I see this as a move towards providing cheap basic medical care. This is timely now that it's possible that the individual mandate will be repealed. Millions of uninsured people could be treated for rashes or flus by nurses at CVS cheaper and faster than at doctor's offices.
More competition in healthcare could be a good thing--many say it's bloated and overpriced. The risk is that poor people get basic care while rich people get full care, widening health disparities.
It's unclear what the new healthcare economics will look like. Currently, minor procedures are profit centers for doctor's offices and hospitals. They subsidize complicated patients (often elderly with multiple chronic diseases like diabetes or COPD) who are riskier and take more time to treat. If CVS is taking that money, then hospitals may need to do some cost-cutting.
How does CVS buying Aetna allow for "more competition"? I'm a lot more concerned that before we know it non-Aetna insurance customers will have difficultly or increased cost fulfilling a prescription at CVS stores.
I'm not sure what Aetna brings to the table in regard to a future where nurses fill CVSes, either. That seems like it would be a far bigger operation than buying Aetna, and the two would be only tangentially related.
I agree that CVS wants to stave off Amazon and mail order pharmacies. But a buyout is an expensive way to secure a fraction of the market.
Buying Aetna makes it easier to expand the new Minute Clinic business model. CVS no longer has to worry about getting paid less than a hospital for treating a cough or fever. Aetna could even charge zero copay for nurse visits. It's more competition in the "basic healthcare" space (if it happens).
The "Caremark/CVS" insurance that I have for prescriptions allows me to go to Target/CVS for covered medications, but I also have the option to mail-order (from them, of course). I also have Aetna Health Insurance just by chance (we have a choice of 3 companies @work).
Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style), and likely will charge low "dispensing fees" (because robots will do most thigs). CVS is looking to be the "other other Walmart" of pharmacies. I have worked (as an intern) in many pharmacies, and I've seen several buyouts. At this point in time, I'm very happy that I made the leap from PharmD to SRE/DevOps about 11 years ago. Pharmacists will be robots in <5 years IMHO.
>Amazon is going to buy drugs in major bulk (Walmart, or Mail-order-pharmacy style)
All pharmacies, electronic and brick-and-mortar, go through one of 3 wholesalers: Cardinal, AmerisourceBergen, or Mckesson. It's, "which retailer can drive distribution?"
Speaking from the US, it's too bad that pharmacists are so disempowered here. I was just in France, and my friend came down with an eye infection. He went to a pharmacist, who just gave him antibiotics and told him to come back in three days if it didn't go away.
We both agreed it would never have been so easy in the states.
While I agree that kind of ease of access to an Rx that would have otherwise required a doctor’s office visit sounds great, antibiotics is probably a bad example. Over-prescription of antibiotics is a known problem. Was your friend seen by a PA or nurse or something? Maybe that model makes sense but I hesitate to give pharmacists the added power of diagnosis.
No. To be clear, I don't make these regulatory decisions, I'm just relaying the reality of the situation. It's very difficult to have these discussions with people that don't even know the basics about the industry under discussion.
Is it even legal to dispense drugs without a pharmacist? The same way that a nurse practitioner is only legally permitted to do so much before a doctor is required.
The pharmacist “supervises” te process. Mail order has been doing this for 20 years. There used to two big ones... Caremark and Express Scripts. Now CVS, the Comcast of drugs, swallowed both up.
Hospitals do this too. In some cases 2-3 pharmacists can cover 10-12 hospitals for off shift dispensing needs.
With the black horse cavalry running the country, we’re going to see lots of M&A activity like this.
Pharmacists must directly supervise dispensing. Many hospitals use a central-fill pharmacy where the prescriptions are filled for many hospitals.
The problem with these mergers is they allow health plans that further disadvantage other pharmacies or providers. Once those other options are eliminated we’ll see prices rise. Do people actually want the Home Depot’s of healthcare rather than the equivalent of the local hardware store? We’ll see I guess.
