Here is the simple reality on health care costs: people without insurance go to the ER and their costs are shifted to those who can pay for insurance, If you want to cur costs you need to stop Cost Shifting. That means that everyone has a means of treatment without their costs being shifted. There are various approaches, but my preference is Australia's approach, mainly because I had to but private insurance there when I was there on business throughout the year.
Australia has a private/public system. You pay a 3% Medibank contribution, or 2% if you have private insurance. You get your Medibank card and use it for deep drug discounts, and free public hospitals.
An example of the quality of private insurance was when I had an abscess while in Sydney. I went to a dentist who lived in the apartment hotel I stayed at, was told to get to the office at 3 pm. He did the root canal using advanced technology. He then gave me a receipt for the AUD 800 that I had paid with my credit card.. On the way back to my apartment I passed a Medibank Private office so I went in and asked what I needed to do with the receipt, I was told to go the counter, fill out a form and take it to the cashier. A fast check that my membership card was valid and current and the cashier started counting out the AUD 800.
No deductions No discounting No waiting - I was paid immediately.
Compare that to how your insurance in the US would work.
Comparing premiums between the two countries:
My US insurance was $1,100 a month, $550 for the wife and $550 for me. There was no Dental coverage.
My Australian coverage was $88 a month, with Dental.
BTW, the private insurance there is very aggressive and profitable. So profitable that the government started their own private insurance corporation to compete and I chose that option.
That type of approach to costs is the only approach that will LOWER costs in the US. Don't like it? Get your checkbook out.
I don't think I'd want my employer to be my healthcare provider. Especially one known for its mastery of mining data. I'd certainly want the strongest of firewalls between the healthcare side and the HR side.
Regarding your last paragraph, the US isn’t the USSR. We don’t need or want Government Healthcare. There is nothing that can be done by the private sector that cannot be made worse when the Federal government gets involved. The entire insurance and healthcare industries are ripe for massive deregulation and innovation shakeups. People will (against current beliefs) come to see that less interference is better and more competition is much better.
Lol. Do you have a reading comprehension issue?
Cite please? Really? ROFLMAO.
Oh, I don't. The bigger problem seems to me to be that you have an authority comprehension issue. Not to mention reading comprehension issue too, since I did not see anything that he said as being against protecting people's privacy.
Companies used to self-insure their employees before healthcare costs exploded. There are several groups to blame for the ridiculous increase in costs, in no particular order, greedy doctors, greedy insurance companies, greedy doctor's medical groups, Wall Street, and greedy prescription companies. Blaming ACA (@SpamSandwich) doesn't get to the root cause. Starting to cover your own employees hopefully would get rid of the money-sucking middle companies, especially the insurance companies. All you have to do is look at the insane profits companies like Anthem (market cap of $62B, stock price 400% increase in last 5 years) makes for pushing paper to understand where the problem lies. You can complain all you want about socialized medicine and government waste but your medical insurance costs are driven by Wall Street greed and not by our government. Why are so many people involved in paying our medical bills? Every extra person who touches that money takes their cut and they don't deserve it. Get rid of these companies and costs would go down--as long as one of the other middle companies doesn't do a money grab to keep it where it is.
The larger problem is insurance companies are treated like banks, too big to fail. More and more companies are being added to that list making it very difficult to streamline any business to save consumers money. (Take consumers either way you want, plural or possessive.) I hope these companies can actually find a way to reduce medical costs but is they simply take a short cut and continue to outsource their medical accounts handling to an insurance company they haven't improved anything.
“Greed” isn’t a root cause of the massive spike in costs, regulation and real market competition interference is the root cause. Everyone, and I mean EVERYONE, is individually self-interested, whether they are willing to admit this fundamental truth or not.
When COMPETITION instead of top-down control is involved, it is competition that squeezes out that self-interest which serves immediate needs in favor of long-term mutual self-benefit.
If there was no competition and unlimited demand for cell phones, a single cell phone company could charge anything it wanted for a phone and there would be nothing anyone could do about it.
Competition in the medical arena disappeared years ago, if there ever was any. Regulation hasn't worked and is regularly removed when politicians pockets are lined. (I forgot to mention politicians.) Self-interest is how healthcare operates. I suggest it's a typical cartel just like too many other things. My daughter is a PT and she's there to help patients but hospital administration only cares about the bottom line and filling beds so patients don't always get the level of help they are paying for.
Don't compare a commodity like cell phones to healthcare, they're totally different.
The comparison is made for the purpose of underlining the idea that limited competition and harmful regulation will cause both scarcity and a decrease of quality.
Competition is critical to squeezing out wasteful spending/costs (something Amazon is terrific at doing) and automation, machine learning and mass-individual production of methods of treatment and medications will press other providers to do better or go out of business.
I maintain that Walmart and other large players will be entering this market also (including Apple) because that’s where all the money is these days. Huge profits mean huge opportunities for improvement.
