MURDER, POLITICS, AND THE END OF THE JAZZ AGE
by Michael Wolraich
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Hits of the Day
Amazon, Berkshire Hathaway and JPMorgan Team Up to Disrupt Health Care
By artappraiser on Tue, 01/30/2018 - 2:12pm |By Nick Wingfield, Katie Thomas & Reed Abelson @ NYTimes.com, Jan 30, my underlining in excerpt:
SEATTLE — In a sign of just how fed up corporate America is with the country’s expensive and often confusing health care system, three behemoths — Amazon, Berkshire Hathaway and JPMorgan Chase — announced on Tuesday that they would form an independent health care company for their employees in the United States.
The news added further uncertainty to an industry already reeling from attempts by new players to attack a notoriously inefficient health care system. The lines between traditionally distinct sectors, such as pharmacies, insurers and providers, are increasingly blurring.
CVS Health’s deal last month to buy the health insurer Aetna for about $69 billion is just one example of the shifts underway. Amazon’s potential entry into the pharmacy business is also reverberating.
The three companies provided few details about the new entity, other than saying it would initially focus on technology to provide simplified, high-quality health care for their employees and their families, and at a reasonable cost.
They said the initiative, which is in the early planning stages, would be “free from profit-making incentives and constraints.” [....]
URL:
https://www.nytimes.com/2018/01/30/technology/amazon-berkshire-hathaway-jpmorgan-health-care.html
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Comments
I see this as taking the initiative to start planning what the country needs but our lawmakers aren't furnishing. They're taking this on precisely because they don't want to be in the business, but our current system requires that they spend a lot of time, money and labor on it. They figure they can do it more efficiently with less waste and anxiety for both patients and providers. If the time ever comes, I am pretty sure they'd be glad to get it off their hands and turn it over to single payer. There's just really a lot of nightmares out there in the health care system, it is not working properly, massive, continual change, that stresses providers and patients out, it's a mess and it's not going to get better as more boomers start using it more.As Medicare isn't woke to reality yet either.
by artappraiser on Tue, 01/30/2018 - 2:26pm
Amazon, Berkshire Hathaway, and JPMorgan Are Going to Fix Health Care—Somehow
The ambition is thrilling. The details are scarce.
By Derek Thompson @ TheAtlantic.com, Jan. 30, 1:07 PM ET
by artappraiser on Tue, 01/30/2018 - 2:44pm
I have some optimism in that 1) Amazon delivers excellent services in online books/electronics and cloud computing, while 2) Warren Buffett is a tech skeptic who stands to rein in overoptimistic reliance on geek stuff over more human/traditional business practices. I can't quite figure out the JPMorgan stance aside from the deep pockets (more than Buffett and Bezos can pony up) for a costly initiative.
by PeraclesPlease on Tue, 01/30/2018 - 2:58pm
Bezos, Buffett, and Dimon all have an identical and easily understood goal. They want to reduce the expense of providing health insurance to their employees. Their solution - self-insuring and thereby eliminating the profits that enrich top insurance company managers and shareholders - is exactly the same, albeit on a smaller scale, as the solution that proponents of single-payer arrived at decades ago.
by HSG on Tue, 01/30/2018 - 4:15pm
I'm sure it's not insurance co. profits that they are concerned with, that's the very least of the worries. Most Medicare coverage, after all, is actually now delivered by for-proft managed care plans who manage to cover the high co-pays for Part B for their customers and still make a profit. It's for the cost of labor and time, all the inefficiencies, the tons of clerks and pushing paper, the complex codes and long arguments about each and every case, the claim forms, claim forms, claim forms ad nauseum, the complexity of referrals, the massive amounts of labor involved, and mostly: the constantly changing complex brokered deals with profit-driven medicine which eats up way lots more money than insurance profits do.
I telling you this because: doing this, they are going to make lots of decent-paying paperwork-pushing jobs disappear. As would single payer.There's a ton of make-work labor that's not necessary in that huge chunk of the our economy that is health care. On the opposite end: there probably will be a bigger need for actual providers of health care like Physician's Assistants and and physical therapists which will require training but the pay may very well be lower.
by artappraiser on Tue, 01/30/2018 - 6:20pm
They are doing it because they want to reduce their labor costs. One significant cost is health care insurance. Single-payer would lead to the creation of more jobs because it would eliminate a very significant expense to start-ups and small businesses which create a disproportionate number of jobs. It would also make it easier for folks to leave their current employers and start a business b/c they would know that they would always have health care.
by HSG on Tue, 01/30/2018 - 6:39pm
by Peter (not verified) on Tue, 02/06/2018 - 10:04am
Single-payer health care systems provide better outcomes for less money. So your fear of massive tax increases is unfounded.
by HSG on Tue, 02/06/2018 - 7:40pm
You are misreading what Peter is saying, Hal and going for the simplistic sloganeering.Peter is pointing out the nuance of actualities. He's pointing out the problem of a government single payer having to be a switch from most people getting an employment benefit that they don't know the cost of, to a deduction on their paycheck.
