Amazon, JP Morgan, Berkshire Hathaway & healthcare reform

Great Debates
41

They say it “underperforms” by blankly staring at longevity statistics. There is no explanation of a causal relationship that is anything more than political speculation.

The causation i posited is backed up by the facts of unhealthy American behavior, therefore it is more than mere speculation. It is also a much more simple explanation of the differences in longevity and health expenditure. Can you cite some health experts that agree that “efficient and effective” healthcare products and services are more important than healthy lifestyles when it comes to manifesting healthy outcomes?

42

Have you backed up your assertion that American behaviour is significantly less healthy than say Brits or Canadians?

43

Trying to explain it away does not make it better really.

Many times reached thanks to the power of the corporate media in the USA.

A corporate media that also has to cater to the same advertisers that do tell the people to have bad choices, not only about behavior, but about bad choices on health care and the medicines they “must” use.

Higher thanks to the war on drugs.

Not surprising that the policies of many conservatives allow the results we do see.

But the main point here is that what it is more likely that when we **do **get universal health care that we will see those other factors to be reduced in their effects if only because more changes are likely under a less conservative congress and administration.

Because under the current ones, even gun violence is bound to affect an issue like health care in the worst ways possible:

http://www.chicagobusiness.com/article/20170706/NEWS03/170709953/dont-expect-health-coverage-if-you-survive-a-gunshot-wound

44

Yet the US rations far more harshly and heavily and end up spending far more money. Also, medical procedures in the US are demonstrably vastly more expensive than in other nations.

That is not a real term. What you are using could describe both Beveridge and national insurance system, and probably some Bismarck ones too. Please use real terms, not made-up ones.

Economics don’t work like that, and healthcare don’t work like that. People don’t forego necessary healthcare if there is a wait. Anyway, again, we can see that US procedures are individually much more expensive. We can also check US rates of amenable mortality, to see that they are higher.

Also, waits are generally considered in measurements of access to healthcare.

The first link divides health care waste into administrative, operational, and clinical waste and provides an overview of each. Sorry about the second link, let me try that again:

NCBI: Waste, Economists and American Healthcare

45

Whatever it’s “thanks to” doesn’t really counter his argument.

Hmm, I thought the rest of the Western world had come close to catching up with American obesity rates but a little looking seems to still have America way out front.

46

Here is one that ranks healthcare systemson care process, access, administrative efficiency, equity and outcomes.

Said unhealthy behaviour does not seem to have the same outcomes in countries with different health care systems though.

Sadly, simple does not always mean correct.

I think most Public Health 101 textbooks should cover that the healthcare system is the biggest factor in lifespan and outcomes?

47

I see. So you’re saying that “a medical appointment” at a future date is equivalent to not getting medical care. That tells me all I need to know about the accuracy of your argument, and therefore its usefulness. Rationing, according to the Oxford Dictionary, is defined as the allocation of “a fixed amount of a commodity officially allowed to each person during a time of shortage, as in wartime”.

Some have argued that rationing in health care is necessary and even desirable, but that’s an entirely different discussion. Future-dated appointments sure ain’t it. What I’ve seen from personal experience here is vast amounts of medical care being lavished even on the very elderly, to an extent that surprised me even with my high expectations. To have someone unfamiliar with the system and peddling a political agenda tell me that it’s being “rationed” is hilarious.

Maybe you should read the actual article instead of, once again, just making baseless statements. The very first sentence states that the US health care system “underperforms relative to other countries on most dimensions of performance”. It then goes on to say that it “… fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity.”

Given the careful analysis cited above – and many many others that come to exactly the same conclusions – do you have any credible cites other than baseless speculation that American behavior alone accounts for such an enormous difference in health care expenditures and worse medical outcomes, as opposed to the broken insurance system that everyone else has concluded is responsible – and that no other country on earth depends on in the same way for its primary health care coverage? Does it not strike you that some medical procedures costing 4 or 6 times what they do in Canada, for instance, is (a) a contributor to health care costs, and (b) an obstacle to access, and therefore an impediment to health?

48

I was rationed at McDonalds the other day. There were 8 people in line and only two cashiers. It would have been much better if they had enough people working so that no one ever had to wait. In the end it took 5 minutes for me to get to the head of the line. I was outraged.