I don't think I'd want my employer to be my healthcare provider. Especially one known for its mastery of mining data. I'd certainly want the strongest of firewalls between the healthcare side and the HR side.
Regarding your last paragraph, the US isn’t the USSR. We don’t need or want Government Healthcare. There is nothing that can be done by the private sector that cannot be made worse when the Federal government gets involved. The entire insurance and healthcare industries are ripe for massive deregulation and innovation shakeups. People will (against current beliefs) come to see that less interference is better and more competition is much better.
Lol. Do you have a reading comprehension issue?
Cite please? Really? ROFLMAO.
Oh, I don't. The bigger problem seems to me to be that you have an authority comprehension issue. Not to mention reading comprehension issue too, since I did not see anything that he said as being against protecting people's privacy.
Get a grip, and don't exaggerate.
HIPAA governs more than just privacy and monetizing patient information IS part of unregulated capitalism.
HIPAA Title 1 regulates coverage for people that lose or change jobs and denying covering of pre-existing conditions and specific diseases. HIPAA Title 2 regulates electronic health care forms so companies can't lock you into incompatible formats as well as protects that data via the privacy regulations. HIPAA Title 3 regulates tack related stuff HIPAA Title 4 regulates group health plan requirements (more stuff regarding pre-existing conditions and coverage) HIPAA Title 5 regulates company owned life insurance and more tax stuff for what happens to non-citizens.
Folks that wish to deregulate healthcare will wish to dismember HIPAA. The non-discrimination rules within HIPAA means they can't discriminate by making you ineligible because you are a higher risk or poorer health and they can't discriminate against you by charging more. That's only moderately annoying to most companies but MUCH more so for those that self-insure.
Don't exaggerate? How about you don't talk about stuff you don't understand? Anyone for unregulated health care because "capitalism is the solution to everything" will get rid of Title 2 along with all the others because monetizing patient information is HIGHLY profitable. If you have access to PHI you can create a huge medical marketing database worth billions. Employers that self-insure will use PHI data to not hire people they expect to lose money on because they have pre-existing conditions or a genetic probability for an expensive disease. Locking medical records into incompatible formats so you can't change health care providers as easily is also profitable.
Employer-managed plans have been around for quite a long time. Some completely "self" managed, some with more oversight/back end support from larger care managers like Aetna & the Blues.
Many larger firms have done this over the years to lower the costs of care for their large number of employees. More succinctly, it removes the middle man's profit margin, and gives it back to the employer.
This really could swing either way - companies will have a far greater incentive to focus on preventative health care, which is far more cost effective that the treatments cost years or decades later (smoking, sugar intake, lack of exercise, regular checkups). Also if they can do something about the insane cost of healthcare in the US, than can only be a good thing. Insurance companies have never addressed that.
On the other hand, your employer knowing everything about your health might not be a good thing. You can see a future where compensation, promotion and other decisions could be made with health considerations in mind, or even decisions about lay-offs. Employees could be more dependent than ever on their employers (COBRA isn't great but it can give you a cushion) so losing your job or quitting because of some unacceptable factor at work, would cost you more than ever.
Of course, the fact that this is even something they need to consider doing, because healthcare in this county is such a freaking mess, is the real tragedy.
Regarding your last paragraph, the US isn’t the USSR. We don’t need or want Government Healthcare. There is nothing that can be done by the private sector that cannot be made worse when the Federal government gets involved. The entire insurance and healthcare industries are ripe for massive deregulation and innovation shakeups. People will (against current beliefs) come to see that less interference is better and more competition is much better.
Highly profitable healthcare middle-men like Aetna and the Blues are who is rattled.
Employers of over 1 million Americans just realized how much money they can save by cutting out the middleman.
Look up the quarterly reports & profit margins of these companies & realize exactly why health insurance in the US is so expensive, and has some of the worst outcomes in the developed world. These middlemen decrease access through cost & closed networks all while delaying treatment & more importantly *not* supporting preventive care.
Other countries have limited this via centralized government regulation, we have let it run amuck in the free market & enrich a few at the expense of our populations life expectancy.
This really could swing either way - companies will have a far greater incentive to focus on preventative health care, which is far more cost effective that the treatments cost years or decades later (smoking, sugar intake, lack of exercise, regular checkups). Also if they can do something about the insane cost of healthcare in the US, than can only be a good thing. Insurance companies have never addressed that.
On the other hand, your employer knowing everything about your health might not be a good thing. You can see a future where compensation, promotion and other decisions could be made with health considerations in mind, or even decisions about lay-offs. Employees could be more dependent than ever on their employers (COBRA isn't great but it can give you a cushion) so losing your job or quitting because of some unacceptable factor at work, would cost you more than ever.
Of course, the fact that this is even something they need to consider doing, because healthcare in this county is such a freaking mess, is the real tragedy.