Optical insurance has been like this for a long time. For example, EyeMed is owned by Luxottica, who owns the majority of eye wear retailers in the USA.
Evidence suggests that they've used their monopoly to artificially inflate prices quite dramatically.
No, it isn't. I worked for CVS for about 8 years, though not as a pharmacist. Some of this information could be Indiana-specific, however:
A brick and mortar pharmacy must have a pharmacist on-site to dispense drugs. Not only are they supposed to do a final check on prescriptions filled, but they must be available for patient question and sometimes medicine requires advice from a pharmacist before it can be dispensed. In addition, there are some stricter laws for certain controlled medications and these checks must be done by a pharmacist. If the pharmacist gets sick or in a car accident on the way to work, the pharmacy can't legally open (they can section the pharmacy off with its own locks to keep the convenience store open).
>The risk is that poor people get basic care while rich people get full care, widening health disparities.
In my experience, that's already the situation. Actually, reality is worse. The rich (meaning, upper middle class and not sick) get full care and even excessive care, while the poor get basic or no care, often emergency only.
If you go to a hospital for an emergency procedure, the level of care and follow up care depends on your insurance. When the hospital thinks they probably won't be paid for services they choose to not offer them. So, the poor get basic care... while rich people get full care.
This may have been true pre-ACA, but it isn't the reality now.
It's now a system where wealthy, government employees, and the poor (i.e. subsidized) have access to full care, and most of the middle class just goes without.
In the past 5 years, I've gone from a decent $20 copay to a employer-sponsored high deductible to currently a fully out of pocket deductible of $2k before insurance pays a cent.
I've begun rationing my prescriptions and simply skip the doctor unless it's a true life-or-death situation.
The deductible for co-workers with a kid or two is something like $5k. That's on top of probably $10k in premiums a year.
Right, it is worse to have some money then none. But still, if you are super poor receiving free care, you do not get anywhere the same level of care as people with good insurance. But at least you're not paying tons of money for it or getting none (massive deductibles) like the middle class.
I sometimes think that's one of the things that's kept health care so expensive. Nursing salaries aren't cheap. A lot of the home health and basic clinic stuff could be handled by an LPN/LVN or even a Paramedic in many cases. Not everything needs an RN. There are plenty of available telemedicine options to put a provider in touch with a higher level of care if necessary.
"Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper. If you show up at an urgent care, just expect that you will be treated by a LPN and a PA or a NP. A Family Practice physician's salary is about comparable to a Sr. Engineer at many tech companies (~160k), and they can have significant malpractice insurance overhead and insane hours. A PA or NP still makes 6 figures, so the "savings" just aren't there.
If you've ever had to attend something like Physical Therapy, you'll see the actual PT (a MS/Doctorate level professional aka DPT) about twice. Once for an eval, and once for a discharge. An "aide" will guide you through all the other exercises, and they make very significantly less than a PT.
The savings are mysteriously gone, even adding lower-salaried professional extenders.
> “Professional Extenders" are everywhere, and it hasn't caused anything to become cheaper.
This needs the caveat of “to American consumers”. The NHS seem to be heavily moving in that direction, and I suspect “cheaper” is no small part of that
"professional extenders" are often "profit extenders", as the supervising physician can enable his / her practice to see more volume and better match revenues and costs (ie have lower cost labor do lower revenue / acuity work). the "savings" from this often end up accruing to the owner of the practice. increasingly this owner is a large hospital system, but they take this delegation a step further, using lower cost primary care as a way to increase volume to higher acuity / reimbursed hospital procedures.
These aren't easy roles to get into. The educational requirements are pretty high (MS or PhD) and the courses are rigorous. The educational requirements are close enough to an MD that I'm sure most people considering being an NP from the onset also debate just getting an MD.
The minimum requirements of a RN is an Associates degree and successful completion of the NCLEX -- though, many hospitals require a person to also obtain a BSN after a few years to continue being employed. That's a big educational jump to make.
