Amazon's Push Into Healthcare Just Cost the Industry $30 Billion In Market Cap (qz.com)

Today, Amazon, along with Berkshire Hathaway and JPMorgan, announced a plan to launch an independent company that will offer healthcare services to the companies' employees at a lower cost. The venture, which will be managed by executives from the firms, will be run more like a non-profit, than a for-profit entity. Even though the plans are vague, the news caused the market value of 10 large, listed health insurance and pharmacy stocks to drop by a combined $30 billion in the first two hours of trading. Quartz reports: "The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty," said Amazon's Jeff Bezos in a statement. "Hard as it might be, reducing healthcare's burden on the economy while improving outcomes for employees and their families would be worth the effort. Success is going to require talented experts, a beginner's mind, and a long-term orientation." Warren Buffett, the CEO of Berkshire Hathaway, likened America's mushrooming healthcare costs to "a hungry tapeworm on the American economy." How the venture will provide less pricy healthcare to the 1.2 million employees of the participating companies isn't yet clear. The new company will leverage "technology solutions" that provide "simplified, high-quality and transparent healthcare at a reasonable cost." Not much else, including the name of the company, is known.

Comments

Don't let 'im kiss ya, Hawkeye

[fustakrakich]

Their intentions aren't so honorable. They're just trying to break up the demand for real universal health care.

Re:Don't let 'im kiss ya, Hawkeye

[DaMattster]

Their intentions aren't so honorable. They're just trying to break up the demand for real universal health care.

Just curious, how do you figure? Of course their intentions are anything less than honorable. They're trying to boost their own bottom lines.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

End result is the same, but I would say they're probably trying to reduce the costs of doing business, more so than trying to make a bid to enter the Insurance market. Although with how Amazon works if they can make it work for their employees you can bet there will be public offerings as well.

Re:Don't let 'im kiss ya, Hawkeye

[ShanghaiBill]

Although with how Amazon works if they can make it work for their employees you can bet there will be public offerings as well.

Indeed. AWS started as an internal service. Today, Amazon is primarily a Cloud Provider, that just happens to do online retailing on the side. AWS makes 3 times the profit of their retail operations.

Re:Don't let 'im kiss ya, Hawkeye

[fustakrakich]

Well, because there wasn't much call for it back when most employers offered it without reneging at the drop of a hat. But now we should know how capricious and undependable these people are when payments come due. They are only offering what we used to get through active and united collective bargaining on much better terms. We could do the same today, and we would save a lot of arguing in the process.

Re:Don't let 'im kiss ya, Hawkeye

[Ungrounded Lightning]

Their intentions aren't so honorable. They're just trying to break up the demand for real universal health care.

What's dishonorable about opposing "real universal health care" - which seems to be newspeak for socialized/nationalized medicine (with all the failures endemic to attempts to nationalize any industry)?

Obama's foray into that quadrupled the price of health insurance for my wife, and has me busting my butt at a startup when we should have been retired for the last half-decade..

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

Nope. Obama failing to hold out for single payer and settling for Romneycare is what cost you. Countries with actual single payer systems spend half or less per capita with better outcomes for all.

Re:Don't let 'im kiss ya, Hawkeye

[fustakrakich]

We don't have to nationalize anything, but the government should be allowed to compete. Then we can have more clout in determining prices and services. The law you speak of was specifically set up to benefit the insurance industry. Through a much older law, the government is specifically prohibited from negotiating for better pharma prices. These are the things, among others, that make medicine expensive in the US.

Re:Don't let 'im kiss ya, Hawkeye

[Goetterdaemmerung]

Nope. Obama failing to hold out for single payer and settling for Romneycare is what cost you. Countries with actual single payer systems spend half or less per capita with better outcomes for all.

I find this argument hilarious given Democrats had both Congress and the Presidency and when it was passed nobody said anything about keeping costs down. The entire selling point was to make more people buy insurance and add layers of complexity. Costs were going to go up, no matter what.

We all know that prices are essentially secret. Do you know that "billing" now accounts for 25% of all hospital spending? Hospital administration costs are 1.43% of the GDP. http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs

There is a tremendous amount of meat that can be trimmed from the bone and if anyone can do it, I'm hopeful this union of aggressive corporations will do a far better job than our government.

Re:Don't let 'im kiss ya, Hawkeye

[cayenne8]

Obama failing to hold out for single payer and settling for Romneycare is what cost you.

Yeah, I"m just really thrilled of a DMV like experience for my medical care.

You see how well medicaid works and saves costs, right?

Re:Don't let 'im kiss ya, Hawkeye

[hdyoung]

Obamacare quadrupled your wife's health insurance? Are you sure that's not hyperbole? A number pretty close to 60% increase in premiums is the typical number. Of course, the ACA also required that the insurance packages provide more benefits. Better insurance, higher costs. We can debate the merits elsewhere, but I'd be interested to hear details about the 4x increase.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

It might do better if it was allowed to negotiate drug prices. Beyond that, I made clear I was speaking of OTHER COUNTRIES that have single payer. Does medicaid fit that description?

Re:Don't let 'im kiss ya, Hawkeye

[Patent Lover]

It's only hilarious because the Democrats let the Republicans have a seat at the table. So how come the Republicans couldn't repeal it with both houses and the presidency?

Re: Don't let 'im kiss ya, Hawkeye

[reanjr]

The entire selling point of going with Romneycare was to preserve the Democrat's control of Congress. It didn't work, but that was the real argument. Obama and the Democrats would rather stay in power than give us decent healthcare.

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

Countries with actual single payer systems spend half or less per capita with better outcomes for all.

This is a misnomer. You can't compare spending in the U.S. to spending in other countries on just about anything. Spending levels in most countries are driven by wealth levels, AKA, the wealth available to purchase things. For example, the U.S. spends 40% more per student than the OECD average. That in turn is way more than third world countries spend. The U.S. spends more on books, houses, cars, air conditioners, etc... primarily because the U.S. is wealthier and wealthier people spend more on most stuff.

Look at the wide range in spending per inhabitant between Euopean countries. It's not because of "single-payer" causing the differences.

In the U.S., Doctors make more (and their numbers are artificially limited), drug companies spend more on researching new drugs and on getting them through the FDA's hoops, people and insurance companies are willing to spend more (i.e. there is more demand for services), etc... You can change or tweak many of those things, but going to single-payer isn't some magical fix which will create more Doctors and provide more actual healthcare.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

Actually, you can by looking at comparable economies and/or by judging in terms of the country's GDP.

Note how those other countries spend less of their GDP on healthcare and how their populations last longer. Before you claim it's better eating habits, have a look at the U.K.

Honestly, no sane person honestly thinks any Western nation spends more on healthcare than the U.S. and no sane person honestly thinks health outcomes in the U.S. are even in the top ten.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

I don't think you know what a misnomer is.

Re:Don't let 'im kiss ya, Hawkeye

[currently_awake]

Americans take trips to Canada to buy American drugs, at a fraction of the price. And the drug companies don't sell at a loss.

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

You apparently missed the whole point. No one was arguing about how much each country spends. The point was that switching to single-payer or not isn't a factor which explains the difference in spending in different countries.

Has it occurred to you to look at countries which switched to single-payer and compare their spending levels before and after the switch? What you'll find is that they didn't save money, in fact, they generally increased spending. So what's your evidence a switch in the U.S. would be a special case which would save money?

Re:Don't let 'im kiss ya, Hawkeye

[ClickOnThis]

I find this argument hilarious given Democrats had both Congress and the Presidency and when it was passed nobody said anything about keeping costs down.

It's only hilarious because the Democrats let the Republicans have a seat at the table. So how come the Republicans couldn't repeal it with both houses and the presidency?

Health care is the Gordian Knot of US economy and society. The left struggles to involve the government selectively in order to bend the cost-curve downwards. And the right tries to fix the problem by opening up the private sector. Obamacare was a herculean attempt to join those two propositions, and it just made it past the post, with the barely-required 60 votes in the senate. Republicans discovered that moving in the other direction was just as difficult, and failed repeatedly to change anything. (Except for repealing the individual mandate, which amounts to sabotage rather than reform.)

Meanwhile, all other industrialized nations have realized what the US may never realize: you need a national health-care plan to ensure that everyone gets care at a reasonable cost. The left would love to see that happen. The right sees it as fire-breathing Marxism, and fights with all it has to keep it from happening.

Re:Don't let 'im kiss ya, Hawkeye

[DaHat]

It's only hilarious because the Democrats let the Republicans have a seat at the table.

Then you should be able to name the specific provisions or amendments which came as a direct result of a republican sitting at the table... and not general hand waving towards Romney and Massachusetts.

So how come the Republicans couldn't repeal it with both houses and the presidency?

Nice attempt at distraction... but I think we are still talking about the original enactment... and not the failed attempts to repeal it in whole... granted even Gruber admits, the individual mandate is the key requirement, which as we heard tonight again... is dead... all thanks to Obama's favorite tool... a pen and a phone.

Re: Don't let 'im kiss ya, Hawkeye

[DaHat]

And worse (for the Democrats)... helped to lead to the wiping out massive portions of their backbench and bullpen for years to come as a result of their narrow mindedness.

Obama's legacy, may just end up being the difficulty the Democrats have fielding a viable candidate for the Presidency for years to come.

Re:Don't let 'im kiss ya, Hawkeye

[lgw]

America has higher prices mostly because we pay for most of the world's medical research. Sure, there's some overhead from insurance companies (mostly from the lack of standardized claims reporting - the government should fix that), but that's only one factor. Higher drug prices (in the private sector) is a big part of that: it pays to acquire the pharma startups that do the actual research (much like the big tech companies rarely invent anything, but they buy tech startups for crazy amounts, which in turn funds most of the actual advances in our field).

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

So it's just a coincidence that EVERY country with a single payer system spends less than the U.S. on healthcare per capita than the U.S.?

When you pull the door and it doesn't open, do you keep pulling or do you try pushing?

I see that health care costs are going up all over, but looking at Canada for example, the rise flattened out for a while when single payer came into effect. So even as costs went up, they went up slower with single payer. Of course, with an increasing population, increase in expendature is to be expected. The U.S. could use slower increases in expenditure for a while.

So let's look at a larger sample. Indeed, it's going up for everyone, but nowhere is it going up faster than the U.S. and nowhere is it as expensive as the U.S. Can you explain why the U.S. would be a special case other than we are the one without a single payer system?

They say you get what you pay for, so the U.S. should be at the top of the charts for healthcare. OOOOps, or not.

Well, Americans must live longer and so cost more. Dang, wrong again.

Looks more like a fool and his money are soon parted.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

So it seems if we want to spread that more fairly around the western world, we will need to similarly clamp down on prices. It's the only way to make the rest of the world pay their fair share.

Re: Don't let 'im kiss ya, Hawkeye

[shilly]

Erm, how do you think Obama and the Democrats -- or indeed any political party -- could have given you decent healthcare while not being in power?

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

So if as you state, no other country had their health care costs cut in half (or even decreased) when they switched to single-payer, then you've pretty conclusively proven empirically that there is no reason to think your original assertion that health care costs would be cut in half if the U.S. switched to single-payer is true. Thanks for confirming that for us.

If you want to discuss why the U.S. spends more on health care than other countries, you'll want to come up with something which explains why the U.S. spends more on just about everything than other countries. Or alternately, what are the things driving up health care costs in the United States. Guess what? Laws and regulations are the largest component of why health care is expensive in the U.S. (And please don't cite people who were completely wrong about what Obamacare would do to costs to try and argue otherwise, they've already discredited themselves on the subject.)

Trying to show causation between having a single-payer system and lower costs requires you to actually show empirical evidence that it was single-payer which makes a difference. Otherwise, you might as well claim that countries without as many paved roads causes health spending to be lower, which happens to be a true correlation, but doesn't mean much in terms of causation.

Re:Don't let 'im kiss ya, Hawkeye

[wyHunter]

Mostly because people see what they have as better than what they did. Too bad that folks who make more than 400% of the poverty line (about 30K for an individual, at $15/hour that's not difficult) end up paying 1K/month in premiums, eh? Sucks to be them!

Re:Don't let 'im kiss ya, Hawkeye

[wyHunter]

Exactly. And many of we right wingers think that Romneycare was an utter failure - Romney is more of a D than an R anyway.

Re:Don't let 'im kiss ya, Hawkeye

[wyHunter]

"Romneycare" was implemented in Massachusetts, by an R gov, but "D" everything else. It would not have existed without the Democrats wanting it. Period. Sorry, you're wrong.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

So if as you state, no other country had their health care costs cut in half (or even decreased) when they switched to single-payer, then you've pretty conclusively proven empirically that there is no reason to think your original assertion that health care costs would be cut in half if the U.S. switched to single-payer is true. Thanks for confirming that for us.

The claim is that the US spends double the amount of GDP on health care than single payer systems.

I am no historian, but back in the days, when the European countries introduced socialized health care I would think the costs on both sides of the Atlantic were fairly similar. That would indicate that one system has a higher growth of costs.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

My understanding is that the main opposition political right has to national health care plan is that it will significantly raise taxes on everyone, while lowering the quality for the top payers.

Which is true. That is how socialized medicine works. To most of us across Europe, that is an acceptable deal. US has a much more "free do succeed or fail" spirit, which makes it unacceptable.

Even here in Finland, if you want high quality care in many fields, you have to go to private sector. We're considered what, top 3 of the most efficient medical system in the world, and right now, it's quite grim. I had to book an appointment for dentist to check my teeth for my once-every-two-years dentist check (they won't allow you to have them more often, and yearly check is done by a hygienist, not a doctor). They couldn't even give me a date when it would happen. Six months wait minimum I was told, and they'll tell me some time in the future when my place in queue is up which of the local private providers I will have to go to to get my teeth checked and when.

Or I can just go pay a lot of money at a private clinic. Being healthy and never really having had any significant teeth problems throughout my life, I don't need to bother. Most people, not so much. So they pay an arm and a leg for private care. Care quality will be the same, because guess what? It's a "purchased service", which is the phrase used for "regional government (which has to provide universal healthcare) buys the service from private sector".

Situation is better for GP, where I only had to wait about a month for my yearly appointment to get a basic health check. Specialist care? Same thing as with teeth checks. Expect three to six months wait, where you can't even ask for specific date for an appointment. You're just given one at some point, and if you don't like it, back in the end of the queue you go. For this reason, private health insurance for children has skyrocketed. You can wait to get medical care for yourself, but your child? Not so much.

And if you're employed at a sizable company, guess what? You get private healthcare because it's mandated by law, to be paid by your employer. Which doesn't have those queue times.

So to pretend that there aren't pros to private-only system is folly. You need to understand that there are pros and cons to each system, and when you misrepresent this in an attempt to sell universal health care, you'll get overwhelming rejection when people notice that they have been fooled. Not a good long term strategy, as people are discovering with "you get to keep your doctor" and other Obamacare debacles in US. Be honest, inform people of pros and cons of each system, and put it to a national vote. I imagine you could probably win that one on universal healthcare. Time seems to be ripe for that in US.

Because in the end, the best system is to have public system that ensures that everyone is provided with minimum healthcare level that lets people stay productive.

Re:Don't let 'im kiss ya, Hawkeye

[AK Marc]

lowering the quality for the top payers. Which is true.

Bullshit. Most single payer systems have a parallel private system, and the 1% can go to private hospitals all they want. The quality doesn't fall. The options aren't restricted. And there's no death panels.

Single payer is better than the US system (pre and post Obama) in every way.

Even here in Finland, if you want high quality care in many fields, you have to go to private sector.

Wait, so does it lower quality for the top payers, or allow the top payers full access to the best care, but only if they go to the private sector that still exists in the single-payer world?

Your complaint isn't even consistent.

And if you're employed at a sizable company, guess what? You get private healthcare because it's mandated by law, to be paid by your employer.

So you have single-payer with everyone else and private on top of that through most companies? That's how many single payer systems do it. UK, NZ, and others with "pure' single-payer systems (where everyone authorized has 100% covered health care), also have a parallel private system as "competition".

So to pretend that there aren't pros to private-only system is folly. You need to understand that there are pros and cons to each system, and when you misrepresent this in an attempt to sell universal health care, you'll get overwhelming rejection when people notice that they have been fooled.

What pro is there to a private-only system? I've never seen any. The costs are higher, and the care worse in the US with private-only, than many other places (costs higher than anywhere, care worse in the US than most industrialized countries for the "average' user, and not much better for the 1%).

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

Holy shit you're a retard.

The facts regarding the cost and outcomes of health care vs other countries are indisputable.

The cost of insurance here is absolutely insane, as is the cost of seeing a doctor, having tests done and getting prescriptions filled.

Compare to a country like Australia where you pay about 1% of your income to fund the public health system, which means you can see a doctor, get tests and surgery at no cost and the government purchases many medicines and drives a really hard bargain with pharmaceutical suppliers so many prescriptions are very cheap.

You may have to wait if you don't have a life-threatening or urgent issue, but if you get your own private insurance (top-shelf coverage for under $150/month) you don't have to wait and can choose your surgeons.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

Slowing an increase over a period of years is also known as a decrease. I never said they cut their costs in half, I said they cost half what the U.S. pays now. If you actually looked at the pretty graphs and charts in the links I gave you, it would be obvious. Those are in terms of GDP by the way, so differences in currency value are already factored out. They are modern western countries, and all somewhat left of the U.S. so it's bizarre that you would claim U.S. regulations are making all that difference.

I have no idea why you are determined to sacrifice yourself for the sake of GOP ideology, but it has become apparent you can't be convinced of the facts because you fervently want to believe something else. I might as well try to convince a born-again fundamentalist to join me in celebration of Darwin's birthday. I can tell because when confronted with facts and figures, you fell back to the previous argument/talking point even though it was already shot down, as if you have forgotten already.

Re:Don't let 'im kiss ya, Hawkeye

[ausekilis]

Those same single payer countries also charge a hell of a lot more in personal income tax. The money comes from somewhere, it's just not labelled the same way it is here in the states.

On average, the total spent on healthcare is less because the the young and/or wealthy pay some of the costs for the old and/or poor.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

You apparently don't know how averages work. Think about it a minute and you'll see your mistake, I'll wait....

Next up, they also don't t have to pay an insurance company for their health insurance. Would you rather send a private corporation $1000/month or send the public insurance $500/month for the same service. Cue Jeopardy music...

Re:Don't let 'im kiss ya, Hawkeye

[rhazz]

America has higher prices mostly because we pay for most of the world's medical research

Except that's not actually how it works. It's the same company selling a drug to both the US and everyone else. For example, in the listing below Mirapex is owned by a German company.

Mirapex, for Parkinson's disease: $157 in Canada vs. $263 in the United States.
Celexa, for depression: $149 in Canada vs. $253 in the United States.
Diovan, for high blood pressure: $149 in Canada vs. $253 in the United States.
Oxazepam, for insomnia: $13 in Canada vs. $70 in the United States.
Seroquel, for insomnia: $33 in Canada vs. $124 in the United States.

A better argument would be that drugs cost less for everyone else BECAUSE they are able to charge more in US markets. As in premium US prices allow them to give discounts to others. But in reality it's simpler than that - drugs cost more in the US because the US health care system gives the drug companies a huge negotiating advantage compared to single-payer.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

Top payers in medical care are not a mythical one percent. It's closet to universal 20/80 distribution. Weatlhiest people paying most into the system tend to also be healthiest, and vice versa.

This is something we tend to discover in countries with universal health care. Wealthy and healthy people get annoyed that they pay a lot of taxes, and they still have to sit five hours in ER queue with all the junkies and alcoholics. It's a real problem. So they end up paying extra on top of the high taxes paying for universal health care. And then they wonder why is it that they have to pay for public healthcare which they don't use.

Which provides them with incentives to vote for the parties that essentially push to defund public sector in favour of private one. Which is now the most popular party in my country, in some part due to this. It's a genuine problem in long term, and your denials of this will create problem on your end, because while you can refuse to address reality, you cannot refuse to address consequences of your denial of reality.

That is why your desperate attempt to build a caricature out of my arguments so you can easily debunk them is not constructive. You're the one who needs to win hearts and minds to get universal healthcare to pass in US. I already have it and I wholeheartedly support it for US, so strawmanning my points on the negatives of the system will not convince anyone who isn't already on your side, and will most certainly alienate those that aren't, because they can actually read my points, and see that you're not actually addressing them.

And by the way. US is not a "private only" system. Emergency care is still universal. Child healthcare is still universal. Elderly care is still universal.

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

"Slowing an increase over a period of years is also known as" speculation.

You've never addresses the original fact that the U.S. spends more on most everything. For example, education. You haven't provided any evidence that single-payer plans would save money in the U.S. Simply saying one of the many difference between countries is single-payer or not and one of the other differences is how much a country spends isn't evidence of anything., it's an unsupported claim to relate them causally.

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

Stating you don't actually know something, then drawing a conclusion from your lack of knowledge is an interesting approach, but if you read the rest of the thread, you'd note that spending wasn't reduced by introducing single-payer elsewhere, so there is no reason it would be reduced in the United States by introducing single-payer. (Also, we're talking about spending. "Costs" is a different concept, because it doesn't reflect the interaction of demand vs supply which determines spending.)

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

Try to provide evidence of your assertions, rather than taking a point-in-time correlation and trying to turn it into causation because it fits your preconceived notions.

Also, we were talking about spending levels, not about "costs". There is a difference between the two concepts.

Either way, looking at this chart, can you tell when Australia (to use your example) introduced single-payer? How about any of the other countries? Guess what, their spending per capita went up after introducing single-payer, not down. There's no reason, nor evidence, to suggest the experience in the U.S. would be different. The economic evidence is that costs would go up after switching to single-payer.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

You mean other than the fact it has worked every single place it has ever been tried? Given that, the onus is on you to show why it WOULDNT work in the U.S. since that would be the unusual situation.

As for education, guess what, in the other countries where it is cheaper, the government pays all or part of the tuition rather than saddling students with loans (for higher education) or pushing it off to the local government (for k-12).

I'll just leave this here

Re: Don't let 'im kiss ya, Hawkeye

[reanjr]

How the fuck do people keep forgetting that Democrats controlled the House and Senate when Obama became president?

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

no sane person honestly thinks health outcomes in the U.S. are even in the top ten.

The US isn't like those other countries. The US is like many top countries in some parts, but has tens of millions of people living in poverty in cities dominated by immigrants from developing countries with many of the same health issues.

We have places in the US that would be in the top ten even without universal healthcare. The US is more ethnically diverse. Has a wide variety of socioeconomic conditions and pockets of great poverty. We have gang war zones where gang criminal violence makes us more like Iraq than the rest of the US.

Universal healthcare has many many downsides when you live in a society that can't afford it and will end up rationing healthcare.

Look at China... you theoretically have universal healthcare. Unless you decide to move into the city or another region without work authorization. Then you are treated like an illegal immigrant in your own country. And millions do move around China for work, so you have a system that saves money by ignoring reality of people's needs to make a living.

The US is more like China in size and its disjointed political system than most of the countries we like to hold up as models.

Re:Don't let 'im kiss ya, Hawkeye

[lgw]

I'd rather have health care advance quickly, even if we have to pay more. America is a wealthy nation, after all.

Re:Don't let 'im kiss ya, Hawkeye

[lgw]

Somebody has to pay for the research. Should we pay the same per dose as Uganda? No, I don't think we should. Maybe it's not the most fair pricing for us, but it's not very far off.