Regarding your last paragraph, the US isn’t the USSR. We don’t need or want Government Healthcare. There is nothing that can be done by the private sector that cannot be made worse when the Federal government gets involved. The entire insurance and healthcare industries are ripe for massive deregulation and innovation shakeups. People will (against current beliefs) come to see that less interference is better and more competition is much better.
Highly profitable healthcare middle-men like Aetna and the Blues are who is rattled.
Employers of over 1 million Americans just realized how much money they can save by cutting out the middleman.
Look up the quarterly reports & profit margins of these companies & realize exactly why health insurance in the US is so expensive, and has some of the worst outcomes in the developed world. These middlemen decrease access through cost & closed networks all while delaying treatment & more importantly *not* supporting preventive care.
Other countries have limited this via centralized government regulation, we have let it run amuck in the free market & enrich a few at the expense of our populations life expectancy.
Don't get me wrong, if the healthcare insurance companies could be put out of business by companies like Amazon, Google or Apple, I'd love it.
1.1 million probably isn't a large enough pool to constrain costs. The reason federally run insurance programs like Medicare have been more successful in controlling costs vs. private insurance is specifically due to it being a nationwide pool. These three groups probably have a lot less leverage than they think, or else they're not admitting some other part of the plan...like jettisoning older employees from employment (i.e., those that aren't in upper level management).
this is simply untrue.
there are many companies that are already self-managing healthcare plans for only a few thousand employees because the bottom line savings is so dramatic.
Medicare vs. private insurance has nothing to do with numbers, and more to do with profit margins. The federal government is ecstatic if the get a *balanced* budget. Private insurance companies are demanded to produce ever increasing quarterly profits by their boards and shareholders.
Since Amazon (not the other two companies) is in the data collection AND efficiency improvement business, I fully expect they will use what they learn here to eventually spin their business interests into streamlining the entire system and offering small, efficient clinics, automated diagnostics and patient services (using AI and robotics or more efficient processes) and even eventually get into a “doctor-on-demand” home service where a tele-doctor or “van” would make a drive up visit and the patient would enter to be examined or conceivably be operated on.
These things all already exist & are being used.
CVS & their minute clinics Uni hospital systems and their small community clinics tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
Since Amazon (not the other two companies) is in the data collection AND efficiency improvement business, I fully expect they will use what they learn here to eventually spin their business interests into streamlining the entire system and offering small, efficient clinics, automated diagnostics and patient services (using AI and robotics or more efficient processes) and even eventually get into a “doctor-on-demand” home service where a tele-doctor or “van” would make a drive up visit and the patient would enter to be examined or conceivably be operated on.
These things all already exist & are being used.
CVS & their minute clinics Uni hospital systems and their small community clinics tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
I'm talking about these things being automated, requiring fewer people in the process. This alone will save a ton of money.
Since Amazon (not the other two companies) is in the data collection AND efficiency improvement business, I fully expect they will use what they learn here to eventually spin their business interests into streamlining the entire system and offering small, efficient clinics, automated diagnostics and patient services (using AI and robotics or more efficient processes) and even eventually get into a “doctor-on-demand” home service where a tele-doctor or “van” would make a drive up visit and the patient would enter to be examined or conceivably be operated on.
These things all already exist & are being used.
CVS & their minute clinics Uni hospital systems and their small community clinics tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
I'm talking about these things being automated, requiring fewer people in the process. This alone will save a ton of money.
so am i - we are doing it! we are, and it does require less staffing, and, especially tele-medicine, can increase the access to hyper-specialists, however other costs - vehicle, driver, highers equipment maintenance costs, etc all come into play too.
honestly, the biggest limitation to our tele-medicine work is insurers, with the biggest limit being the requirement for the MD to hold a medical license in whatever state the patient is in. (malpractice lawyers & unlimited tort awards are the most likely root-cause of this)
1.1 million probably isn't a large enough pool to constrain costs. The reason federally run insurance programs like Medicare have been more successful in controlling costs vs. private insurance is specifically due to it being a nationwide pool. These three groups probably have a lot less leverage than they think, or else they're not admitting some other part of the plan...like jettisoning older employees from employment (i.e., those that aren't in upper level management).
this is simply untrue.
there are many companies that are already self-managing healthcare plans for only a few thousand employees because the bottom line savings is so dramatic.
Medicare vs. private insurance has nothing to do with numbers, and more to do with profit margins. The federal government is ecstatic if the get a *balanced* budget. Private insurance companies are demanded to produce ever increasing quarterly profits by their boards and shareholders.
How many of the CEOs in the self-managed healthcare use that health plan vs something from BCBS or Cigna?
Tell me there’s no difference between a doctor that works for Kaiser and one that works for Stanford.
The bottom line savings won’t be used for better benefits but rather even more cuts and even more limited options in health care.