I don't think pay is a big motivator for nurses. There are so many better paying jobs out there that are easier to get, and don't involve dealing with the figurative and literal shit nurses deal with daily.
Do a search for "McKinsey health costs" and browse the report. It breaks down category spending in the US vs. other western countries. Yes, admin cost more in the US, but it doesn't add much to the overall costs. The biggest driver of US healthcare spending are out-patient care. The US just does a shit-ton more of it then most countries.
ACA without the individual mandate is not the same as no ACA. Plus, lots has changed in the meantime: a growing shortage in physicians, even higher healthcare costs, an expanding role for nurses. The healthcare market is not static.
ACA without the individual mandate means that the insurers can't make the exchanges work causing their collapse. One benefit for the insured of millions fewer insured is that it will aliviate the shortage of doctors and nurses, probably to near pre-ACA levels.
If this turns every CVS into a uniform, inexpensive office/urgent care/etc., particularly with telemedicine, I'll be happy -- the "minute clinic" stuff already provides cheaper and more convenient access to care, but CVS+Aetna+some kind of EHR could do something amazing.
Aetna is a healthcare payer (or commonly known as a 'carrier') and CVS is a healthcare provider (specifically 'pharmacy') and minute clinic's are also providers (specifically 'care').
Aetna doesn't add any more to the equation of CVS other than streamlining payments. It's only interesting if you use Aetna I guess, but you can generally use CVS pharmacy + minute clinic with your insurance provider today.
Isn't it possible that the two companies being under the same management could have a second-order effect of expanding their Minute Clinic business? That is, because Aetna is part of the same company, it would be less costly for patients to visit MC since the prices that insurance providers usually have to negotiate with providers would go down enormously (to cost + profit instead of cost + MC profit + Aetna profit), thereby bringing more patients into the fold.
Depends. Kaiser is a great example of this (its a closed loop payer and provider) but it has a huge network within certain regions and doesn't cover nationally. The problem is that CVS via pharmacy retail and MinuteMan only satisfies a part of the whole care provider package. Kaiser on the other hand has it's own providers that carry everything from head to toe (no pun intended). That's why I don't see why this would be such a big deal.
costing savings isn't as immediate or apparent as horizontal merger, otherwise more companies would be doing it. Perhaps it makes more sense in space where there are fewer players, but in healthcare as an overall pie is huge.
When I had Aetna, they didn't even cover getting a flu shot at the pharmacy. Maybe they changed that, but it's dumb, they covered it 100% using primary care.
Flu shots are required to be covered in all U.S. insurance per the ACA. The point was that Aetna was requiring the more expensive (for them!) visit to a doctor's office for them to cover it and wouldn't cover it happening at a pharmacy.
When I had Atena they did cover pharmacy flu shot but only at one specific pharmacy. It's been years but if my memory serves right think I had to go to CVS to get the flu shot rather than my usual Walgreens.
The ACA states that your insurance provider must spend 80% of their premiums on health care. The doctor is more expensive, so the health insurance provider is allowed to keep more nominal dollars.
Although true, I doubt that's the reason since stuff like this was common pre-ACA.
The truth is that everything that a payer pays for is done through contracts. Payers will often default to a specific provider because the contract covers it and they don't have a contract for other providers.
In terms of the cost, back-end rebates often bring it down. Also, this particular contract may cost more for a flu shot, but save them even more for other procedures.
probably not more expensive for them... to go to your doctors office, you need to make an appointment, take time off work, etc.
To go to a pharmacy, you can stop by on your way home or do it on the weekend.
By making it inconvenient, you reduce the number of people getting a flu shot... and I would bet that more people drop out from the inconvenience, than the extra amount it costs aetna when you go to the doctors office.
But if just one of the people insured by Aetna ended up in the hospital due to complications from the flu due to not getting a flu shot, the amount of money they'd have to pay for the hospital stay would pay for hundreds of flu shots.