Re:Don't let 'im kiss ya, Hawkeye

[TheRaven64]

I'm quite happy for US citizens to subsidise my heath care, but I'm not convinced that 'if we implement socialised health care then our costs will go down but citizens of other countries will go up' is actually a compelling counterargument for the average US taxpayer.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

You mean some Americans are wealthy.

But tell me, do you routinely pay double the sticker price for things in the hope it will advance improvements to the product? Do you try to make others do the same?

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

OH, I see, we're uniquely challenged. Not at all like the influx of refugees to Germany and the U.K.

I guess you're saying it's too much of an authoritarian hellhole to have good health care?

Personally, I think it's still salvageable.

Re: Don't let 'im kiss ya, Hawkeye

[Green Mountain Bot]

How the fuck do people forget that A) The Democrats only had a filibuster-proof majority for 9 months, B) the GOP demonstrated a willingness to filibuster any and every proposal, and C) even with the filibuster-proof majority, the Democratic party is not a monolithic entity that demands every member toe the line like the GOP does? For example, the Democrats had to keep the votes of blue dogs to pass anything, and they nixed the Public Option, which would have been the primary mechanism to force private insurance to compete throughout the country. Without it, many places - particularly rural areas - didn't have competition between insurance companies, thus completely undermining the power of the market to provide a better product.

Re:Don't let 'im kiss ya, Hawkeye

[Green Mountain Bot]

Written by that bastion of liberal thought and Democratic stronghold that is the Heritage Foundation.

Re: Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

LOL how dumb, the dem bench hasn't been all that deep since the 80s but its all Obama's fault

Re:Don't let 'im kiss ya, Hawkeye

[Green Mountain Bot]

His use of "misnomer" qualifies as one.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

-1 Troll

Once again asshole moderators take personal offense.

Re:Don't let 'im kiss ya, Hawkeye

[eth1]

US is not a "private only" system. Emergency care is still universal. Child healthcare is still universal. Elderly care is still universal.

"Universal" in that you still have to pay for it... I ended up in the hospital via ambulance for two days once. If I hadn't had insurance, it would have been $700 for the ride, and over $50,000 for two days/one night in the hospital. Sure, they'll still "universally" pick you up and take you, but then most people would have to declare bankruptcy.

Re:Don't let 'im kiss ya, Hawkeye

[del_diablo]

The defunding is also not a easy issue.
Defunding is never done in a linear manner. It usually starts off with the upper class realizing that they can pay to skip the queue, and then slowly try to influence their local positions about this. The problem only appears as you have the media, a political party, and a few voters, straggling alongside party politics. Slowly, the private offering will increase in quality, slowly it will penetrate the part of society willing to pay.
In most Nordic countries, everyone who can bother, can pay for private insurance to cover this, meaning its not a issue of money, but more a issue of social class(and their way of managing money). The interesting part, is that since the class of people paying for the part is loop sided, the feedback is loop sided.

So, running this experiement live, in Norway, since the The Grand Adventure of Oil started: The Politicians kids are now adults, from those times. As a weird upperclass crust, they most likely grew up with the extra protection the upper class is willing to invest into. From higher sport participation, more activities as kids, to more networking, to better public morale, and simply to having better health insurance.
So what is happening, is that those kids are now becoming politicians, and since the parties are basically aristocratic dynasties in many ways, the pile of class have a impact. And thats before you consider that the upper class has rather normal ways of networking: Newspapers and social circles.
What is interesting, is how this ends up being portrayed. Currently, local doctors are the more stressed parts of the public sector, is basically crying wolf. Because of the state media, their cry get heard. But because of rather harsh populism and tabloid culture, there is no digging into WHY they are crying wolf, and how it has been adapted into their workforce since at the least the war.
So basically: The local doctors(needed to get access to the rest of the public health sector)
Are in this situation where they are understaffed, because they need to do somebody elses job. This much is obvious, but beyond that, why they needed somebody else to do their job is not researched, or why we live in a era of extra paperwork.
Still, this feeds into the feed back loop causing the issue: So if the public sector is getting worse(a little), regardless of the issue, it will result in it getting further slashes down the road, because the aristocrats influencing the political cabal do not care about its ability in the long term.

The political situation in other nations with universal health care is similar: Not the same, but in broad strokes, the pattern is there. And it really doesn't have anything to do with the base quality.

Re:Don't let 'im kiss ya, Hawkeye

[lgw]

You mean some Americans are wealthy.

If you make $30k/year, you're a 1%-er by world standards. The median family income in the US is amazing in the broader view. It's good to sometimes take the broader view, it helps your perspective.

Re:Don't let 'im kiss ya, Hawkeye

[wyHunter]

Immaterial. You're clearly from the People's Republic of Vermont. How does an industry with no industry to speak of, no income work for ya? Oh wait, you're probably on a trust fund! Those of us in the real world have to have real world solutions.

Re:Don't let 'im kiss ya, Hawkeye

[david_thornley]

The ACA was a real mess, but there was an attempt to involve Republicans in the process.

Re:Don't let 'im kiss ya, Hawkeye

[david_thornley]

And $30K/year will allow you to buy only the most basic drugs in the US. If you need insulin, and you don't have some sort of insurance or assistance plan that covers it, well, sucks to be you.

Re: Don't let 'im kiss ya, Hawkeye

[shilly]

I haven't forgotten. But you apparently have forgotten the comment you made in the post I replied to: "Obama and the Democrats would rather stay in power than give us decent healthcare."

Implying the moral thing to do was to give up power and give the US decent healthcare. Those are, um, incompatible actions.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

Don't forget the distinction that the US doesn't just spend more per capita on healthcare than every other nation, we spend more tax dollars per capita on healthcare than any other developed nation, and then we pay about that much again at point of care. So not only is the average US citizen personally spending drastically more money at the point of care compared to the rest of the world, but they're also paying more in taxes to pay for for healthcare than all those nations with universal care, because we only provide care using tax dollars to the most expensive patients, and let the private companies profit off the less costly healthy folks. We have the worst of both worlds.

Re:Don't let 'im kiss ya, Hawkeye

[Green Mountain Bot]

Nice post. I especially like the part where you make up a bunch of crap about someone you've never met as a way to deflect from the fact that you have no support for your argument. When you don't have facts, intellect, or class: attack!

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

Canadian Patented Medicine Prices Review Board regulates prices for brand name medications. The comparison you are making is to government mandated price controls for those medications. Not to say there shouldn't be something similar in the US, but there's a reason for the difference.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

The problem with comparisons is the data being compared. There's no standard that requires the data reporting to be consistent country to country. Definitions even change country to country. Always take them with a skeptical eye. There's no argument that US spends a lot on healthcare. But, it's well known that most significant changes in life expectancy had nothing to do with 'healthcare'. Clean water and a stable safe food supply provided much more % benefit.

Re:Don't let 'im kiss ya, Hawkeye

[AK Marc]

US is not a "private only" system. Emergency care is still universal. Child healthcare is still universal. Elderly care is still universal.

Emergency care is private and unfunded. It's a cost of doing business, like marking parking lots with fire lanes, and having handicapped spots.

Child-only care that's income tested isn't "universal" and neither is an age-tested system. That you don't understand "universal" doesn't make it true.

Medicare and Medicaid are government paid plans, who only pay private for-profit providers who opt-in to their system (also note, Medicaid is a state system, not federal, though uses federal funds). You should have gone for VA. A medical system overlay, the only government medical system with no "profit" in it. Deliberately kept at bare minimums to "prove" how bad government health care would be.

The VA would be a better basis for Universal Health Care than the Medi[care|caid] system. Fund the VA, and send all Medi[care|caid] to the VA, shutting them down as the care transfers to the VA, then expand the VA until it can serve the entire population. It would take years to do gracefully, but would be an effective and reasonable path to universal care. No changes to the private system, but creating universal care.

Wealthy and healthy people get annoyed that they pay a lot of taxes, and they still have to sit five hours in ER queue with all the junkies and alcoholics.

Healthy people don't go to the ER. And in my Universal Care location, I can go to my GP and get a referral to the hospital and get no lines. And yes, that even works for ER, with private ERs referring to the hospital and eliminating the wait, so you have to go through triage at the "free" ER, then skip to the front of the line. And there are lots of private facilities you can go to and never touch the public system. So the 20% (since apparently 1% offends you) gets private insurance, and goes to private doctors, and doesn't use the public system if it's that important to them.

And yes, one thing the rich do best is complain about taxes.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

Sure, but average age of death is fairly unambiguous.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

Now, as soon as rent and mortgage payments come down to 3rd world standards (not to mention food and drug prices) that might matter.

Until that happens, the cost of medical care in the U.S. compared to income is ruinous for many people and is a drag on the entire economy. If you want to see research advance (laudable, BTW), donate some of your disposable income to that cause. Don't demand that people who don't have disposable income choose between their heart pills and rent.

Now, about the two questions I asked...

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

You seem to be quite generous with other people's income there. In particular, those who have a lot less of it than you do. Perhaps we should be paying more than Uganda, but should we really be paying double what Canada, the U.K., Germany, Switzerland, etc. pay?

Yes, DOUBLE.

How fair is it to have average Americans paying that much more to support the development of drugs they won't be able to afford? Should we be paying a food surcharge to develop a new $10,000/oz super caviar while we're at it?

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

We established (including via your links) that single-payer hasn't reduced spending from the pre-single-payer system anywhere else it's been tried. So you're going to have to define "worked" as something other than that if you want to claim switching to single-payer "worked" everywhere.

The primary causes of higher health care spending in the U.S.:
1. People in the U.S. are wealthier. Wealthier people demand, consume and pay for more health care than poorer people who have to prioritize spending on other things first. This is why, for example, people in India spend so much less on books than people in the United States and Indian books which are purchased tend to be lower quality (cheaper paper, bindings, etc...) in order to keep them less expensive.
2. The government in conjunction with the AMA restrict the entry of new providers into the marking, significantly reducing the supply. This is via requirements for practicing (especially those which don't recognize medical training or experience from other countries) and limiting residency spots.
3. The government distorts the health care market via laws, regulations and rules. This includes things like the tax law incentivizing employer-based insurance groups, restrictions on competition between health insurance providers, restrictions preventing opening new hospitals to compete with old ones, restrictions on what someone can purchase in terms of health insurance, medicare/medicaid/va-related distortions, etc...
4. The FDA regulatory process, especially requiring testing for efficacy (not just safety), requiring double-testing (no reason a drug or device which has proven safe in Europe has to start all over in the U.S., to give one wastefule example), ridiculous definitions and rules for "medical" devices.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

You're just repeating yourself. It has all been shot down before. You have yet to explain how such an impossible thing as single payer works everywhere in the world but somehow can't work in the U.S.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

They should come over here. Then they can pay top dollar for private care AND sit for 6-8 hours with the junkies. then get lesser quallity care.

Funny thing I'be seen, the mere existence of public care reduces the costs of private care in most places just by providing an option.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

ha!

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

Norway due to its unique economics makes for a very bad example for anything outside it. Literally worldwide, it's the only state that operates the way it does.

My native Finland is much closer to your typical Nordic system. We actually have severe money problems within the system, and can't just go the way of Norway and offer better salaries to vacuum doctors and nurses from other Nordic countries. Notably, this is the issue that Finland, Sweden and Denmark are facing right now - Norway can simply pay far better wages due to its unique economic structures, which is causing brain drain across its neighbours.

The Grand Experiment in Finland right now is essentially the same that crushed the quality of universal healthcare in Sweden about a decade ago to the point where people in Sweden now come here to Finland to do quality-critical things like childbirth. Population average ages and is less healthy due to problems like obesity. That means more demand. At the same time, doctors and nurses are more slowly becoming changing to female dominated field, and math on that one is brutal. Female doctor will on average do about 2/3 of work hours of a male doctor, typically due to wanting to have multi-year maternity leave and not wanting to do as much overtime.

So you have a classic "more demand, less supply" problem that keeps growing slowly, boiling the frog. Private sector is increasingly stepping in, offering things like non-emergency health care outside traditional work hours, little to no queue times and so on. All while being able to dump the actually difficult cases on public sector, because public sector must treat all patients. Private sector is under no such obligations.

So you get a system where public sector is for those who are the poorest, most ill people that need expensive treatment, while private sector skims the cream off the top and posts record profits year after year. And the wealthiest and healthiest who go to private sector for their overwhelmingly easy to treat problems start voting for the parties that want to defund public care. And private sector companies keep funding said party off their ever increasing profits.

And so, you have a self sustaining process which leads to disaster.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

You really need to read the second to last paragraph:

>That is why your desperate attempt to build a caricature out of my arguments so you can easily debunk them is not constructive. You're the one who needs to win hearts and minds to get universal healthcare to pass in US. I already have it and I wholeheartedly support it for US, so strawmanning my points on the negatives of the system will not convince anyone who isn't already on your side, and will most certainly alienate those that aren't, because they can actually read my points, and see that you're not actually addressing them.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

It depends a lot on the system. In Nordic system, where you have parallel private and public health care, what happens is that private healthcare gets to skim the rich and easy cases off the top, and dump the rest on the public system. Which results in massively overloaded public system which gets all the difficult and expensive cases, resulting in lowered quality of care as doctors who have a choice go to private sector.

This is a major problem across Nordics right now. Sweden is so bad at this point, that you have people coming to Finland for quality-critical deeply specialized things like childbirth. Rest of us are a decade or two behind them, which is why our public system at hospital level (specialized care) is still of generally high quality, while the local (i.e. health clinic) is in a downward spiral. I.e. one of the best cancer survival rates in the world, one of the lowest infant mortality rates in the world and so on, because these things remain in high demand, cannot be easily delivered by private sector that finds it most profitable to treat rich with runny noses. A caricature, but it delivers the correct message in this case. In clinic, it may literally take you days just to get to see a doctor, even after you get sick, because of how badly clogged public system is at this point.

And the worst part is that private care does slowly go up in price, even when public option is available. It's just that we are at the start of the progression, while US is much further down the line. Specialized care in private sector is a small business, and while private companies are clearly lobbying hard for more universal payer system payments to private sector (hence allowing less wealthy people to get into the private system) and we have a major legislative package on the topic that has been on and off in parliamentary limbo for something close to decade at this point. The issue is incredibly explosive and painful, that even the main party pushing for defunding public care and shifting to private, that is currently the most popular party in the country simply cannot push the changes through the parliament. The rejection from the rest of the nation is simply too strong.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

I pay for every doctor visit I do in Finland, with universal public healthcare, up to a certain annually reset maximum, at which point the national pensions organisation KELA will pay 100% of the rest afaik. I never needed any such services to such a costly extent as to hit the maximum. Same party also pays for a portion of medical purchases, after a certain annual minimum is fully paid by me. They also make decisions such as which medicines are partially paid for by them, to what extent, and for which illnesses. If your illness is not deemed "correct for this medication", even if medication is found helpful by the doctor, you pay for it in full. A very contentious issue for many patients organisations who lobby for new medications to be accepted on the list for their illness.

And you cannot even declare private bankruptcy here, as the private bankruptcy doesn't exist in the law. Which caused a severe issue with suicide after the economy crash of early 1990s. Instead you're could spend your entire life on the hook for debts in an endless debt spiral. I know they introduced some changes to it so that one failed business doesn't ruin your finances for life, but there's still no "private bankruptcy". We have a Nordic attitude to debt in general, where you are expected to pay what you owe. That's why we have such a major culture clash between North and South in Europe in relation to Greek debt crisis. We expect them to pay back their debts in full, just like we expect our own to pay back their debts in full.

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

That's because you still haven't provided any evidence at all that when single-payer systems are implemented, they reduce health care spending.

But hey, at least you finally got some mod points for your alt account.

Re:Don't let 'im kiss ya, Hawkeye

[AK Marc]

"Cows are cats. If you disagree, that's you building a strawman."

That's a joke. Reality isn't a strawman. I don't have to win any hearts or minds. I have better universal care than you do.

I was just correcting your outright lie that ER is a form of universal healthcare, and throwing in some other corrections. You are just being an arrogant prick. And you are factually wrong on almost every point. Anyone can look back on your words and see that clearly.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

Gotta say, "my healthcare is better than yours" was a true cherry on the cake. I guess you subscribe to belief that when you go retard, you may as well go full retard.

More power to you.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

I provided ample evidence. You simply refused to follow the links. I'm not interested in attempting to spoon feed you further.

Re:Don't let 'im kiss ya, Hawkeye

[lgw]

Now, as soon as rent and mortgage payments come down to 3rd world standards (not to mention food and drug prices) that might matter.

You live better than almost everyone who has ever lived. You should try to appreciate that, and maybe be a little more generous given your position.

About the two questions you asked: advances in many areas are funded by the rich doing just that. Car technology e.g. comes down from luxury cars that cost twice what they need to. There's a lot of medical technology that only the rich can afford this year, but in 20 years will be common. Without a health care system that allows for that, innovation will slow to a crawl (you'll still have the occasional Dr DeBakey, but guys like him are vanishingly rare).

Re:Don't let 'im kiss ya, Hawkeye

[AK Marc]

Given the complaints you have about your system, mine can't be worse than yours. Do you know of a ranking of countries by government healthcare? Where I am has had universal healthcare longer than Finland.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

You seem unable to appreciate the situation. Many Americans simply cannot afford to pay what you want them to for healthcare. They don't buy those luxury cars, they either buy older used cars, more basic cars, or no car. No healthcare really isn't an option. Older healthcare still costs a fortune in this country compared to the rest of the world. Basic healthcare costs a fortune in this country compared to the rest of the world.

Again, you seem to be REALLY generous with other people's limited income.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

It sounds like a problem of underfunding the public system, possibly the same sort of monkey wrenching that the right has perpetrated in the U.S. in it's efforts to make sure we all have the most expensive and profitable (for a few) healthcare possible.

It's a common tactic. Push legislation that makes a public service inefficient or insufficient and then claim the sorry state of affairs is somehow intrinsic to a public service.

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

I looked at all your links. None of them provide any evidence that single-payer reduced spending when implemented. You keep trying to change the topic to the fact that the U.S. spends more than other countries, but that's not something we've ever disagreed on in this thread. To recap, the discussion is about "why", which you apparently have no knowledge of and no evidence of beyond your own opinion which contradicts the experience of every country which has implemented it.

Re:Don't let 'im kiss ya, Hawkeye

[lgw]

Many Americans simply cannot afford to pay what you want them to for healthcare.

Correct. Just like luxury cars. My point is that "luxury health care" funds innovation, and that's the most important thing in the long run.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

Only if it isn't you or a loved one who can't afford necessary care.

More "I got mine, screw you!" mentality from the well off.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

What pro is there to a private-only system? I've never seen any. The costs are higher, and the care worse in the US with private-only, than many other places (costs higher than anywhere, care worse in the US than most industrialized countries for the "average' user, and not much better for the 1

Switzerland and Holland have highly regulated private-only systems. I don't know much about the Dutch system.

In the Swiss system, everybody has to buy insurance, with low income families getting state aid. People seem pretty happy with it, especially compared to the USA.

Of course, that's going to be true with any Western developed nation and some others - they're better on average than the USA with respect to health care, both in terms of costs and customer satisfaction.

The Swiss system is highly regulated, with public votes on important matters, or so I understand. The system costs a little more than the French system (as a fraction of GDP), but the Dutch system costs less than the French system.

Given that the cost of living is considerably higher in Switzerland than in France, the Swiss system actually costs less than I would expect - they're clearly doing something right.

The US health care system is a disaster, but don't misrepresent the others, it just undermines your argument. Also, I highly doubt we'll ever be able to fix health care in the USA without fixing some other things, such as tort reform and generally reforming legal ethics, plus reforming a bunch of other things like the cost of education and student loans.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

Problem being that parties that push for this enter parliament because populace votes for them. And populace votes for them because the wealthy don't use the public system all that much, and use private one.

So it's not the "right wing" problem. Our "right wing party" is left of US democratic party. It's the society splitting by class lines - problem. And US has a much harsher culture when it comes to splitting society by class and each class voting only for it own benefits, ignoring the whole. So to sell the universal public healthcare in US, the discussion will have to talk about pros and cons for everyone, in an honest way. Because the majority of the populace will benefit from universal healthcare. And because this discussion will inoculate the system from subversion such as one occurring around the Nordics right now for at least two generations.

Re:Don't let 'im kiss ya, Hawkeye

[Anonymous Coward]

You've never addresses the original fact that the U.S. spends more on most everything. For example, education. You haven't provided any evidence that single-payer plans would save money in the U.S. Simply saying one of the many difference between countries is single-payer or not and one of the other differences is how much a country spends isn't evidence of anything., it's an unsupported claim to relate them causally.

Learn to use a search engine.

The US spends 5.6% of GDP on education - on par with most other Western developed nations, substantially less than some such as Denmark (8.7%). It spends 17% of GDP on health care - the highest any other Western nation spends is around 11%, most are in the 9-11% range.

GDP is not a perfect measure, but it's perfectly adequate for this comparison. You get the same conclusion when you break out the details, looking at things like cost of living and so forth. It's been done many times. When you measure something many different ways and get the same answer, you can be confident that answer is reasonable.

In short, the US is NOT spending more on education. It IS spending a lot more on health care.

Don't live in denial or let yourself be confused by facts. The US system is a mess: excessive greed, political corruption, and unethical practice of law all have a cost to a society that permits these things. There's nothing wrong with an ordinary level of greed, and no system is perfect - but you need to learn to see past the bodyguard of lies that protects the sociopaths in the USA.

Re:Don't let 'im kiss ya, Hawkeye

[_Sharp'r_]

The actual statement I made, complete with original link containing, oh, evidence, was that "the U.S. spends 40% more per student than the OECD average. That in turn is way more than third world countries spend."

At least learn to read the thread on the page right in front of you before suggesting someone learn to use a search engine.

Also, percent of GDP as a way to compare the price of virtually anything is ridiculous and only serves to attempt to obscure things. We don't compare prices and spending on most products as percent of GDP, we compare the actual cost. When is the last time someone asked you: How much is your rent as a percent of GDP? How much is a loaf of bread as a percent of GDP? What does a pencil cost in percent of GDP? That's stupid.

Re:Don't let 'im kiss ya, Hawkeye

[wyHunter]

I have all the support in the world - look at the fact that single payer in your state failed miserably. And yours state is easy to do it in.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

In the U.S. it's the right. While it;s a bit complicated due to the GOPs unholey alliance "if you'll forgive the pun" with fundamentalist Christianity, the GOP has long represented primarily the upper class, so there's truth in it being a class issue. It's confounded here by the aptly described "temporarily embarrassed millionaires" voting against their own class.

I didn't mean to imply that it's everyone's right.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

I find this to be a gross oversimplification, found mainly in fart left edge of US political spectrum. Republicans are the party of the working class working for various production fields and winning this vote with policies aimed at making it easier to get production into US and limit immigration driving the wages of working class down. Democrats are distinctly hostile to these people, down to calling them "deplorables" in last election and openly supporting all of their main class enemies - immigrants and white collar intelligencia.

Democrats appear to be on the other hand the party of big business, who have shown clear support for Clinton in last elections in many non-production industries such as IT.

There's just a whole lot more to US party system and its alliance networks than just "evil christians doing the work of satan and republicans" caricature commonly painted by the same people who call working class "deplorables". Each party has it's own connections and alliances among various strata of society, and interestingly, it seems that our time is the time when many of these connections are shifting. Democrats used to be the party of working class just a couple of decades ago for example, while republicans where the big business party. That has flipped 180.

