Lots of cheap takes in here. I think it’s a solid bet. Healthcare makes no sense.
Example: I fractured my elbow 2 weeks ago snowboarding (sticky down-flat-down). In order to see an orthopedic, I need to see a primary care physician for a referral. But I don’t have a doctor in the area and haven’t had a checkup in a long time. So in order to get an xray of my elbow I need to get a new primary care physician to write me a referral for an orthopedic specialist. It would take like 6 hours of my time to go through this process.
So what am I doing? I’m hoping and praying that it doesn’t require surgery and letting it heal on its own. I still can’t fully extend or retract my arm.
You might think this is dumb on my part, but I don’t want to miss work. Millions of people think the way I think. Telemedicine changes everything.
I just want to walk into a place, ask for a price, pay with cash and get a xray (or anything else I want or need).
The clusterfuck US healthcare is just show how deeply dysfunctional the political system is.
Health insurances should be banned. Everything should be paid in cash, prices posted at the door, and government should maybe co-pay to help low income and/or unfortunate (cancer and such), possibly funding most effective preventing healthcare to make sure everyone gets, all paid from normal taxes.
National government run health insurance provided to everyone, along with a flat deductible for everyone scaled to income, would be an interesting model.
You pay 100% up to deductible (out of pre-tax HSA), government insurance covers everything after that.
It would be interesting to see how many people stay under the deductible, and not cost the government program anything. Along with publicly posting prices for most services, so people can spend their deductible most efficiently.
This isn't very well thought through. But I'm trying to imagine a system that combines market forces for everyday health care expenses, paired with government health insurance for the truly massive expenses of traumatic health events.
Spending any money is a bigger deal to people with less (or no) money than people above a certain threshold.
So one problem you end up with is people that won't go to the doctor for preventative care or before issues become worse (and thus more expensive to fix) to save money now.
It's why the ACA specifically says preventive care, immunizations, medical screenings, etc. cannot be subject to copay or deductible or coinsurance.[1]
Once people realize they can vote to lower the deductible the system will quickly turn into just government run healthcare.
I’ve had the same thought, but keep it private. Mandate everyone is on a high deductible plan with government support to make the deductibles lower for the truly poor.
Make health insurance actual insurance again - instead of health plans.
It’s the same basic idea but a little less vulnerable to the whims of politics. Of course, your idea is more palatable for democrats (though not very) and mine is more palatable for republicans, meaning neither will happen.
Also, tie drug prices to the prices other countries pay damnit. The only reason something so obvious hasn’t happened can only be because of lobbying.
There are more possible health care systems than the NHS and the worst of all worlds disaster that is US healthcare. I know British people love the NHS but I don't think the US should copy it given its bad outcomes and constant issues with Tories underfunding it (as if the "deficit hawk" wing of the Republicans that is currently blocking the debt ceiling increase wouldn't do the same thing to an American NHS).
I think any kind of reform to US health care is going to require a substantial role for the market (ideally without coverage networks, deductibles or those insurance company death panels that refuse to pay for care that a doctor considers medically necessary) and probably an expanded role for Medicare, Medicaid and CHIP. There should probably also be a single payer malpractice insurance program so that doctors can start private practices again, a federal law requiring safe staffing ratios for nurses (maybe tying this to Medicare funds?) and antitrust action to break up hospital monopolies. Addressing college costs and cancelling all student loan debt would also help as many doctors are still repaying their med school loans decades after graduation.
> I know British people love the NHS but I don't think the US should copy it given its bad outcomes
keep in mind that for the vast majority of Americans the bad outcomes of the NHS would still be a massive improvement from what they have now which is basically no care at all. I know people who are solidly middle class but are putting off needed healthcare because of costs that wouldn't be any issue whatsoever if they were UK citizens and for lower income US families there's no NHS waiting list as long as "You will never be able to afford what you need"
I agree that, if we were to look to implement some version of the NHS here, we should learn from their mistakes and shortcomings, but if we took it "as is" today it'd still be a net win for Americans.
Of course it's a good example. The whole point of nationalizing things is to make them subject to politics, and an important consideration in nationalizing important services is that they will only run as well as your country's politics.
While the NHS is subject to the whims of Tory politicians, it can still be kept trudging along through a period of incapable government thanks to the legion of civil servants running in the background. I don't think the US has any equivalent answer for the UK Civil service.