The insurance provider doesn't care how much it costs. The ACA states that the insurance provider must spend 80% on services. So as far as they're concerned, the higher the costs of healthcare the more money they get to keep. They just can't let costs skyrocket faster than they're able to increase your premiums.
The market is a horrible contrivance, and insurance is fundamentally unworkable in a market, unlike actual services and products where you know what you're getting and when you'll need it…
But that said, do you have even the tiniest bit of evidence that insurers actually do what you're saying in order to keep their costs up per ACA requirements??
There's all sorts of shenanigans in the industry, but your speculation sounds far-fetched. Remember Hanlon's Razor…
This is the fundamental flaw in the ACA. It did nothing to increase competition. In fact, increased regulation pushed some competitors out of the market. I can't tell whether this was a fool's errand or an intentional destruction of the market, pushing us towards socialization.
I'm sure Atena has/had a ton of different plans (especially in different states). Theres PPOs, HMOs, POSes, EPOs, high deductible, etc. so any general comments about what Atena does and doesn't cover won't always apply.
I have used amwell with great success, recently. I have no affiliation with them, and I am paying them for their services, but my experience was top notch, and I have a PCP through them. I have yet to get my insurance to process automatically, but I just paid with their FSA VISA card and I'm doing an offline bill to submit. Many states REQUIRE covering telemedicine, even for Medicare/Medicaid in some cases.
A big chunk of the health care industry is the oligopoly of distributors. There's only 3 of them: McKesson, AmerisourceBergen and Cardinal. If Amazon can bring much needed competition to that part of the healthcare market it'd help bring prices down.
CVS is moving up the stack because they're afraid of Amazon entering the industry. They're combining a retailer, PBM and now a health insurer. Personally I think it should be blocked because the last thing the health care industry needs is more concentration, but it will likely pass because of the nonsense (Bork-created) antitrust regime of the past 40 years.
IF you want to disrupt the pharma market, just let drug importation go free, and instead of debating the effects of a one new player, see the effects of the entire world getting in on it.
> IF you want to disrupt the pharma market, just let drug importation go free,
Yup. Allowing reimports of prescription drugs would be the single easiest way to have a massive effect on the costs of care in the US, with pretty much no negative impact on patients, providers, or pharmaceutical companies in the US.
How would that not significantly harm the pharmaceutical companies? Don't they make a decent percentage of their revenue off of brands which are currently price protected via these tariffs?
> How would that not significantly harm the pharmaceutical companies? Don't they make a decent percentage of their revenue off of brands which are currently price protected via these tariffs?
As lostapathy explained below, US prices are currently high because that's where pharmaceutical companies are capturing their profits. In fact, even European pharmaceutical companies make most of their revenue from sales in the US, not Europe. (This is why the US funds over 50% of R&D for the entire world, even though it only has 300 million people, and many of the largest pharmaceutical companies are based in Europe, not the US).
If reimportation were permitted[0], pharmaceutical companies would adjust the prices of drugs across those countries, which would bring drug prices in the US and Europe in line with one another.
Ultimately, pharmaceutical companies would still be able to make the same amount of money off the drugs, but it would distribute the sources of that money more evenly across the people who are actually using the drugs (and benefiting from the research and development).
[0] it would almost certainly only apply to reimports of drugs from other NATO countries (more or less), because those are the countries that abide by US patent law on drugs (India and China, by contrast, do not recognize US patent law on large classes of drugs),
>>> In fact, even European pharmaceutical companies make most of their revenue from sales in the US, not Europe. (This is why the US funds over 50% of R&D for the entire world, even though it only has 300 million people, and many of the largest pharmaceutical companies are based in Europe, not the US).
This just isn't true. Take Norvatis for example, one of the biggest pharmaceutical companies in the world. The US makes 35% of their revenue and Europe another 35%, with the rest of the world sharing the rest. [0]
I wouldn't call that "most of their revenue". In fact, I don't see anything out of the ordinary about revenue gained per customer, given the size and purchasing power of the US.
There's little evidence to suggest that higher drug prices actually help the drug companies.