We live in interesting times when it comes to US politics. Two party system may lock out other parties - but it also causes the two big parties to keep adopting their platforms to various interests, often making friends among those that were their foes just a few decades ago.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

You seem to have mistaken me for a Clinton supporter. Because of the DNC's many shenanigans combined with Clinton's abandonment of the rank and file Democrats, I didn't vote for her either. The actual working class and for that matter, the middle class are essentially unrepresented today.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

I didn't make any kind of assumptions on your voting pattern. I merely pointed out that you appear to hold same misconceptions on what class is supported by whom as far left edge of US political spectrum.

Working class have a clear representation in Trump. There's absolutely no question about that. His entire "get production jobs back to US, stop immigration, lower taxes on producers so they can invest in US" platform is about as pro-working class as you can get in modern day. The only way you could even think otherwise is if you subscribe to thinking model that to be pro-working class, you have to be socialist or communist. Which is also a far left misconception.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

OTOH, raising the minimum wage would be quite pro working class. As would making taxes more progressive. Stopping immigration can go either way depending on how carefully employment of illegals is watched. If that enforcement is lax, it's just a way to make sure there are plenty of illegals who can't complain when their rights are violated. Expanding public healthcare would be a huge benefit to the working class and small businesses that employ them.

You seem rather avid about U.S. politics for someone living in a nordic country where your right is to the left of the Democrats.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

You're once again demonstrating the same far left assumptions, such as that legality of immigration has a significant impact on immigration's impact on working class, or that working class is on minimum wage.

Legality of immigration is all but irrelevant for working class. The fact that there is immigration in the first place is which both creates competition for jobs that would not be there otherwise and suppresses wages. Most industrial workers have healthcare provided by their employer. Most of them are not on the minimum wage but salaried at a significantly higher rate. More progressive tax would indeed help them, to an extent. However as industrial workers tend to be fairly well paid, they may get hit by progressive curve, so that is debatable. Here in Finland, industrial workers pay around 40% of their income as income tax due to progression for example.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

Consider though, when the income tax was first imposed, the minimum income that required any payment at all was (in inflation adjusted dollars) $74,000. The average person didn't need to file.

Meanwhile, you are putting words in my mouth and ideas in my head that simply aren't there. I do not assume that all working class people are on minimum wage, but I do recognize that many are and nobody in the upper class is.

What you seem to not realize is that employer paid healthcare is still an expense that limits how many people the employer will hire. It's also why many employers make sure to cut hours for part time employees and not allow them to become full time. Until the ACA came along, it would sometimes force small business owners to shut down entirely just so they could actually get health insurance for themselves. Note, I'm not claiming that ACA is a great solution, or even a proper solution, but it is marginally better than the previous state of affairs.

Can you think of any employer that wouldn't rather not have to deal with health insurance at all? Can you think of any working class person who wouldn't rather not get surprise bills? That wouldn't rather not deal with limits, deductibles, co-pays, billing errors, failures to submit claims, etc, etc, etc? Can you think of any working class people who were happy to not be insurable due to pre-existing conditions?

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

You talking about "support for minimum wage" among working class infers that working class care in a significant way about it. They do not. As long as immigration is controlled as to not significantly compete with it, they are salaried at rate significantly above minimum wage. This isn't me putting any words in your mouth. This is me addressing misconceptions you demonstrate. Remember, we're talking about political alliances, political parties, and things that such political parties advocate for to gain support of certain societal groups.

For example, you just stated with all seriousness that "employer paid healthcare is still an expense that limits how many people they will hire". This is something that is not considered sane thinking model even in social democracies like mine, because either employer pays for it through payments to the insurer, or through taxes. The money still needs to be paid. Even the most hard line lobbyists of employers group EK around here don't try this level of silliness when they lobby for tools to hire more people.

So I certainly agree that employers would prefer to deal with as few added costs of employment as possible. They're not social organisations, but for profit enterprises. And this is where far left stops, because the core tenet of far left thinking is class warfare. Employers are at war with their employees, and that's that.

In real world on the other hand, they also want efficient workforce, which means they want their workforce to be reasonably healthy. Especially considering the whole "infectious illness" aspect of reality and what it does in a collective of people interacting with each other. Which is why organised healthcare for factory workers was introduced as a concept by the factory owners originally, and why same people understand that providing reasonable health care for their workers benefits their bottom line as long as there isn't a massive oversupply of work force.

Re:Don't let 'im kiss ya, Hawkeye

[sjames]

All of that may be true of your country, but not this one. Many employers actively avoid providing health insurance for their employees by either limiting their hours so they can be classified as part time or mis-classifying them as contractors. It may be stupid, but that's what they do. Your claim that people making minimum wage are not a significant part of the working class is simply absurd. Even people making more than minimum wage suffer for it since it creates a large pool of people ready to replace them if they demand even a tiny raise.

The article that this discussion is connected to is all about some large businesses that are anything but satisfied with the current state of healthcare in the U.S. Small businesses and sole proprietorships are no more satisfied, they just aren't big enough to make a move like this. Many individuals have complained that they still can't afford healthcare because after paying for the insurance, they don't have enough left over to cover the crazy co-pays and the many things that aren't covered.

Re: Don't let 'im kiss ya, Hawkeye

[reanjr]

Funny, it only takes a few minutes to vote on a bill. Seems like 9 months is more than sufficient. And I was replying to a comments that claimed the Democrats weren't in power. That's bullshit. Democrats need to take responsibility for their inability to govern. They can't keep blaming Republicans for their incompetence and/or poor party management.

Re: Don't let 'im kiss ya, Hawkeye

[reanjr]

No, they are not. They just seem so to you because you've intentionally framed the causality backwards.

Re: Don't let 'im kiss ya, Hawkeye

[Green Mountain Bot]

How long does it take to write a bill that can pass both houses? Longer than a few minutes.

Re:Don't let 'im kiss ya, Hawkeye

[Luckyo]

Certainly. I literally prefaced my first post in this thread with "I think universal healthcare should be pushed through in US, but your arguments are bad, and here's why".

I'm not arguing against universal healthcare. I'm pointing out that arguments used are just too extreme, pushing well beyond reality into falsehoods. Which makes them very easy to debunk, by using social democracies that have universal healthcare as a data point at healthcare system that actually works and is one of the most efficient ones in the world while maintaining cutting edge survival rates for complex and expensive to treat illnesses such as various cancers.

Arguments used need to be far more realistic, and discuss actual, tangible benefits of universal healthcare, while taking care not to slide into extremes of "just how good universal care is". The whole "you get to keep your doctor" lie did more damage to the cause in US than much of right wing propaganda combined.

Re:This is a BS article..

[bobbied]

Amazon got hit in the overall down day in the market, not this roll your own insurance company thing.

Let me restate that... Insurance companies got caught in the market day.. Not by Amazon's roll your own insurance thing.

Re:This is a BS article..

[sexconker]

Let me restate that, you got caught responding to a headline after parsing it incorrectly and failing to read TFS or understand WTF you were talking about.
Then you replied to yourself trying to sweep your failure under the rug.

Good!

[DaMattster]

Let the "for profit" blood suckers get rocked on their heels a little. After all of the reasons that they have found to deny people care that need it, fuck those big boys.

Re:Good!

[ShanghaiBill]

After all of the reasons that they have found to deny people care that need it, fuck those big boys.

Any system that gives people all the healthcare they want will bankrupt the nation. You have to ration, whether it is by price, willingness to wait in a queue, or death panels.

Re:Good!

[msauve]

"Any system that gives people all the healthcare they want will bankrupt the nation. You have to ration, whether it is by price, willingness to wait in a queue, or death panels."

+1

Much of the cost of healthcare is because people expect that because there's a treatment available, they have a "right" to it, cost be damned. Society can't afford expensive treatments which have a small probability of extending a life for a short time. Hence the GP's "all of the reasons that they have found to deny people care that need it." He says it like it's a bad thing - nope, it keeps overall costs down.

Any "right to health care" is not a right to force others to collectively pay for it.

Re:Good!

[sjames]

The U.S. uses all three.

Re:Good!

[Anonymous Coward]

This is exactly why I'm okay with people dying because they can't afford insulin. "Sorry! If you needed that insulin so badly you should have been a billionaire and bought up the patents before that other guy jacked up the price. Can't all get what we want."

Re:Good!

[blackomegax]

And you're arguing, effectively, to genocide the unhealthy and the poor. GTFO with your class war, Ayn Rand bullshit. Every other civilized country works out great, with none of the straw men you brought up, lines, death panels etc. For profit health care denying coverage *is* the death panel.

Re:Good!

[msauve]

Eat shit and die.

200 years ago, everyone was completely on their own regarding healthcare. 100 years ago, it was family and trading a chicken for some care. STFU and be thankful for the advances since then, you don't deserve the benefit.

Re:Good!

[Anonymous Coward]

Sounds to me like you got brainwashed by the big pharmas into giving them all your money for the slightest injury.

Re: Good!

[Anonymous Coward]

You sound so happy with your for-profit healthcare. Americans are the nicest people online.

Re:Good!

[ShanghaiBill]

Every other civilized country works out great

Bullcrap. Every civilized country rations healthcare. Every. Single. One.

There is nowhere where you can get any treatment, on demand, at anytime, for free.

Even in Norway, a woman can't just walk in and get a breast enlargement anytime she wants, and expect someone else to pay for it.

Disclaimer: I realize that most Norwegian women don't actually need breast enlargements. It is just an example.

Re:Good!

[darthsilun]

... deny people care that need it.

versus

... gives people all the health care they want ...

wow. Yes, giving people all the health care they want almost certainly would bankrupt the nation. But that isn't what the PP wrote.

Someone with cancer that needs chemo is not, as near as I can tell, also getting a boob job, their teeth straightened, and a hip replacement. You're just playing on people's emotions with what is essentially a false premise. I smell a Russian troll.

Re:Good!

[No Longer an AC]

Obviously there has to be a balance. If healthcare cost me absolutely nothing (aside from whatever taxes I may pay) and I had easy access to a doctor I trusted and was confident in, I wouldn't really be that expensive....right now anyway. But if I got cancer or some other terminal conditions that's when it may get to be an issue.

Maybe basic medical checkups should come out of our pocket and the government should foot the bill for the major problems. Or maybe everyone should be guaranteed at least a minimal level of care even if they can't afford it.

I'm looking at this optimistically though. It's private business taking the initiative and health care costs are ridiculous. If they can succeed at lowering health care costs they might just shake up the industry.

Not that I really trust JPMorgan or Amazon - I'm not familiar enough with Berkshire to trust them either.

"Free to those that can afford it, very expensive to those that can’t." - Withnail

That's a quote from an old movie, but it describes American healthcare very well. If you have a good job with a good health plan and are reasonably healthy you hardly even notice the cost. If you lose any one of those 3 things though you might not be able to afford it anymore.

Re: Good!

[Brockmire]

You just changed need to want, changing the discussion point. "Need" would be tied to "to live", " want" is more of quality of life.

Re:Good!

[ClickOnThis]

Even in Norway, a woman can't just walk in and get a breast enlargement anytime she wants, and expect someone else to pay for it.

I fail to see how that strengthens your argument. Is there one, single country that has a national health-care program that pays for breast augmentation? (Aside from the obvious worthy case of cosmetic restoration for a medically-necessary mastectomy.)

Re:Good!

[ClickOnThis]

This is exactly why I'm okay with people dying because they can't afford insulin. "Sorry! If you needed that insulin so badly you should have been a billionaire and bought up the patents before that other guy jacked up the price. Can't all get what we want."

I see that Martin Shkreli has behaved well enough to earn access to Slashdot.

Don't drop the soap, Martin.

Re:Good!

[shilly]

The problem with individuals paying for basic checkups while the government paying for major problems, is that it encourages people to skimp on cheap, effective early interventions. They don't go and see their primary care provider when they first develop that ache in their side, because they don't really have $100 to spare...and then that ache turns out to be something serious, and costs a shit-load more to treat because it's progressed.

Re:Good!

[dunkelfalke]

200 years ago, imbeciles like you seldom survived to the adulthood and if they did and somebody shot them on the street, nobody would give a shit. Good old times.

Re:Good!

[dunkelfalke]

Unlikely. Russia does have universal healthcare, although it is broken due to the pervasive corruption.

Re:Good!

[Anonymous Coward]

GTFO with your class war, Ayn Rand bullshit

Of course, why think when you can feel right? If somebody doesn't agree with you, they're the devil or Ayn Rand if you're a socialist. Perhaps you need a refresher course in how well socialism works. Might I suggest Venezuela where the health care is absolutely free of charge? At least, that's what the government of Venezuela says and we should believe them, right? After all, socialists are on the side of the poor and the angels and would never lie to us, unlike the evil Americans and their private insurance companies. Consider sunny Venezuela by way of El Salvador for your next vacation. I'm sure they'll have a great time at your expense.

Re:Good!

[Strider-]

Wow, you've really drunk the kool-aid.

Re:Good!

[Anonymous Coward]

Is there one, single country that has a national health-care program that pays for breast augmentation?

In both the UK and Canada the government will pay for surgery in cases where extremely large natural breasts create serious difficulties in performing tasks of daily living. Not every woman wants to have her breasts enlarged. At least some of them want to have the size of their breasts reduced to something more normal and manageable.

Re:Good!

[Anonymous Coward]

The problem with individuals paying for basic checkups while the government paying for major problems, is that it encourages people to skimp on cheap, effective early interventions. They don't go and see their primary care provider when they first develop that ache in their side, because they don't really have $100 to spare...and then that ache turns out to be something serious, and costs a shit-load more to treat because it's progressed.

This is easily solved by witholding $100 per month from bi-weekly paychecks and depositing it into a custodial account that can only be used for qualified medical expenses, like visiting the doctor. Many of us are responsible enough to put aside this much and more each month for unforeseen expenses on our own, but I recognize that a substantial minority of Americans are too ignorant and stupid to do this, and so we need to have forced savings for everybody in this case. Having people spend their own saved money, albeit forced savings, on their own healthcare is still far preferable to the government spending tax money on them for the same small dollar doctor visits and ordinary drugs.

Re: Good!

[Anonymous Coward]

It should be noted that there is more of a reasonable attitude to death in many other countries.
People 80 (maybe 90 by now) and older might often refuse some treatment because they think they got to live long enough, and they'd rather have a quiet end than lots of treatments for 1 year more to live.
The US supposedly has a much more widespread attitude of "if there's a way to live even 1 month longer it must be taken". No matter the (not just financial) cost. It's very far from the only, but it certainly is one of the reasons for higher costs.

Re: Good!

[Anonymous Coward]

You are missing the point. Making people pay for the USEFUL, cheap and COST-SAVING things is idiocy, no matter how many layers you add. Also the little bit of statistics gathered in e.g. Germany when introducing a nominal fee for visiting a doctor hinted that it did little to nothing to revent the USELESS visits, but did more to discourage the USEFUL ones. As far as I remember it wasn't conclusive, but it looked liked it was likely to end up costing exactly as much in higher costs due to delayed treatment as it got in in fees.
And that's not due to people not being able to afford it, that was basically entirely the "hand of the free market".
Showing again, that without information and most people CONSISTENTLY getting it wrong whether they need treatment or not, a free market just makes things WORSE.

Re:Good!

[Anonymous Coward]

And you're arguing, effectively, to genocide the unhealthy and the poor. GTFO with your class war, Ayn Rand bullshit.

No. He's not. Every nation in the world with publicly accessible healthcare rations it in some way. "Death panels" while an unnecessarily emotionally evocative term is essentially what is done in, say, Norway. There are constantly articles in newspapers about some new drug that helps with some disease but will not be made available because the effect is too little for too short a time and it compromises treatment of other patients. Pharma companies use this emotional nonsense as leverage in negotiations and they buy outrage in the population with sob stories in the newspapers about some kid who won't get his meds due to the nasty cheap state. How dare they prioritize cancer treatment for hundreds of people vs. prolonging the life of this child for six months etc. and hyper-emotional single mothers buy it because they don't understand how budgeting works.

Rationing can seem cruel and when profit is a motive it can *be* cruel but some form of rationing is necessary if we are going to collectively pay for it (as we should). Any civilized society with a claim to the name must provide healthcare for the population but not at any price dictated by private for-profit interest. The people who *can* pay for it privately, may do so. The rest will have to be rationed because budgets just aren't infinite. If you act like they are, pretty soon *only* the rich will be able to afford healthcare at all and then the poor die anyway.

So you gtfo with your utopian fever-dream bullshit.

Re:Good!

[shilly]

I agree with what the other poster said in reply to you.

Additionally, you may be able to see a meaningful difference between a system of mandatory savings that can only be spent on one thing that the government deems is in your interest, and taxes, but it eludes me.

Re:Good!

[Ash-Fox]

Is there one, single country that has a national health-care program that pays for breast augmentation?

You're forgetting people who transition to the other sex.

Re:Good!

[Anonymous Coward]

Eat shit and die.

The Republican view on healthcare in a nutshell.

Re:Good!

[Anonymous Coward]

How is that in any way related to necessary treatment?

Re:Good!

[Anonymous Coward]

Actually, the USA rank very high on the per-capita costs of healthcare among developed countries, and very low on actual results.

That is a pretty clear indicator there is an astounding amount of money in USA healthcare that gets diverted to non-productive activities (probably by all the companies that just tanked).

Get this bloodsucking to normal levels (for developed countries) and then you can argue wether the result is in risk of bankruptcy or not.

Re:Good!

[Anonymous Coward]

By the time that ache has developed, the tumor is the size of a human fist and is inoperable.

Re:Good!

[Anonymous Coward]

Oh look, Romco Shill-omatic!

Re:Good!

[Anonymous Coward]

Or, just thinking outloud here, you could automate the hundreds of buildings worth of billing middlemen who earn salaries from insurance premiums and don't provide *any* healthcare.

Re:Good!

[Anonymous Coward]

No, but every country with UHC offers MUCH cheaper preventative measures that lower the chances of anyone getting the huge expensive problems. Americans seem to love the big expensive problems though to further provide for their self victimization complex.

Re:Good!

[dcornewell]

A lot of "for profit" companies have already embraced what Amazon is doing. Many companies built their own healthcare facilities. They had to comply with OSHA requirements to test their employees for exposure to chemicals and manage on the job injuries so they brought it in house. Since they had the healthcare facility they started to assist their employees with all of their healthcare. Providing care for everything from sinus infections to long term illness management not only makes your employees healthy and happy it makes them more productive. It is a win all around.

Re:Good!

[Anonymous Coward]

It's easy to feel some sort of satisfaction when an event sends the "for profit blood suckers" stock values tumbling, but that's not your brain talking. Watch this talk by Scott Galloway. Start at 18:48, if you don't have a lot of time. That's the part where you should recognize a pattern, but the entire talk is worth watching.

Re:Good!

[Anonymous Coward]

Talking about boob augmentation is picking on fringe cases. Let's not talk about what is obviously elective surgery. Let's talk about things like back surgery or knee replacement. These are typically not life threatening conditions which have a huge impact on quality of life. In many countries with national health care someone who needs treatment for painful, but not life threatening conditions can wait months for treatment. Sometimes they are forced to wait so long that effective treatment is no longer possible.
If they are in Canada, and they have money, they travel to the U.S. and pay out of pocket to get treatment. So yea they get better treatment than other Canadians because they have money.
Because treatment not considered life threatening is pushed off, when problems are misdiagnosed people die of treatable conditions because they are force to wait until treatment of the condition is nor longer possible and they denied treatment because their chance of treatment success has dropped below some arbitrary level.
Let's talk about places where because euthanasia is cheaper than treatment people are pushed into that in the name of saving money. That's not being done by private insurance companies. That's being done by government appointed panels.

Re:Good!

[Anonymous Coward]

He has to say this shit.. some argument,, any argument in response to commie bullshit or he'll lose friends irl. We should pity him for being a cuck to worthless redneck social connections.

Re:Good!

[Anonymous Coward]

I didn't see any argument in favour of any outcome, just a statement they believe to be true. I happen to also believe it to be true, is there any healthcare system anywhere on the planet, or has there ever been one, where there was absolutely no limit to the services available or who they were available to? If there hasn't is there a viable way of providing healthcare without any restriction at all available we could implement immediately?

But aside from your own aforementioned straw-man, your outright lie, be it by ignorance or intention, that every other civilised country's healthcare system has none of those restrictions is impressive by how blatantly untrue it is. There may be many better healthcare systems out there, and they may be better because they aren't for profit, but no healthcare system public, private, for profit, or non-profit offers unlimited and unrestricted medical service. You could triple the budget of the most generous public healthcare system in the world and there would still need to be restriction to service (even if by that point the benefit to cost ratio used for rationing could be vastly decreased).

Re:Good!

[Green Mountain Bot]

I'd rather wait to get a knee replacement than not be able to get it at all because I can't afford it.

Re:Good!

[Anonymous Coward]

Maybe basic medical checkups should come out of our pocket and the government should foot the bill for the major problems.

There's plenty of pretty strong arguments against that kind of system. It discourages people from having checkups while leaving the government on the hook to fix the major problems which might have been avoided by the checkup.

In the UK they have been restricting free vaccination services for travel. It's a relatively easy option as travel is seen by some as the persons choice etc. However, if someone doesn't get vaccinated and contracts a disease it is the NHS that ends up paying for treatment. Maybe they do end up saving money irregardless (because enough people pay for own vaccinations) but it seems more than a little backwards.

Re:Good!

[strikethree]

They don't go and see their primary care provider when they first develop that ache in their side, because they don't really have $100 to spare...and then that ache turns out to be something serious, and costs a shit-load more to treat because it's progressed.

On the other hand, my experience has been that doctors have no fucking idea what that mysterious pain is and can only diagnose it once it has become something serious.

My skin is currently eating itself (has been for 3 years now, likely bacteria) and the doctors/dermatologists just shrug and hand me steroid cream. Bear in mind, this is only a current problem. Don't talk to me about past issues that were apparently WAY beyond what medical science could discover (but were eventually found to be simple once it became terrible).

The medical industry has some very good points. A friend of mine got shot in the leg and they saved his life and gave him appropriate care to get everything back to normal... but again, a gunshot wound is VERY easy to identify. If it wasn't for the obvious solutions like this, I would declare the entire medical industry a bunch of lazy and dumb parasites.

Re:Good!

[ChatHuant]

Even in Norway, a woman can't just walk in and get a breast enlargement anytime she wants, and expect someone else to pay for it.

If I understand you correctly, you say that because - I quote - "any treatment, on demand, at anytime, for free" isn't supported by any country's medical system, therefore no country's medical system is better than the American one. Even with your disclaimer, this is a terrible argument, on many levels.

First, you should really understand the difference between "needed" and "wanted". Nobody ever said a single payer health system would support wants - as you say, "any treatment, on demand, at anytime, for free". Public health care is supposed to cover needs: prevention, medically necessary procedures, cost of catastrophic illness. As an aside, I find it interesting that similarly flawed arguments are brought against UBI: some opponents also (intentionally?) confuse "want" and "need" and argue that UBI is unsustainable because the government would be obliged to give everybody a mansion and a Ferrari, for free.

Second, that any healthcare system in any country can't provide anything and everything doesn't mean they aren't better than the American one. It's a documented fact that on the whole, Americans pay more for healthcare and get less than pretty much any other developed country. Pointing at flaws in Norway or wherever while ignoring the larger issues here looks like a distraction, not an argument.

Re:Good!

[david_thornley]

Depends on the person. I'm getting all the health care I want, personally. I could easily get more medical care, but it wouldn't do anything useful, or it would have a 10% chance of killing me, or something like that.

Re:Good!