You do not need referrals to go to an ER, and they will perform initial care, including x-rays and surgery if needed.
If you don’t need immediate surgery they will patch you up and send you away, and that’s when you have to go see a specialist with a referral (if your plan requires it).
A lot of urgent cares don't do much at all. Many don't even do X-Rays. Most are basically just there to treat very-minor, clean, uncomplicated, superficial injuries, and to tell you "yep, that thing you already knew is a sinus infection is a sinus infection, here's a prescription for antibiotics" when it's a weekend and you can't see a normal doctor, or the normal doctor's wait time is too long.
I suggest reading this reddit post about hospital billing [1]. You certainly have options other than paying a shitload or leaving your arm untreated. Money can be negotiated, but you only get one body.
Edit: I see elsewhere in the thread you have health insurance. If you're paying for it, utilize it. You're in a better position to deal with this than uninsured people.
Joints are critical. I can't judge without knowing a situation, but I wouldn't want to live my life with a fucked up elbow because I didn't go to the doctor.
When I was briefly without insurance between jobs, I went on a desert hike and was scared about getting injured, so I get it.
Your untreated joint injury has a strong chance of winding up much more expensive later, especially if you develop chronic symptoms that make it difficult to work.
I’ve never had insurance that doesn’t let me directly make an appointment with specialists. Never once have I been asked for a referral.
Last year I thought I fractured my heel or something. I called an orthopedist, did X-rays with him, and he went through them on the spot. No break but he told me about a bunch of stretches to prevent my heel pain from coming back. Same deal with an ENT for an ear problem after a lake swim and another issue.
Well maybe this is more to my point: I don’t know how my insurance plan maps to what I’m required to do in terms of seeking care. But I do know that if I guess wrong I’m looking at paying my entire deductible, so what I end up doing is avoiding the medical system as much as possible.
My point is just that if it’s an app on my phone, it’s a lot different. I’m probably going to sign up for this.
My healthcare plan has a website and you can put in a zip to see who is around you. They should list in network doctors, if there are only out of network doctors you can call the insurance and get an authorization.
United Healthcare dropped a large provider in my state for a few months and I had to do the authorization thing to see my regular doc. No out of network changes.
Have you never known anyone in your life for whom this was a requirement? This is a pretty common occurrence for the less well-off folks I've known as the risk profile for lower-income insurance markets puts the cost analysis toward requiring referrals to "prevent excessive utilization."
The inevitable outcome when you have such segregated risk pools.
I have family members who qualify for subsidized Obama healthcare on my state’s marketplace based on income. Their kid has another special state provided insurance.
It’s an interesting question I will ask them.
What does Medicade and Medicare do? I’d imaging there are more hoops to jump through with government plans.
Most of the urgent care I've used don't have the equipment to handle this. I've been twice in the last 6 months to 2 seperate urgent cares. In both cases I had to go to the ER anyway for X-rays. The doctor in one urgent care gave me a referal since she has surgical rights (I think?). I was sent straight to the X-ray tech rather than waiting it out in triage.
That sounds tough, sorry you have to go through that.
I do want to share that up here in BC, we have both, publicly funded health care AND telemedicine offered by private companies but charging MSP (Medical Services Plan). So it's not an either or. We don't need Amazon to bring health care to people.
That's not a very complete story. The proliferation of telemedicine services by private sector services in BC, and Telus in particular has actively reduced the availability of healthcare professionals in rural communities.
While telemedicine is a suitable replacement for some medical services, the cannibalization of public health services for privately owned, less capable service delivery models is actively harming folks who need in person care. This isn't theoretical, there have been numerous cases across BC, Alberta, Manitoba and Saskatchewan where medical offices in rural communities have simply closed to in-person visits and the doctors have shifted to deliver telehealth services exclusively. This increases access for prescription refills, or low-to-moderate risk, non-acute diagnosis that can be done, but lowers access to in-person care, or the established doctor/patient relationship for prescriptions for high risk medications.
I am not opposed to private participation in publicly funded health care programs, but the increased push across Canada from business and some political parties for increased private care options appears to be directly undermining the public health care system. We should have a true single payer system, with mandated pricing for medical procedures, and drive private sector competition to allow them to compete with publicly delivered options in a way that increases, not decreases access.
