Amazon has quietly put together a syndicate including Berkshire Hathaway and JP Morgan to provide better and more affordable health care for their combined 1.2 million workers.
The joint effort, called Haven, makes sense because many companies of size today are self-insured to provide health care at lower costs. But this is different. Jeff Bezos, Jamie Dimon and Warren Buffett seem to be personally involved in the development of Haven. So, what could they possibility have up their sleeves?
At the same time, many Democrats running for president are promising single payer health care (Medicare For All) as the solution to controlling costs and providing quality health care for everyone. Republicans argue that this is socialism and will result in unacceptable increases in taxes that will ruin our economy.
While politicians debate, Amazon’s real objective may be to create a health care payer to rival all payers with tens of millions of Amazon Prime Members as health plan members.
With Amazon’s buying power, scale and capabilities, the ecommerce giant could create a health payer offering that could render the need for a single payer system moot.
In the industrialized world and especially in United States, health care expenditures per capita has has significantly outgrown per capita income in the last few decades. The projected national expenditures growth at 6.2%/year from 2015 onwards with an estimated in 20% of entire national spending in 2022 on healthcare, has resulted in passionate deliberation on the enormous consequences in US political and policy circles. In US, the ongoing public healthcare reform discussions have gained traction especially with the recent efforts by the Senate to repeal national government intervention with Affordable Care Act (ACA).
In this never ending debate the role of government interventions has been vehemently opposed by conservative stakeholders who strongly favor the neoclassical economic tradition of allowing “invisible hands” of the free market without minimal (or any) government regulations to achieve the desired economic efficiency (Pareto optimality).
A central tenet of this argument is that perfect competition will weed out inefficiency by permitting only competent producers to survive in the market as well as benefit consumer to gain more “value for their money” through lower prices and wider choices.
Restrained by limited societal resources, in US to make our health market ‘efficient’ we need to aim for enhancing production of health services provision at optimal per unit cost that can match consumers maximum utility (satisfaction) given income/budget restraints.
Keeping asides the discussion on whether a competitive market solution for healthcare is even desirable as adversely impact the policy objective of ‘equity”, however from a pure ‘efficiency’ perspective it is worthwhile to focus on the core issue whether conditions in healthcare market align with the prototypical, traditional competitive model for efficient allocation of resources.
Jessica DaMassa asks me about single payer polling high, big VC for women’s pelvic floor digital therapeutic Renovia, 23andme cutting off API access to its data, plus guest mentions for Shafi Ahmed and Glen Tullman. All in 2 minutes (more or less!)–Matthew Holt
As is customary for every administration in recent history, the Trump administration chose to impale itself on the national spear known as health care in America. The consequences so far are precisely as I expected, but one intriguing phenomenon is surprisingly beginning to emerge. People are starting to talk about single-payer. People who are not avowed socialists, people who benefit handsomely from the health care status quo seem to feel a need to address this four hundred pound gorilla, sitting patiently in a corner of our health care situation room. Why?
The all too public spectacle of a Republican party at war with itself over repealing and replacing Obamacare is teaching us one certain thing. There are no good solutions to health care within the acceptable realm of incremental, compromise driven, modern American solutions to everything, solutions that have been crippling the country and its people since the mid-seventies, which is when America lost its mojo. To fix health care, we have to go back to times when America was truly great, times when the wealthy Roosevelts of New York lived in the White House, times when graduating from Harvard or Yale were not cookie cutter prerequisites to becoming President, times when the President of the United States conducted meetings while sitting on the toilet with the door open and nobody cared. Rings a bell?
Single-payer health care is one such bold solution. Listening to the back and forth banter on social media, one may be tempted to disagree. We don’t have enough money for single-payer. Both Vermont and California tried and quit because of astronomic costs. Hundreds of thousands of people working for insurance companies will become unemployed. Hospitals will close. Entire towns will be wiped out. Doctors will become lazy inefficient government employees and you’ll have to wait months before seeing a doctor. And of course, there will be formal and informal death panels. Did I miss anything? I’m pretty sure I did, so let’s enumerate.
With concern rising that a Republican alternative to Obamacare could fail to adequately cover pre-existing conditions (“Eight billion won’t even begin to cover it,” one Washington insider told THCB late this week) and will likely sharply cut benefits for Medicaid recipients, a number of states are preparing contingency plans. Some are preparing legal challenges. In California, progressives are once again laying the groundwork for a single payer system.
Could it happen? And could California serve as a model for other states?
California, the largest state in the union by population and the world’s sixth-largest economy, has good reason to push public policy in the opposite direction.
A recent commentary in the Wall Street Journal announced, “Obamacare’s meltdown has arrived.” Over the years I’ve heard conspiracy theories that the Affordable Care Act was designed to fail, as a means to nudge a reluctant nation one step closer to a single-payer, Medicare-for-All health care system.
Bernie Sanders famously advocated for single-payer during his campaign.In 2011, the Vermont legislature passed a bill to create a single-payer initiative. Green Mountain Care was abandoned in 2014 by Vermont’s governor — a Democrat — as being too costly. Despite an 11.5 percent payroll and a sliding-scale income tax of up to 9.5 percent, Green Mountain Care was projected to run deficits by 2020.