"the US funds over 50% of R&D for the entire world"
Not sure exactly what numbers you're basing that on, but I believe a significant portion of that research (especially basic level stuff) is government funded, which is not a good argument for allowing pharma companies to keep prices high.
> Not sure exactly what numbers you're basing that on, but I believe a significant portion of that research (especially basic level stuff) is government funded, which is not a good argument for allowing pharma companies to keep prices high.
Depends how you look at it. On one hand absolutely. On the other hand, these practices make the US market subsidize other parts of the world. Seeing the same drugs cost the same in every country would help the US customer, hurt some abroad. Prices would surely meet somewhere in the middle
>Don't they make a decent percentage of their revenue off of brands which are currently price protected via these tariffs?
Yes. If consumers and/or pharmacies in the US could easily and reliably source cheaper brand-name drugs from international markets where price ceilings are in effect, it would ruin many drug companies, especially smaller ones.
> Yes. If consumers and/or pharmacies in the US could easily and reliably source cheaper brand-name drugs from international markets where price ceilings are in effect, it would ruin many drug companies, especially smaller ones.
Those price ceilings only exist because of the artificial trade barrier between the US and those other countries. Without that trade barrier, pharmaceutical companies would charge roughly equivalent prices in the US and other countries. It wouldn't ruin drug companies at all.
The companies would be fine, but it would probably severely limit the availability of life-saving drugs in poorer countries. One can argue that on the whole, that's a worse outcome.
That cannot be the reasoning behind imposing import restrictions. And even then I find the economic reasoning fault.
> That it was the spirit of monopoly which originally both invented and propagated this doctrine cannot be doubted; and they who first taught it were by no means such fools as they who believed it. In every country it always is and must be the interest of the great body of the people to buy whatever they want of those who sell it cheapest. The proposition is so very manifest that it seems ridiculous to take any pains to prove it; nor could it ever have been called in question had not the interested sophistry of merchants and manufacturers confounded the common sense of mankind.
> The companies would be fine, but it would probably severely limit the availability of life-saving drugs in poorer countries. One can argue that on the whole, that's a worse outcome.
Not really - countries like China and India don't recognize US (or European) pharmaceutical patents to begin with, so they're not bound to purchasing brand-name drugs from the original manufacturer.
Drug distributor is probably the easiest space for Amazon to get into, but it's not where the cost savings opportunities lie. Margin isn't very high in that space.
In order for anti trust flag to be raised through vertical integration like this, the combined entity would need to start buying up other entities in the vertical chain.
There's excessive concentration at every level of the health care industry. The top 3 PBMs have 80% of the market. Hospitals have consolidated. Doctors practices have consolidated. Consolidation begets consolidation as everyone seeks to increase their leverage over suppliers and customers.
If Amazon is going to get into the pharmacy business they'll probably become a distributor as well since it's an outgrowth of the logistics they already do.
I was talking about the for-profit hospitals mainly but non-profit hospitals have been consolidating as well. In Massachusetts, a Partners HealthCare acquisition was blocked on antitrust grounds [1]. If other parts of the value chain are consolidating, everyone feels the need to consolidate.
What's interesting is there have been other Healthcare mergers that have gone under the radar. For example United buying a large physician group based in CT. So now you have an insurance company also providing the healthcare. This was a few years ago too... http://www.modernhealthcare.com/article/20151221/NEWS/151229...
The only real upside I see here is that, the more vertically and horizontally concentrated the private sector gets, the more absurd most arguments for privatized, profit-driven healthcare appear.
Basically every other developed country has shown that the government can do as good of a job at half the cost. Socialize it all.
I agree in spirit but I'd also point out that our public spending on health care is already at about the same costs as western counties with socialized medicine. [1]
Our tax dollars are already paying out as much as other countries do but their citizens get a lot more for their money.
The solution to lowering the cost of medicine in the US has not a single solution but lies at every level of the system.