I'm not sure how to do that because I am an application security specialist, not a medical policy specialist, but it's obvious to many Canadians that the current approach is not working, and is probably not a model to promote.
Have you called a local urgent care facility? I don’t think I’ve ever paid more than $150 for a visit out of pocket (no insurance) even when I got X-rays for broken ribs. You can charge it to a credit card if you need to and figure out reimbursement from your insurance later.
>In order to see an orthopedic, I need to see a primary care physician for a referral
I've never had insurance that requires a PCP. But if I did, i'd be sure to have a PCP. It's not that complicated.
Even if you wanted to go the One Medical route, that means you pay Amazon $200, and choose a PCP. So essentially nothing in your circumstances have changed. I don't believe One Medical, or any other virtual doctor service will give you referrals that will be accepted by your insurance.
Your insurance will still require a PCP. Your PCP might or might not be accepting virtual appointments. In One Medical they do not. The virtual appointments are done by nurses who don't work in the One Medical offices
> But if I did, i'd be sure to have a PCP. It's not that complicated.
In all fairness, this isn't possible everywhere. There's such a shortage of doctors in my part of the US (a medium-large metro area) that there are literally none accepting new patients. I know four people who have been actively looking for a PCP for more than two years now.
> Your PCP might or might not be accepting virtual appointments. In One Medical they do not.
Not true, and thanks for the reminder -- I just booked a remote followup with my PCP (the very same Dr, not a NP or anyone else) to discuss some test results.
I'm sorry that happened to you but you could go to the ER if you could afford it? I fractured my elbow on a bike and went to the ER who scheduled me an ortho the next day. Ended up with surgery two days after the accident and paying my high deductible health plan for the year.
This was my first major health problem. It solidified to me how much of a clusterf the healthcare system was and how fortunate I was to be able to take off work for a week afterwards and be able to pay my high deductible.
wouldn't you walk into an urgentcare for exactly this?
I had an ache, havent had a PCP for a while, walked into an urgentcare, they xrayed me and everything...
Primary care doctors can order xray's and many primary care offices have their own machine. You dont need an ortho referral to check for a fracture or apply a basic cast
Elbow fractures aren’t simple, it’s not just about identifying the presence of a fracture and putting it in a cast. They send you home in a sling for elbow fractures in adults, either with surgery or without it. PCPs aren’t qualified to make the determination about how it’s going to heal and whether surgery is needed.
When I broke my collarbone a few years back, urgent care turned me away. Maybe others have had better luck there, but in my experience they're not good for much more than maybe stitches and dispensing over-the-counter pain medication.
Park crew doesn’t do their job in terms of removing rust with a wire brush, and we pay the price. If I wasn’t concerned about getting my pass pulled, I’d buy one of those small cans of WD-40 to spray on the rail on my first lap.
Jesus Christ where is the government in all this???
How is this level of consolidation of information and services being allowed?
After Amazon purchased Whole Foods, we've been forced to use their absolutely shitty grocery delivery app instead of Instacart, and it hasn't improved in 3+ years. Just monopolist garbage.
It's not a monopoly when a company you don't like buys a chain that you did like and ruins the experience. It sucks, but it's not a problem for antitrust unless the acquisition creates unfair competition in the target industry.
I didn't pick the grocery industry, OP did, I was just working with what they were discussing.
Anyway, the question isn't whether grocery stores have a consolidation problem (they do), it's whether Amazon's purchase of Whole Foods made that problem better, worse, or unchanged.
Looking at the market, it's hard to argue that Amazon buying Whole Foods made the consolidation worse, because Amazon wasn't a grocery store player until they bought it. And, in fact, it's likely that Amazon's purchase could slow the consolidation because they are better able to keep Whole Foods independent of the existing conglomerates than Whole Foods could while operating alone. If an acquisition was inevitable, better Amazon than Kroger.
It isn't clear to me why, but mergers have been huge in the USA for decades, and it appears to be happening faster all the time. Look at Tyson Foods – they've snapped up dozens of meat farming and processing companies in the last couple of decades. There are many like them. Consolidation appears to be a prominent and long-term strategy for US companies.
While true, what Amazon is doing doesn't really resemble the consolidation we're seeing in other companies. Amazon isn't so much consolidating in any one industry as they are trying to make a play in every industry. As far as I know they're the only ones doing this, and I wouldn't count it as part of the overall trend towards consultation because it's not clear that existing antitrust laws could be leveraged against them at all.