Since Amazon (not the other two companies) is in the data collection AND efficiency improvement business, I fully expect they will use what they learn here to eventually spin their business interests into streamlining the entire system and offering small, efficient clinics, automated diagnostics and patient services (using AI and robotics or more efficient processes) and even eventually get into a “doctor-on-demand” home service where a tele-doctor or “van” would make a drive up visit and the patient would enter to be examined or conceivably be operated on.
These things all already exist & are being used.
CVS & their minute clinics Uni hospital systems and their small community clinics tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
I'm talking about these things being automated, requiring fewer people in the process. This alone will save a ton of money.
so am i - we are doing it! we are, and it does require less staffing, and, especially tele-medicine, can increase the access to hyper-specialists, however other costs - vehicle, driver, highers equipment maintenance costs, etc all come into play too.
honestly, the biggest limitation to our tele-medicine work is insurers, with the biggest limit being the requirement for the MD to hold a medical license in whatever state the patient is in. (malpractice lawyers & unlimited tort awards are the most likely root-cause of this)
IBM already has an expert system that reviews radiological images and can provide a more accurate analysis than a professional. This will continue to happen in any field requiring highly paid medical personnel (general practitioners, specialists, etc.).
Since Amazon (not the other two companies) is in the data collection AND efficiency improvement business, I fully expect they will use what they learn here to eventually spin their business interests into streamlining the entire system and offering small, efficient clinics, automated diagnostics and patient services (using AI and robotics or more efficient processes) and even eventually get into a “doctor-on-demand” home service where a tele-doctor or “van” would make a drive up visit and the patient would enter to be examined or conceivably be operated on.
These things all already exist & are being used.
CVS & their minute clinics Uni hospital systems and their small community clinics tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
I'm talking about these things being automated, requiring fewer people in the process. This alone will save a ton of money.
so am i - we are doing it! we are, and it does require less staffing, and, especially tele-medicine, can increase the access to hyper-specialists, however other costs - vehicle, driver, highers equipment maintenance costs, etc all come into play too.
honestly, the biggest limitation to our tele-medicine work is insurers, with the biggest limit being the requirement for the MD to hold a medical license in whatever state the patient is in. (malpractice lawyers & unlimited tort awards are the most likely root-cause of this)
The root cause is a desire for people not to die from bad doctors.
There is a huge difference between routine care and preventative medicine and urgent care and significant invasive medicine.
You guys seem to think that systems like Kaiser and remote clinics that can do preventative medicine well can also handle the complex or chronic cases equally well.
Not so much as Kaiser kidney transplant patients found out in 2006. They were forced out of the UCSF and UC-Davis programs and forced to use Kaiser transplant services only. Several died that should have gotten kidneys.
How many self-insured health plans want to shell out for $500,000 liver transplants? Zero. Like in the Kaiser lawsuit where Kaiser doctors refused to authorize a MRI it’s a lot more cost effective to under-test so they can under-treat and hope the patient dies quickly.
Wait until it’s your loved one getting inadequate care.
Since Amazon (not the other two companies) is in the data collection AND efficiency improvement business, I fully expect they will use what they learn here to eventually spin their business interests into streamlining the entire system and offering small, efficient clinics, automated diagnostics and patient services (using AI and robotics or more efficient processes) and even eventually get into a “doctor-on-demand” home service where a tele-doctor or “van” would make a drive up visit and the patient would enter to be examined or conceivably be operated on.
These things all already exist & are being used.
CVS & their minute clinics Uni hospital systems and their small community clinics tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
I'm talking about these things being automated, requiring fewer people in the process. This alone will save a ton of money.
so am i - we are doing it! we are, and it does require less staffing, and, especially tele-medicine, can increase the access to hyper-specialists, however other costs - vehicle, driver, highers equipment maintenance costs, etc all come into play too.
honestly, the biggest limitation to our tele-medicine work is insurers, with the biggest limit being the requirement for the MD to hold a medical license in whatever state the patient is in. (malpractice lawyers & unlimited tort awards are the most likely root-cause of this)
The root cause is a desire for people not to die from bad doctors.
There is a huge difference between routine care and preventative medicine and urgent care and significant invasive medicine.
You guys seem to think that systems like Kaiser and remote clinics that can do preventative medicine well can also handle the complex or chronic cases equally well.
Not so much as Kaiser kidney transplant patients found out in 2006. They were forced out of the UCSF and UC-Davis programs and forced to use Kaiser transplant services only. Several died that should have gotten kidneys.
How many self-insured health plans want to shell out for $500,000 liver transplants? Zero. Like in the Kaiser lawsuit where Kaiser doctors refused to authorize a MRI it’s a lot more cost effective to under-test so they can under-treat and hope the patient dies quickly.
Wait until it’s your loved one getting inadequate care.
Well, none of us are guaranteed immortality and we’ll all die of something eventually. The best medical services in the world can’t prevent that.
