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Comment by cavisne | Hacker News Reader

There is a large administrative load for all healthcare which seems to serve no one except the hospitals (to avoid paying any local taxes their non-profit status does not get them out of), and the insurers (who justify their margins by negotiating through the bureaucracy).

The three companies all self fund their employees insurance, so the goal was to cut out some of this bloat by providing services directly to employees.

The Amazon Care implementation was amazing, it's unclear why it failed. I would speculate its because costs are dominated by services they didn't provide (emergency rooms etc).

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Sure, but if it was as easy as cutting out the bloat, then wouldn’t Kaiser Permanente (KP) be the healthcare insurer/provider of choice where it exists?

Yet other plans are able to compete on the west coast.

KP has always been about the cheapest option for me. The Google/Stanford health plan was marginally cheaper when it launched while I worked at Stanford and then later at a Google subsidiary but living in SF they had very few local doctors (most of their network was down in Silicon Valley.)

People are certainly willing to pay more for PPO plans which give them more options but personally I’ve never run into problems with KP. And the California rule which means hospital charges for HMO patients are capped at the deductible for an out of network ER visit is hugely important. Otherwise you get nickel and dime’d by all sorts of charges for each professional who sees you in the ER and some hospitals even went after patients for $1000s when they charges more than the insurance company would pay. https://www.sfchronicle.com/bayarea/heatherknight/article/In...

> Otherwise you get nickel and dime’d by all sorts of charges for each professional who sees you in the ER and some hospitals even went after patients for $1000s when they charges more than the insurance company would pay.

The No Surprises Act took care of these issues nationwide as of Jan 1, 2022:

https://www.cms.gov/nosurprises

It took less than 6 months for hospitals to find a loophole. Participating Providers.

https://www.npr.org/sections/health-shots/2023/02/28/1159786...

Well, that is some nonsense that is ridiculous to have been left out of No Surprises Act. Although, at least in this case, it still seems the state government says the loophole is not valid.

> The office told KHN that the "participating provider" contract does not override the laws barring out-of-network charges in emergency situations. "Danielle had an emergency and Regence acknowledges it was an emergency, so she cannot be balance-billed," said Stephanie Marquis, public affairs director for the Washington state Office of the Insurance Commissioner.

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