It may not be consolidation in the legal sense, but it's certainly true that Amazon is consolidating an increasing number of businesses in diverse industries into their company.
What makes me nervous about it is that I fear the day may come when I am forced to do business with Amazon.
I can see how it comes across that way, but to clarify my message, I wasn't implying I can't go anywhere else, I was implying that the delivery software they use for the grocery store they bought (which was already using better software) has gotten worse and we are "forced" to use their shitty software to shop at a grocery store we like. And they haven't improved it because they know that we will just put up with it so we can buy food from that grocery store.
How can it be a monopoly when you have several other grocery stores where you can go to? Did amazon buy all the stores in your area and is forcing you to do delivery from them or you’re choosing to use Whole Foods?
I’m not a fan of Amazon generally but it’s clear you haven’t used Instacart in a while if you think ordering from Whole Foods is worse. Instacart these days is the absolute worst experience I’ve ever had with any shop. The day my Covid risk profile allows me to go back to grocery stores is the day I order a large 3D print of the Instacart logo, find an empty field, and recreate the printer scene from Office Space.
Amazon having a finger in every pie isn't a monopoly in the traditional sense. There is competition in the PCP market, in the shipping market, in the grocer market, in the cloud services market, the booksellers market.
While I'm not thrilled in general about a big company acquiring one more thing, I'm honestly glad that it's in this industry. The medical world (in the U.S. anyways) needs some serious competition from folks and this, paired with Amazon's foray into prescription services, gives a signal that they're willing to do something here. Probably won't be a panacea, but much better that Amazon's buying them than some major healthcare company.
Agree, I think the US has the best specialists in the world but it is missing a middle layer of primary care physicians that spurred companies like One Medical and Carbon.
Having a company like Amazon (hopefully) establishing this middle layer would be great for healthcare in America. Although I do think the Doctor to NP ration should be much lower in these places.
Instead of going to a primary care physician and them telling me everything is normal, just take an advil and then getting two $300 bills from different vendors, one being out of network but not disclosed because even though they're in a hospital in network they're a third party provider? Yes, absolutely prefer somebody like Amazon for a first screen telehealth or basic primary care. That said, I use Forward medical and it is phenomenal!
for all the flaws amazon has, i generally get great service from them as a company and happily keep giving them my money. so i am actually looking forward to whatever they come up with and will probably try it
Speaking of this, my employer provided healthcare (Aetna) refused (according to Costco) to fill my existing prescription at Costco after messaging me that they would like to transfer it to CVS (which Aetna now owns). They'll allow it if I call them, but it was jarring.
This is sadly common. I have a compound that I'll likely have to take for life. Compounds are freaking hard, most pharmacies act clueless when asking. And they're regulated by state, so when you move, you often have to find a new one.
Anyhow, our insurance decided everything should be done via Walgreens or CVS(don't remember now), or denied. They had no idea about it, and said they don't do compounding.
Like you, I called insurance co, and they said oh, we'll just opt you out no problem. Why wasn't that the default?
Anyhow, I found it easier to just pay cash anymore. 600/yr, but still somehow less frustrating than dealing with insurance that just finds ways to try to screw you constantly.
I think that's more about shoring up local political support so they're not a target of people complaining about affordable housing and how big tech co's lead to higher rental costs rather than a business opportunity (but you never know!)
It seems to be fully awake, just totally content with this stuff. The merger of TickerMaster and Live Nation was remarked as a positive development which left abundant space for competition to thrive, for example.
HIPAAcalypse when? Forgive me for feeling a bit skeptical/cynical of making Amazon an even bigger data hoarder...
There's also some irony in Amazon caring about health when its warehouse workers have to pee in bottles and sometimes die because they aren't allowed to evacuate during a tornado.
So aside from the data governance concern, I am curious to see how they'll change one medical.
Wholefoods definitely got worse after Amazon took over. Even prior to the pandemic they started having difficulty keeping stuff in stock, they've swapped out a lot of better brands for their private label, and their locations can feel like fulfillment centers.
So ... what will they do to one medical? There are certainly many opportunities for improvement, but I'm guessing that's now how this will play out.
