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An open letter to Jeff Bezos: You are needed to disrupt health care (qz.com)
57 points by SQL2219 on Sept 30, 2017 | hide | past | web | favorite | 45 comments



Bezos will read this and think, whatever happened to Google Health? Anyways, the health care system in this country is intentionally fucked up on a policy basis. Private industry mostly extracts pounds of flesh and puts bandaids on it. We need public policy to fix it.

Also, holy shit this is a brain disease: "Congress enacted a law that bans Medicare from negotiating drug prices with the pharmaceutical industry. However, since Amazon Health would act as a private corporation dealing with other private corporations, it is hard to imagine Congress could prevent it from getting favorable prices for its patients."

Great. Instead of fixing public policy for the benefit of the public, create a monstrous new private entity that sucks blood money from the public.


I also would like to point out how insane it is that the author of this piece is crying out for a Nietzschesqe superman to save the public from itself. Mutual aid and the democratic process are quite enough. Just a hint though, solving some of our problems will take some redistribution of wealth, though in the case of medicine universal health care will save an ungodly amount of money which will make things easier.


>the democratic process

The will of the people is clear: illness ought to be ruinously expensive, health insurance ought to be a privilege for those who can afford it. The democratic process has considered the issue quite seriously, several times in recent years, and decided on the present situation. There is overwhelming bipartisan support for keeping healthcare pretty much as is, with very slight variations between red and blue.

Barring a major change in public opinion, any improvement in healthcare will have to be undemocratic.


> The will of the people is clear

I thought quite a lot of research showed that voters across the board are actually in favor of more Europe-style/better health care policies, but that they vote against their own interests because of partisan issues/politics.

If that's true, you might still be right in practice of course, but at the very least there's a bit more hope that things can change.


>they vote against their own interests because of partisan issues/politics.

This isn't like some temporary blemish on democracy, it is democracy. People have different opinions (partisanship) about what ought to happen in the public sphere (politics) and outcomes are dictated by the people's actual votes rather than expert opinion about their best interests.

I'd be down for a technocrat philosopher-king, but that's not the world we live in. In fact, technocrats are being soundly rejected by both left and right.


And yet here we are..


In a country where a law that is only supported by 17% of the public easily gets through the House and only fails in the Senate by a single vote.


Yes?


Our democracy is broken, we must fix it. Policy is made against the wishes of the great majority of people in favor of the wealthy. This has been documented time and time again.


In New Zealand, there’s a government agency with a role to subsidise medication and decide which products to subsidise.

It is pretty successful at driving down costs.

Unsurprisingly, it was targeted in the thankfully now failed TPPA, because god forbid a government flex its muscle and keep the market competitive.

https://en.wikipedia.org/wiki/Pharmac


create a monstrous new private entity that sucks blood money from the public.

Kinda like what IBM is trying to do with Watson.


Why can't America have a public health care? They have public post service USPS..


The Post Office usually loses money:

http://thehill.com/policy/finance/306224-us-postal-services-...

I don’t know the right answer but starting with a good system that works seems like a good idea.

https://en.m.wikipedia.org/wiki/Healthcare_in_Switzerland


Key point from the article in your post:

> Controllable income, which takes into account operational expenses including compensation and benefits, excludes the $5.8 billion payment mandated by the government to prefund the agency's retirement benefits. > > Excluding the obligation, the Postal Service would have recorded net income of about $200 million in 2016.


Fine. Public transit usually loses money, too. I'm OK with all of that, because they're public goods, they're things that make life better for everyone in the city/county/region/country.

I don't expect government entities to make a profit; as long as they're run reasonably well (and they usually are), well, that's what taxes are for.


If I were building a healthcare system, I'd be looking to France/Germany for a role model


Switzerland's health care systems beats those by a mile. Every expat who knows these countries can confirm this.


Because it is a democracy, and an electoral majority of the country vehemently opposes it.


Too many politicians receiving lobbying money.


Amazon has been looking into healthcare space for awhile, including pharmacy benefit manager. The trouble is, healthcare space is extremely regulated and entry barrier is very high. It takes inordinate amount of industry knowledge to get your foot in the door and the only realistic way to enter is through acquisitions

Even then, Amazon is completely dwarfed compared to all the players in the sector; pharma, hospital systems, chain pharmacies, indie pharmacies, long term care facilities, drug distributors, health insurance, TPAs, PSAOs, medical instrument makers, DME makers, all with their own agendas.

Regarding the pharmacy missing drug interaction problem cited in the article. It isn't due to lack of sophisticated system or lack of data. Far from it. Healthcare entities sit on colossal amount of data. The issue is fragmentation and lack of centralized mechanism that prevents effective communication and sharing of data. That's a regulatory and policy problems, not innovation problem.

Believe me, I want this problem fixed too, but Amazon isn't going to be the one to solve it.


This sentence is eye-opening:

> No wonder we pay more for health care and get poorer outcomes than any other industrialized nation.

Ok, we figured out that healthcare works better in other countries. So what could we do? Maybe look how other countries are doing it and try to do something alike? But that would be too easy, right? So better ask some billionaire to fix it for us.


We are all commie socialists in Europe, thats why. It's like a dirty word in the USA.


> Health care is a huge sector of the economy, comprising close to 18% of US GDP

This is why health care is hard to change. 1/5th of the economy is in the current system. Systems that big are going to be hard and slow to change - some inertia, some corruption. The revenue of "McKesson Corporation" (one of the highest in healthcare) is single-handedly(!) 1% of US GDP. Imagine how much power those guys have. They must have shaped the entire country (laws, regulations, public opinion) to an extent with that big a share.