Thank you, the top comment and all its follow-up seem to think it's a good thing and may lower cost. It's hard for me to imagine this being anything less than a way to make more money with the combined companies.
Of course it's a way to make more money. They wouldn't move forward with this deal if it wasn't. But this doesn't preclude the possibility that end result will be a more efficient, vertically integrated healthcare provider.
It's terrible! The best doctors I've ever had were private practices where they had their own office. Every time I've dealt with anything remotely corporate it was a nightmare.
No. But the potential is there. They were better off separate as they operated as different entities but together their incentives are overlapped and the potential to exert undue power over the market is that much easier. Separate Comcast and NBC had no incentive to go into any exclusive agreements. Disney buying Marvel is a similar case. They are pulling content licensed for viewing on Netflix into their own service. Not illegal but not a win for consumers in an already crowded steaming market. And unfair to Netflix in that sense.
It is a consolidation but CVS is a consumer focused company, which is something the US Healthcare system needs more of direly.
Part of the problem with health insurance tied to a job in the US is the fixed market that is shrouded from consumers leading to horrible pricing and service. Employment handling healthcare, in addition to a fixed pricing market, also harms the individual market due to horrible grouping, invades privacy, makes it harder to change jobs or start a company, and on top of that fuels ageism as costs go up with age in health. Employers should have no part in your healthcare, pay people more to go get it is all that should be allowed.
All other insurance types are consumer focused for auto, life, home and more. CVS taking over Aetna could be a great force in the market to make other companies get competitive on the consumer front. Aetna and BCBS are two of the worse non consumer friendly insurers around, they really hate dealing with individuals and small companies.
Antitrust activities while still provided for in US law have essentially stopped in the modern era, leading to massive concentration of power and economic disasters associated with monopoly and consolidation (e.g. financial crisis). So a general call to bring that job of the federal government back is certainly a welcome one.
Does this mean that many CVSs will become magnets for sick people as CVS tries to integrate more basic health services into its stores?
I realize that most people going to an expanded minute clinic aren't going to be some sort of walking dead, but it seems that if CVS tries to make its stores too much like primary care with ill people going to get prescriptions from a doctor, then people will avoid buying things at its stores to avoid getting sick.
CVS is a pharmacy. That means it is already a magnet for sick people.
Allergies? Pharmacy. Long-term disease? Pharmacy. Cold or flu or want to try the natural meds for pinkeye? Pharmacy. And a slew of other infectious and non-infectious diseases, maladies, and injuries.
The one I've seen was just an extra room inside the store, beside the pharmacy. There was no physical separation of patients from shoppers. Same thing at Walgreens Healthcare Clinic, just extra rooms beside the pharmacy.
Why do we still have to pick prescriptions up? We have pizza delivery — why not for medicines? Order your drugs with an app and it shows up at your door.
Prescriptions have been available with delivery or mail order service for at least the last ten years. I have worked for at least two private pharmacies (in different states) who offered delivery service, and several of my classmates went to work for the mail-order fill companies as the "stare and compare" pharmacist checker.
The VA offers mail delivery for prescription medications. I imagine it has something to do with it being a single payer system, & they have to look for any chance to optimize in the whole medical food chain instead of just the pharmacy portion.
>Both CVS and Aetna played down the prospects of regulators moving to block their deal. The breakup fee for the transaction is not especially large, reflecting that belief.
What's the causality here? Why does a lower chance of being blocked imply a lower fee if blocked?
Takeovers cost time and money to execute (lawyers, consultants, bank fees) beyond just the purchases price. If the deal does not go through it is a loss for the acquirer, hence breakup fees. If the chance of takeover failure is low the acquirer will be willing to accept a smaller insurance.
I wonder if this will lead to restrictions on the use of copay coupons [1]. Insurers hate them since they break my incentive to use cheaper drugs from their formulary, but pharmacies don't care (and probably are better off for me using them.)