[Anonymous Coward]

Or consider any of the Scandinavian countries...heck, most of Europe does better healthcare-wise than the US does. Lots of socialized healthcare there. 100% capitalism doesn't work either. Look at Kansas and OK for examples where that has been attempted and see how well they are doing.

Re:Good!

[Mike Van Pelt]

Cisco, for one. When I worked there (I assume this hasn't changed) they didn't provide "normal" insurance; they self-insured. It was administered by Cigna, but Cisco paid the claims. Cisco had their own clinic (in Building Q, I think I recall) with doctors, pharmacy, PT operation. Very convenient having most medical needs right there on the campus.

Re:Good!

[shilly]

Are you seriously claiming that early interventions in healthcare *isn't* a method that delivers cheaper care with better outcomes?

Re:Good!

[shilly]

Well, bully for your personal experience. But when you look at populations as a whole, rather than your random skin condition, cancers caught late are much more likely to kill you; diabetes treatment is much more effective if you don't wait for the retinopathy to develop; etc etc.

Re:Good!

[strikethree]

Well, bully for your personal experience.

My apologies. I thought I was speaking with someone of at least average human intelligence. I will reword my original message so that you may understand it:

You said:

They don't go and see their primary care provider when they first develop that ache in their side, because they don't really have $100 to spare...and then that ache turns out to be something serious, and costs a shit-load more to treat because it's progressed.

And a rewording (for your diminutive intellect) of what I said is:

They will not go to their care provider because their care provider has already told them 99 times that whatever problem the patient thinks they are experiencing is all in their head and nothing to worry about... until it becomes a full blown problem.

Is that a little easier for your thought processes to digest?

I do not actually mean to be insulting. I fully understand that there are people with varying cognitive abilities. I am just frustrated at trying to communicate while the average person just doesn't seem to operate at any cognitive level that modern society needs. I feel like my original message, delivered through anecdote, was perfectly clear... but apparently, that is a level of abstraction too high for you to grasp and it frustrated me. Have a nice day and don't forget to wear your helmet.

Re:Good!

[Anonymous Coward]

Um, Jeff ain't doing this out of the goodness of his heart. He wants another 0 in his bank account, just like the insurance industry sociopaths.

Sociopaths are sociopaths. Tech ones aren't somehow better than non-tech ones.

Stop drinking the Cool Aid already.

Re:Good!

[NeoTubNinja]

Eat shit and die.

That's not very suave of you. You lost the argument before you even tried.

200 years ago, everyone was completely on their own regarding healthcare. 100 years ago, it was family and trading a chicken for some care. STFU and be thankful for the advances since then, you don't deserve the benefit.

Good thing it's not 200 years ago or even 100 years ago. Hell, 100 years ago we didn't have computers. Should I be eternally grateful and let people shit all over my need to use a computer because people lived without it 100 or even 200 years ago? No. Times change, just like technology and medicine. You can go kindly fuck yourself.

Re:Good!

[shilly]

I beg your fucking pardon.

You began your post with the words "my experience has been". If that wasn't an argument from personal experience, it was a pretty fucking dumb choice of phrase.

What's happened so far:
1. I assert that patient co-pays for primary care are a really bad idea because patients wait too long to see their doctor and by the time they are diagnosed and treated, the disease has progressed, outcomes are worse, and costs to treat are higher. This is a pretty well documented phenomenon. Germany introduced co-pays in 2004, and poorer people in particular put off seeing the doctor, resulting in a greater burden of disease and exacerbated health inequalities.
2. You assert that your experience demonstrates that the real reason patients don't see doctors early is that seeing a doctor early simply results in being told a disease is psychosomatic.

That is such a spectacularly bad response to what I posted, it's almost a work of art. It doesn't address my assertion *at all*. Not even slightly. A coherent -- but still very wrong -- response to my assertion would be that there is *no value* in seeing a doctor early, because psychosomatic diagnosis blah blah -- in other words primary care doctors have such high Type 2 error rates at early stages, there's no use seeing them (although I suspect you believe these are not errors but deliberate malpractice / negligence). The evidence does not support this *at all*. Instead, the evidence is that Type 1 and 2 error rates are fairly low for primary care, and that primary care leading to early diagnosis and intervention is the single most value-adding component of any health system beside public health interventions.

But of course, that's not what you argued. You didn't argue there would be no value in seeing a doctor early; you argued patients have already made that conclusion for themselves and don't see doctors early. Which is obviously not true even for you, as your original post described you seeing doctors for multiple conditions early on, when they failed to diagnose.

It's very sad to hear that the horrid doctors couldn't help you with your various problems until it got really serious. But I'm not sure you're really ready to jump into making health policy just yet.

How can I convince my business to use them?

[Anonymous Coward]

It certainly provides more potential than dealing the current insurance "provider" they use.

The NHS model and control of doctors' salaries

[Bruce66423]

The UK's system is widely recognised as the most efficient, so the basic model - of single payer contracting with controlled hospitals - has a lot of efficiencies to offer in the American context. In the light of the news that the arrival of an Amazon distribution centre LOWERS the wages of warehouse workers, perhaps we will see this happen to doctors...

https://www.economist.com/news...

Re:The NHS model and control of doctors' salaries

[110010001000]

Oh yeah right. The NHS is widely known as the most efficient. Give me a break...

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

Attorneys would never allow a UK NHS in the USA, as they'd have no more malpractice suits.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

Tea Party conservatives and the big corporations would never allow such a system. Period.
They say it doesn't work. But all those European, Japanese, Taiwanese, etc systems just seem to keep working.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

Doctor's salaries are not the reason healthcare is expensive

Re:The NHS model and control of doctors' salaries

[macsimcon]

Is the NHS costing you $2,000 a month for a family of four? Because that's pretty common here.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

Binary Luddite man likes things just the way they are, and fuck everybody else.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

oh yeah right it gets much better outcomes/cost than the US system and i agree it's a bit of a joke, but by extension the US system is one of the worst in the world

(and i'm sure that you think that i'm just saying this to upset you so here's the numbers: UK life expectancy = 81.6yrs. Annual cost per person = ~2,200 pounds/~3120 US Dollars. US life expectancy = 78.74yrs. Annual cost per person = ~9,100 US Dollars. relative normalised ratio: UK38.2 , US 115.5.

The US is 3 times worse than the UK for health outcomes vs expenditure.)

Please do point out how you didn't mention the US system now, Mr. Moderated Insightful. Must have been moderated by millenials who just believe whatever they hear.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

The NHS and the socialist system in the UK is insanely expensive. I speak as someone who sees whats happening in both countries more so than most. I have employees and businesses in both countries. Most people don't see what is being stolen from them from government because the governments of the world are really good at hiding the theft. Even where I live which is much better than many big government states in the US (and I moved from one; ie NJ) they do a good job of covering up the theft. For example we have vehicular registration fees here in NH that result in hundreds of dollars a year. NJ I paid $5 a year. The point I'm making is they hide taxes in different places in different states and while NH is better than NJ tax wise most people just don't understand how much they're actually paying in taxes because the government takes the taxes from employers before the employee ever sees that money. If the government takes 15% from your paycheck for example there is another 15% they steal from you via the employer. You employer doesn't tell you that your actual wage is $20 / hr. They tell you its $15 / hr because that is how the government writes the laws. And people think that they don't own property so they aren't paying property tax. WRONG. Where do you think your landlord gets the money to pay his property tax/mortgage? I'll tell you. It's from you stupid. We pay an insane amount in these srots of hidden taxes and things are only getting worse for people. Pathetically the population at large is becoming more and more dependent on the state the more the population votes for "free" this and "free" that. Then the stupid get enraged about "illegal" immigrants taking jobs etc when the immigrants aren't the problem. The government is. The government is what is making it so insanely expensive to operate a business in the US/UK/Europe and it's the government making it not cost effective to live in these places. You shouldn't be dependent on government to cover your child car costs. It's absolutely insane that the middle class in the UK is actually becoming dependent on the government stealing from the population to pay for child care.

The US is easier than the UK/Europe I think because people in the US can relatively easily move to a different state to get away from the insane cost of living and taxes. At least to one degree or another. Though things are getting much more like Europe here. And the US isn't that far behind the UK and Europe. We've had social security since the 1930s. We are a socialist hell hole too- just not to the same degree- but we're getting there. We have health insurance mandates now that have resulted in people being forced onto the street and resulting in people not being able to afford to eat. Just talk to my significant other and he'll tell you about how Massachusetts implemented mandatory health insurance and how it resulted in his homelessness and being forced onto the street and having to quit school. Basically he was living in poverty and working and when Massachusetts mandated health insurance employees had to start taking out money from employees paychecks to cover it. That resulted in less money which put him into a state where he could not afford to cover his room that he rented and eat any more. To make it all the worse his employer wasn't actually providing the health insurance despite taking the money from his paycheck and the government then was going to fine HIM for not having health insurance. A ton of paperwork later and he finally did avoid the heavy fine. But none-the-less. Socialism ain't what its cracked up to be and it hurts the poorest most of all.

Re:The NHS model and control of doctors' salaries

[DaHat]

The US is 3 times worse than the UK for health outcomes vs expenditure

I will admit... leaving patients out in the parking lot in an ambulance is a fantastic way of reducing costs... though do their turning for the worst end up counting in the final figures you claim to cite?

http://www.independent.co.uk/n...
http://www.telegraph.co.uk/new...
http://www.dailymail.co.uk/new...
http://www.bbc.co.uk/news/heal...
https://www.theguardian.com/so...
http://www.bbc.co.uk/news/heal...

Re:The NHS model and control of doctors' salaries

[shilly]

So many words, so much wrong.

UK health spend is 7% of GDP. It's 15%+ in the US.

But don't let facts get in the way of your world-view.

Re:The NHS model and control of doctors' salaries

[shilly]

Do you really think the US can't out-anecdote the UK for horror stories related to healthcare??

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

The UK's system is widely recognised as the most efficient, so the basic model - of single payer contracting with controlled hospitals - has a lot of efficiencies to offer in the American context.

One problem with single payer health care that's rarely discussed is the tremendous temptation to make private payments of any kind illegal so as to further concentrate the buying power into the hands of the single government payer and gain Monopsony power. In the UK for example, it's illegal to "top up" care with private payments if the NHS paid for any of the care during the episode. This most commonly comes up during cancer care and other expensive treatments. If the NHS pays for your chemo and radiation but denies you the experimental cancer drug when the standard treatments fail, you may not pay for the experimental drug out of your own pocket, even if you could otherwise afford it. To do so is to commit a crime in the UK. The episode is either all private pay or NHS pay, but never both in the same episode. You might argue that such restrictions are worth the trade off versus the US system, but don't pretend that single payer is a panacea, because it's not. Sometimes the rules conspire to create some really nasty surprises for patients and their families.

Re:The NHS model and control of doctors' salaries

[umghhh]

I recall doing contract job in IT in UK some years back. I had to register in NHS too at the beginning. After 6months I left the country and after 2 more I got a letter from NHS that they processed my data and my insurance card is waiting for me. This much for efficiency. This said I do not trust efficiency of the private industry either - there is no benefit for me as a customer if they get efficient. More efficiency here means that I get sucked dry more efficiently. The rest stays the same. From this perspective a naive reader could draw a conclusion that any change would be good. Well if I understand this correctly Amazon is not doing it for me or for industry but to get costs cut. These are own costs that they are cutting so common man can maybe expect some benefits but they way this usually goes they will be paid with something else. So whether anybody but its CEO and possible shareholders get anything out of it remains to be seen.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

As was posted above but not in the original claim.

http://www.commonwealthfund.org/~/media/files/publications/fund-report/2017/jul/schneider_mirror_mirror_2017.pdf

I am sure this is not the only study if you want to find one for yourself.

Re: The NHS model and control of doctors' salaries

[Anonymous Coward]

Not true any longer -- https://www.nhs.uk/chq/Pages/2572.aspx?CategoryID=96

Re:The NHS model and control of doctors' salaries

[Ash-Fox]

I recall doing contract job in IT in UK some years back. I had to register in NHS too at the beginning. After 6months I left the country and after 2 more I got a letter from NHS that they processed my data and my insurance card is waiting for me.

Weird, it took my other-half a week to receive his after he registered and they mailed us to our address, no pick up required.

Re:The NHS model and control of doctors' salaries

[Ash-Fox]

In the UK for example, it's illegal to "top up" care with private payments if the NHS paid for any of the care during the episode.

Uh, I have insurance with both AXA and BUPA and they both do this?

The episode is either all private pay or NHS pay, but never both in the same episode.

Nope, I've done this for dental work.

Re:The NHS model and control of doctors' salaries

[Ash-Fox]

My estimate for two parents (amount of children doesn't matter). The NHS yearly cost is about 1880.64GBP, assuming both parents are earning 16,000GBP each a year. If they're on welfare, they pay nothing.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

"widely recognised as the most efficient"? According to what?

https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

at least your not paying more than you earn for the ambulance.

And the reason it's like that is the fucking tories ( = your repubs) deliberate running down of the NHS to prepare for privatisation so we end up in the same shit the americans are in!

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

I have not clicked on the links provided, but I have listened extensively to BBC (e.g. Radio 5 via Alexa Show) and was surprised at the extent of the problems they are dealing with.

Re:The NHS model and control of doctors' salaries

[eth1]

The UK's system is widely recognised as the most efficient, so the basic model - of single payer contracting with controlled hospitals - has a lot of efficiencies to offer in the American context.

Plus, the last numbers I saw had NHS covering the UK's entire population for the same (or less) per capita cost that we in the US pay for Medicare and Medicaid, which only covers, what, about 1/3 of the population? It would seem that simply copying NHS verbatim would get everyone covered, AND save the money that I'm currently paying for private insurance (which I could then use for more limited private insurance if I wanted to - like paying for a private hospital room instead of shared, etc.).

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

My wife was recently injured in the USA, and spent thirteen hours in the ER before being seen after breaking her leg in three places. Waiting four hours is seen as a scandal in the UK.

Re:The NHS model and control of doctors' salaries

[shilly]

The NHS has had 8 years of being shat on by the Tories, so it's pretty ropey right now. At the end of the Brown era, patient satisfaction was at an all-time high and it was tremendously successful.

But it's never been anywhere near as terrible as the US.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

Doctor's salaries are not the reason healthcare is expensive,

It is 20% of all money spent on healthcare. The second largest category and twice what is spent on prescription drugs. So, yes, doctor's salaries are certainly part of the problem.

Re:The NHS model and control of doctors' salaries

[Anonymous Coward]

nope, you need to read what's included in the data you are quoting. "physician and clinical services" that lumps in things like lab services, office xray services, infusion therapies (i.e. chemotherapy)..

Re:This is a BS article..

[ShanghaiBill]

Let me restate that... Insurance companies got caught in the market day.. Not by Amazon's roll your own insurance thing.

The overall market fell by about 1%, mostly because of the fall of the health industry, which represents about 18% of the American economy. Some health companies fell nearly 9%. If you take health out, the rest of the market barely fell at all.

I am skeptical that Amazon et al will be successful in this, but I wish them well. If the politicians can't fix healthcare, many nerds can.

Re:This is a BS article..

[Anonymous Coward]

I hope you got good insurance - your going to need it to treat your severe case of the dumbs

Wrong Solution

[labnet]

The rest of the modern world looks at the USAs health system and just shakes their head.
Every other modern western country uses government run primary health care, usually overlaid with a smaller private system.
The private system gets used for those who want a specific surgeon, less wait time, or elective procedures.

but, in the land of the free, home of the brave, god forbid if someone who made poor health choices got treatment from my tax dollar: let the loser die or least be a debt slave for life.

Bezos should be advocating for government funded primary health care: not yet another private system.

Re:Wrong Solution

[Anonymous Coward]

Half of the nation has been advocating for government funded health care, the government isn't doing it. I think this is a great idea that might prove that non-profit health care is cheaper. Kill off a few large health insurance companies and then maybe the government will act and this private venture won't be necessary anymore.

They're doing it so their companies can save money now, not wait for the government to maybe do it later.

Re: Wrong Solution

[Anonymous Coward]

PSA no one gives a damn if the rest of the world shakes their head at us. Shaking heads don't affect me. Trying to guilt people into believing a certain way because "what if they think I'm not modern" is about the dumbest argument one could produce. Fuck the rest of the world and fuck you so long as the US as a country is doing well. Also if someone spends their entire life in the pursuit of medical science and then saves your life, you are indebted to them, because without them you would be dead. If you don't like it then spend 10+ years becoming an MD and heal your own useless body.

Re:Wrong Solution

[Anonymous Coward]

The rest of the modern world looks at the USAs health system and just shakes their head. [...]

The rest of the modern world looks at the USA and just shakes their head.

There, FTFY.

Re:Wrong Solution

[Jeremi]

Bezos should be advocating for government funded primary health care: not yet another private system.

Government funded primary healthcare is likely the best solution, but it's no solution at all if it can't be implemented for political reasons.

People have been advocating for universal health care for a long time without a lot to show for it; too many people in this country have a knee-jerk anti-government reaction to it. And Bezos is unlikely to be the person to finally figure out how to get universal health care through Congress.

On the other hand, Bezos has a whole lot more control over the actions of his company, and Amazon is large enough, rich enough, and innovative enough that they might actually come up with something useful. Therefore I think Bezos isn't necessarily wrong to be going about this the way he is doing it.

Re:Wrong Solution

[Anonymous Coward]

The rest of the modern world looks at the USAs health system and just shakes their head.

There are some that want to move away from the NHS and tout the USA as a model.

Re:Wrong Solution

[aduchate]

That is not the whole story.

The US health system is more like a layered cake of expenditures with private money coming on top of public money.

see https://ourworldindata.org/fin...

The US governement actually spends per capita as much as Germany, Belgium or France. These spending are then doubled by the private sector. All that to end up performing way lower than these countries (and about all the other rich countries in the world) in terms of life expectancy (4 years), child and maternal mortality.

see https://ourworldindata.org/the...

I think a much deeper problem is at works here : the twisted chain of accountability that separates a doctor from his patient. US is the only country I know of where you get a health insurance through your job, the health insurance contracts with an hospital, the hospital hires doctors which you end up consulting with because of the job you got in the first place.

In Belgium or France, the patient choses his Doctor. Much simpler relationship, much better results

Re:Wrong Solution

[Anonymous Coward]

"Can't be implemented for political reasons" - you mean the political influence health insurance and big pharmaceutical companies, and possibly general anti-taxation pro-Capital elements? Well, that should be overcome. Remember that government health care has solid majority public support even while most lawmakers oppose it.

Re: Wrong Solution

[Anonymous Coward]

I think you're missing the point, it's not the doctors' salaries which are up for grabs here, its the administrators at the insurance companies who get paid for issuing bills and chasing payments. How much could you save on your healthcare if they simply didn't exist ?

Re:Wrong Solution

[houghi]

It is not just the rest of the modern world. It is all the countries that use Metric that shake their heads. Some people say correlation is not the same as causation, but I am not so sure.

Re: Wrong Solution

[Anonymous Coward]

Spoken like a true cancer cell. Congratulations.

But don't be surprised if someday the "rest of the world" gets sick and tired of this "cancer" of yours and decides to treat it accordingly.

Re:Wrong Solution

[coofercat]

By the sounds of things, campaigning for government funded health care in the US, right now, with the orange one in office is about as effective as trying to suck up a tornado with a vacuum cleaner. Hats off to him/them though - they're good at running companies, so they're gonna run one to completely show up how terrible the government has been on this subject.

I'm not entirely sure I'd be happy receiving a treatment marked "Amazon Basics" or "Amazon's choice" though ;-)

Re:Wrong Solution

[Anonymous Coward]

The rest of the modern world looks at the USAs health system and just shakes their head.
Every other modern western country uses government run primary health care, usually overlaid with a smaller private system.
The private system gets used for those who want a specific surgeon, less wait time, or elective procedures.

False. The Swiss and Dutch systems are not single payer. They are heavily regulated, but not government run.

Both systems are far more efficient than the US system, with the Dutch paying slightly less than France (as a fraction of GDP), and the Swiss slightly more.

The US system runs around 17% of GDP, the others are 9-11% - a huge difference.

Given how corrupt government in the US is - and given the massive problems with legal ethics in the US, and the potential this has to destroy a government run system - it's unlikely a government run system would work out well. So other options are worth looking at.

non-profit or low-profit might be very good

[schweini]

IIRC, the german public health insurance companies are basically companies who are competing with each other, but may not turn a profit.

It would be quite ironic if some billionaires will manage to basically set up socialized healthcare in the US this way, and out-compete the current HMOs!

Re:non-profit or low-profit might be very good

[Anonymous Coward]

It is basically what ObamaCare was going to evolve into. I noticed that there was a fund that acted like insurance for any company that got hit by a spike of customers using a lot of money, something similar to something used in Germany.

And I think the German system is based on public health care laws.

Perhaps there are Germans who can explain how their system works?

Re:non-profit or low-profit might be very good

[davecb]

Canada has a set of per-province plans that originally covered just major injury, then were upgraded to include proactive doctor visits. The doctors are private, the hospitals are typically from bond drives in the cities and the payments are collected by employers, separate from taxes.

Works reasonably well, and backstops low-cost benefits plans the employers offer, like dental and drug plans.

For example, as a kid my parents paid into the Ontario Hospital Insurance Plan, and dad campaigned door to door on a bond drive for the Chatham General Hospital. When I broke my heel, it got fixed in that same hospital, and OHIP paid for it.

Re:non-profit or low-profit might be very good

[ClickOnThis]

Canada has a set of per-province plans that originally covered just major injury, then were upgraded to include proactive doctor visits. The doctors are private, the hospitals are typically from bond drives in the cities and the payments are collected by employers, separate from taxes.

Works reasonably well, and backstops low-cost benefits plans the employers offer, like dental and drug plans.

For example, as a kid my parents paid into the Ontario Hospital Insurance Plan, and dad campaigned door to door on a bond drive for the Chatham General Hospital. When I broke my heel, it got fixed in that same hospital, and OHIP paid for it.

This. When I was in graduate school in Canada, I had a reconstruction of a torn ACL. Didn't pay a dime for it. (But paid taxes of course, and willingly.)

Re:non-profit or low-profit might be very good

[dryeo]

It varies from Province to Province. Never heard of a bond drive to finance a hospital here in BC. We still pay premiums (about $70/month for a single person with a decent income, often taken straight out of the paycheck, soon to be halved) for medical as well though it sounds like that'll be going away.
Basically the Federal government sets minimum standards and each of the Provinces run their own system.

Re:First time I think Buffet is stupid!!

[Tyrannosaur]

Maybe you should not have considered that as your money in the first place? You have your life savings in something that is not risk-free. Oh well.

Seems like a good call for them.

[skam240]

I do IT for a small grocery store chain and we went self insured a few years back now and we've saved a ton of money doing it.

Pricey vs privacy

[ljw1004]

How the venture will provide less pricy healthcare isn't yet clear

Unclear whether this is a typo for less pricey or less privacy. Knowing Amazon it might be both...

Re:Pricey vs privacy

[93 Escort Wagon]

Unclear whether this is a typo for less pricey or less privacy. Knowing Amazon it might be both...

But think of the advantages of information sharing within Amazon...

Let's say you have an impacted molar. When you get home, Amazon Video might recommend you watch the SpongeBob Squarepants episode where Patrick goes to the dentist.

Just 1 thing US medicine hates more than socialism

[Applehu Akbar]

And that would be capitalism. The FUD campaign waged by medallion cab drivers against Big Bad Uber is a child's sandbox fight compared to Amazon going up against America's most monopolistic industry.