1.1 million probably isn't a large enough pool to constrain costs. The reason federally run insurance programs like Medicare have been more successful in controlling costs vs. private insurance is specifically due to it being a nationwide pool. These three groups probably have a lot less leverage than they think, or else they're not admitting some other part of the plan...like jettisoning older employees from employment (i.e., those that aren't in upper level management).
this is simply untrue.
there are many companies that are already self-managing healthcare plans for only a few thousand employees because the bottom line savings is so dramatic.
Medicare vs. private insurance has nothing to do with numbers, and more to do with profit margins. The federal government is ecstatic if the get a *balanced* budget. Private insurance companies are demanded to produce ever increasing quarterly profits by their boards and shareholders.
How many of the CEOs in the self-managed healthcare use that health plan vs something from BCBS or Cigna?
Of the ones I am familiar with? All of them.
of course, self-pay is the go-to option for the wealthy, so being on any group plan is simply window dressing.
In terms of gross costs (cancer, transplants, etc) their are actuaries that deal with this, and self-managed & funded plans also include multiple levels of insurance policies in place for such costs, the same as with large insurance companies.
Ever notice how insurance companies have investment arms as well? Nationwide, Etc... it is all a revolving door of financial risk, all trying to mitigate the excessive single cost
similar to the healthy supporting the sick, or the accident-less driver supporting the guy that totaled his car. This is what insurance is. If your company manages it though, they have a person to picture, and the levels of bureaucracy & out-sourced call centers tend to be lessened.
not perfect, but life itself isn’t, it always ends in death.
Since Amazon (not the other two companies) is in the data collection AND efficiency improvement business, I fully expect they will use what they learn here to eventually spin their business interests into streamlining the entire system and offering small, efficient clinics, automated diagnostics and patient services (using AI and robotics or more efficient processes) and even eventually get into a “doctor-on-demand” home service where a tele-doctor or “van” would make a drive up visit and the patient would enter to be examined or conceivably be operated on.
These things all already exist & are being used.
CVS & their minute clinics Uni hospital systems and their small community clinics tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
I'm talking about these things being automated, requiring fewer people in the process. This alone will save a ton of money.
so am i - we are doing it! we are, and it does require less staffing, and, especially tele-medicine, can increase the access to hyper-specialists, however other costs - vehicle, driver, highers equipment maintenance costs, etc all come into play too.
honestly, the biggest limitation to our tele-medicine work is insurers, with the biggest limit being the requirement for the MD to hold a medical license in whatever state the patient is in. (malpractice lawyers & unlimited tort awards are the most likely root-cause of this)
The root cause is a desire for people not to die from bad doctors.
There is a huge difference between routine care and preventative medicine and urgent care and significant invasive medicine.
You guys seem to think that systems like Kaiser and remote clinics that can do preventative medicine well can also handle the complex or chronic cases equally well.
Not so much as Kaiser kidney transplant patients found out in 2006. They were forced out of the UCSF and UC-Davis programs and forced to use Kaiser transplant services only. Several died that should have gotten kidneys.
How many self-insured health plans want to shell out for $500,000 liver transplants? Zero. Like in the Kaiser lawsuit where Kaiser doctors refused to authorize a MRI it’s a lot more cost effective to under-test so they can under-treat and hope the patient dies quickly.
Wait until it’s your loved one getting inadequate care.
Well, none of us are guaranteed immortality and we’ll all die of something eventually. The best medical services in the world can’t prevent that.
No, but the odds of surviving are higher with the best medical services. No one is asking for immortality but better health care than a crappy HMO that refuses to do MRIs to save money.
1.1 million probably isn't a large enough pool to constrain costs. The reason federally run insurance programs like Medicare have been more successful in controlling costs vs. private insurance is specifically due to it being a nationwide pool. These three groups probably have a lot less leverage than they think, or else they're not admitting some other part of the plan...like jettisoning older employees from employment (i.e., those that aren't in upper level management).
this is simply untrue.
there are many companies that are already self-managing healthcare plans for only a few thousand employees because the bottom line savings is so dramatic.
Medicare vs. private insurance has nothing to do with numbers, and more to do with profit margins. The federal government is ecstatic if the get a *balanced* budget. Private insurance companies are demanded to produce ever increasing quarterly profits by their boards and shareholders.
How many of the CEOs in the self-managed healthcare use that health plan vs something from BCBS or Cigna?
Of the ones I am familiar with? All of them.
of course, self-pay is the go-to option for the wealthy, so being on any group plan is simply window dressing.
In terms of gross costs (cancer, transplants, etc) their are actuaries that deal with this, and self-managed & funded plans also include multiple levels of insurance policies in place for such costs, the same as with large insurance companies.
Ever notice how insurance companies have investment arms as well? Nationwide, Etc... it is all a revolving door of financial risk, all trying to mitigate the excessive single cost
similar to the healthy supporting the sick, or the accident-less driver supporting the guy that totaled his car. This is what insurance is. If your company manages it though, they have a person to picture, and the levels of bureaucracy & out-sourced call centers tend to be lessened.
not perfect, but life itself isn’t, it always ends in death.
