The US has the most extreme form of rationing of any system anywhere, to the point that you can be put in a life-threatening position from lack of access to essential medical care.
Actually, the culture is such that Americans have come to accept the inevitable meddling of health insurance bureaucrats in every single major medical decision. As the late Princeton health care economist Uwe Reinhardt has noted, people in civilized countries with UHC would be horrified – and would never accept – that degree of clinical interference in their medical care from self-interested bureaucrats with the profitability of their employer their first, second, last, and ONLY priority.
Are you saying that the US does not have rationing?
Just so we are clear on definitions here:
Being denied treatment because the private company that controls your access to healthcare chooses not to cover it != Rationing.
Having to wait for other patients, including some who get bumped ahead due to being a higher priority, and getting bumped ahead of others if your condition worsens = Rationing.
ISTM that this discussion has been handicapped by certain posters’ inability to distinguish their (firmly held!) positions on the morality and overall efficacy of various alternative health care systems from a discussion of how the features of various systems produce the results they produce and why. I’ve been focusing on the latter, and don’t intend to engage these posters in this particular discussion.
Maybe the debate of healthcare as a universal right, or the debate of whether American healthcare *needs *reform can go somewhere else. For better or worse, Bezos, Buffet and the dude at Chase (he’s like the third tenor) see a problem that needs to be fixed in the American healthcare system. If you personally don’t think healthcare needs reforming, that’s fine. Perhaps this thread isn’t for you. These guys see an opportunity, a need, maybe just a way to further enrich themselves-- by reforming healthcare, reducing health costs, or whatever. How do you think these businesses can reform healthcare? Is there something totally revolutionary they could do? In what ways can private enterprise meet the needs of those who are currently underserved and/or not served at all by today’s American healthcare system? Is it possible for for-profit entities to set up a healthcare program that is not profit driven? Will this just ultimately be something to benefit their employees? Or will this ultimately flop like other corporations that have at some point decided to tackle the rising healthcare costs?
Can you prove that Americans make more bad choices than Canadians? That they abuse drugs more? Even if they do, how it costs Canadians only about 60% of what it costs Americans to have a greater life expectancy? The province of Quebec runs local vaccination clinics all over starting Nov. 1 each year where anyone with a health card can get a free flu shot. Don’t you think this makes more sense than the nonsense described above.
What I would hope to see would be to have Amazon et. al. start to open hospitals, hire doctors, etc. and start delivering medical care without all the extra profits built in. For example, every hospital has a small army of “medical coders” whose job it is to describe every procedure in the most expensive way possible and every insurance company has its army of medical coders whose job is the opposite. These two armies are fighting each other constantly to no real purpose. My physician daughter-in-law spends hours each week calling insurance companies to get necessary procedures approved. Where is the sense in that? It is the immense amount of non-productive and counter-productive work built in to the American health care system that explains the excess costs, not the people who make poor choices. I’ll wager they don’t cost the system much because they largely cannot get medical care anyway.
You should consider that maybe you’re ignorant of the correct use of that term within this field. See for example the usage by the source quoted in post #53.
If there’s one thing worse than pointless semantics, it’s pointless semantics by people who don’t actually know what they’re talking about.
I fail to see how the correctness of the usage of the term “rationing” by the source quoted in post #53 has anything to do with your incorrect usage of the same term, especially since you’ve already declared that you think “standing in line waiting for service” is “rationing”
That would be a benefit. If companies find themselves having difficulty recruiting and maintaining their workforce, then they will look to change their benefits to be more competitive. If that means adopting this model, great. If that means creating something new and even better, then even greater.
Changing the way healthcare works is not easy, but the biggest difficulty is that you have to be in a position to actually make changes in the way healthcare works. You need to be able to own hospitals and hire your own doctors and other medical personnel. The govt could do it, they certainly have the market, but, absent govt, this is probably the better route.
If they are able to create affordable healthcare to their employees, then there is no reason they cannot extend that to non-employees, who then can get a better healthcare system than the current, and “Amorgashire Health” still makes a profit, then it can roll out across the country.