Kaiser

[Anonymous Coward]

It used to be a shipyard, remember ... this has been done before, and it worked then too.

Re:This is a BS article..

[rtb61]

How do health care 'er' cough, cough, make money. They charge more in premiums than they allow in payouts. Hmm, compulsory health care for company employees, how do you reduce cost, deny payouts. I doubt very strongly that if my healthcare was dependent upon a company who first and only goal were returns for shareholders and they were deciding whether they would pay out or not, that I would be willing to work for that company.

Think about euthanasia laws, how many corporations would put you down, if there return on your future employment was lower than the cost of health services, if they could get away with it (just remember all it takes is a tiny handful of them to bring in those laws, couple of hundred control freaks and no matter what tens of millions say, it happens).

Single payer sounds a whole lot better, than allowing my employer decide whether I live or die, especially when their publicly declared number one priority is returns to shareholders and their desire is ZERO payouts.

Hopefully Amazon focuses on low hanging fruit

[schwit1]

Unnecessary tests and pharmaceuticals. Doctors use unnecessary tests to protect themselves from lawsuits. Then there's the medication problem.

the-myth-of-drug-expiration-dates
  The government needs an independent lab to determine the expiry dates, not big pharma.

drug-firms-shipped-208-million-pain-pills-to-west-virginia-town

drug-company-payments-mirror-doctors-brand-name-prescribing

I also have to wonder if doctors prescribe drugs as the easy solution instead telling the patient to make lifestyle choices.

Re:Hopefully Amazon focuses on low hanging fruit

[Anonymous Coward]

It's absolutely the American lifestyle - the War on Fats coupled with sugar - that is the main factor in keeping our health costs much higher than the rest of the rest of the first world. We also have much higher work related stress on average than just about all of the EU due to our time-off policies. You can track the rise of heart disease-related deaths with women (remember to wear red on Friday!) directly against the timeline with women entering the general work force over the last several decades.

We need all the fats put back into things like yogurts, coffee creamers and salad dressings, and get the sugar removed from them. We need tort reform to reduce the need for all the extra CYA testing doctors have to order, as well as malpractice insurance, and get hospitals back to caring for patients rather than simply focusing on not getting sued (very similar to the school system!). We need to find a way to force vacation time or somehow reduce hours worked without significantly reducing pay, as well as revisiting all these bogus salary classifications which so often mean you're working 1.5x as much as you should be (and earning 33% less on rate than you think you are). We need to get real psychiatric care facilities opened across the country and use them for lower end drug abuse sentences as well, reduce the chemical dependencies both prescribed and abused, and have the health industry pay for it.

We need to get the WWE the fuck off the Syfy channel, and get the goddam music videos back on MTV!

Re:Hopefully Amazon focuses on low hanging fruit

[Anonymous Coward]

Doctors use unnecessary tests to protect themselves from lawsuits.

The second half of that is the problem. People in the USA are extremely litigious, that puts doctors and everyone else on the defensive. I can't really call a test unnecessary if they're doing it to protect themselves. It might be unnecessary for the health of the patient, but it seems the doctors need to do it anyway for other reasons.

Re:Hopefully Amazon focuses on low hanging fruit

[houghi]

I also have to wonder if doctors prescribe drugs as the easy solution instead telling the patient to make lifestyle choices.

My doctor once told me if I was willing to change my lifestyle (as I am fat) and I said no. He explained me what would happen and prescribed me my year supply of Alipurinol (Gaut prevention).

So should I now go bankrupt because of the way I want to live my life? Am I allowed to tell you what you must eat and do? I hope you anwer is no, because otherwise it would go against everything else that makes you a free man.

My choice ALSO does not mean that it is ok to blackmail me into how I live in name of the Almighty Dollar. e.g. I can not be excluded by law from payout by insurance. In Belgium you could get a request for a physical when you start a life insurance, but none after that. Even if I had an illnes for 15 years that went unnoticed and I was aware of, they must pay out. Obviously I am not allowed to lie on the forms I fill out and fraud is fraud, wherever you go.

The reason doctors are often that easy to prescribe drugs instead of telling people what to do (as my doctor did) is that after a while you notice that those people will not come back after they came into their office. That means less income. In Europe we have no advertisement for medicine, so you are less likely to go to a doctor and say "I want that." Instead you go and say "I have this pain here" and he will gibe you that specific thing or something else or nothing at all.

Now with my history, I can call my doctor and say "I have a gout attack, subscribe me some Colchicine" and he will. But if I have some pain in my stomache, I can't just ask for something. I honestly do not know WHAT I would need to ask as I have never heard of it somewhere in an ad.

Re:Hopefully Amazon focuses on low hanging fruit

[jittles]

My doctor once told me if I was willing to change my lifestyle (as I am fat) and I said no. He explained me what would happen and prescribed me my year supply of Alipurinol (Gaut prevention).

So should I now go bankrupt because of the way I want to live my life? Am I allowed to tell you what you must eat and do? I hope you anwer is no, because otherwise it would go against everything else that makes you a free man.

This is why healthcare is such a tricky and sensitive topic. In general, I believe that it is unfair to ask someone to help pay for your gout medication because you do not make healthy lifestyle choices. However, someone who chooses to exercise regularly could become severely injured and then someone who does not like exercise is stuck paying for that person's recovery as well. You are clearly externalizing the cost of your choices by using subsidized healthcare to continue to make poor choices. I don't think anyone wants to tell you what to eat or drink, who has time for that? But maybe they don't want to help pay for your medication unless you are willing to put in effort to reduce your cost? Even if you made an attempt to change your lifestyle and failed, I think most people would be far happier about that than your blatant refusal to change.

But you're right, in general people should not be trying to tell each other how to live. That should be reserved for times where one person is infringing upon the rights of another. I don't understand your choice, but there is no requirement that every choice a person makes be understandable, even to the person who made that choice. I do hope that your choices make you happy, though. Best of luck to you.

Re:Hopefully Amazon focuses on low hanging fruit

[Anonymous Coward]

"I also have to wonder if doctors prescribe drugs as the easy solution instead telling the patient to make lifestyle choices."

I've been fortunate to spend time (at least a few years in each instance) living and working in the USA, Canada, the UK, and Australia. After receiving medical care in all of those countries I can say that anecdotally I see the same pattern in all of them.

Re:Hopefully Amazon focuses on low hanging fruit

[NewYork]

I hope Machine Learning will replace Unnecessary tests and Generic Medicines replace Pharmaceuticals

It's very smart

[Darkling-MHCN]

These are big companies with lots of employees, they are already bleeding huge amounts of cash to fund health programs for their employees in a broken healthcare system. They're going to pool their resources together to create a new company, not with the goal of making money out of the venture, but with the goal of reducing the costs they already have within their existing companies. Due to their size they'll receive immediate benefits by having the clout to bargain with the big pharmas and that clout will only increase as they offer this to the rest of corporate america.

It's another game changer from Amazon.

Re:It's very smart

[MightyMartian]

Exactly. It's why my company sets aside some of professional development funds for exercise and wellness, because the healthier the employees are, the less sick leave they take and the more productive they are. In a tight labor market, it also can serve as good marketing to potential employees.

Re:It's very smart

[aaarrrgggh]

Yup... add in prescription delivery by Amazon and their purchasing power with the Pharma companies just got a lot more powerful.

Re:It's very smart

[Anonymous Coward]

AHAHAHAHAHAHAHAHAHAHA. You can't be serious. You think that wellness programs are something employees want? Maybe we have difference experiences, but I only worked at one company with a wellness program. It was a big company, and participation was mandatory (otherwise you paid a LOT more for your health insurance premiums). There is no argument to be made that wellness programs do anything good, and certainly they don't attract employees. They're complete bullshit, and anyone with some common sense can smell it downwind for miles. The evidence is in my favor. Wellness programs are worse than a joke.

Re:It's very smart

[hawkfish]

Exactly. It's why my company sets aside some of professional development funds for exercise and wellness, because the healthier the employees are, the less sick leave they take and the more productive they are. In a tight labor market, it also can serve as good marketing to potential employees.

My company provides flu shots every year (paid for by company insurance, but whatever). No idea why flu shots aren't just viewed as national defense.

Re:It's very smart

[MightyMartian]

Our program isn't mandatory, so it's not like there's a gun to your head. But people do take advantage of it, because not everyone is proud to be 80 pounds overweight.

Re:It's very smart

[MightyMartian]

It isn't covered up here in British Columbia either... except it sort of is. Anyone who "works with the public" gets one covered by government health care, and it's been so broadly interpreted by doctors and pharmacists that pretty much everyone gets one. At the end of the day, I have no idea why they don't just fold and just say "We're covering it for everyone." The costs to the economy of an influenza outbreak are so monumental that it can easily be justified.

Re:It's very smart

[DarthVain]

Pretty much what I was thinking. They took a look at the broken system, and was like "fine, I'll just make my own"...

What is an interesting thought, if you speculate and extrapolate enough... What if Amazon over a period of time is so successful with the non-profit gambit that they eventually Googleify the rest of the industry in that their market share is so large that they put the rest of the vultures out of business? You could basically get privately run universal health care (or national if sold to the US).

What's more long game is even if they decided to continue to run it as a non-profit indefinitely (and no guarantee of that after they put everyone else out of business), they could probably still monetize it enough by selling it Amazon services or in other such non-direct ways where the company itself is "non-profit" but is serviced by it's company holders for profit.

Anyway it is a huge sector, and even with the deep pockets of the companies involved, their opponents are also pretty massive as well, so this could all play out over a longer period of time before we really have an idea of how it is all going to shake out.

Re:It's very smart

[sdinfoserv]

I hadn't thought of that angle, it's genius. Bezos should contact some other huge employers up here and get them involved. Boeing, right down the road from Amazon, has (c) 77K employees.

compared to the US model ?

[aepervius]

"Oh yeah right. The NHS is widely known as the most efficient. Give me a break..." compared to the US model, with the outcomes it has right now, the total cost , and the coverage ? Yes it is far more efficient than the US model.

Re:compared to the US model ?

[Anonymous Coward]

Health Insurance is complicated. Mainly because operations research is not used for optimum outcomes.

Externalizing costs and services is a failed model - it costs what it costs. Any 'savings' comes from claim denials, and premature deaths - such as caused by waiting lists or old age. Many health insurers had to buy up hospitals, so they could not be blackmailed by doctors. They were not allowed to send non-urgent stuff to foreign countries - but that may happen yet.

Amazon and partners WILL acquire the advantage of knowing the prices, and regional differences, and outcomes.More to the point, they will use that information like Walmart does to screw suppliers down. The also have healthy younger employees - so that is another inbuilt advantage. And they have clout, meaning their plan will not be killed easily. And I am sure tax advantages will also be in there.

I foresee many changes, including sending people interstate for operations, and weeding out bad surgeons with poor reputations and complications. And reverse bidding for procedures. Cherry picking the low risk people with a healthy income is a winning formula. Thus marking down established players if fully justified.

Eventually normal people will wiseup and take medical tourism where possible. That leaves the poor and deplorables (in the USA) as the loosers, again.

Re:First time I think Buffet is stupid!!

[sentiblue]

And that wouldn't be your nor their business now would it?

Yes really

[Bruce66423]

The NHS costs rather less than half the percentage of GDP that the US system does and produces better health outcomes, with 100% free coverage for citizens.

Re:Yes really

[shilly]

Fortunately, these studies have been done time and again, and the result is that the UK spends about 7% of GDP on healthcare vs 15%+ in the US.

http://www.commonwealthfund.or...

Re:Yes really

[Anonymous Coward]

But the US system is providing healthcare to most of the world, and most of the innovation, and most of the litigation, which may or may not improve the product.

Re:Yes really

[mjwx]

The NHS costs rather less than half the percentage of GDP that the US system does and produces better health outcomes, with 100% free coverage for citizens.

The NHS is not without it's problems, but the US system has the same problems plus some.

I'd much rather have the cheaper system with fewer issues, even if it means I might have to wait a day or two to see a GP about an owwie, I'll get all the care I need without having to worry about if my deductible covers it or being prescribed medications I don't need because the clinic gets a kickback.

Besides, I've rarely had to wait more than 24 hours to see a GP. They usually have slots during the day when everyone's at work and if you need to see a doctor that badly you shouldn't be going to work anyway.

Fun fact, packaged medicaments are one of the UK's largest exports accounting for 5.3% of all UK exports.

Re:Yes really

[Anonymous Coward]

The US basically subsidizes health care globally by paying much more for pharmaceuticals, allowing drug companies to sell them for much less elsewhere. That needs to be corrected. Trump will attempt to do that, but will meet stiff resistance.

The other cost driver is liability protection. Your options for malpractice reimbursement are vey limited outside the US. Many in the US have tried to limit malpractice liability, but that has been also met with stiff resistance (too many lawyers). I hope that can get corrected but don't hold out much hope.

Many 'single payer' countries don't include the cost of private insurance that many get to supplement the government provided care which is often seen as insufficient.

Re:Yes really

[coofercat]

I've only had one private healthcare experience in the US (on a ski hill). It was okay, nothing crazy awesome, but perfectly good for what I needed from it (I did have a chuckle when a nurse said "I'll just go get some ice" and headed off towards some fridges... and went right past them, opened the door and took a scoop of snow from the ground outside).

One touch they did which I wish we got here in the UK was I was sent away with a piece of paper with a summary of what had happened on it. It's a great way to remember all the crazy language the docs talk when they tell you what they're doing.

All that said, I've never had anything other that doing-our-absolute-best-with-what-we've-got from the NHS. It's obvious they're cash-strapped, but the people in it are still doing an amazing job.

Re:Yes really

[shilly]

The Commonwealth Fund report looks at total cost of care, including both public and private, across countries to do an apples-to-apples comparison.

The notion that US consumers are subsidising global pharma research is sweet but really quite wrong. Take a look at the gross margins of Pfizer et al: there's plenty of fat in there.

Re:Yes really

[Anonymous Coward]

GDP is the wrong metric to look at when comparing countries' health care expenditures per capita.

PS remember free means FREE

[Bruce66423]

Apart from a charge for each prescription of about $12, there are NO other copayments for most conditions. There are charges for dental and optician care, but that's pretty much it. It's not perfect; there are queues and delays, but in terms of bang for your buck, it's massively better than the US system.

Re: PS remember free means FREE

[Anonymous Coward]

Nope not free. Pssst if I take 50% of your income and then use 20% to pay for your healthcare am I providing free healthcare or stealing your money? The money has to come from someone or somewhere. NHS is not free healthcare, its just shuffling money around.

Re: PS remember free means FREE

[shilly]

He didn't use the word "free", dumbass. You did. It's tax-funded and it is *free at the point of care*. All economic activity is just "shuffling money around" -- turns out *how you shuffle money around* affects the cost and effectiveness of healthcare.

Re:PS remember free means FREE

[Anonymous Coward]

In some parts of the UK, e.g. Wales, there are no prescription charges. For the unemployed, elderly, or those with certain long-term conditions, there are also no prescription charges.

In terms of waiting, it's currently getting worse due to underfunding (about £60 a month extra tax from the average family would go.a long way towards solving that issue.

Re: PS remember free means FREE

[jabuzz]

Indeed more than 20 years ago when Bill Clinton was trying to get health care reform passed I read a report that said the USA spends more pushing paper around to pay medical bills than the UK spends on the NHS in it's *ENTIRETY*. Now granted the population on the USA is 5-6 times that of the UK, but that should give you reason to stop and think about how inefficient the system actually is in the USA.

Re: PS remember free means FREE

[shilly]

It's mad as a box of frogs.

Re:PS remember free means FREE

[Ash-Fox]

It reminds me of a UK guy the other day saying he can't afford to take the family out to dinner and pay for legal entertainment. The point and the wording were clear. This wasn't just him but the majority in the UK.

If this were true, we wouldn't have nearly as many restaurants as we do.

In NJ and the UK things are not very good for employees in similar jobs. Employees are dependent on the state and the state hasn't taken good care of them.

This is particular pattern I've seen in many unskilled labour markets.

Re:PS remember free means FREE

[TheRaven64]

For anyone not reading the US press, for the 20-30 years prior to the current government, the increase in NHS funding has, more or less, kept pace with inflation. It could have done with a little bit more, but that was just about enough to keep it operating. The current government has increased NHS funding by less than this (while shouting that they've increased it by a larger number of pounds than anyone else before). At the same time, they've cut funding for training nurses and have helped create a hostile climate for EU nationals (a fairly large proportion of junior doctors are non-UK EU nationals), leading to skill shortages for both nurses and doctors. This has, unsurprisingly, led to a serious drop in NHS quality over the past few years.

Re: This is a BS article..

[Anonymous Coward]

Disagree - US macro signals and trump are making all the markets wobble at the moment.

Buy buy buy!!

Re:First time I think Buffet is stupid!!

[sjames]

You say that like it's their fault. Think of the stock market as a big grid on the ground and a million chickens. Occasionally someone tosses in a handful of corn and occasionally someone blows and air horn. The chickens respond as chickens will.

You pick a square or two on the grid. At the end of the day, if your square has the most chickens on it, you win a prize.

It's a bit like no limits cow patty bingo for city folks. If you don't believe me, how come 3 guys making noise in the corner caused such a change in the market?

Periodically, the SEC makes a move to keep the market moving. The decision making process can be a bit confusing. Here's a helpful video.

And this is what's wrong with America's

[rsilvergun]

health care. You can't have a for profit system built around something complex, expensive and life or death. Because people can just keep raising the price and you'll pay it or you'll die. Hell, our for profit system of agriculture only barely works with a _lot_ of government interference and subsidies and even then it relies heavily on borderline slave labor. This is why America spends more and gets worse outcomes to take care of less people. It's also why it costs $32k to give birth here and we still have the highest maternal mortality rates in the developed world.

Anyway, Single Payer Now. Medicare for All.

Re:And this is what's wrong with America's

[iggymanz]

no, average cost of birth is less than $9,000

no, we don't have highest MMR in the developed world either.

http://thefederalist.com/2017/...

Re:And this is what's wrong with America's

[Anonymous Coward]

What's wrong with America is people like you who buy everything you see on YouTube, hook line and sinker.

Re:And this is what's wrong with America's

[Anonymous Coward]

The Federalist is a white supremacist website.

Go back to Stormfront, boy.

Re:And this is what's wrong with America's

[Anonymous Coward]

A free market economy is at its heart, an optimisation algorithm for the efficient distribution of limited resources according to the ability and willingness to pay.

The problem is that the need for healthcare products and services is, to a good first-order approximation, inversely correlated with the ability to pay.

Question: How does a free market optimise for that?

Answer: It can't. It's a pathologically ill-conditioned problem for the free market. The results are, at best, ludicrously inefficient, and at worst, monstrously inhumane.

Re:And this is what's wrong with America's

[houghi]

Nice newborn you are going to have there. Would be a shame something happened to it.

For a small company that only works

[rsilvergun]

with fairly healthy people. My bro worked for a small company that tried the same. He had some health problems so he was politely told if he signed up for the insurance he'd be fired.

The best way to do insurance of any kind is to have as many people chip in as possible. Buying power gets rates down, and that's what's got the health care industry worried. As more and more companies consolidate an buy each other out we've got fewer and fewer employers, but that also means that if a few of them get together they can exert enormous pressure.

Of course, if you take this to it's logical conclusion the largest pool of insurable people is everybody; e.g. single payer health care. But once you've got a for profit insurance industry it's almost impossible to do away with it since they'll spend every penny they have to make sure folks don't realize they don't want or need yet another middle man.

Re:For a small company that only works

[skam240]

Man, how big was the company? Our four store operation employs about a thousand people (a good grocery store employs a surprising number of people for those outside the industry). In the context of the company I work for we've been able to grow our pool of insured people drastically so that generally speaking only people a couple of years junior or purposely part time people like college students don't get insurance.

I suppose the nature of the company matters a lot here too though. Our founder is in the process of making us employee owned so it's safe to say he gives a rats ass about the least of his employees.

Based strictly on my own experience though, there's money to be saved for a company going self insured.

Re:For a small company that only works

[aaarrrgggh]

Well stated.

From what I see, it seems like going in with a technology focus, simplifying the payment process for doctors, and destroying the highest-margin procedures with competition could have a pretty significant impact. The for-profit insurance companies don't have any real interest in getting end-user costs down, just their costs. The non-profits seem to have other challenges (those little spoken about for-profit divisions as an example).

You could save 10% over night pretty easily in my mind... maybe 25%.

Re:For a small company that only works

[Anonymous Coward]

But once you've got a for profit insurance industry it's almost impossible to do away with it since they'll spend every penny they have to make sure folks don't realize they don't want or need yet another middle man.

That's not true. In fact Obamacare is working precisely as designed in this case by escalating the cost of private insurance to the breaking point. Ezekiel Emanuel let it slip at an academic conference that the secret goal of the Cadillac Tax, Medical Device Tax and other Obamacare Taxes was to accelerate costs and bring on the collapse of the private health care system in a way that most Americans would be too ignorant to understand or predict in advance. One the private system had been destroyed the way would be clear to install single payer. This was their secret ambition all along. This is why, even to this day, the Democrats oppose loosening the grip of the taxes built into Obamacare. They cannot choke the private system to death with a flaccid grip.

Re:For a small company that only works

[TheRaven64]

The best way to do insurance of any kind is to have as many people chip in as possible.

It's not always that clear cut. For things that are likely to be claims for some significant subset of your population and the probability is similar for the general population, it's often better to budget for paying them than to go through the overhead of an insurance company. For example, my employer runs its own travel insurance scheme, where they just pay a bunch of common and cheap things directly from a pot of money and only go to the underwriter for less common things.

For high-cost, low-risk things, you want to get a large pool to spread the risk. For low-cost, high-risk things, the overhead of insurance is high and you're better off doing whatever minimises the per-claim overheads. If you've got the sort of thing where 20% of your employees are going to claim for it, and that's close to the average for the population, then you're probably better off just paying out of your local pool, because you don't reduce the risk noticeably by using a large pool, but you do increase the overheads.

what else

[sit1963nz]

I wonder what else the USA is going to "invent" by copying off other countries.

True single payer health
The metric system
Gun Control

Re:what else

[slashdot_commentator]

I'd love the US mandating the metric system, as should all STEM professionals.

Re:what else

[Anonymous Coward]

Gun Control

If you take away the deaths from the ten worse offending cities, our gun death rate is in the bottom half of all countries in the world. WAY down in the bottom half.

The only thing that needs to happen is for those ten cities to fix their gun problem, and leave the rest of the country alone. And taking away guns is not going to fix that problem (it hasn't so far, while other places that allow honest citizens guns to defend themselves with have done just fine, thank you - the guns are NOT the problem).

Re:This is a BS article..

[CyclistOne]

"Single payer sounds a whole lot better ..." Yeah, good luck with that. I hope Amazon et al shake up the "health care" industry. Making money on providing medical care should be illegal. It's certainly immoral in my book. The Europeans have good systems which provide good care at much less the cost than what we all pay. But here in "America First" we've got this huge insurance bureaucracy which is expensive ... all for the purpose of improving the bottom line for the insurance companies. So our insurance premiums go in part to pay the insurance companies to work to keep their payouts as low as possible. What a great system for them! What a lousy system for the patients. So if Amazon et al can come up with a system which delivers better care for less, good for them.

It's called self-insurance

[davide marney]

And if your risk pool is large enough and broad enough, you can save a SUBSTANTIAL amount of money.

Re:It's called self-insurance

[ClickOnThis]

You do realize that your post is an oxymoron?

Self-insurance is inconsistent with a spread-out risk-pool.

