep down the costs down works. The US couldn't use the generic strategy because the drug companies get funded and create the new drugs this way. Cutting off the funding would mean no new drugs to copy so no new generics. Australia wou…

As sibling mentioned thats not the model. From what Ive seen australia lags US access on the order of 6months to a few years for most things. Effectively theres an additional review period where TGA reviews foreign research and approval before (generally) allowing and entering it to the ARTG and PBS with the relevant prescribing advice. Once its on the MBS/PBS the patient gets access through their prescriber and/or chemist.

The PBS listed medications are essentially price capped copays at the point of sale, with the bulk of the cost covered directly by the government (who negotiates prices with the manufacturer, and fronts the pharmacist distribution costs). Its the same pfizer etc patent protected medication, unless theres a generic version which chemist & prescriber can vend with patient consent.

Re: Brave Care Has Closed

#66

Post by blindriver »

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?

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.

Re: Brave Care Has Closed

#67

Post by hedora »

godisdad wrote: post #41

OP here. I visited their clinics for my daughter several times when she was a toddler for ear aches and other ailments— I found the experience refreshing: instant online booking, no BS registration and online communication with staff was seamless. Very sad to see them go so abruptly. Up until this morning when I was told they were gone, I had no idea they were YC or otherwise VC funded. Just came here to pour one out…

We had basically the same experience with Kaiser Permanente in the SF Bay Area.

Currently, there’s a doctor shortage problem (supposedly, they can’t hire, or there aren’t enough positions, depending on who you ask), which has caused issues with the quality of care (according to the doctors that went on strike over this, and personal experience).

It’s unclear what the root cause or solution is.

Anyway, you can get the experience you described, and it’s great until you hit an understaffed corner case health problem.

Re: Brave Care Has Closed

#68

Post by inferiorhuman »

tptacek wrote: post #51
duk3luk3 wrote: post #49

Earlier quoted context omitted.

You seem to be implying that the providers set the prices, but isn't it true that insurers can pick and choose which providers they cover, and because of the large amount of patients they insure, they have a huge amount of negotiation power to exert downward pressure on what providers charge?

No, that's not true. All the market power is with the providers, which is why they're responsible for something like 9x total health care spend in the US than all health insurers combined. Medicare is better than private insurers at regulating prices (to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated, and the governor of New York proposed a statute preventing them from…

  to wit: when Anthem tried to adopt Medicare's rules for anesthesiology
  comp, they were excoriated
For everyone in the back: that's not what happened. BCBS tried to place arbitrary limits on anesthesia payment. Medicare does not do this. Physician complaints with Medicare payments revolve around the hourly rate. Physician complaints with BCBS revolve around arbitrarily setting a hard limit for the amount of time a procedure is allowed to take. One is limiting cost, the other is limiting care.

Re: Brave Care Has Closed

#69

Post by inferiorhuman »

tptacek wrote: post #58
pilotneko wrote: post #55

Earlier quoted context omitted.

I acknowledge there are issues on the provider side, but it is disingenuous to say that providers set the prices alone. Payers introduce a ton of inefficiencies in billing and also remove money from the system, which negatively impacts care. They implicitly affect care patterns and pricing through denials. HMOs, for all their problems, have many advantages as well, such as the aligned incentives you allude to.

So, I don't disagree that there are inefficiencies with private payers, but I do disagree that they're significant, or the reason US costs are so high, or that insurers deny so many services. You can see this for yourself with Medicare's admin overhead. Admin overhead is, roughly, the ratio of money spent by insurers to money insurers pay to providers. Medicare has "low" admin overhead --- but that's in large part be…

  inefficiencies with private payers
Inefficiencies like billions of dollars in overbilling annually?

Re: Brave Care Has Closed

#70

Post by tptacek »

inferiorhuman wrote: post #68
tptacek wrote: post #51

Earlier quoted context omitted.

No, that's not true. All the market power is with the providers, which is why they're responsible for something like 9x total health care spend in the US than all health insurers combined. Medicare is better than private insurers at regulating prices (to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated, and the governor of New York proposed a statute preventing them from…

to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated For everyone in the back: that's not what happened. BCBS tried to place arbitrary limits on anesthesia payment. Medicare does not do this. Physician complaints with Medicare payments revolve around the hourly rate. Physician complaints with BCBS revolve around arbitrarily setting a hard limit for the amount of time a pro…

No, that's precisely what they didn't do. Medicare has a schedule of anesthesia compensation rates broken down by procedure; the last time this came up on a thread, the schedule was literally posted. Anthem announced they were using it.
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