No one is asking for perfect. Just the ability to pay a reasonable amount for a PPO so you can go out of network for your second opinion rather than stuck getting one from the same corporate doctor pool.
Both of the companies I worked for that self insured had a different executive health plan vs the employees. In one I could do a PPO. In the other not and all we had was a crappy HMO.
Not all of the management was personally wealthy enough to self pay.
If the company manages it’s own healthcare it has huge incentives to cut costs by cutting care. They have zero reason to want to improve employee outcome over shareholder outcome.
You’re pretty cavalier with other people’s lives. Wait till it’s somone you care about.
1.1 million probably isn't a large enough pool to constrain costs. The reason federally run insurance programs like Medicare have been more successful in controlling costs vs. private insurance is specifically due to it being a nationwide pool. These three groups probably have a lot less leverage than they think, or else they're not admitting some other part of the plan...like jettisoning older employees from employment (i.e., those that aren't in upper level management).
this is simply untrue.
there are many companies that are already self-managing healthcare plans for only a few thousand employees because the bottom line savings is so dramatic.
Medicare vs. private insurance has nothing to do with numbers, and more to do with profit margins. The federal government is ecstatic if the get a *balanced* budget. Private insurance companies are demanded to produce ever increasing quarterly profits by their boards and shareholders.
How many of the CEOs in the self-managed healthcare use that health plan vs something from BCBS or Cigna?
Of the ones I am familiar with? All of them.
of course, self-pay is the go-to option for the wealthy, so being on any group plan is simply window dressing.
In terms of gross costs (cancer, transplants, etc) their are actuaries that deal with this, and self-managed & funded plans also include multiple levels of insurance policies in place for such costs, the same as with large insurance companies.
Ever notice how insurance companies have investment arms as well? Nationwide, Etc... it is all a revolving door of financial risk, all trying to mitigate the excessive single cost
similar to the healthy supporting the sick, or the accident-less driver supporting the guy that totaled his car. This is what insurance is. If your company manages it though, they have a person to picture, and the levels of bureaucracy & out-sourced call centers tend to be lessened.
not perfect, but life itself isn’t, it always ends in death.
No one is asking for perfect. Just the ability to pay a reasonable amount for a PPO so you can go out of network for your second opinion rather than stuck getting one from the same corporate doctor pool.
Both of the companies I worked for that self insured had a different executive health plan vs the employees. In one I could do a PPO. In the other not and all we had was a crappy HMO.
Not all of the management was personally wealthy enough to self pay.
If the company manages it’s own healthcare it has huge incentives to cut costs by cutting care. They have zero reason to want to improve employee outcome over shareholder outcome.
You’re pretty cavalier with other people’s lives. Wait till it’s somone you care about.
Insurance companies are profit machines, do you think shareholders aren’t holding the c-suites feet to the flames to reach higher & higher margins? (Aka cut payouts & increase revenue)
I cannot judge your company or your markets options, but the issues you state are the precise reasons single-payer, non profit health insurance has such a large following.
Profit is currently the single largest driver of healthcare in the US. This is why the Dow dropped triple digit when national brands announced their plan to undermine the big insurers.
1.1 million probably isn't a large enough pool to constrain costs. The reason federally run insurance programs like Medicare have been more successful in controlling costs vs. private insurance is specifically due to it being a nationwide pool. These three groups probably have a lot less leverage than they think, or else they're not admitting some other part of the plan...like jettisoning older employees from employment (i.e., those that aren't in upper level management).
this is simply untrue.
there are many companies that are already self-managing healthcare plans for only a few thousand employees because the bottom line savings is so dramatic.
Medicare vs. private insurance has nothing to do with numbers, and more to do with profit margins. The federal government is ecstatic if the get a *balanced* budget. Private insurance companies are demanded to produce ever increasing quarterly profits by their boards and shareholders.
How many of the CEOs in the self-managed healthcare use that health plan vs something from BCBS or Cigna?
Of the ones I am familiar with? All of them.
of course, self-pay is the go-to option for the wealthy, so being on any group plan is simply window dressing.
In terms of gross costs (cancer, transplants, etc) their are actuaries that deal with this, and self-managed & funded plans also include multiple levels of insurance policies in place for such costs, the same as with large insurance companies.
Ever notice how insurance companies have investment arms as well? Nationwide, Etc... it is all a revolving door of financial risk, all trying to mitigate the excessive single cost
similar to the healthy supporting the sick, or the accident-less driver supporting the guy that totaled his car. This is what insurance is. If your company manages it though, they have a person to picture, and the levels of bureaucracy & out-sourced call centers tend to be lessened.
not perfect, but life itself isn’t, it always ends in death.