I’m really upset. I love OneMedical and I would hate to have to go back to the traditional model. One of the best features about OM is its relative obscurity. So I as a customer have a huge amount of supply available to me. That means I get whatever health needs met immediately. If Amazon makes the user base larger, I will lose this wonderful experience.
- in my city, One Medical offices are in several neighborhoods and are very far from obscure
- I generally can't get an appointment with my GP without scheduling a month ahead. For anything short term, I end up having to use whatever PA or NP is free. Labs onsite are not done by appointment, and depending on the line I can wait up to an hour to get a quick blood draw.
Quoting the article : "One Medical’s seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses, and mental health concerns have been delighting people for the past 15 years."
Not experienced with Amrican healthcare services, I understand this is a huge telemedecine firm. It's reasonable for Amazon to invest in a virtual medecine provider. Too much cash on-hand waiting for a strategic investment in a new industry.
Reminds me of Berkshire Hathaway's purchase of the insurance provider Gecko. Both are business deals that are convincingly different from Alphabet buying FitBit (software company seeing value in another software company).
If you're a customer of Amazon, this will satisfy you and disrupt the whole healthcare sector. I expect more effectiveness and value-added than from the US gov initiative "Obamacare" (harshly challenged by political backlashes).
One Medical acquired Iora and completely hollowed out what made Iora awesome... the "health coaches" exist in name only now and aren't distinguished from regular medical assistants anymore, no more room or time for community efforts anymore, etc.
I think it's just another example of metrics run amok. You do too much of that, and all the slush and slack gets drained out of the system, and the system starts to die since it never learned how to measure how that slush/slack is valuable. This seems to be such a general pattern these days, but I guess it's been a slow march ever since the 80's.
A good app where you can schedule appointments sometimes within the same day or often a day or two, a dedication to on-time appointments in the office (I've yet to wait for than a minute or two beyond my appointment time in 5+ years of membership, across different providers), and fast turnaround of lab tests that they run often in-house.
I couldn't possibly go back to the old way of waiting weeks for an appointment and waiting god knows how long once I get there.
EDIT: A have a handful of doctors to choose from here in Seattle that rotate between the offices in the city, along with a bunch of nurse practitioners
They still use your insurance. The service makes it extremely easy to get lab work done and see a PCP very quick (I set up appts same or next day). I've used it for physicals/checkups and for getting set up with physical therapy. My local hospital system had a multi-month long wait to see anyone for a simple annual physical.
I'm kind of OK with this. The only force large enough to force change on the healthcare industry is probably a megacorp like Amazon/Google/Walmart/Apple. Similar to how Uber (for all it's many many problems) was the one to get taxi service to improve.
I am willing to give them the benefit of the doubt - if amazon can show they can make money in this space by streamlining the medical experience, all the power to them - and it should attract others to try and do the same. Competition is a good thing.
The medical industry is in need of a bit of disruption, why not give it a try.
I don't want to be a competitor or employee of Amazon (I've been the latter), but being a customer of them has been a pretty consistently good experience.
"stuff has become so poor" because users don't care. Counter point : all cars are now luxury cars, they don't make sedans anymore and trucks have leather massaging seats because for whatever reason people care about luxury in cars and vote with their money.
Also houses are twice as big now. Clearly capitalism doesn't always mean a race to the bottom.
Well, first, that's not true. There are plenty of economy cars being sold. I see them all the time. But even so, look at what's sold as "luxury cars" these days. Most of them (including Teslas!) would not have been considered luxury cars a few decades ago.
> Also houses are twice as big now.
Size is not an indicator of quality.
> Clearly capitalism doesn't always mean a race to the bottom.
I never said it did. I'm commenting on how things are going in the US, not commenting on the concept of capitalism at all.
Example: I fractured my elbow 2 weeks ago snowboarding (sticky down-flat-down). In order to see an orthopedic, I need to see a primary care physician for a referral. But I don’t have a doctor in the area and haven’t had a checkup in a long time. So in order to get an xray of my elbow I need to get a new primary care physician to write me a referral for an orthopedic specialist. It would take like 6 hours of my time to go through this process.
So what am I doing? I’m hoping and praying that it doesn’t require surgery and letting it heal on its own. I still can’t fully extend or retract my arm.
You might think this is dumb on my part, but I don’t want to miss work. Millions of people think the way I think. Telemedicine changes everything.