As to reducing costs, he's not at all disagreeing how it is done, he gets it: Even more important than the savings from eliminating profit they may be able to directly negotiate with health care providers which is where the constantly rising costs come from.
In effect what these three corps are doing is taking the business away from the private insurance companies and making a little experimental non-profit single payer system for themselves to show the way. You should laud it, the experimenting is going to help. It will help candidates pushing for changing our system. If they manage to get better outcomes than the relatively lousy outcome that Canada single-payer is getting vis a vis other countries, they can show the way.
I have no backup for this, but I suspect Canada's got such a lousy review in this report because they are close to our medical industrial complex and more susceptible to its effects, too. That they are having difficulty negotiating with all the constant new treatments the big for-profit companies are pushing that are high price patented, where patients and doctors clamor for the stuff in the U.S. advertising.
Meanwhile you never address the problem of jobs jobs jobs going for the simple slogan. Streamlining means not just negotiating with providers but cutting numbers of paper pushers. That Amazon, Berkshire and J.P. Morgan are taking their insurance business away from insurance companies means they will create a few jobs but a lot of people elsewhere will be laid off.
Single payer will eventually mean loss of a lot of jobs. In far flung areas like health care litigation, all kinds of places we can't even imagine. If it is continually negotiate lower costs it certainly will not mean highly paid home health care aides. Home health care is a cost-saving measure because home health care aides are paid much less than hospital workers. Our medical industrial complex provides for a huge number of jobs. It's where a lot of growth in our economy is. Done correctly, single payer will stop that. Done correctly, single payer would make medicine a place where you can't expect to get rich anymore. Because if you can get rich at it, people will be able to see that in the amount deducted in their paycheck. It won't be hidden anymore by an employer paying for it.
by artappraiser on Tue, 02/06/2018 - 3:46pm
Good points, AA, but I disagree on some points.
-As to reducing costs by negotiation, I am constantly amazed when I look over my “This is not a Bill” statements. Procedures that are billed at, say, $140 often have the “Allowed amount” as $39, and “Amount paid” at $11. My husband gets a treatment every 3 months that is billed at $275, but ultimately gets a payment of about $20.
I don’t see how further negotiations would be possible. We are both on Medicare with supplemental coverage.
-As to jobs, OBAMACARE increased health-care Jobs, and saved many (rural) hospitals from folding. The latest GOP attacks and sabotage are reversing that trend. Yes, it’s true that the pencil-pusher who currently works for an insurance company, and whose job it is to figure out a way to decline coverage will likely not be re-employed as a care-giver. But which job is more valuable to our society? The care-giver or the care-denier? And for sure, health care access to all means more jobs in health-care.
-As to home-health workers being paid less than hospital workers, well...hospitals are increasingly becoming highly specialized therapeutic centers. Each hospitalized patient is visited each day by multiple professionals who monitor their care. Home-health Care is not a substitute for that; it is a substitute for a nursing home, or other rehab. Only stabilized patients are discharged to Home Care. The RN’s who do Home Care are very well compensated, but they do the jobs of several people (nurses, physical therapists, nutritionists, and more), so overall it is still a bargain.
This is the place where I agree wholeheartedly with you:
My point is that getting rid of advertisers, paper-pushers, and the profit-motive will not produce a net loss of jobs.
As to Canada...Canadians love their health care.
by CVille Dem on Tue, 02/06/2018 - 7:26pm
On Canada, I was referring to the bad outcome for expenditure scores their system just got on the Commonwealth report for 2017 as opposed to U.K., Australia, the Netherlands, NZ, Norway, Switzerland and Germany. They and France are down signficantly below the others, only above us at rock bottom. See the link and graphics downthread.
Just checking googling now, it's not like no one is complaining up there about how much it costs and what they are getting for it and how they are going to pay for it.
by artappraiser on Tue, 02/06/2018 - 9:15pm
But compared to the US, on this continent with all its corruption and BS, it is still better than we are.
A few years ago I was searching for better infertility drug prices for patients in my practice. The EXACT SAME DRUGS, made by the exact same drug companies could not be ordered because the USDA could not vouch for them. It was total BS.
I wrote a little blog at the time about how I spent 2 weeks in Canada and never once had to move my car out of the way to avoid dead Canadians who had taken Canadian medications.
by CVille Dem on Tue, 02/06/2018 - 10:02pm
hah, good one.
