Amazon officially becomes a health care provider after purchase of One Medical
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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.
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.
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.
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]
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.
One small edit is how it actually works in much of the rest of the world:
You just walk into a place, hand them your health card, and get an xray (or anything else you want or need).
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.
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.
I imagine it's still a lot better than the high cost and poor outcomes we have here in the US.
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).
Did you go to the ER?
Also, don’t mess with joints, go see a Dr.
HMO's usually require referrals. PPO's usually need no referrals and you can go many more places.
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.
[1] https://www.reddit.com/r/TrueOffMyChest/comments/x9b7vm/im_p...
When I was briefly without insurance between jobs, I went on a desert hike and was scared about getting injured, so I get it.
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.
I updated my regular doctor on my next visit.
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.
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.
The inevitable outcome when you have such segregated risk pools.
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.
I was wondering, shouldn't you go to an emergency care for an accident like this one?
(But now might be a decent time to think about it anyways?)
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.
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.
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
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.
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.
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.
Take care of yourself. 6 hours is a very small price for your health.
> In order to see an orthopedic
Why does even a simple thing like fracture need a specialist in USA.
This is exactly how I broke my collarbone.
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.
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.
What makes me nervous about it is that I fear the day may come when I am forced to do business with Amazon.
Way back when before the internet it was the stores themselves who would be doing the delivery. Or the dairy’s, hardware store, etc.
https://techcrunch.com/2023/01/23/amazon-launches-rxpass-a-5...
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.
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.
Source: https://www.cvshealth.com/news/company-news/cvs-health-compl...
I learned about this specific case from Adam Conover's video: https://www.youtube.com/watch?v=ayrVYwoe-DY
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.
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.
- 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.
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).
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.
I don't see how they can pay doctors to provide this service, and still make money at this price point.
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
tl;dr - quick and easy access to a consistent PCP
Just think of all the interesting data they will aggregate!
The medical industry is in need of a bit of disruption, why not give it a try.
That might be true, but it's really hard for me to see how the change they force would be for the better.
And this focus on lower prices seems risky to me. This race to the bottom of the price scale is why so much stuff has become so poor.
I may be overreacting, though. I find this move by Amazon to be genuinely scary.
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.