A similar single-payer initiative is now taking place in Colorado. Amendment 69, known as ColoradoCare, would create a taxpayer-funded health insurer. ColoradoCare would be available to nearly all Colorado residents, including Medicaid enrollees. Federal programs, such as Medicare, TRICARE and the VA would remain in place, however.
Early results from our California crowdsourcing project on MRI prices are in. Payments range from $255 to $2,925.15. MRI pricing is a complete mystery: What should you pay? Can you ask for a discount? We’ve been looking at health-care prices for three years, so if we say it’s a mystery, we can imagine what it looks like to you.
How much should you pay? Well, one person was told the price is $1,850, but if you pay up front, you can save almost $1,300.
The note on our form, shared by our community member: “I was told procedure would be 1850. I have a 7500 deductible. So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580.”
On our Facebook page, one contributor wrote, “I was going to be billed $830 through my PPO for an MRI. The cash price? $500.”
This is the second part of our crowdsourcing project in California with KQED public radio in San Francisco and KPCC/Southern California Public Radio in Los Angeles. We have been asking people to share pricing information for MRI’s, especially of the back; last month we collected mammogram pricing.
A note: We are often asked in this crowdsourcing prototype project if we believe what we are being told by people who fill out our online form at the PriceCheck page. The answer: yes, we do. Though some of our community members have said their bills are confusing, or the coding they see on the bills doesn’t match what we’re collecting, we believe our contributors’ shares. We have seen wide variations in health-care pricing.
So: here are early results.
Lower-back MRI: $255? $602.85? $973.25? $1,660?
Eight identical MRI’s, and eight vastly different payments.
No. 1: We heard from one Kaiser member, who received an MRI of the lower back, without contrast or dye (CPT code 72148) at the Kaiser Antioch Medical Center on Sand Creek Road in Antioch, Calif. This person was charged $973.25 and paid $973.25; insurance paid nothing.Comment: “This price was the contracted amount through my insurance. Deductible had not been met so I was responsible for all charges. This does not include the two office visits required to obtain and analyze the results.”
No. 2: Same kind of MRI, code 72148, at Radnet Medical Imaging at 3440 California St. in San Francisco. This person was charged $1,660 and paid $1,660, out of HSA funds. (Note: Our ClearHealthCosts pricing survey included that Radnet location, and they did tell our survey agent that their cash price is $1,660.)
A seasoned colleague recently told me that some PowerPoint presentations have no power and make no point.
But sometimes, a picture really is worth a thousand words. Or maybe — in the case of any meaningful discussion of health reform, thanks to its density and complexity — it might be worth 10,000 words. Hence our handy little exhibit.
This picture captures the 10,000 words it would require to explain with technical precision where President Obama’s Affordable Care Act fits relative to all health reform plans. It places “ObamaCare” along an ideologically scaled continuum of all serious reform options developed, debated and discarded or ignored since the 1980s.
They are all here: from the single-payer, centrally controlled models popular with those who detest corporations and the influence of money in medicine — two actual, not imagined “government takeovers of health care” — to two free market, laissez-faire models favored by those who detest regulation and the heavy hand of government in medicine.
The United States is the only major nation in the industrialized world that does not guarantee health care as a right to its people. Meanwhile, we spend about twice as much per capita on health care and, in a wide number of instances, our outcomes are not as good as others that spend far less.
Under our dysfunctional system, 45,000 Americans a year die because they delay seeking care they cannot afford. We spent 17.6% of our GDP on health care in 2009, which is projected to go up to 20% by 2020, yet we still rank 26th among major, developed nations on life expectancy, and 31st on infant mortality. We must demand a better model of health coverage that emphasizes preventive and primary care for every single person without regard for their ability to pay.
It is certainly a step forward that the new health reform law is projected to cover 32 million additional Americans, out of the more than 50 million uninsured today. Yet projections suggest that roughly 23 million will still be without insurance in 2019, while health-care costs will continue to skyrocket.Continue reading…
The Supreme Court’s decision on the constitutionality of the Affordable Care Act (ACA) will likely be handed down on the last day of this year’s term. If the Court finds that the ACA—either in whole or in part—violates the Constitution, the health care industry will be shaken to its core. And, no matter what legal justification the Court uses to invalidate the ACA, the structure of constitutional law will be severely undercut. The resulting medical and legal chaos will be expensive, divisive, and completely unnecessary. Nothing in the text, history or structure of the Constitution warrants the Court overturning Congress’s effort to address our national health care problems.
For the health care industry, a decision striking down the entire ACA would be an absolute disaster. Physicians, hospitals, and private companies have been shifting how they practice medicine in anticipation of the ACA’s implementation. They’ve been creating accountable care organizations, envisioning a significant reduction in uncompensated care, and enjoying increased Medicare and Medicaid reimbursement in primary care settings. That will all vanish if the ACA is struck down. Moreover, seniors will pay more for prescription drugs and young adults will be taken off their parents’ insurance. The private insurance industry, which has seen its market shrink significantly over the last decade, will see a real chance to reverse that trend disappear. According to one estimate, if the ACA is overturned, insurers may lose over $1 trillion in revenues between 2013 and 2020.