Where I am coming from: fighting yesterday's propaganda wars isn't going to cut it anymore. That Trump uses old propaganda about this topic doesn't mean it's smart to fight back with old propaganda as everyone knows by now that he understands zip about health policy issues. Even the fans know something went wrong with delivering on the "repeal and replace" front....
Even the "nobody's complaining over there" argument has a new answer "well, nobody's complaining about their employer provided coverage either". Except the employers. Who aren't the favorites of lefties and vice versa.
by artappraiser on Tue, 02/06/2018 - 10:52pm
p.s. I'd like to point out that we can't even use Medicare anymore as a single payer example to compare. It's not single payer anymore for the most part. Most retired people these days don't sign on with plain vanilla Medicare because it is high deductible and co-pays, instead they sign with a private insurer who does the managed care for the cost savings. And they do manage to save costs, as they then can offer the recipient other benefits like eye care or gym membership or the like which plain vanilla Medicare doesn't, and then still make a profit and pay the salary of all their employees.
And Part D for drugs is not single payer at all, there is no single payer at all, you have to pick a private insurer.
And Medicare is still very expensive. Fee for service where you have choice of going to any provider with no "in plan" requirements feeds the medical industrial complex. The private insurers who require "in plan" Medicare are doing a better job of Medicare as they negotiate with the "in plan" providers enough to not just make a profit but offer the retirees more benefits than vanilla Medicare does without costing the retirees more. Reality hurts: you cannot have choice, someone's got to manage who gets what.
Add to all of this: Medicare is not free even after you retire and costs are rapidly rising. It is very expensive, csots are not managed well. For those using plain vanilla Medicare, costs are not controlled well at all because they can't be, people can go to any doctor or provider they wish for Part A and Part B. Even though all working people in this country are helping pay for it every month with FICA, retirees premiums for Part B deducted from their Social Security check are being raised. The cost of living adjustment retirees just got in their Social Security check will be eaten up by a rise in the premiums deducted from their checks for Medicare.
by artappraiser on Tue, 02/06/2018 - 4:04pm
Here's what the actual cost per month is for Medicare Part A alone, just insurance for hospitalization. No Part B coverage, all medical care outside the hospital. Citizen retirees with enough employment credits get this free (subject to like a first time big chunk deductible) after paying for it all their lives, but this is what the government charges those who don't have enough credits to get it free:
Paying premiums for Part A (hospital insurance). If you have fewer than 30 work credits, you pay the maximum premium, $411 in 2016.
That's just for Part A, per month. For Part B, retirees with enough benefits to get Part A free are now going to pay a minimum of $134 a month (some higher income will pay more.)
So that's $545 a month minimum per person for Medicare without even getting into drug coverage, no drug coverage in that figure. I could find the higher figure that people without enough credits are supposed to pay for Part B, but I'm not going to bother, that number will suffice to show how much Medicare is able to control costs.
And Congress argues all the time about whether that enough, that it might be dipping into setting aside what the non-retired are paying into the system, the idea is that there's supposed to be a fund set aside for their own costs when they retire.
by artappraiser on Tue, 02/06/2018 - 4:29pm
A person earns 4 credits each year of employment. Someone at the age of 65 (the age of eligibility for a non-disability claim for Medicare), who had 30 credits would have worked 7.2 years in 65 years. Any person who has worked 10 years in their life (and paid into FICA) pays ZERO for Part A.
Most people who collect Social Security pay nothing for Part A because the requirement is simply to have worked 10 years. (Disability requirements are different).
I really think that this worst case scenario does not help inform.
by CVille Dem on Tue, 02/06/2018 - 7:44pm
But CVille, it does inform on how much it actually costs. It's the current value that the government puts on that coverage which the qualified receive without further charge, for the money they paid into in their lifetime. Therefore, if people like the idea of offering "buy into Medicare" for other age groups, one can presume buying in to the Part A hospital insurance would cost at least that much.
Edit to add: It is often suggested that the first group to be allowed to buy into Medicare as like a "public option" would be those like 60 and over, because they tend to access more health care, to get them out of the general population pool. So that makes it an even more accurate estimate. And again, that's just for hospitalization: $411 a month.
It informs a lot, I would say. It's also informative of other things, like: how much hospitals are feeding the rapid rise in costs. This is a government figure, for plain vanilla coverage, without any insurance company profiting.
by artappraiser on Tue, 02/06/2018 - 8:04pm
Sorry, I don’t see it. The requirement for Part A to be “No Charge” is to have worked at a job that paid into FICA for 10 years. My daughter worked for a Vet when she was 15, and paid into FICA from the get-go. My sons came along later, and didn’t start paying in until they were 18.