Re:It's called self-insurance

[davide marney]

Not at all. ALL insurance works the same way. The difference between 3rd party insurance and self insurance is who collects the premiums and who sets the coverage. The reason you can save a LOT of money by self-insuring is because you can shape coverage specifically to your risk pool.

But you still need a big, broad pool.

Re:It's called self-insurance

[judoguy]

you can save a SUBSTANTIAL amount of money.

Everyone keeps saying "You will save all this money if we socialize medicine" Bullshit.

I won't save anything. All this crap costs me far more than I spend on actual health care and I'm in my mid 60's.

I work my ass off to stay healthy. Yes, I'm an old meany who doesn't want to be forced to pay for other peoples healthcare. "What about when YOU need it?????". I want pay for what I use rather than pay a lot all the time for something I might not use.

The real goal for responsible adults should be how to reduce cost inflation's for healthcare products/services. Get the government totally out of healthcare. That would allow for true competition in the market when the various providers can't use the coercive power of government for rent seeking.

Just let providers offer any products they want and let me decide which if any I want to buy. The only legitimate role for government here is recourse for fraud.

Re:This is a BS article..

[cayenne8]

Making money on providing medical care should be illegal.

Err...if you didn't allow anyone to make money (a profit) with healthcare, why would anyone go into that industry for a lively hood?

I doubt seriously there are that many altruistic people out there.

I mean, if you're a Dr...why would you sacrifice 4 years of medical school, plus internship years, plus extra years if you are specializing...on top of college, if you didn't see a payoff in the end that was worth your sacrifice up front?

Why would anyone develop medical equipment if they weren't going to be rewarded for it?

Hell, why does anyone do anything if they couldn't make money at it?

Seriously, where is this mythical Shangri-La that you are referring to where people work healthcare, the long hours, research etc.....and don't count on making money at it...?

Re:This is a BS article..

[macsimcon]

No, I think the market was down because the bond market is taking a hit now that the Fed is trying to sell all those treasuries, which is going to drive up insurance rates, which cools down the economy, which causes the market to fall. Round and round we go.

Re: This is a BS article..

[wellingj]

Who is John Galt?

Re:This is a BS article..

[thesupraman]

Nice miss-interpretation, make a lot of money in the industry do you?

As I am *sure* you know, your example is BS.

There is plenty of competition at the staff level, so income is in general sensible.
There is practically NO competition at the insurer/provider level. This has been remove from the system through regulatory capture and other techniques for a lot time now, and the price is being paid.

If there is no competition, then the consumer suffers, and 'suffers' in the context of health is, eventually, dies early.
So, the cost of the high profits of insurers and providers is the deaths of consumers.

Care to try and defend that?

The only two solutions are enforced REAL competition (which does not mean two 'friendly' huge providers colluding), or state regulation of prices.
 

Re: This is a BS article..

[peragrin]

The fed is trying to cool the economy down. If it heats up to fast because of a tax cut there is zero the fed can do yo recover except for negative interest rates. All other tools have been expended.

The good news is that Europe is growing faster, and Trump's anti imigrantion stance kills manufacturing and farming, so that should drag down the economy.

Re: This is a BS article..

[Anonymous Coward]

Private for-profit healthcare makes babyJesus weep.

Lower Cost

[tquasar]

Lower cost means lower care. Doctors know what insurance patients have and how much it pays them. The difference is you get two minutes in the exam room if you are poor or thirty minutes and a referral to a specialist if you are wealthy. Money talks.

Re:Lower Cost

[Anonymous Coward]

Lower cost means lower care. Doctors know what insurance patients have and how much it pays them. The difference is you get two minutes in the exam room if you are poor or thirty minutes and a referral to a specialist if you are wealthy. Money talks.

That hasn't been my experience. It appears that you get the same 2 minutes whether you are on medicaid or the best insurance there is (I pay about $230 for a GP visit).

Re: This is a BS article..

[macsimcon]

The Fed affects the economy by raising or lowering interest rates, but this is different. The Fed is trying to unload $4.5T in treasuries that it has bought since 2009, but China, Russia, and Saudi Arabia have all cut back on their purchase of treasuries, so rates are rising to make them more attractive. But this is also going to cause rates on everything else to rise, including corporate debt, with many corporations will be unable to shoulder those higher rates.

This isnâ(TM)t good.

$30B ain't shit to the health insurance industry

[damn_registrars]

The majority of the health insurance companies in the country are led by CEOs who are either billionaires on their own or will be by the time they cash in their retirements. Many of them decline $30B worth of claims - or tell providers to eat $30B worth of billable service - in a week without thinking twice about it.

On top of that, the health insurance industry bought Washington DC years ago. They got most of their ROI in the form of the ACA back when Obama was president; they know where to turn if they need another bailout.

God, I hope they are successful!

[GerryGilmore]

Seriously: our health care "system" (in quotes for a damned good reason!) is a complete and total clusterfuck. Yeah, if you have squillions of dollars and/or the most super-ultimate health insurance (at the moment...), you can get pretty damned decent care. Fall off of THAT island, though, and you land in a swamp of uniaginable, Rube Goldberg-like complexity that is designed to do one thing and one thing only: separate you from as much of your money as possible. Period. End of fucking story! I once spent 9 years working for a company that provided IT systems to hospitals for billing. We had the most technology in the hospital....for billing. The scope of change needed is vast and while I'm a tad skeptical, Warren Buffett's involvement gives me more hope. He's a Good Capitalist.

Today Employee Healthcare, Tomorrow...

[Humbubba]

Amazing! An amalgam of successful capitalist thinks a nonprofit is better than capitalism for "reducing health care's burden on the economy while improving outcomes ". They should know.

Re:Today Employee Healthcare, Tomorrow...

[iggymanz]

It's not a "non-profit" though, you were fooled by choice of words. And of course the money for this will come from, wait for it...capitalism.

Re:Today Employee Healthcare, Tomorrow...

[Humbubba]

As Yuval Harari points out, real power is switching from Davos to the cloud. Neo-capitalism rules for now, replacing 'The Golden Age of Capitalism' which started in the post WWII environment and ending in the 1970s. What comes next? I think it's wise to see which page the existing power elite is turning to, and why.

Re:Today Employee Healthcare, Tomorrow...

[iggymanz]

nonsense, there are no more elite now than there ever was. there were always elite.

there is only capitalism as it ever was, no neo-capitalism.

Re:Today Employee Healthcare, Tomorrow...

[Humbubba]

iggymanz said

nonsense, there are no more elite now than there ever was. there were always elite... there is only capitalism as it ever was, no neo-capitalism.

I prefer this to be an impudent thrashing, but fear naivety.

The elite is much more rarefied now. According to Oxfam, just eight men own as much as half the world. 'The Economist' shows how that number can be stretched to 98 billionaires. Either way, the concentration of wealth comes from a capitalism different from that of the post WWII. https://www.oxfam.org/en/pressroom/pressreleases/2017-01-16/just-8-men-own-same-wealth-half-world. https://www.economist.com/news/finance-and-economics/21715043-oxfams-headline-grabbing-comparison-has-some-flaws-are-eight-men-wealthy-half. https://en.wikipedia.org/wiki/Post%E2%80%93World_War_II_economic_expansion

This new form of capitalism is the reason manufacturing moved overseas; why it's not really the products, but the logos that are marketed now; why Greece was forced to borrow money from lenders who did not expect Greece to be able to pay the loans back. It's the great economic experiment Augusto Pinochet tried in Chile. It's what Obama did in response to the 2008 Great Recession. And it is the ultimate cause of that Great Recession.

The ideas of Fredrick Hayek, Milton Friedman, Murray Rothbard and others in their school of thought are ubiquitous today, and the consequences have moved us from a relatively egalitarian "regimented capitalism" to a "new liberty" of power concentrated into the hands of a few private indivudals.

It's actually much more complicated. For Hayek, the marketplace knows more than anyone knows, more than anyone can know. I could go on but, needless to say, my own naivety is showing.

Re:Today Employee Healthcare, Tomorrow...

[iggymanz]

Oxfam is incorrect, none of the men listed are the elite and none of them are the richest. Guess again, here's a hint: banking cartel.

Re:Today Employee Healthcare, Tomorrow...

[Humbubba]

iggymanz said

Oxfam is incorrect, none of the men listed are the elite and none of them are the richest. Guess again, here's a hint: banking cartel.

My point isn't who's on the list. Whether it be 7 or 98 billionaires, a portion of this cadre of super rich capitalists is departing from the capitalist model for their employee health care. And where do they go? To a nonprofit model reliant on sensors and other new technologies, AI and information control.

Think about it. When you get a job, you sign an employee-health care agreement and are forced to wear sensors 24/7. The company's Alexa Watson can legally tell you not just to exercise but how to exercise, what to change your diet to, warn about your drinking and\or drug use, send you to a nurse, therapist or doctor, and get you prescriptions you have to take as prescribed. Thanks to the sensors, monitors, and other information sources, Alexa Watson will know everything you do or don't do, so you better do what it wants you to. Alexa Watson can make you to take the day off, put you on leave, demote, suspend, or even fire you - and every single step based on algorithms no one understands. And because the nonprofit is owner controlled, it will be much cheaper for them, and maybe their employees too. Maybe.

'Sorry,' your boss might say, 'I really don't know why. I thought you were doing OK. But Alexa Watson says clean out your desk right now.'

It may not be this oppressive. This nonprofit tech assisted healthcare model might actually be more user friendly, efficient and effective than our current capitalist model. Regardless, it's very announcement started the health care stocks to drop. My guess is, whether it's good for the employees, if it's good for the owners, it will become how healthcare is done.

Re:Today Employee Healthcare, Tomorrow...

[iggymanz]

of course firing someone for health issues is illegal though, wait till the first time that shows up after a subpoena.

Re:Today Employee Healthcare, Tomorrow...

[Humbubba]

Good AI will take legal issues into consideration. Humans won't know why AI fired you. But if a subpoena shows up, the requisite data will be made available to the lawyers, who are a completely different species, more related to bank cartels.

The US healthcare system needs disruption

[cliffjumper222]

If as a consumer you want to save your hard-earned dollars (e.g, you have an HSA) when you need healthcare in the US, tough luck - you can't. The US health care system is not set up to enable anything like the usual way we shop. It's like being forced to buy things on recommendation from a stranger without knowing the prices for anything until you get your credit card statement. And then experiencing utter sticker shock at the cost!

Case in point: I went to the doctor for a check up. The doctor had no idea how much it would cost me for the checkup or how much any of the recommendations she made to me would cost me. So I asked the insurance system. They couldn't give me a price or even a quote, and only pointed me to a web-based useless "calculator" that gave rough numbers. It's not surprising, because the actual cost had been negotiated by some unseen, unknown entity (my employer? the company my employer contracts with?) and it certainly wasn't ever to be shared with a lowly patient/employee. The only time I could find out how much it cost was when I received the bill. And it was outrageous! Over $200 for a simple look-see. The doctor had claimed it was the "annual checkup", which was much more expensive. Apparently, there are multiple types of check up, with the cheapest being $60, but there's no way to request that, or know what you are getting in advance. Other procedures are completely opaque too and often involve bills from multiple entities. My wife received bills from approximately 6 different entities after an ER visit for concussion, including the individual doctors, the MRI, the CT staff along with billing for various bits and pieces (tubes, packs, etc.) that apparently were used. What a load of crap.

Another area that the health care system needs to address is their methodology of tracking the status of health issues. Currently, they run completely on the squeaky-wheel system. If the wheel don't squeak, it's not an issue any more. (Doesn't matter if the wheel has crumbled into dust or not!). As engineers, if we find an issue we usually have a process to track progress to resolution. Not in the health care system! It's completely random and ad hoc. You as a patient have to manage your own "bug tracking" because no one else will. They seem to be pretty good in tactical situations, but anything that isn't an easy fix, or takes a long time isn't handled well at all.

I'm glad that this is happening. The system needs a really big kick up the butt.

Re:The US healthcare system needs disruption

[Anonymous Coward]

There is absolutely wrong with heathcare in the United States. We have the best medicine and healthcare in the world by any measure. The problem here are the common practices of health insurance companies, and not with the healers, the doctors, nurses, and other medical personnel, nor the healthcare facilities, that are also all encountering problems with absurd healthcare insurance practices. Make sure you know who the enemy is before you go to war. Health insurance is not healthcare. The healthcare is good. The health insurance is bad.

Re:The US healthcare system needs disruption

[avandesande]

If you ran a auto repair shop this way you would be thrown in jail.

Re:The US healthcare system needs disruption

[Anonymous Coward]

Auto repair shop standard labor costs should be outlawed. Whenever they tell you it's 1 hr of labor ($100+), they really mean "our normal mechanic can do it in 5 minutes, but it might take up to 15 minutes if you get the trainee that's never worked on a car before; but we're still going to bill you the full amount, because we can."

Also, in many cases the book says 1hr for X, and it says 1hr for trivial Y that's obstructed by X, but you don't get a break on labor if you ask them to replace both X and Y at the same time, and they won't let you stand out in the shop and demand that they remove X twice because you're paying for them to do it twice. That's how you can get a repair bill with several hours of itemized labor, but they only had your car for 30 minutes you watched the car sit in the service queue while they waited for the shop guy to get to it in the first place.

Re:The US healthcare system needs disruption

[whoever57]

Under the ACA, you should get one annual checkup (some blood tests not included) at no cost to you.

Probably your doctor didn't bill your checkup properly (perhaps deliberately), or you exceeded the parameters of the annual "wellness" check.

Re:The US healthcare system needs disruption

[sabbede]

The market is where the problem lies, and you hit on why when you asked your doctor about cost. The feedback mechanisms that bring prices into equilibrium are broken or missing, letting prices spiral out of control. Your doctor can't know what something will cost, you probably won't know what anything actually costs (most people have copays, never see prices), the insurer only knows what price they've negotiated, leaving only the accountants working for providers with any idea about what anything costs, but not what they'll charge you until it's time to finalize the bill when they've figured out what they can get from your insurer. Which is hidden from consumers by a tangle of confidential negotiations and privacy laws.

Re:The US healthcare system needs disruption

[l0n3s0m3phr34k]

"because the actual cost had been negotiated by some unseen, unknown entity" I've been told it's negotiations between Cthulhu and the Hypnotoad, written down in non-Euclidean petroglyphs. Sure, they COULD show you these contracts, but it would break your puny human brain and immediately drive you insane.

Re:The US healthcare system needs disruption

[jittles]

Another area that the health care system needs to address is their methodology of tracking the status of health issues. Currently, they run completely on the squeaky-wheel system. If the wheel don't squeak, it's not an issue any more. (Doesn't matter if the wheel has crumbled into dust or not!). As engineers, if we find an issue we usually have a process to track progress to resolution. Not in the health care system! It's completely random and ad hoc. You as a patient have to manage your own "bug tracking" because no one else will.

Is this really so unreasonable? There are diagnosis where this does not make sense but, on the whole, who else could possibly track the resolution of a problem you have? Take, for example, a common cold. You get sick, you don't feel well, maybe you're not sure if it's something serious so you go to the doctor. They tell you to go home, get some bed rest, and come back if you aren't feeling better in a few weeks. Do they have any objective way of knowing that you are better or worse? They cannot measure your symptoms. How can they know if you're back in the office, or in a coffin? They have nothing to measure, nothing to look for. You provide them with all the information they have to make a diagnosis and determine if there is a problem. You're an adult. You ought to be able to manage your own resolution to a cold.

Now if you take something like chlamydia they will likely treat you entirely differently. If you went in and were diagnosed with chlamydia, they would probably send you home with antibiotics and schedule a follow up for you after a few weeks to make sure that you tested negatively for it. In this case they have a clear test that shows whether or not you have the disease, and can tell if it resolves itself. You may be asymptomatic and it is important to know whether or not you are still spreading it to every bar patron at your favorite hangout. They will do everything in their power to make sure you have resolved the issue short of forcing you into their office for a test.

So what exactly are you hoping that they will change in regard to resolving your complaints?

Re:The US healthcare system needs disruption

[edtice1559]

They tell you the price up front. And if you don't want to pay them, you can do it yourself. And if you don't like the price, you can go to another shop. I don't think this is much of an issue at all. Mechanics seem to charge incredibly high rates. But I don't think that should be illegal.

Re:The US healthcare system needs disruption

[dcollins117]

Of course your going to get fucked if you just bend over and take it. All you have to do is dispute a bill and the onus is on them to justify it. Here you can negotiate rates more in line with reality.

Ultimately it's up to you whether you pay anything or not. It's not like they're gonna come over and put your appendix back in if you don't pay.

Re:The US healthcare system needs disruption

[Anonymous Coward]

Think about the alternative also, do you want your doctor making recommendations based on their assumption of your ability to pay?

Many doctors in large organizations are probably so far removed from the billing department they may truly not know. Smaller operations they are more likely to have an idea. But, you asked a complicated question, you asked how much it would cost 'you'. That's not the actual cost of the procedure or testing, that's asking how much is your insurance company not going to pay and pass along to you. Whether that be a portion of the yearly deductible amount, the copay amount, etc.. all that is really determined by the contract between yourself and the insurance company. And every insurance company is different and every patient may be at a different portion of their deductible for the year.

Re:The US healthcare system needs disruption

[tsstahl]

Congratulations! You just realized that you are the product of healthcare, not the customer.

The actual customer can get a detailed cost of any particular DRG/CPT code....because it's in their contract.

Re:The US healthcare system needs disruption

[foghelmut]

I just assume my cost is my out of pocket max and I live poorly to put away the $4k per year in my HSA.

Re:The US healthcare system needs disruption

[volmtech]

Group insurance was the cause of our current system by separating buyer and provider. Government got involved but only in ways that increased costs. If everyone else is doing something a better and cheaper way you than you should entertain the though that you might be wrong.

Medicare and Medicaid are single payer but 10% of the cost is due to fraud. Single payer will only work with single provider, doctors are government employees and are on salary. Government owns and operates the medical facilities and testing labs. I needed a CAT scan, there are three places in my small town that provide them. My doctor uses a facility in a town 30 miles away. After driving there and parking I walked past one imaging center to a different one a few doors down where I was the only patient. In who's world does this make sense?

Re:This is a BS article..

[Anonymous Coward]

they will be successful because this is a limited deal between the partnering companies only, not offering health care or insurance to the general public. limited liability with only those companies' employees but still more than big enough pool to get providers' attention and negotiate (amazon style.. 'demand' and dictate pricing), and some added clout from amazon's two partners will help.

it could easily expand into a national health care offering. expect kindlekare and kindlekare prime to hit the market in 5-10 years if the feds don't get their shit together before then and go single payer with automatic coverage for all citizens who file and pay their taxes.

Re: First time I think Buffet is stupid!!

[reanjr]

You can make better investments.

Re: This is a BS article..

[Anonymous Coward]

lol.....you think tax cuts are a driver of economic growth.

While i'm...

[Anonymous Coward]

...pro healthcare and think the US system is a little crazy and full of absolutely insane defences for financial practices that would never be acceptable anywhere else...

Isn't this a vertical monopoly that allows Amazon to fully control these peoples' lives?

It isn't that difficult

[nehumanuscrede]

it's just no one with the authority to do so has the spine to make the decisions necessary to make it happen.

Well, that and *campaign donations* tend to ensure the status quo remains the status quo.

"Hard as it might be, reducing healthcare's burden on the economy while improving outcomes for employees and their families would be worth the effort."

The only thing you need to do is take away the health care and Big Pharma industries ability to charge whatever they want for their products or services and you'll stop this problem stone cold.

You need only speak the words that shall not be spoken ( Regulation ) within earshot of said industries and watch how quickly they'll be willing to compromise on what they charge. They do for a while until the latest scandal becomes a fleeting memory, then it's right back to business as usual.

Quit threatening it and just do it.

When a single trip to the hospital is capable of bankrupting all but the insanely rich, it's time to burn it down and rethink the issue.

I don't want, nor need, vouchers, coupons or reduced insurance premiums that do nothing but increase over the long term. Fix the problem at its source and you fix the " economic burden " it has become.

When people have more money in their pockets to spend on something other than ludicrously priced healthcare, the economy tends to benefit from it.

Re:It isn't that difficult

[TheGratefulNet]

think about it this way: the ultra rich want us (the regular folks) to live in constant fear. that distracts us and keeps us in-fighting (ie, not fighting THEM or coming after them with pitchforks and fires).

they keep wages down, they hire outside the country as much as they can and they actively seek to lower the standard of living for all but their friends. reasoning is the same as above, keeps us fighting between ourselves over stupid shit. and if we're all just 1 paycheck away from being homeless, we are properly kept 'in line' and in fear.

this is all by plan. entirely. not coordinated, mind you, but its in the back of the minds of EVERY rich motherfucker out there.

zero doubt about it. they are all sociopaths. the ultra rich are not nice people.

Re:It isn't that difficult

[Nothing2Chere]

Well said. I broke my foot a couple of years ago and the attributed total bill when all was said and done was $52k. n2ch

I'll see your right wing Federalist website

[rsilvergun]

and raise you an NPR Article and a BBC one too.

Our health care sucks, particularly in rural areas. And you can't blame that on the US being spread out. Look at Canada. Better outcomes and just as if not more spread out population centers.

Re: This is a BS article..

[Brockmire]

Profit != income. I'm like, wtf is this guy talking about? Does he think everyone working at a nonprofit is volunteering with no salary? Surely, he's not that dumb. People become doctors for several reasons. It could be for money and prestige, it could be to fucking help people, like firemen and cops aren't in it for the money. I know several of both kinds of doctors.

Re:First time I think Buffet is stupid!!

[Anonymous Coward]

Did you sell today? Only if you sold did you actually lose $5K.

Solution # 3

[rsilvergun]

single payer healthcare, just like the rest of the civilized world.

Re:Solution # 3

[shilly]

The rest of the civilised world does *not* all use single payer. Many European health systems -- France, Germany, Belgium and others -- use a system of regulated mandatory insurance. It's not that different from the US system in concept -- but the execution is very different, not least because they haven't allowed regulatory capture. The Dutch system is particularly effective.

Re:Solution # 3

[Elledan]

Speaking as a native Dutch person who recently moved to Germany, I call complete BS to this. Since they privatised the Dutch healthcare system it has completely gone downhill. Worse care, and skyrocketing costs with reduced coverage.

The German system is dual: with both private insurance and public. Not ideal, but at least it pretty much always functions, without the horrors of privatisation.

Re:Solution # 3

[shilly]

The plural of anecdote is not data. I prefer the Commonwealth Fund's evaluation of 11 advanced economies' health systems:
http://www.commonwealthfund.or...

UK is 1, NL is 3, DE is 8, US is 11.

Plenty of detail of how they did this analysis. It's a 2017 report, and done annually, so it reflects recent changes to the Dutch system.
Report: http://www.commonwealthfund.or...
Excerpt from method statement: "This edition of Mirror, Mirror reflects refinements to methods used in past reports. No report can claim to capture every aspect of the performance of health care systems. Health care systems are complex. Even if a report included thousands of measures, nuances would remain. In that spirit, the report underwent a thorough review by an advisory panel of international, independent performance measurement experts. 11 The framework for Mirror, Mirror 2017 was developed in consultation with the advisory panel from January through December 2016.

Using data available from Commonwealth Fund international surveys of the public and physicians and other sources of standardized data on quality and health care outcomes, we identified 72 measures relevant to health care system performance, organizing them into five performance domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. The criteria for selecting measures and grouping within domains included: that the measure be important, that the data to support the measure be standardized across the countries, and that the results be salient to policymakers and relevant to performance improvement efforts. Most of the measures are based on surveys designed to elicit the public’s experience of its health care system.