Well, since I’ve shown you that your concept of “rationing”, as well as the very real and life-threatening nature of bureaucratic interference in medical care, are both signature characteristics of profit-motivated private insurance, I guess it’s fair to say that the worst thing of all is abuse of semantics by people such as yourself who either don’t know what they’re talking about or have ideological motivations to act like they don’t know what they’re talking about.
Certainly, they can reduce costs through sheer economies of scale and bargaining power. The combined financial size of the three entities have huge leverage in any pricing negotiation. That gets you to someplace more cost-effective. Amazon knows logistics and leveraging economies of scale. Berkshire knows insurance. JP Morgan Chase knows financing. Whether they will be able to effectively partner with people who know health care delivery will be an interesting challenge.
Whether such a venture gets to 33% more cost-effective (Germany/France-levels of aggregate cost) is another matter entirely. As my earlier question alluded to, a lot will depend on just how much more (if any) health care goods and services US health care consumers consume, compared to other top industrialized nations with solid health care systems. If it turns out we consume about the same or a little more, then pricing power and bargaining power coupled with the potential for increased administrative efficiency will go far (and might indicate that some sort of limited-rationing UHC system would be viable in the US). If it turns out our health care consumption is significantly greater than other industrialized nations, then I tend to agree with Fotheringay-Phipps; you won’t be able to implement the necessary controls to reduce consumption, and that it will be just another large health care venture, maybe something like a scaled-up Kaiser Permanente, perhaps. Not necessarily a bad thing, mind you, but nothing revolutionary or game-changing.
I just have to add the following, with apologies to Happy Lendervedder for the continuing digression:
The first link describes a wide-ranging definition of what “rationing” might possibly mean, and notes that given a suitable definition, there are necessarily circumstances everywhere where it must occur with respect to health care. It notes in the conclusion that “everywhere in the world healthcare services are allocated in limited amounts, i.e. rationed.” I have shown that rationing is most real and meaningful and worst of all under profit-motivated private insurance, which scrutinizes every single claim from a medical-loss ratio perspective and can and frequently does deny access to health care altogether.
The second link is from a discreditable right-wing tabloid that I’m not going to waste my time on.
The current prices for health care services are not being negotiated by individual employers which are smaller than these three mentioned. As things currently stand, the prices are mostly negotiated by national insurance companies like Aetna, UHC, Cigna, the Blues, and CVS or ESI on the Rx side. These companies have many more members than these three employers combined. I don’t see any reason to think that these three companies will have greater economies of scale and bargaining power than the players already in the field.
The argument is that, when a person does go to the doctor, they spend more, not that they go to a doctor more often. (Though, elective surgery is more common in the US than OECD countries, just not enough to explain the cost discrepancy.)
While it’s hard to get a full average cost breakdown for everything, it is certain that we pay double the cost for drugs, and we have more of the big machinery - CAT scans, etc. - than other OECD countries, if I recall correctly. The hypothesis matches all of the data that I have been able to track down.
Other hypotheses that I’ve seen floated, that we put the elderly on life support for longer, that insurance companies are eating up all the extra money, that we don’t use preventative medicine to the same extent, etc. aren’t born out by the data. I don’t recall which ones had some level of truth or what the specific numbers were, but they offered things like 3% more spending or 0.5% more spending, not 200% more spending than other OECD countries. You couldn’t add them together to reach anywhere near the number.
They can also change the way the system works, through their sheer weight.
If nothing else, creating a standard list of prices for common procedures and treatments that is accessible to the consumer so that they are actually capable of consuming healthcare knowledgeable would be a massive first step.
Then maybe you order your procedure online. You get a time and place for the procedure, go in, all done.
It seems that with as much medical equipment and personnel that actually are underutilized in order to be ready for when someone who can afford them needs them, you should be able to schedule “discount” procedures when those resources would be otherwise idle.
A travelocity for health, as it were.
What reasons do you think would cause that?
I would think that if we overnight created a UHC type system, that there would be a spike initially, as everyone who has been putting off treating conditions that they were not able to afford to address all goes in to finally have their quality of life restored.