Ten years? Most 60-something’s have most likely worked at least 10 years.
by CVille Dem on Tue, 02/06/2018 - 8:23pm
The dysfunction is real (And that includes Medicare. So a switch to single payer for all without other reforms and management would far from solve this, might even accelerate it, as it could further feed the "medical industrial complex" that nearly guarantees poor outcomes, with profit incentive over quality of life:)
Mirror-Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care
The Commonwealth Fund
by artappraiser on Mon, 02/05/2018 - 9:02am
by artappraiser on Mon, 02/05/2018 - 9:11am
Yeah, that illusion of teh best damned healthcare you can get is the most disconcertng - we're paying premium bucks for sub-prime service.
Here's more on the premiums scam/intentionally disrupted market - https://www.nytimes.com/2017/11/16/us/politics/obamacare-premiums-middle...
Being held hostage is a good description. Kind of like the DACA "compromise" - kick it down the road for a year, so no one feels safe. Fear and panic are 2 key tools in the Republican toolchest. Why they like guns so much - the image of a gun to the head or chin is too much to resist.
by PeraclesPlease on Mon, 02/05/2018 - 10:05am
Health care corporations are people, my friend, they're hungry and to feel valued, need the newest hottest medical devices, testing machines, pharmaceuticals, bionic body parts, software systems et. al., aiming for the finest doctor-induced prolonged illness money can buy .
And come to think of it, Romneycare is basically what we've had for the last few years, isn't it?!
by artappraiser on Mon, 02/05/2018 - 10:44am
Better than people - replicants. Hungry replicants.
by PeraclesPlease on Mon, 02/05/2018 - 5:35pm
What I'd really like to understand though I am not interested enough to delve into the report (would rather wait until I runa across a good analyst or reporter I trust splain it, i.e. Kaiser or Sarah @ Vox.com): why is Canada and France down there with us on the graph with the bad outcomes? What are the other countries doing different than us 3 aren't?
by artappraiser on Tue, 02/06/2018 - 4:28pm
HAH! they must be mentioning the above Commonwealth Report on Fox News and countering it with how our system is better It just came out. Trump tweeted this morning out of the blue bashing "the Dems" for trying to install UK health care system. UK is rated # 1 in the report. We really have "Fox & Friends" suggesting this admin's policy , just like the SNL skit:
More like Howard Beale in "Network", talk about Deep State type conspiracy. Except he probably didn't get it straight, they may not have said anything about "the Dems", don't trust him to even repeat them accurately.
by artappraiser on Mon, 02/05/2018 - 9:23am
So do we now have a consensus that single-payer universal care is best? If so, let's agree to support candidates who campaign on it.
by HSG on Tue, 02/06/2018 - 1:54pm
Who is "we" and what causes you to think "we" all now agree? That we certainly doesn't include all voters nor does it even include all democratic voters. Even if this hypothetical "we" is defined narrowly enough that it agrees that still doesn't mean that "we" agrees it's politically feasible to make the transition from our current system.
by ocean-kat on Tue, 02/06/2018 - 3:30pm
deleted duplicate comment.
by artappraiser on Tue, 02/06/2018 - 4:51pm
Kind of the opposite, I would say. Amazon, Berkshire and JPMorgan have analyzed the situation and decided that there will be no political consensus for the foreseeable future. That they are not going to wait for the consensus, that they think it will profit them to try it themselves right now. And if they are successful, it will help change the consensus, which will be a side benefit, that they will look like good guys for helping to change the consensus. But they are not doing it out of the goodness of their hearts. They are doing it because they believe it can be a "win win" along those lines. The "don't be evil" thing is a marketing side benefit, wil make them look good to like, millennials.
The one deep down ideology they might be pushing here is that they don't believe that the economy should be ever increasingly about health care, that it shouldn't be taking a bigger and bigger chunk of the world's economy. One thing is clear: they will now be the enemy of the smaller start up health care company stocks. And this will accelerate the trend of mergers, like of CVS and Aetna.
The merger mania in health care provider companies does take us down a path where single payer could be easier to enact. But it means a lot of pain, literal and figurative for patients in the meantime. There will be less choice and more bureaucratic hassles in accessing health care. Eventually people get to the point of: would I rather have a government bureaucracy to hassle with to get my prescriptions and tests? I.E., would I rather have a government approved formulary than the CVS-Aetna-Radiology Monopoly's behemoth formulary?
by artappraiser on Tue, 02/06/2018 - 4:53pm
This example from CNBC makes it clear with them devoting time and money to a whole project on topic, with a conference and all, that this is what lots of business people are interested in. They are trying to get objective analysis with the following selfish motive: They hope to be able to predict where it's going, whether growth in share of economies worldwide is going to rise unabated, what system is going to win, or is someone is going to come up with a better system, etc.
by artappraiser on Tue, 02/06/2018 - 11:45pm