The indicators were carefully selected from among the best-available measures with comparable data across the included countries. The selected measures cover a wide range of performance domains. Mirror, Mirror is unique in its use of survey measures designed to gather the perspectives of patients and professionals—the people who experience health care directly in each country every day."

Re:Solution # 3

[Anonymous Coward]

Same in Switzerland. We were promised a more efficient healthcare system if it was run by competing insurance companies rather than the inefficient government.

Since then, cost has skyrocketed. More often than not, premiums went up 5-10% when salaries increased 0-2% tops.

The worst of all is that the premiums are not income-dependent and insurance is mandatory per person. In 2018, I pay for my family with 2 kids around USD 800 per month with the highest possible deductible (USD 3000/year and person). All that with a salary of around 6K USD (I'd pay the same if I got 20K...as I said, the premiums are not progressive).

On top of that, cost of medication went also through the roof and is often 2x as high as prices for the same medication in neighboring countries. Obviously, big pharma has our dear congressman in their deep pockets.

Politics & capitalism at its best.

Re:Solution # 3

[Anonymous Coward]

the UK is heading toward the privatisation due to fucking tories...

Re:Solution # 3

[Anonymous Coward]

In the german system doctors make most of their money with the stuff the insurances do not cover.

and privately insured patiens tend to have much easier access to get an appointment, but otherwise it's mostly fine.

Re:Solution # 3

[david_thornley]

So that's why you guys are paying about 2/3 US per capita costs for health care. Hope you can get that under control.

Re:This is a BS article..

[Anonymous Coward]

> Seriously, where is this mythical Shangri-La that you are referring to where people work healthcare, the long hours, research etc.....and don't count on making money at it...?

Your hyperbolic musings are trying to deflect the incestuous problem with insurance greed, which is a thing.
The question of what "making money" is, comes to mind when trying to de-tangle your "make as much as possible" drivel.
People go into business to make some money. People do things that are not as profitable as others, for lots of reasons.
Maximization of profit is morally reprehensible when dealing in healthcare, ironically for the reasons you bring up (not for the idiotic strawmen you're trying to prop up). SMH

Re:This is a BS article..

[currently_awake]

America has the most expensive healthcare in the world, there is plenty of room for improvement. As for euthanasia, to keep most dialysis patients healthy you need to provide 5 hour treatments 3 times per week. That's not what most American insurance companies pay for. Yes, countries with single payer healthcare DO consistently get better results at lower cost.

Re:This is a BS article..

[emaname]

There is practically NO competition at the insurer/provider level. This has been remove from the system through regulatory capture and other techniques for a lot time now, and the price is being paid.

Brilliant! THANK YOU! And yes, I meant to use all caps for that.

Finally someone who understands what has happened to our government.

I'm tired of hearing the term "big government" or the claim that it's the source of all our problems. That is a distraction from the real cause which is big business which now essentially owns the government. That allows them to generate the influence to effect regulatory capture. This is why people have been saying "we are owned."

For me, the day "Citizens Divided" passed was the end of our democracy. And that should be the name of that crap rationalization of a legal concept. Calling it "united" was a slap in the face to all of America. That was the "owners" version of giving us a spoonful of sugar to help swallow the poison.

New Amazon Prime Benefit!

[tofu2go]

Next step is for Amazon to open up their insurance to Amazon Prime subscribers and become the largest health insurer in the U.S.

Re:This is a BS article..

[Hognoxious]

Err...if you didn't allow anyone to make money (a profit) with healthcare, why would anyone go into that industry for a lively hood?

s/healthcare/law enforcement/. Funny thing, there's plenty of cops out there.

s/healthcare/military service/. There's plenty of soldiers. Literally an army of them.

Your logic seems a bit flawed somewhere.

P.S. "livelihood". One word. It's not some kind of headgear.

Re: This is a BS article..

[ixidor]

you miss the part in the summary, this is going to be ran as a non-profit?

Cost? WTF!

[Anonymous Coward]

Losing market cap isn't a cost.
Market cap and a company's viability and produce are unrelated.

Sorry, no story here.

Re:This is a BS article..

[DaHat]

I'm tired of hearing the term "big government" or the claim that it's the source of all our problems.

Would you prefer ear muffs? Or to stick your head in the sand for a while longer? ... Because I wouldn't expect it to end anytime soon.

That is a distraction from the real cause which is big business which now essentially owns the government

I'm sorry that you are in effect supporting a full 8 years of Trump.

Don't get me wrong... I'm no fan, unlike most of you Bernie Bro's, I can see that you are going to split the Democrat party into pieces... a fact no one on the right is going to shed a tear for.

For me, the day "Citizens Divided" passed was the end of our democracy.

Odd how again, your focus is on the 'big businesses'... and not say... the labor unions who also benefited from that... well until recently as the 'fair share fees' keep getting chiseled away at.

Calling it "united" was a slap in the face to all of America.

Except that refers to the name of one of the parties involved... again... why let facts get in the way of a good screed?

Solving the worlds problems....

[WolfgangVL]

My buddies an I often sit in front of the fire and solve the worlds problems. Healthcare is one of my favorites. We like to look at what exactly causes the high costs and address them one at a time... (Completely ignoring things that work or don't in other countries, because those are saved for discussions like "what works and doesn't in other countries") Here are some of our ideas relating to healthcare.....

Tax rebates for high cost medical equipment. This addresses the high costs of medical equipment at least a little, and helps maintain profitability in creation/manufacture/research of said tech.

Transparent pricing, no hidden fees, like every damn thing else traded for American dollars. That $.03 asprin is only $25.00 because you can't just say "no thanks, I can't afford that today.", so the market will bear any price. If it's painful, good, get your shit together healthcare. It's damn sad that I can check the costs of airfare across nearly an entire industry run mostly by brain-dead customer service people (which is also bogged down with massive regulation hoops and legal liabilities) in two minutes, but an industry run by over-schooled and highly paid professionals who are often smarter than I am can't seem to write a complete legible sentence or count past $100.00 without the insurance mans help.

Free government funded tuition for in demand medical field studies, paid for by taxes paid on medical practitioners earnings. (much like the industrial taxes I pay now pretend to cover industrial overhead) This addresses the licensed doctor shortages... For profit schools will love this shit, and the socialized education camp gets a win. Free doctor/nurse/med-tech/ect... training!

Immunity to malpractice accusations and court nonsense on all non-trivial procedures. People are going to die under the knife. You can choose to just die, or ask for help. With transparent pricing and lower overall prices, it's on the consumer to do their research when seeking a "family doctor". This all but eliminates the insurance against insurance bullshit driving costs through the roof. Personal responsibility time folks. Buyer beware. I know a LOT of people that travel to other countries to have medical procedures done and take a vacation while there- for half the price of half the care in America. They do their research before they buy a ticket. Seems to work.

State level cooperatives negotiating pharma prices, which are allowed to shop outside of the country. This addresses 500% increase games on life-saving drugs due to the captive market, and ends the market for smuggling life saving drugs that is fueling organized crime. This is so fucked up by the way... and also leads to the next one....

University and government funded research CAN NOT BE PRIVATE. Breakthroughs and moonshots in the medical field should be shared if funded on the public dime, and works and studies encouraged. Patents never granted on medicines derived from government (citizen) funded research. I've never understood how breakthroughs achieved and sciences explained/attained at state universities is not public by default. Who in the hell came up with the current system and how can they sleep at night?

I'm just another nerd pissed off about 15k emergency room visits and $30000 stillborns. I have no idea how these things would pan out, but nobody else ever seems to put forward any ideas addressing what seems to me to be the sources of the high costs of care that require the money sucking insurance companies to begin with. You gotta do more than creative accounting to fix this, and lives are at stake.

I imagine Amazon will drive costs down by sheer volume, access to data, simplicity, reliability, and scope of options. (Based on your shopping habits, you might also like.... a colonoscopy! available from these practitioners...)

The only thing more fun to discuss than American healthcare is American law enforcement. Hooo-boy do the tempers flare on that one.

Re:Solving the worlds problems....

[david_thornley]

A couple of things....

Immunity to malpractice accusations and court nonsense on all non-trivial procedures.

Sometimes things just go wrong. It happens. Sometimes doctors are incompetent, and patients are crippled or killed through negligence. I've seen varying claims on the significance of malpractice insurance, but there has to be some sort of penalty for being careless with people's lives.

University and government funded research CAN NOT BE PRIVATE.

It isn't. I believe the NIH moved some years ago to require all NIH-funded research to be publicly available within a year of publication. However, research like that almost never comes up with something that can be put into production without massive additional expenses. A research paper might say that a med like this (description of a chemical or whatever) shows a lot of promise. To get from there to the market requires extensive testing, very often including changing the chemical so it's still recognizable but has different effects. That's really expensive, and doesn't always pan out, so drug companies need to be able to protect their development expenses and make lots of money on the drugs that do make it through the process.

If we're going to have enough testing to know that our drugs are reasonably safe and do something, somebody has to pay for that. Personally, I think market incentives work best when they can be applied, so something like the current system is probably best.

Re:Solving the worlds problems....

[Anonymous Coward]

Immunity to malpractice accusations and court nonsense on all non-trivial procedures.

Sometimes things just go wrong. It happens. Sometimes doctors are incompetent, and patients are crippled or killed through negligence. I've seen varying claims on the significance of malpractice insurance, but there has to be some sort of penalty for being careless with people's lives.

There already are laws on the books for addressing this kind of thing, such as manslaughter. There's no reason to have this be a matter of civil tort law. It's purely a matter of having a largely unethical legal profession that see tort law as a huge cash cow, and fights tooth and nail to protect it, with lots of propaganda and large campaign contributions. The true costs to society of the ethics problems in US law are hidden behind a bodyguard of lies - like many other things in today's world.

Also, it's not just malpractice insurance, it's all the costs of all the businesses making up the logistics chains that supply goods and services for medical use. Any sane business person will have liability insurance (any sane person with even a moderate amount of money or property will have this as well, on an individual basis). Many businesses will spend lots of additional money - in addition to the insurance - to protect themselves from the abuse of tort law that is a routine part of the practice of the highly unethical US legal system. It costs money to build walls, install and operate security systems, to train employees in appropriate behaviour to protect the organization from being exploited by the legal profession, to implement policies on limiting data handling and to routinely destroy data after a reasonable time, and so forth. Businesses in the USA have to spent a lot of money on defences that their counterparts in other countries do not need. Of course, all this unnecessary stuff also leads to inefficiencies in routine operations, further increasing costs.

These costs ripple through the logistics chains supplying goods and services: each business passes its costs on to its customers - and since everybody has to do it there aren't any opportunities for markets to correct.

The problem is especially bad in the medical area, because people have a lot less choice to "do without" - and it's not really in the long term interests of society in many cases for them to forego treatment. Worse, many businesses often lower employee benefits or profit sharing or otherwise do bad things to their employees, or lower product quality in subtle ways, to make up for the money they lose on defences against abuse of the law by the largely unethical US legal profession. All of this means we ultimately have more stress in ordinary people's lives and hence more medical problems - and people have fewer resources to deal with those problems. It's a huge mess.

I know a lot of ordinary people - those not working for big organizations with good health care - and I see the stress in their lives as a result of health care issues. It's really, really ugly.

But insurance companies have what patients crave!

[istartedi]

Billing codes. The body mutilator!

Really though, One of the things I've said about health care is that we could easily care for patients without all that overhead. Thing is, just like Brawndo, the economy sort of depends on it. Until the plants actually start growing again, this is going to hurt.

Re:First time I think Buffet is stupid!!

[DaHat]

Apparently you are a pretty poor investor.

A few years back someone I know touted how great the Facebook IPO was going to be and that he was happy to have them make him money... that back on May 18, 2012... a Friday.

The following Monday he was up in arms about how there were lawsuits pending about the overvaluation and that he got out before things got 'too bad', but not much above the eventual price a day or two later. Hearing this I chuckled, then purchased some FB out of pure spite (and believing it to be then properly valued).

Ever since then, I've held on to those shares... which are up nearly 400%... all because I didn't view them (a small part of my 'life savings') as vital to anything in the short term.

Long term thinking my friend... always think long term... which in retrospect I wish I would have done more of as I only purchased two shares :)

Kaiser did this about 80 years ago

[perpenso]

I am skeptical that Amazon et al will be successful in this, but I wish them well. If the politicians can't fix healthcare, many nerds can.

This has been done before, Kaiser about 80 years ago. They created their own medical care for on the job heavy construction site injuries, doctors with modern and sufficient equipment to stabilize the injured so they could be transported to a "big city" hospital. This quickly expanded to cover health care in general. Then it expanded to cover the worker's families too. And now we have a major non-profit healthcare provider covering the western US.

Re: Kaiser did this about 80 years ago

[WindBourne]

Exactly. And Kaiser is the cheapest insurance going. Technically, it is nonprofit, but like Ikea, it really is profit based. Just hiding from taxes, while paying into a large family. Hopefully, this insurance will be either non-profit, or will push for Medicare for all.

Re: Kaiser did this about 80 years ago

[Joey Vegetables]

Yeah. My first impression was that Amazon is trying to reinvent the HMO. That might very well work. In Seattle. But scaling that model up to a much larger city, or a less wealthy or developed one, or conversely down to a more rural and widely dispersed area, may pose challenges. In the end, people's lives often depend on specialists who may not actually practice outside of large cities, and/or may be too busy to take new patients or to see patients as soon as they need to be seen if there is to be a positive outcome. Those won't be in the HMO. So the HMO will need to negotiate with whomever controls them. In the process, gradually becoming a PPO, which is basically the least-broken kind of insurance model that we have, but still very badly broken to other countries' "national healthcare" systems which ironically are often much more market-oriented than our own. (I favor market-oriented reforms, but realize most of them are not economically viable, which is why I might be OK with a national system PROVIDED that a genuinely market-oriented system is allowed to exist in parallel with it.)

Re: Kaiser did this about 80 years ago

[Joey Vegetables]

Uggh . . I meant politically viable, not economically viable. Markets are always more economically viable than their alternatives; just not always politically viable.

We have not-for-profit hospitals

[perpenso]

I hope Amazon et al shake up the "health care" industry. Making money on providing medical care should be illegal.

Amazon et all seem to just be replicating Kaiser which created not-for-profit hospitals to provide their employees and their families with healthcare about 80 years ago. Today Kaiser is a major healthcare provider for the general public in western states.

Various churches also offer not-for-profit hospitals. Locally we have Loma Linda University Medical Center, a full service and level I trauma center for the county.

Not-for-profit hospitals aren't really anything new. And companies providing medical facilities for employees and their families isn't exactly anything new either. Besides the large scale like Kaiser there are also small clinics on various corporate campuses, some with capabilities on par with small urgent care facilities. Best of luck to Amazon, perhaps they can help modernize these sort of efforts.

Re:This is a BS article..

[perpenso]

Err...if you didn't allow anyone to make money (a profit) with healthcare, why would anyone go into that industry for a lively hood?

The employees at not-for-profits get paid.

Re:First time I think Buffet is stupid!!

[Anonymous Coward]

I'm sorry that you lost money, but you need to diversify if it's not money you can afford to lose. Hopefully you can recover and diversify.

I am not a doctor

[Anonymous Coward]

And neither are you, so stop prescribing your snake oil for me.

Re:This is a BS article..

[mysidia]

The overall market fell by about 1%, mostly because of the fall of the health industry, which represents about 18% of the American economy

Sounds like a high chance that some buying opportunities have been created.

Whatever Amazon is planning is not going to have an affect on the entire insurance industry overnight; the market tends to react irrationally lately ---- whenever Amazon suggests they might be entering a new business suddenly market cap evaporates from any of the perceived competition.

But Healthcare is very much unlike retail Amazon is familiar with in so many ways.

Re:

[Anonymous Coward]

The main motivation here is profit. When a company is able to know cancer is a problem with their employees quickly, it is easier to plan for it and potentially cause some attrition. This is about access to medical records for more corporate profits, nothing more.

Re: This is a BS article..

[mysidia]

In other words.... The Fed will not be able to keep the interest rates low, because the fed's ability to lower interest rates requires that there actually be demand for the treasury notes --- lesser demand would mean the notes will be auctioned off at a lower bond price = higher interest yield.

About 15 years late.

[Anonymous Coward]

My dad financially ruined himself with *JUST* healthcare premiums between ~2000 and ~2010. His medical insurance for the past 40 years kept jacking rates up on him after he retired from corporate life to find a more fulfilling personal job.

From ~150/mo per person for a 4 person family up to 750 each for two of them and 350/mo for the other two. At once point it was based on age, at another it was based on 'pre-existing conditions'. Needless to say blowing over 2 grand a month just on medical insurance sent him from having a nice comfortable retirement next egg to basically destitute before he reached 'official' retirement age. And subpar coverage that entire time. Now all of a sudden when there is medicare to suck off, they started providing him all the tests they'd been denying him for the past 15 years. He switched providers ASAP once he had medicare supported options, but the pre-existing conditions axe weighed heavy on his choice not to change providers.

I personally haven't had medical coverage since my 20s and haven't been to a doctor since, knock on wood. At this point in time I'd sooner die than trust my life to another random health insurance doctor, and in my region that is all we have out here, unless you can pay top dollar for a private doctor (which aren't necessarily any more competent or lifesaving than the aforementioned.)

Re:This is a BS article..

[mysidia]

Odd how again, your focus is on the 'big businesses'... and not say... the labor unions who also benefited from that

The Labor unions ARE among big businesses. Just because they call themselves non-profit unions, does not detract from their large size and unjustifiable influence in affecting our government.

Re:This is a BS article..

[AK Marc]

I am skeptical that Amazon et al will be successful in this, but I wish them well.

This shit is simple. Lots of companies have replicated non-core business functions to reduce cost, often eventually spinning them off as separate businesses, selling them at a profit and continuing to buy from them.

Woking in telecom, some of the most used subscriber tracking programs are spinoff companies from other telcos. GMAC is not a division of GM, as they started, but is a separate company, and unrelated (and since, renamed).

Health Care is easy. Price books, discounts, and tricks that are well known. Negotiating for the insurer discount off the price book, and you are 99% of the way to solving the problem, from there you simply set up fraud protections and spread the cost. Easy. The problem is it takes enough spread of risk to cover everyone, something that 3 large companies covers.

Re: This is a BS article..

[AK Marc]

No. The fed could pay 90% interest on T-bills, while charging banks 1% for the FED rate. Sure, that would cause problems with debt, but there's no physical reason why it wouldn't work.

Re:This is a BS article..

[AK Marc]

Paying a doctor for his time is different than a for-profit pharma, who all spend more on marketing than R&D, and for-profit insurance company paying a for-profit hospital. About 50% of health care expenses ar profit-related. This is new. Previously, almost all hospitals were non-profit, and many insurance companies started as non-profit. Everyone trying to profit from it is the #1 cause of the increasing costs.

Re:This is a BS article..

[TheRaven64]

Lots of companies have replicated non-core business functions to reduce cost

Including Amazon. AWS began with someone noticing that they needed a load of computers to cover their peak demand, but most of the time they were below that peak and wondering if they could sell some of their excess capacity. It was never intended to be a large part of their business, just a way of reducing the costs of operating their store. It turned out to be quite profitable...

Re:This is a BS article..

[Plammox]

I mean, if you're a Dr...why would you sacrifice 4 years of medical school, plus internship years, plus extra years if you are specializing...on top of college, if you didn't see a payoff in the end that was worth your sacrifice up front?

I once sat next to a doctor at a dinner party, and boy, he was a real grade A asshole. Patients should pay out of their own pocket for treatments, so they could better appreciate the service he delivers them and that Scandinavian countries with free healthcare are communist hellholes doomed to financial fail. (Although all credit agencies beg to differ with him on that last one). So yeah, money plays a role for some, although mostly, it's about seeking to be an authority, worshipped as a healing demi-god.

Re:This is a BS article..

[GrandCow]

Well-well look. I already told you: I deal with the goddamn customers so the engineers don't have to! I have people skills; I am good at dealing with people. Can't you understand that? What the hell is wrong with you people?

Re: First time I think Buffet is stupid!!

[Anonymous Coward]

Nope, startups and organic growth is gold. Disruptor, double that again. Steady recession proof income - yup.
Picking on lazy established practices. Check. Room for innovation. Check.
But it sure took a long time for the penny to drop.

Just wait till they tell people where cheaper pharma can be got, or send rare cases to specialist Chinese doctors, but Italy and Canada may be options.

Sounds good to me. Sounds good for me.

[sabbede]

That 1.2 million includes me, and though we just got a new plan option that saved me a boatload, I'm looking forward to the possibility of saving even more.

You mean people who...

[Anonymous Coward]

...cosplay as the other sex? A man who chops off his his dick and wears a dress is still a man, albeit dickless.

Re:You mean people who...

[Ash-Fox]

As long as they're not directly hurting other people, I don't really care. Let them live life and be happy.

Re: This is a BS article..

[mysidia]

No. The fed could pay 90% interest on T-bills, while charging banks 1% for the FED rate.

The Banks would borrow out their maximum from the fed window and use ALL the money to buy the T-Bills and profit from that arbitrage instead of using it to make loans that carry risk; there would likely be some forms of collusion games where financial institutions would make deposits with each other to increase their borrowing power... consumers suddenly wouldn't be able to get mortgages or auto loans --- even with perfect credit you're more risk than a T-Bill; credit cards would be priced out of the market unless they can charge consumers 120% interest.

Re: This is a BS article..

[Anonymous Coward]

...and it's possible to earn mega-bucks in a not-for-profit. Admittedly, it's not the obvious or easiest place to get a crazy-big salary, but it's possible.

European Health access card

[Bruce66423]

One of the features of being an EU citizen is that you get equal access to other EU countries' health systems - but need to apply for a card to obtain it. I applied on line, and it arrived within days. You were obviously unlucky. And remember, you wouldn't have needed the card to get medical care; turn up, explain the situation and you would have got treated.

We so need this...

[PortHaven]

Amazon.com looked at their bottom line, and they saw one very large expenditure that they had zero control over, and no ability to optimize. What do you think that was?

Employee healthcare costs!

Now, I recently had to get an albuterol inhaler. Albuterol is cheap, it was created in 1966. But inhalers, where they put a tiny bit of albuterol into an aerosol spray run like $65 after insurance contracted discount. That is INSANE!!!!

I'd be surprised if those inhalers cost more than a $1 to manufacture. So imagine, AmazonBasicsHealth offering a similar inhaler for $4. This monstrous price hike is extremely common. CPAPS are basically over-glorified aquarium air pumps. Yet, they cost around $2,000. And many who have utilized, will attest to the fact that the designs are often poorly thought out and build quality lacking. But hey, that plastic tubing is FDA approved, so you get billed $20-$80 for a hose that probably cost 79 cents.

So Amazon looking at this, can easily be like,....well we don't need to make a profit. Because, if we simply sell RX and services at cost, we can reduce our employee overhead by around 10%-15%. For Amazon, a 15% reduction of employee costs is a huge profit margin increase. And Amazon.com is big enough, that once they get it on the ball, can be very disruptive. They can go, and say to a manufacturer, we want a good CPAP for $500. If they don't relent. They design and build their own, and then sell it for $200. The companies will either have to come to the table or face eradication.

But the big thing is services....the doctors and nurses themselves. I've thought that the solution to this problem is to actually fund free medical school - with the catch being that half of a doctors time for the first 20 years or so is obligated back to either the company or community.

Re:We so need this...