Since I mostly hate my insurer and want to help them towards bankruptcy by extracting as much coverage from my fixed premium as possible, I have no objection to using these coupons if they'd help me and I felt like an expensive drug choice was better for me, though it's not come up for almost any drug I've needed.
Though I do need new epi-pens; maybe I should look for one while I still can!
That highly depends on your prescription insurance coverage and how much they have to pay compared to the generic.
For example, some simply won't cover the brand name if the generic works for you. Others will let you get the brand name, but will only cover the amount they would pay for the generic. In either of these situations, the coupon wouldn't matter to the insurance company.
With other plans, though, the insurer pays more with the coupon. And if yours does, you can "stick it to the man" using coupons.
I don't know if insurance company cares whether you use copay coupons or drugs on their formulary as much as your employer does, because they're the one ultimately footing the bill for cost of your meds. Insurance companies and benefit managers try to position them in the middle, so that they would benefit either way.
Many are questioning if this move will help consumers. I think it will.
Aetna is the third largest insurer and CVS is soon to be second largest pharmacy chain. Pharmacies provide basic care at lower cost, many insurance companies are moving Prescription Benefit Managers (PBMs) in-house to lower cost. By combining the two: CVS is able to get more customers for PBM due to Aetna and distribute the cost over a larger base of patients, Aetna maybe be able to reduce costs per customer and better compete with larger insurance firms - its a win-win and a win for consumers.
I like your optimism. Personally, I don't think this will help consumers, but it won't hurt them either. I think this is more about 1. Leverage. 2. bigger data set on patient and prescribers.
They should break up the big insurance companies and not consolidate each point of sale area for more profit.
Ex: A knee brace went over the $500 requirement to have a prior approval before issuance. No one knew this at the time so the doctor gave a cost price of $100 for the brace to avoid phone calls, letters, and time.
Can we please eliminate medical bills if not sent to the patient within 90 days? 2-5 years late is just pathetic.
I wonder how much this has to do with the strong push for Online Pharmacies over the past decade. I hate using them, but my deductible costs next year have increased so much that I will have no choice.
I feel that perhaps healthcare is the ultimate triumph of capitalism.
Every other avenue of runaway consumerism and overconsumption can obviously be pointed to as either indulgent or unnecessary.
But not healthcare: it's your health, after all - your wellbeing. It's a fundamental right, right ?
...
The received wisdom is that the aging of the baby boomer generation is driving expanded healthcare expenses as this large sect gets older. It's obvious that they need all of this "healthcare".
But what if there were an alternative, more insidious explanation:
The boomers represent an irresistible pile of money. But they don't smoke. They don't have new households to start. They're getting wise to the whole sugar thing. What is left to tempt them with ?
What if there were a clear imperative on the part of a variety of industries to keep this population as unhealthy as possible - so they can stripmine their assets for "healthcare" ?
> The boomers represent an irresistible pile of money. But they don't smoke. They don't have new households to start. They're getting wise to the whole sugar thing. What is left to tempt them with ?
> What if there were a clear imperative on the part of a variety of industries to keep this population as unhealthy as possible - so they can stripmine their assets for "healthcare" ?
It's not clear that living a healthy lifestyle reduces healthcare costs, it can actually make you more expensive to care for.[1][2][3]
Diabetes medications and death from sudden heart attacks are cheap. Healthy people who live into their 80s/90s are the biggest drag on the healthcare system. They spend more of their lives as retirees. They end up needing 24-hour care. And then they still incur the same end-of-life causes as the obese/smokers... they get cancer, they get heart disease, alzheimers, etc.
Smokers and obese are inexpensive to care for in terms of lifetime cost. The best-case scenario for an insurance company is that you get hit by a bus or something. Barring that, I think they might actually prefer that you be a smoker or become obese.
I'm not surprised, but eliminating those costs isn't as simple as eliminating diabetes. If diabetes is cured tomorrow, those costs don't just disappear, they get remapped to whatever other health complications and end-of-life events those people run into instead of diabetes. Then it gets complicated even further when you compare the impact to working years vs retiree years, and the resulting default rates and bankruptcies.