No one is asking for perfect. Just the ability to pay a reasonable amount for a PPO so you can go out of network for your second opinion rather than stuck getting one from the same corporate doctor pool.
Both of the companies I worked for that self insured had a different executive health plan vs the employees. In one I could do a PPO. In the other not and all we had was a crappy HMO.
Not all of the management was personally wealthy enough to self pay.
If the company manages it’s own healthcare it has huge incentives to cut costs by cutting care. They have zero reason to want to improve employee outcome over shareholder outcome.
You’re pretty cavalier with other people’s lives. Wait till it’s somone you care about.
Insurance companies are profit machines, do you think shareholders aren’t holding the c-suites feet to the flames to reach higher & higher margins? (Aka cut payouts & increase revenue)
I cannot judge your company or your markets options, but the issues you state are the precise reasons single-payer, non profit health insurance has such a large following.
Profit is currently the single largest driver of healthcare in the US. This is why the Dow dropped triple digit when national brands announced their plan to undermine the big insurers.
Single payer, non-profit isn’t the same as self insured and non-profits aren’t necessarily low cost anyway. Hopkins is a non-profit health care provider.
Profit is why we have the best doctors and hospitals in the world. Nothing touches Stanford, Harvard and Hopkins for producing doctors and nothing touches Mayo, Hopkins, Mass General, Cleveland, etc.
if you’re middle to upper middle class (like say an Apple engineer) you can afford a PPO that gives you access to the top hospitals in the world with the top doctors. There’s a world of difference between a Kaiser hospital with Kaiser doctors and those at Stanford or UCSF. When companies self insure you end up with Kaiser like HMO systems. People who like Kaiser type systems aren’t sick. All they interact with is the nice PCP that does checkups and preventative medicine. When they get sick they realize too late the limitations of these systems and they simply aren’t going to get the level of care required for the best outcome that someone with better insurance has the option of getting.
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Australia has a private/public system. You pay a 3% Medibank contribution, or 2% if you have private insurance. You get your Medibank card and use it for deep drug discounts, and free public hospitals.
An example of the quality of private insurance was when I had an abscess while in Sydney. I went to a dentist who lived in the apartment hotel I stayed at, was told to get to the office at 3 pm. He did the root canal using advanced technology. He then gave me a receipt for the AUD 800 that I had paid with my credit card.. On the way back to my apartment I passed a Medibank Private office so I went in and asked what I needed to do with the receipt, I was told to go the counter, fill out a form and take it to the cashier. A fast check that my membership card was valid and current and the cashier started counting out the AUD 800.
No deductions
No discounting
No waiting - I was paid immediately.
Compare that to how your insurance in the US would work.
Comparing premiums between the two countries:
My US insurance was $1,100 a month, $550 for the wife and $550 for me. There was no Dental coverage.
My Australian coverage was $88 a month, with Dental.
BTW, the private insurance there is very aggressive and profitable. So profitable that the government started their own private insurance corporation to compete and I chose that option.
That type of approach to costs is the only approach that will LOWER costs in the US. Don't like it? Get your checkbook out.
Get a grip, and don't exaggerate.
Competition is critical to squeezing out wasteful spending/costs (something Amazon is terrific at doing) and automation, machine learning and mass-individual production of methods of treatment and medications will press other providers to do better or go out of business.
I maintain that Walmart and other large players will be entering this market also (including Apple) because that’s where all the money is these days. Huge profits mean huge opportunities for improvement.
HIPAA Title 1 regulates coverage for people that lose or change jobs and denying covering of pre-existing conditions and specific diseases.
HIPAA Title 2 regulates electronic health care forms so companies can't lock you into incompatible formats as well as protects that data via the privacy regulations.
HIPAA Title 3 regulates tack related stuff
HIPAA Title 4 regulates group health plan requirements (more stuff regarding pre-existing conditions and coverage)
HIPAA Title 5 regulates company owned life insurance and more tax stuff for what happens to non-citizens.
Folks that wish to deregulate healthcare will wish to dismember HIPAA. The non-discrimination rules within HIPAA means they can't discriminate by making you ineligible because you are a higher risk or poorer health and they can't discriminate against you by charging more. That's only moderately annoying to most companies but MUCH more so for those that self-insure.
Don't exaggerate? How about you don't talk about stuff you don't understand? Anyone for unregulated health care because "capitalism is the solution to everything" will get rid of Title 2 along with all the others because monetizing patient information is HIGHLY profitable. If you have access to PHI you can create a huge medical marketing database worth billions. Employers that self-insure will use PHI data to not hire people they expect to lose money on because they have pre-existing conditions or a genetic probability for an expensive disease. Locking medical records into incompatible formats so you can't change health care providers as easily is also profitable.
Many larger firms have done this over the years to lower the costs of care for their large number of employees.
More succinctly, it removes the middle man's profit margin, and gives it back to the employer.