[Anonymous Coward]

Albuterol is cheap in it's liquid form, but the US government between the EPA and the FDA outlawed the propellant used in the cheap hand held inhaler that had been around for 30 years. Then the FDA approved an alternative propellant that's used in the now BRAND name albuterol inhalers ProAir HFA and Ventolin HFA. 90% of the recent drug pricing scandals are the result of the FDA and it's polices. File these under the unintended consequences of government regulation.

Re:This is a BS article..

[Joey Vegetables]

Single payer sounds a whole lot better, than allowing my employer decide whether I live or die,

Except now you have government deciding whether you live or die. You can change employers. Good luck changing the government.

Re:This is a BS article..

[usuallylost]

Health insurance companies make their money that way on smaller clients. Most larger companies self-insure. In those cases the insurance company makes their money off of fees for managing the plan. The actual costs for care are directly paid by the company. That is why at many larger companies you can get stuff that is not technically in the plan covered anyway if you can convince HR. The insurance company has no skin in the game so if the employer says they'll pay for it they will cover it.

My problem with euthanasia is anybody you put in charge of it is incentivized to kill you when you get expensive. The various national health systems have proven to be at least as slimy as private insurers when it comes to saving money at the patients expense. I do not want my doctor incentivized to do me in when my care becomes expensive.

Re:This is a BS article..

[edtice1559]

Attacking the "evil" insurance companies is a great way to get a +5 but is completely divorced from reality. Nobody pays claims anymore. When you go to a doctor, they get pre-authorization from your insurance company. I've never heard of a visit being pre-authorized and then denied. Sure they could deny the visit up front but that's not really denying a claim. And insurance companies aren't in the business of denying care. They'd rather you get something addressed right away when it's cheaper to fix. They way you save money as an insurance provider is (1) Encourage people to get healthy and save medical costs. (2) Encourage preventive medicine like an annual physical (3) Negotiate for discounts with the doctors. None of those amount to denying claims. Also insurance has to pay out 85% of premiums as medical care. It's a requirement of the patient protection and affordable care act.

Three of the world's biggest capitalists punt

[Anonymous Coward]

Three of the world's biggest capitalists have decided that capitalism doesn't work in the healthcare industry.

TOO BIG

[Anonymous Coward]

They are all too big which is why I won't do business with any of them.

Re:This is a BS article..

[Anonymous Coward]

There are more than you may think. Many people feel more fulfilled doing what they love to do in life, rather than doing what they hate because it makes them more money that effectively means nothing because they'll never be a billionaire. Personally I don't know a single doctor (and I know quite a few) who did it to get rich. Most of them volunteer their time for socialist causes because most intelligent people can recognize that helping everybody helps yourself as well.

Bottom line, you'd be much less frustrated with your life if you didn't sacrifice yourself to make someone else richer.

Re: This is a BS article..

[Anonymous Coward]

If manufacturing and farming are dependent on illegal immigration it deserves to die. Maybe if we stop paying farmers not to grow things and enforce labor protections on all factories owned by U.S. companies, no matter where they're located, we might have a slower economy and a more moral nation.

The Healthcare Insurance corporations

[pjv936]

profits come out of Amazon pockets. To lower healthcare cost you have to remove the profit and the overhead. They need to create a nonprofit healthcare service company that will own hospitals and clients and that has doctors that work for them. They can then offer this as an health care option to their employees at zero out of pocket cost.

I hope you die of dickworms

[Anonymous Coward]

You're just arguing to argue then. Nobody here is so stupid they don't recognize a finite resource. You're just so stupid you can't recognize artificial scarcities.

Re:First time I think Buffet is stupid!!

[Anonymous Coward]

"how come 3 guys making noise in the corner caused such a change in the market?" oh I don't know; maybe because those 3 guys consist of the head of the largest bank in the US and 2 of the top 5 richest people in the world?

Re:First time I think Buffet is stupid!!

[sjames]

But no matter how hard they wave their wallets, the thing they talked about can't really get going for a year or so. But the chickens are clucking and scurrying now.

Kinda like last month when a couple random companies said the word "blockchain" without demonstrating that they even knew what it was.

Re: This is a BS article..

[macsimcon]

Right, but normally the Fed would just have to deal with sluggish demand, which would be bad enough, but now they're having to do a lot of selling when demand is low, which is going to make their job (controlling interest rates) that much harder.

I'm not saying QE was a bad idea, I think it was a good idea. I just think that the Fed is always late to the party: they wait too long to lower interest rates and inject money into the economy, and then they wait too long to raise interest rates and pull money out of the economy. They should have begun slowing their purchase of treasuries years ago, not wait until there's another bubble.

Until we again separate banking from investment banking, we're going to continue with these boom/bust cycles, and people are going to get hurt.

Re: This is a BS article..

[CaptainDork]

Good reference. I just finished that again, after reading it 35 years ago.

Re:This is a BS article..

[CaptainDork]

The fault lies with you and me.

We enjoy a duality that is at odds

1.) We desire fair play from corporate America.

2.) We expect asymptotic earnings over time increments measured in nanoseconds (in lay terms: "greed").

We vote 2.) and we bitch about 1.).

Re:First time I think Buffet is stupid!!

[Dragonslicer]

Three of the most richest men in the World... sat together for a talk about something that doesn't concern me... and it cost my life savings $5K within just one day.

And how much has your "life savings" increased over the past year or so? My retirement and investment accounts went down by about 1% yesterday, but they're still significantly higher than a year ago. If it's your "life savings", you shouldn't care what happens on a day-to-day basis.

Obama's foray into socialized medicine?!

[Anonymous Coward]

Obama's foray into that

What the fuck are you talking about?

Obama may have wanted to foray into socialized healthcare but he got smacked down and it died just like it did in the 1990s. He ended up signing a bill that mainly just served to make people have to do business with private insurance companies (as opposed to, say, government instead). Republicans were ok with most of that and had been pushing for such a bill for a couple decades, but then the conservative party (Democrats) slipped a "you have to pay your bills" part in.

That one part, mandatory coverage, is what ended up being so divisive and controversial.

The hippies (Republicans) were super-pissed about the having-to-pay-their bills part, so their goal in 2017 was to remove it. That (going back to publicly subsidized healthcare by means of Emergency Rooms) is the biggest step we ever took toward socialized medicine, but more as a symbolic statement (things should be free; you shouldn't have to get a haircut or a job) than an actually government-run healthcare system like UK has.

If there is some part of ACA that reminds you of socialized medicine, please tell us about it. I totally understand you hated that your bills went up, and I'm not mocking you for that, because you damn well do have plenty of reason to be angry and discouraged. I'm just saying that you aren't paying very close attention to whom you giving all that money, and more shockingly (I can't understand how you fucked this part up), you totally missed where the actual medical services are coming from.

Next time you're with a doctor, please look more carefully around the room and please, please try to point at the person who is working for the government. I bet you can't.

ACA was classical government corruption, except with a weird conscientious "no more freebies" slipped in by conservatives, that the hippies have been furious about ever since, and finally won the 2016 election over,

The biggest problem with US Healthcare

[Anonymous Coward]

The biggest problem with US Healthcare is the games they play with pricing.

If they would charge reasonable rates, a LOT more people could afford health care, even without insurance.

Example? Thought you'd never ask

Ten years ago, I had a heart problem fixed. Amount billed? A bit over $483K. Amount settled for? A bit under $75K.
So - without insurance, I'd be dead - no way I could come up with nearly half a million dollars.
But $75K? Of which I provided &6.5K, BTW - I could get a loan, take out a second mortgage. I could do it.
But I wasn't offered $75K.

Stop playing games with the cost, and people will be able to afford getting healthcare.

Re:This is a BS article..

[pots]

Care to try and defend that?

Okay. Insurers and providers don't have high profits. I posted this the other day in response to someone blaming everything on the ACA, but: Health insurer profits, which were never extraordinarily high, are down since 2007. I don't have a convenient link for hospitals, but they're also in the 5% range.

Pharmaceuticals are the most profitable sector of the healthcare industry (by a pretty good margin), and they are responsible for a good portion of the increase in costs in recent years, but even they can't be blamed for everything. A lot of it is just ridiculous inefficiency: you've probably heard that filing health insurance claims, just doing the paperwork, costs hundreds of billions per year. Some of it is high salaries - that competition in staffing that you're talking about doesn't work very well, since patients can't really comparison shop between doctors. And doctors who work in hospitals can demand compensation based on how many patients they bring in... which is independent of how much they charge those patients, since the patients can't comparison shop.

Anyway, if you need to blame a single industry then you can blame the pharmaceutical industry, not health insurers, but that's not really accurate either. It's a big complicated problem without an easy scapegoat.

Re: This is a BS article..

[AK Marc]

Then they would be investment companies, not banks. It would take some changes in rules for banks to allow them to only grant loans to the fed. The liquidity and such are designed for consumer loans and such, not super-long-term T-bills.

But, as you say, the fed could easily change the rules to allow banks to become buyers of T-bills, and if the rates continue to increase, they may do that, in an attempt to limit the interest rates they have to pay, as higher rates mean greater debt/deficit. But if consumer credit is stifled, the entire economy will collapse.

If interest rates on T-bills climb, the government will do something to encourage *anybody* to buy them including banks, so long as it doesn't shut off consumer credit.

Re:This is a BS article..

[david_thornley]

Odd how again, your focus is on the 'big businesses'... and not say... the labor unions who also benefited from that.

The focus is on who's winning. Unions are besieged. Companies run things. Putting pressure on unions isn't going to help much of anything on a national scale. Getting government somewhat independent of big business would pay off big-time.

Re:This is a BS article..

[david_thornley]

While you're running your prejudices, other countries, with much more government involvement, have significantly higher life expectancies while paying maybe half we do (per capita). Try a little empiricism sometime.

Re:This is a BS article..

[david_thornley]

Pre-authorization? Yes, I make sure I schedule all my heart attacks, strokes, and traffic accidents at least a month in advance, to get the paperwork in order.

Sometimes, when I find out about a medical condition, there's time to plan out how to do it and get everything in order. Sometimes there isn't.

ARe:Yes really

[shilly]

Yeah, no.

I'm more convinced by the McKinsey analysis that RCA begins with than the rest of that article. And the Stiglitz report it links to doesn't prove what is claimed, at all.

Re:ARe:Yes really

[FallLine]

Yeah, no.

I'm more convinced by the McKinsey analysis that RCA begins with than the rest of that article. And the Stiglitz report it links to doesn't prove what is claimed, at all.

That's not much of an argument.

A few points:

1) Adjusted Household Disposable Income and Actual Individual Consumption are widely acknowledged by people that have studied this to be superior indicators of material living conditions. GDP is a measure of domestic production, full stop. It is not and was never intended to be a measure of resources actually available to households and it is the household perspective that matters here. GDP is often used as a proxy for these types of measures in lieu of better data, but they're not the same and they can and do deviate quite significantly for a number of reasons.

2) When it comes to predicting national health expenditures and other health system characteristics, these measures, AIC and AHDI, fully mediate GDP in multiple regression and in multiple specifications (much the same if one subtracts HCE from these household measures).

3) CMS uses a close analog to AHDI, disposable personal income, as the dominant exogenous variable in their long-term projections because their research and theory suggest it's much superior as a predictor.

4) These measures are also much stronger predictors of essentially all other measures of living conditions (e.g., life expectancy, life satisfaction, satisfaction with financial conditions, poverty rates, access to clean water, etc). Indeed, if one sets about systematically comparing indicators from organizations like Social Progress Index, Gallup/WVS, Legatum, and others, at least 90% of these indicators have markedly higher r-squared with AIC than GDP. Likewise, in OLS, AIC clearly mediates GDP or, if one disaggregates GDP, the remaining components of GDP (e.g.,net exports, CFC, etc).

5) There is also tremendous consistency in consumption patterns if one looks at disaggregated SNA data by function (COICOP and the like). The patterns the US exhibits in consumption across individual categories/functions is highly consistent with its aggregate AIC, adjusted household disposable income, and so on. The US consumes much more of almost everything in real terms (especially those goods and services that are clearly elastic at a national level). It certainly consumes more in most categories than the handful of significant countries with higher GDP, so it can hardly be surprising that the US would also consume much more healthcare (one of the most elastic categories with respect to national income).

Note: These results are also consistent with what we find if we look at other sorts of more granular measures (e.g., number of rooms per capita, household possessions, private car ownership rates, frequency eating out, etc).

Re:ARe:Yes really

[shilly]

I think you may be confusing me with someone who gives a shit about arguing economics with you.

You say what you like. I'll rely on McKinsey and Stiglitz, thanks.

Also, you mention Legatum as a data source. I mean, really.

https://www.mckinsey.com/~/med...

Re:This is a BS article..

[edtice1559]

And emergency claims rarely (if ever) get denied. In fact we seem to have the opposite problem. Insurers are paying obscene amounts to out of network providers (with whom they haven't pre-negotiated) in emergency situations. I've heard of $100k for a one hour consult in an emergency room and insurance has paid it. Again they have to pay out 85% (or more) in claims so you can't blame the insurance companies profits for the problems with our medical system.

The household perspective is what matters

[FallLine]

I think you may be confusing me with someone who gives a shit about arguing economics with you.

In other words, "I don't have any substantive objections and my sole contribution here is to blithely paste links to widely cited documents that just about everyone has already seen". Why even bother?

I'll rely on McKinsey and Stiglitz, thanks.

I'll take science over expertise any day. I am especially wary when the so-called expert analysis is a little more than the rudimentary analysis of a bunch of kids fresh out of school with only a skin-deep exposure to these topics (I have known many such people, including peers of these authors, and while most of them are reasonably intelligent people, their bluster far exceeds their subject matter expertise).

As for Stiglitz, he has not published anything on healthcare and shared any sort of rigorous analysis, so far as I can tell, so I see no reason to defer to his professed (left wing) preferences. He has, however, published stuff closer to his knitting with Amartya Sen, Jean-Paul Fitouss, and others that pertains to the discussion. Indeed, they recommend AIC and AHDI over and above GDP as an indicator of material living conditions.

Here are just a few instructive quotes:

"GDP mainly measures market production.... However, it has often been treated as if it were a measure of economic well-being. Conflating the two can lead to misleading indications about how well-off people are...Material living standards are more closely associated with measures of net national income, real household income and consumption – production can expand while income decreases or vice versa when account is taken of depreciation, income flows into and out of a country, and differences between the prices of output and the prices of consumer products.
[snip]
In a world of globalization, there may be large differences between the income of a country’s citizens and measures of domestic production, but the former is clearly more relevant for measuring the well-being of citizens...the household sector is particularly relevant for our considerations, and for households the income perspective is much more appropriate than measures of production.
[snip]
While it is informative to track the performance of economies as a whole, trends in citizens’ material living standards are better followed through measures of household income and consumption. Indeed, the available national accounts data shows that in a number of OECD countries real household income has grown quite differently from real GDP per capita, and typically at a lower rate. The household perspective entails taking account of payments between sectors, such as taxes going to government, social benefits coming from government, and interest payments on household loans going to financial corporations.
[snip]
Properly defined, household income and consumption should also reflect in-kind services provided by government, such as subsidized health care and educational services. A major effort of statistical reconciliation will also be required to understand why certain measures such as household income can move differently depending on the underlying statistical source"

Also, you mention Legatum as a data source

As a source? No, I don't think you don't understand. These services, of which Legatum is just one, have helpfully aggregated a wide variety of indicators from various 3rd parties that measure the sorts of lives that people live (health, happiness, material conditions, etc) and these indicators are overwhelmingly better predicted by household measures like AIC, the same measures that Stiglitz et al recommend, than GDP.

For instance:

Social Progress Index:

Re:The household perspective is what matters

[shilly]

Oh bullshit. You don't know peers of these authors, or you wouldn't talk about "kids fresh out of school". Nico Henke is in his 60s; Jean Drouin is in his mid40s. And if you think what either of them does is "rudimentary analysis" and they only have a "skin-deep exposure" to the topic of evaluation of different health systems, you're letting your prejudice hang out. And if you think what you're linking to is "science", you're indulging in more of the same.

Go on, name the "peers of these authors" that you know. The ones who are "kids fresh out of school".

Re:The household perspective is what matters

[FallLine]

The things you choose to engage on is kind of odd.

That observation was very much of a tangential to my argument. I was speaking more generally there as McKinsey has published several high level analyses of healthcare for public consumption and you seemed to be making a broader statement (RE: "I'll rely on McKinsey"). I know a a good number of current and former McKinsey people and stand by what I said.

Jean Drouin is in his mid40s

We're about the same age and surely know several people in common between Princeton, Stanford, and McKinsey. I would not call him a kid now, but at the time the particular analysis you cited was published (2008) he would have only been a few years out of school. Further, there's a good chance much of the (percieved) scutwork has performed by people even more junior than he was at the time.

The point is not that I have any particular reason to believe any of them are stupid or particularly naive, but that I don't put much weight on so-called expertise generally (especially not when I have better information to go on) and even less on this particular "mile wide inch deep" approach to the world. Getting to the bottom of topics like this tends to require a lot close independent study of the details and the McKinseys of the world basically represent the antithesis of this approach (not usually a lot of value add).

And if you think what you're linking to is "science", you're indulging in more of the same

It is the approach the makes it science whereas appealing to expert opinion is pretty much the opposite of science.

Re:This is a BS article..

[david_thornley]

I read something recently about an insurance company denying emergency room charges if they didn't think they were warranted (putting the onus onto the insured to determine whether it's a medical emergency or not), but I have no idea how typical that is, and the company was apparently moving towards looking at the original symptoms rather than the diagnosis.

Insurance companies are part of the problem. They add a lot of overhead. They are nowhere near all of the problem.

Re:This is a BS article..

[edtice1559]

Insurance companies add overhead (15% overhead to be exact) but they typically make up for this (and more) by being able to negotiate better rates. The alternative would be mandated rates (or single player). However with single payer (or in many traditional insurance plans), the patients have no incentive to think about costs at all. This is hugely problematic as there is a wide range of expensive (and marginally useful) treatments out there. In single payer, the government becomes the only insurance company and decides what care you do or do not get. This isn't awful. But with no other changes, single payer will give everybody overpriced healthcare until such time as the country can't afford it. High-deductible plans actually seem like a good choice (whether private or government financed, but no country has HSA-like single payer system). One result of this is that we are seeing many "urgent care" places spring up. You go there is you aren't sure how serious something is. I've gone there and been told to just tough it out costing my insurance only like $80 vs an expensive ER visit. I've gone there and told that I'd better get to the emergency room soon or I'll end up being an amputee. Cost an extra $80 over just going to the emergency room but still savings. Consumers have to have an incentive to control their healthcare costs. Those are very difficult to put together. It's not an easy problem.

Bar Raiser Model

[Anonymous Coward]

So, in Bezos version of health care, do you have to meet some bare minimum of worthiness to get health care?

Cull the bottom 10%? Only allow the rockstar, superhero, Alpha, bar-raisers to get treatment?

Amazon's culture of arrogance isn't likely going to result in a good outcome for patients.

Re:First time I think Buffet is stupid!!

[NeoTubNinja]

Hey guys, get a load of this. The guy who said "most richest men" called one of the richest men stupid!

Re:First time I think Buffet is stupid!!

[NeoTubNinja]

If you don't have 100% control over the money, then by default it is somebody else's business.

It's like saying nobody has the right to know how much money is in your bank account. Well, I beg to differ. Employees at the bank DO have the right to know considering they are part of the equation. Nobody is stopping you from buying gold and storing it in a safe in your closet.

Re: This is a BS article..

[mysidia]

Then they would be investment companies, not banks.

Banks are free to buy T-Bills and often do. Just in the same way as they can loan money to businesses. 7 years ago, there was a time when they were doing mostly that, and mortgages were tough to get and coming at a significant premium.

Banks are less inclined to write loans to consumers and businesses if higher interest is available at zero risk from a government note ---- as a result, there cannot be a large gap between the short term treasuries and new short term debt for consumers, because the high rates available from the treasury notes will reduce the supply of loans to individuals and businesses until the market interest rates for those rise high enough for the banks to expect profit given the risk of making those loans.

Re:This is a BS article..

[Anonymous Coward]

Okay. Insurers and providers don't have high profits. I posted this the other day in response to someone blaming everything on the ACA, but: Health insurer profits, which were never extraordinarily high, are down since 2007. I don't have a convenient link for hospitals, but they're also in the 5% range.

First, never use Forbes as a source of information: they're paywalled, and they have problems with regurgitating something somebody else did - and they miss stuff due to bias and preconceptions about how the world works.

Next, learn the definition of profit: then go look up the salaries and benefits paid to US executives relative to the rest of the world. It is common for people to become filthy rich as executives of a business that "only" gets 5% profits. Then there's the issue of how much the big stockholders are making, which also isn't part of the profits ...

Finally, the right comparison involves looking at health care costs relative to GDP. It's not perfect, but it's the best reasonably neutral comparison. Western European nations are around 9-11% percent of GDP, the USA is at 17%. That's an enormous difference: health care in the USA is massively overpriced.

Some of this comes in doctor's salaries, which are 30% higher than their counterparts in Switzerland (despite Switzerland having roughly a 40% higher average cost of living). But some of that is lost due to the need to pay malpractice insurance and educational loans. So this isn't the biggest factor.

So most of the health care difference comes down to the lawyers (who affect the entire US economy in a negative way, including every step in the complicated logistics chains needed to produce goods and services - a compounding effect like compound interest, or like a regressive VAT tax affecting all goods and services), the pham companies, the patent holders, the health insurance companies, and the wealthy (who have large amounts of stock - make huge amounts of money off for-profit health care - and only pay very little taxes on it due to loopholes).

Re: This is a BS article..

[AK Marc]

I've never seen loans hard to get. When was that? When the rates are super-low, the banks stop lending, but brokers do 100x the business. When rates are low, brokers prey on the low interest making a 30 year loan half the payment of regular rates, pushing people into super-high cost houses, then using fraudulent or near fraudulent actions to classify the loans to AAA and sell them off to banks. But even in the '80s, loans weren't hard to get. You just had to pay 10% (or more) for a "low interest" home loan. 2010, when loans were "hard" to get, the issue was the massive investigation into the "subprime" crisis (named to blame poor Blacks, and caused by rich old white men). Loans were restricted by everyone while the mess was cleaned up. Not a full shutdown, but great restrictions on brokers, and limits on new loans as the risk pools we reset from the fraudulent levels.

Re:This is a BS article..

[david_thornley]

You're making assumptions and overgeneralizing.

Keeping the costs of health care down is not a real impressive return on 15% of the take.

Single-payer does not mean everyone gets what they want without cost to them. It's possible to have co-pays and medical screenings. What it does is provide everyone with access to basic health care, which does a whole lot more than high-deductible plans. Most developed countries have something of a public-private mix of payment solutions.

Bernie says...

[martinfb]

What is Bernie Sander's take on this?

Re: This is a BS article..

[buchanmilne]

Including Amazon.

Yes.

 

AWS began with someone noticing that they needed a load of computers to cover their peak demand, but most of the time they were below that peak and wondering if they could sell some of their excess capacity. It was never intended to be a large part of their business, just a way of reducing the costs of operating their store. It turned out to be quite profitable...

No, this is a myth.

Here is the story from one of the people who was there. There is another article somewhere (couldn't find it now) quoting the head of infrastructure at Amazon at the time saying there was no way he wouls have given up any capacity to AWS or their customers.

AWS was primarily envisioned to reduce the time spent deploying new services, and yes, that was something that Amazon thought other people would pay for.