Diabetes can represent a massive chunk of healthcare spending, and also be an inexpensive patient outcome relative to many alternatives. Both can be true at the same time.
Healthcare is not worth infinite, we make decisions everyday to sacrifice our own health for other benefits, from taking the bus to work instead of a bike, from not eating what is best for us, from taking unnecessary risks in pursuit of pleasure, etc.
Healthcare is first a necessity service like any other, like food, clothing and shelter, and that doesnt mean all the other services extract the most out of people.
I get it, the U.S. healthcare system is broken beyond recognition and a fully state-sponsored solution looks like tempting next step. But lets not go overboard with patently false ideas and abstractions.
> ...used to describe engineers and other technical folks assuming their technical knowledge of systems (usually computer, mechanical/electrical) gives them expertise in solving other complex issues.
Most of health care is a power/influence and social problem: Who gets to control things, who gets the money, who gets influence over the streams of money through the system? That's not an engineering problem but power play. Even if you _could_ show, using science, that you would get better outcomes with other methods, I don't think the people struggling for the honey pot care.
That's why thinking an engineer could build a better health care system seems misguided to me. Better machines to be used as part of the system, sure, but not the system itself. That's politics and hard-core power struggle for the money first of all. If the currently relevant people cared about the health outcomes they would already have changed the system. After all, that "U.S. Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health" (Americans Get Less Health Care, Spend More for It) [0] is not exactly news.
Engineers build systems, but who writes the specification for those systems, and who pays for them? Jerry Weinberg's [0] second law of consulting is "No matter what it looks like, it's a people problem." [1],[2].
Engineer's Disease refers to specialists in one field assuming that they can speak with authority some other unrelated field. Healthcare in the US is notoriously complex and complicated, it would be naive to assume Amazon's success in distribution, ecommerce, and cloud services would necessarily translate to health care.
Complex and complicated is an understatement. It's a complete mess with a lot of very greedy unscrupulous people involved.
A lot of times the "care" people get is really crappy also, in spite of expensive insurance. Oh, but they'll be sure to offer you a $30 orange juice. Then you'll be getting bills for months/years afterwords and not be completely sure what they are for.
I realize medicine is a specialty. I realize it takes a lot of training to be a doctor. But I've always believed that a lot of what medicine solves isn't unknowably esoteric. A lot of it can be solved by a person with some hands on experience and good observational powers and base knowledge (not brain surgery obviously but things like yeast infections, simple broken bones, etc.).
The whole thing really is more ripe for disruption than any other area I can think of.
People have been pursuing "low hanging fruit in the digital health space" for the last 5 years with little to show for it. Most successful (as measured by acquisitions / adoption in the broader industry, not by VC funding raised) health IT startups come from "flyover" states and are created by people with tons of domain expertise and enough engineering chops to execute, not the other way around
Because Bezos is good at playing whatever competitive/industrial game he's playing at doesn't mean he can "fix health care"
Also countries that have reasonable policies don't have them because of Jeff Bezos or any single "savior" (industrial or political maven), outside of a few (but well known) exceptions; in many ways, our "faith in science" (lol) and the next high tech tweak is preventing us from delivering pragmatic, proven, reasonable solutions today
All I can say is fuck Aetna. Worst insurance ever, maybe this will make them not be shit. Good luck getting your promised benefits out of them and making it work for you. Every single time I've called them, I get put on hold for 20 minutes, before getting someone who can barely speak English, and the worst part is that their call center is in America.
More competition in healthcare could be a good thing--many say it's bloated and overpriced. The risk is that poor people get basic care while rich people get full care, widening health disparities.
It's unclear what the new healthcare economics will look like. Currently, minor procedures are profit centers for doctor's offices and hospitals. They subsidize complicated patients (often elderly with multiple chronic diseases like diabetes or COPD) who are riskier and take more time to treat. If CVS is taking that money, then hospitals may need to do some cost-cutting.