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Comment by chevman | Hacker News Reader

At the scale of Amazon sized companies in the US, healthcare costs become part of the strategic equation of how you manage your business.

Get large enough (you will have moved beyond fully insured plans to self ensuring your population long ago) and you'll continue to look at opportunities further down the supply chain in actual healthcare delivery itself to better manage, forecast, and optimize costs.

Primary care and Rx are usually the first place to go.

My guess is this is as much about that dynamic, as it is about buying some good leadership (look at the board/leadership of One Medical and you'll see many familiar faces if you are in heathcare/plan/PBM space).

Will be very interested to see if they keep this mainly in house, or if they begin to scale beyond that.

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> At the scale of Amazon sized companies in the US, healthcare costs become part of the strategic equation of how you manage your business.

Amazon employ about 1.3 million staff. Say you wanted to provide healthcare for your employee's families too, so we'll pick about 2.75 million in total (because I'm guessing that a lot of Amazon employees have a partner but no children). That puts you at roughly half the population of Scotland.

Scotland spends about £16 billion a year on healthcare, for everyone in all stages of life, many of whom have extremely complex healthcare needs. To provide the equivalent of NHS Scotland to an Amazon-size company you'd get change out of £8bn, and that would provide things like free prescriptions, and all healthcare requirements free at point of need. I bet you could sharpen the pencil a bit on that since you've already got massive supply chain logistics in place.

That's not a lot of money really.

Half the population of Scotland, with very few elderly and sick patients since their employees are relatively young and healthy. In-house healthcare makes a lot of sense.

So Scotland pays about £3000 per person per year for all health care?

That's slightly more than my deductible in Germany, and about half what I pay for private insurance for one person.

Seems like Prime Health Care could be a good business, and "dogfooding" it on their own employees for a few years would be the obvious way to streamline it.

Then again, I can't imagine doctors would be happy with the AWS Management Console experience...

> Then again, I can't imagine doctors would be happy with the AWS Management Console experience...

I can assure you health care professionals in the US deal with far, far worse IT situations. It’s very unfortunate.

About £2500 on average. I've been fortunate enough to have very little go wrong with me over the years, but my mum has had cancer about six times and at the end of next month have just completed two years of immunotherapy so I reckon I've had my five grand's worth.

Walmart has done tons of work lowering the prices they pay on their self insurance. They pretty recently started flying everyone who needs knee surgery out to some hospital in bumfuck Pennsylvania. From what I hear most of that hospitals business is now knee surgeries for Walmart. It makes sense, the hospital can specialize and you can do in patient rehab for way cheaper since land and labor are cheaper in the rust belt. In house primary care is only the beginning.

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