Oh god, please no.

If America 'fixes' it's healthcare with an billionare's 'disruption' power play the pressure on the rest of the world with functioning social healthcare systems to dismantle them will reach a sickening crescendo.

We're already in many ways pulling it apart, even with the less than stellar lesson of the USA to learn from...

(Australia, for reference.)


Is anyone in the western world that's not leaning conservative looking to dismantle their healthcare system? Australia and the UK are, but from what I know ow the been infected by the US's ideology of thinking that private corporations can do no wrong by definitjon. The rest of the west though, EU and Canada, aren't trying to dismantle their healthcare.


One of the issues in the UK that is pushing these changes through is wait times and understaffing. Unless you have an emergency or something life-and-death serious you might as well forget about it. The people don’t like it and wanted change, which is why the Torries and Brexit was voted for.

My mother was recommended to visit the hospital by an optician for a more in-depth check related to glaucoma. She ended up having to wait 9 months for her appointment...

I don’t think the general public want to see it privatised though, it’s just the governments are pushing it through as their agenda to avoid having to raise taxes (corporate and income tax in the UK is on the low side compared to other Western-European countries).


GP asked

> Is anyone in the western world that's not leaning conservative looking to dismantle their healthcare system?

It's important to be honest about this: the conservative party have made the decision to de-fund the NHS and in real terms they've considerably cut funding for the NHS. This is even more true when you look at the changes to the NHS and the collapse in social care.

the changes were splitting out public health (eg, sexual health, drug and alcohol rehab, suicide prevention) to local authorities. Collapse in social care was caused by defunding LAs.


That's a tried and true method from any group that wants to get rid of some system and then gets in charge of said system. Just make it impossible for it to succeed, for instance by decreasing their funding or adding onerous beuracracy that makes everything run slower. After that you can just point to how the system is running poorly as an excuse for dismantling it


Please don't bring Brexit into the NHS debate, the reasons for Brexit were broad, and the debate over the future of the NHS is already complicated enough.

That aside, the push for the privatisation of the NHS has been going on for a long time. For example "Britain's Biggest Enterprise: Ideas for Radical Reform of the NHS" was a policy essay written by Oliver Letwin and John Redwood in 1988. You can read it here: https://www.cps.org.uk/files/reports/original/111027171245-B... . It sets out a group of suggestions for moving the responsibility of the NHS away from the government and towards the private sector. It's quite interesting reading it now (it's only 20 pages), as despite key problems with each approach being identified back in 1988, we've ended up with similar policies being pushed forward in 2012. I think this boils down to the blindness of ideology, if you're determined to break up public healthcare institutions, it doesn't matter if your reforms lead to a more effective healthcare system or not.

As an example of this, PFI has been used heavily since New Labour came to power in 1997 (and by the Conservatives that followed them) to fund the building of new hospitals and schools. To explain, PFI is effectively funding public building works by private, for-profit loan companies. Before PFI, these building works were funded by government at low interest rates. To give some idea of the burden of PFI on the NHS, it's been estimated to drain £2 billion a year from NHS funds. If you want to reduce NHS waiting times, I'd suggest pushing for scrapping PFI would be a good start.

http://www.telegraph.co.uk/news/nhs/11748960/The-PFI-hospita...


Fly to Romania or Hungary etc., and she'll likely get almost immediate attention at an Austrian/German/US-funded state-of-the-art private clinic at a fraction of the UK private cost.


Actually if the US wanted they could copy paste the Dutch healthcare system right now. It's better and cheaper, though not free.

But this is an ideological problem, nobody wants to pay up. Things like income equality and social justice aren't things most Americans care about. I don't mean that as criticism. The US is just different.


Hey an open letter. Instant credibility and gravitas.

Really all communication should be open letters, so much more would be taken seriously, and so much more stuff done.


I just recently after moving back to the US had to sign up for an ACA plan. For my family I pay about $250/month only to find that our annual deductible is over $9000, meaning I have to spend an additional $750/month on health care just to for the insurance to pay 40% of the bill. I need to find a new solution or we'd just need to resign ourselves to never seeing the doctor.


Where did you move from? I'm sorry you have to be subjected to our "heath care" system that essentially functions as a machine that draws money from the arms of the well to do and turns the poor into blood.


Great analogy! We were living in Thailand and we luckily just paid for care when we needed it, which for us was very affordable.


The health system is not working: diabetes has officially no cure but hundreds of doctors cure it. A senator has brain cancer but nobody points him to an expert who cures brain cancer for 20+ years (see the clinic of Dr Burzynsky), low energy, headaches, ADD, ADHD, arthritis and many more diseases are being cured for many years. Alzheimers can now be cured (See Dr dale Bredesen's work) and I can go on.

The health system continues to be in a bad state if Bezos will try to do the same thing cheaper. If Bezos is smart he will have a chat with Dr Mark Hyman on how to introduce functional medicine to the whole country. It is cheaper and ... it works!


A $1 bag of water (sterile saline solution) in the American healthcare system costs hundreds of dollars.


You don't need Bezos to disrupt it. Just copy what Europe does.


If I were him, I would take a pass. No reason to "accidentally" die on an operating table. Let the imminent revolution handle the problem!


HMOs like Kaiser Permanente already achieve large savings and reduction in paperwork and copays vs fee for service health insurance.


Bezos is too smart to enter a market with such high regulatory risk.


There's more of a people and policy problem than there is money


I'll disrupt it for you (us), just need the seed funding.


What is his "vision" then?


"Alexa... I'm having a h-heart attack." "Got it. The temperature is sixty-eight degrees."




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