49

Anyway, leaving the notion that long waits somehow translate into fewer procedures performed, and returning to the comparison of health care rationing between the US and the rest of the developed world:

The US has fewer GPs per 1000 population than the developed world average. Americans have fewer doctors appointments than other nations citizens. It has fewer hospital beds per citizen. And Americans are more likely to report barriers to health care access than peer countries.

Limits on care based on medical need are fundamentally different from limits on care based on wealth, employment status or insurance company’s ability to deny funding.

50

Not challenging you on this, as I don’t have data either way, but do you have any data/cites to back this up? I know this isn’t GQ, but this is something I have always been curious about. There are many possible causes to the high US health care costs, administrative waste/inefficiency, lack of price transparency, overconsumption/defensive medicine, profit motives, and a whole host of other possible causes that I’m omitting. Is there strong data evidence that, on a per-capita basis, the United States simply consumes more medical goods and services (prescriptions, doctor-hours, whatever…) than, say, Canada, the UK, or France? We consume more on a monetary basis, but US services also cost more, so comparing consumption in dollars is not necessary the best apples-to-apples comparison.

I agree that US health care consumers and doctors have a tendency to resist restrictions on health care consumption. If it is true that US consumers consume vastly more medical goods and services than other industrialized nations, then I agree with you that there will be limits to what Amazon, JP, and Berkshire can accomplish (although they still have the ability to reduce inefficiencies and leverage their purchasing power to secure lower prices per good/service). If, on the other hand, US consumers do not, on a per-capita basis, consume substantially more goods/services than other industrialized nations, then we should be able to bring our costs roughly in line with other nations, on a %GDP basis, by applying strong downward price pressure on suppliers (while hopefully being careful to not to apply so much pressure as to put them out of business).

51
  1. Well, there is one way. See the animation in that video? It shows the reason why fewer payers in healthcare do lower costs, because fewer payers can force hospitals to accept lower reimbursements. This is the reason why medicare can pay so much less, because any hospital that doesn’t accept medicare is going to have trouble maintaining enough revenue to keep their doors open. (it’s better to bring in double the revenue even if that portion of revenue is low profit, because at a minimum it buffers your business against fluctuations in your high profit business)

I am guessing here, but I see a way that *might *work.

If Amazon creates a division that runs it’s own hospitals, where these hospitals are state of the art and heavily use machine learning and AI to reduce labor expenses (this may sound scary but regular doctors and nurses make countless mistakes daily, human doctors and nurses are in fact shit for reliability, fail to consider countless risks and symptom pairings as they diagnose and treat, and have barely enough mental energy to just follow a simple procedure for most patients they see), they could lower the actual cost side.)

Then this “mega conglomerate” would accept healthcare premiums directly, eliminating all the bureaucracy of claims vs claims processing. They would handle all this instead via the same technology that powers Amazon.com.

This would eliminate about half the cost right there.

JP Morgan and Berkshire are just a conduit for the absolute immense amount of money this would take. Also, political favors, this plan probably violates some antitrust law or state government regulations of some sort.

52

But, reading the article, all I see is that Amazon has noticed the pharmacy business is something it can get in on.

Obviously, Amazon’s technology would allow for fully robotic drug packaging and delivery, with the drugs delivered by their same day delivery or even drones if they get them to work.

Their new machine vision tech would allow for much more accurate robotic pill counting, since a load cell + optical count could ensure basically 100% accuracy.

And they could handle the pharmacist consulting requirement through video conferencing or something. Much more efficient than deploying a pharmacist to every CVS and Walgreens and paying them all 6 figures.

Also, if you look at what a pharmacist is supposed to be doing mentally - cross referencing lists of side effects between different medications and between the patient’s weight and other factors, you realize that this is something the latest and greatest in machine learning can do way better than humans.

53

There are other issues in play as well (e.g. the US absorbing most of the cost for R&D).

Sorry I think it’s a real term and you know what I mean.

You’re wrong about that, unless you’re being strict about the term “necessary” (which you yourself have introduced here and was not part of my formulation). Besides for common sense, there’s also your own source:

(Emphasis added.) This is precisely the point I’ve been making since my first post on the subject, and it’s surprising that a guy who uses this very source would be disputing this.