Employers of over 1 million Americans just realized how much money they can save by cutting out the middleman.
Look up the quarterly reports & profit margins of these companies & realize exactly why health insurance in the US is so expensive, and has some of the worst outcomes in the developed world. These middlemen decrease access through cost & closed networks all while delaying treatment & more importantly *not* supporting preventive care.
Other countries have limited this via centralized government regulation, we have let it run amuck in the free market & enrich a few at the expense of our populations life expectancy.
this is simply untrue.
there are many companies that are already self-managing healthcare plans for only a few thousand employees because the bottom line savings is so dramatic.
Medicare vs. private insurance has nothing to do with numbers, and more to do with profit margins.
The federal government is ecstatic if the get a *balanced* budget.
Private insurance companies are demanded to produce ever increasing quarterly profits by their boards and shareholders.
These things all already exist & are being used.
CVS & their minute clinics
Uni hospital systems and their small community clinics
tele-health screenings in RVs and vans all over the US, from rural Appalachia to under-served urban neighborhoods with vitals & imaging being automatically screened & triaged
telaDoc standing in for PCPs as med students flee general medicine in droves, creating a PCP shortage
pop-up sterile ORs being used around the world in places where permanent structures are not feasible
This announcement, for sure, puts household names on the ideas, but everything you mentioned already exists & is being done.
so am i - we are doing it!
we are, and it does require less staffing, and, especially tele-medicine, can increase the access to hyper-specialists, however other costs - vehicle, driver, highers equipment maintenance costs, etc all come into play too.
honestly, the biggest limitation to our tele-medicine work is insurers, with the biggest limit being the requirement for the MD to hold a medical license in whatever state the patient is in. (malpractice lawyers & unlimited tort awards are the most likely root-cause of this)
Tell me there’s no difference between a doctor that works for Kaiser and one that works for Stanford.
The bottom line savings won’t be used for better benefits but rather even more cuts and even more limited options in health care.
There is a huge difference between routine care and preventative medicine and urgent care and significant invasive medicine.
You guys seem to think that systems like Kaiser and remote clinics that can do preventative medicine well can also handle the complex or chronic cases equally well.
Not so much as Kaiser kidney transplant patients found out in 2006. They were forced out of the UCSF and UC-Davis programs and forced to use Kaiser transplant services only. Several died that should have gotten kidneys.
How many self-insured health plans want to shell out for $500,000 liver transplants? Zero. Like in the Kaiser lawsuit where Kaiser doctors refused to authorize a MRI it’s a lot more cost effective to under-test so they can under-treat and hope the patient dies quickly.
Wait until it’s your loved one getting inadequate care.
of course, self-pay is the go-to option for the wealthy, so being on any group plan is simply window dressing.
In terms of gross costs (cancer, transplants, etc) their are actuaries that deal with this, and self-managed & funded plans also include multiple levels of insurance policies in place for such costs, the same as with large insurance companies.
Ever notice how insurance companies have investment arms as well? Nationwide, Etc... it is all a revolving door of financial risk, all trying to mitigate the excessive single cost
similar to the healthy supporting the sick, or the accident-less driver supporting the guy that totaled his car. This is what insurance is. If your company manages it though, they have a person to picture, and the levels of bureaucracy & out-sourced call centers tend to be lessened.
not perfect, but life itself isn’t, it always ends in death.
No one is asking for perfect. Just the ability to pay a reasonable amount for a PPO so you can go out of network for your second opinion rather than stuck getting one from the same corporate doctor pool.
Both of the companies I worked for that self insured had a different executive health plan vs the employees. In one I could do a PPO. In the other not and all we had was a crappy HMO.
Not all of the management was personally wealthy enough to self pay.
If the company manages it’s own healthcare it has huge incentives to cut costs by cutting care. They have zero reason to want to improve employee outcome over shareholder outcome.
You’re pretty cavalier with other people’s lives. Wait till it’s somone you care about.
I cannot judge your company or your markets options, but the issues you state are the precise reasons single-payer, non profit health insurance has such a large following.
Profit is currently the single largest driver of healthcare in the US. This is why the Dow dropped triple digit when national brands announced their plan to undermine the big insurers.
Profit is why we have the best doctors and hospitals in the world. Nothing touches Stanford, Harvard and Hopkins for producing doctors and nothing touches Mayo, Hopkins, Mass General, Cleveland, etc.
if you’re middle to upper middle class (like say an Apple engineer) you can afford a PPO that gives you access to the top hospitals in the world with the top doctors. There’s a world of difference between a Kaiser hospital with Kaiser doctors and those at Stanford or UCSF. When companies self insure you end up with Kaiser like HMO systems. People who like Kaiser type systems aren’t sick. All they interact with is the nice PCP that does checkups and preventative medicine. When they get sick they realize too late the limitations of these systems and they simply aren’t going to get the level of care required for the best outcome that someone with better insurance has the option of getting.