But, we are all still human, and have pretty much the same bodies. Why would we be consuming significantly more over a longer span of time?
Maybe it will be the first healthcare delivered by rocket!
But, seriously, there are many fixes that can be made to our healthcare system that aren’t that hard to do by those with the power to do them, they just need to be done, and they are nearly impossible for them to be influenced by those without the power to do them.
These are some pretty smart people with some pretty decent resources behind them. I will be interested in seeing what they come up with, and if it is a solution that scales up for all of us.
The large insurance providers have the members, but they don’t have access to the kind of cash that the three referenced companies do. United Health, for example, pulled in $200B in revenue on $50B Net Assets in 2017. Berkshire alone is stting on $75B cash. Amazon’s sitting on $19B cash. All three companies have relatively easy access to credit. Obviously, they’re not going to plow everything into a side venture; they have core businesses to run.
And sure, it’s not like you can wave around a $50B check and suddenly you’re a health care company. There’s a long, high-risk slog ahead. But I can certainly see the three companies pooling resources to undercut the competition on premiums, even if they have to suffer some short-term losses to do it, in an effort to swell their membership beyond the 500,000 or so employees among them. I can also see them leveraging their extensive networks of businesses to promote (smaller?) providers that cut them a good deal. And the entire venture is going to be non-profit, so that helps slightly.
All speculation, admittedly. They haven’t even hired a CEO for their venture or laid down a clear strategy. But I don’t find it totally implausible that this venture could result in a health care company that becomes a major player in the market space over time.
Besides for that, what does cash have to do with bargaining power and economies of scale? What counts for those is member headcount and healthcare spending. Aetna tells such and such provider “we want lower costs or we cut you out of our network” that counts for much more than a small company saying that. In that regard, I don’t see anything that these employers can do that Aetna/United etc. can’t.
I don’t know about that. These are not non-profit companies. If they’re doing this, then they’re hoping to recoup something, presumably in the form of lower cost for their employee health care. If they can’t beat what the major insurers are doing in this area, it’s not worthwhile for them.
As noted above most big companies and virtually all jumbo companies are already self-insured, in that they’re on the hook for claims payments, and they pay the insurers only for plan administration (in various forms, including claims processing, network access fees, subrogation fees, wellness programs etc. etc.) But the insurers are doing something for these fees, and the question for these companies (assuming they’re going out on their own) is if they can do this better than the insurers who have the infrastructure already set up and enormous experience and economies of scale.
It should also be noted that the BCBS plans are mostly non-profit. It doesn’t seem to me that this provides them with any huge advantages.
Sure they can be a major player. Any time three companies of this size decide to be major players they can be major players, especially considering the number of captive members they already have. (Also note: Berkshire Hathaway is itself an insurer - though in the P&C space, it may help them out somehow.)
The question is not whether they can become major players, it’s whether - and how - they can fundamentally change the way medical insurance and care is provided in the US. If it’s just a matter of them becoming major players doing something similar to what the other major players are already doing, then it’s of relatively minor interest.
But you can use cash to buy members. Undercut the other players by offering plans at a slight loss, acquire other players outright, and other such things. I am not saying this new venture should do this, or that they will do this. As you say, just doing the same thing as everybody else, but perhaps doing it slightly more efficiently is nothing terribly remarkable and somewhat pointless. But the cash has meaning, in my view.
Just going off the press release, it seems like their initial strategy will be the large tech strategy of lots of small-scale experimentation to see what sticks.
I can imagine things like streamlining reimbursement processes to reduce admin overhead, publishing service pricing lists to members for plans that have significant co-pays, paperwork reduction, establishment of standardized electronic payment network system, some rudimentary AI to advise members in the selection of plans and providers that best fit their needs, establishing a standard format for electronic health records; these types of things would be some obvious areas of exploration before committing to more “out-there” ideas. And who knows, if you’re willing to take a shot on worker-free stores and drone-based home delivery, maybe you’re willing to entertain some crazy health care ideas too.