Further from your own source:

(Emphasis added. This is a different type of rationing than the long lines that I’ve been discussing, but it’s rationing just the same.)

54

Not much offhand. As above, I’m a health care actuary by profession, so I’ve read an enormous amount of this type of analysis over the years, but it’s not like I keep a file on this or anything.

However, if you look at the first linked study helpfully provided by Grim Render, they discuss this and give some examples.

55

Actually, it was to comment that his was not a counter either to what that **Giles **said. If anything it was what Giles noticed, part of why health care is more effective in other developed nations is a result of taking into account other factors, that are “coincidentally” also made worse by conservative ideologies.

56

Your axiom that health care is a basic human right is not universally shared.

57

In the US health care for the elderly is paid for through Medicare, which is socialized medicine by his definition. I’d like to see him cite rationing in this case. I haven’t seen any.

58

I assume “him” refers to me.

You may have misunderstood my initial post, as I’ve not said anywhere that think government paid healthcare has to be rationed - I suspect this may be a kneejerk reaction from certain people. What I said was that government pay systems deal with the issue (of non-payers making decisions) in large part by rationing, which is true, as has been shown (in the case of GB specifically).

It’s theoretically possible for a government system to not ration and deal with the issue by raising taxes or the equivalent. In the case of the US, payroll taxes pay most of the cost and price controls (a form of tax) are also in place.

I would think one big reason the US doesn’t have the form of rationing as in other socialized countries is that the bar for medical care is set by private insurance plans, and once the culture is such that people can choose whatever medical care they want without approval from bureaucrats, it would not be politically viable for the government to treat Medicare patients differently. (The dynamic here is that seniors are an enormously powerful political bloc which is strongly behind Medicare, while the actual funding is mostly by active workers and indirectly subsidized by price controls on providers.) But Medicare’s long-term financial projections don’t look good, and once the money runs out it’s anyone’s guess as to how it gets dealt with.

59

It should be, and not just for the old and valid moral reasons, but if that bug remains, then we should manage with the economical reasons why it should be a good idea.

From Robert Harris Frank. Professor of Management and a Professor of Economics at the Samuel Curtis Johnson Graduate School of Management at Cornell University:

60

You still beating that dead horse about a scheduled wait for a non-critical appointment = rationing? :rolleyes:

As for the above article quote, I guess it’s fortunate that private insurance would never consider such cost-effectiveness and would never, ever, deny anything! … [what I need here is a massive rolling-eyes emoticon!] …
David Chaplin-Loebell had been using the same asthma maintenance drug, Advair Diskus, for 10 years. Despite a recent exacerbation, his primary care physician and his specialist agreed back in January that the Advair Diskus was his best option.

But when he showed up at his pharmacy for a refill in February, Chaplin-Loebell, an IT director, was told that Advair was no longer covered by his insurer, Aetna. The denial contained the confusing message “requires pre-certification or step therapy,” and that was the only explanation he got from Aetna.

… In most cases where drugs are suddenly denied by an insurer, it’s because the insurer has updated its formulary, the list of approved drugs it will cover.** The insurer’s goal is “to keep access to prescription drugs affordable**, which can result in changes to drugs included in the formulary,” …
https://health.usnews.com/health-news/patient-advice/articles/2015/05/05/when-your-insurer-pulls-your-drug-coverage
(Bolding mine.)
This is not an isolated occurrence. One of my own close relatives, a long-time US resident, was recently denied drug coverage by his insurer, who insisted on something cheaper. And he has a top-tier executive-level plan from a major employer.

Let me give you a word of advice, wanted or not. Most reasonable people on the left, the right, and everywhere in between agree that the US health care system is fundamentally broken in terms of access, out-of-control costs, out-of-control bureaucracy, and bureaucratic meddling in the clinical process that should be strictly between doctor and patient. Opinions just differ on how to fix it. Meanwhile every civilized country on earth has some form of universal health care for all its citizens, and most UHC models closely correspond to single-payer even if they differ in the implementation, and here, again, people might disagree on optimal implementations but not on the general philosophy of UHC. To blindly defend the catastrophic US system while trying to disparage the UHC systems in the rest of the world based on some made-up hokum about “rationing” is always going to be a losing proposition.