I'm afraid that Joe Lonsdale's partner's ideas do not impress me.
So far, all that has been accomplished by the electronic medical records drive has been to put small physician practices out of business. They have not been able to absorb the overhead involved in implementing these symptoms, so that they have been forced to lose their independence, primarily to hospital-owned conglomerates.
The other ideas also are beside the point. If you change the metrics for compensating health care providers, in the end all you do is give them a different system to be gamed. What you have to do is reduce the incentive for *consumers* to obtain procedures that have high costs and low benefits. That means doing something unpopular, like making them pay out of pocket for a higher share of spending or else denying them coverage for some procedures.
All good points, but how about questioning how much "treatment" may be unnecessary? My own experience is that many physicians, by way of generating more office revenue for their practice, may tend to over-treat, requesting more visits than necessary, more drugs than necessary, and so forth. My sense is that this is a result of their training in medical school, as well as the need for CYA in the case of potential legal liability in our litigious culture. More treatment, whether paid out-of-pocket or federal and/or insurance subsidies, doesn't make us healthier.
You've hit the nail on the head. Recall that health insurance became married to a person's employer during WWII, an arrangement where "business" people effectively became involved in medical care in the HR office, and later in the doctor's office.
Frankly, the modern health insurance system has become a Soviet-style jobs program that otherwise captures, and shares, peoples' very sensitive personal information. In hindsight it appears that, generations ago, the insurance industry mapped out a long game to accomplish these ends.
Doctors are told by the tech industry that the tech industry understands that electronic records permanently complicates and slows down the work of a doctor. Coming to the rescue of the tech industry are lawyers who argue that the 2% improvement in safety offered by electrical systems is worth the gazillions of dollars that patients pay to subsidize the work of tech/insurance workers in a hospital.
The tiny-percent improvement in patient safety offered by tech workers in the hospital is more than completely offset by all the increased disease burden and death associated with jumping through insurance and computer-system hoops. This is easy for a doctor to see who has practiced in countries with neither insurance companies or computerized record systems. This is impossible to accept for tech people who cannot see, or routinely do not care about, what is on the other side of their paycheck.
Take home point: if the healthcare industry does not purge tech and clerk jobs, losing them permanently, then any other measure is just reshuffling unnecessary workers in a system where they are ultimately harmful. Such a purge, though, obviously would cause larger economy problems. And so, we effectively kill lots of patients so that healthy tech workers and clerks have a job in a hospital, or in an insurance cubicle somewhere. Soviet Union 2.0
Yes and in WWII, the adoption of untaxed health insurance was to circumvent government price controls. Employment is a terrible way to define risk pools. After all, what event does a pre-existing condition pre-exist? Date of hire. Nobody seems to know this basic fact.
And with employer provided health insurance we fund our health care system for the ages 18-64 with what amounts to a VAT. So in the Obamacare debates you had Republicans defending a VAT!! WTF??? So when you purchase a good or service in America you are paying for someone else’s health care coats!! This Substack subscriber is paying for the Substack executives’ health care!!
With respect to electronic health records, few step back to look at the information half life of data in an EHR. A Lp(a) result may be relevant for life. A month old pregnancy test is useless if you're about to have surgery. The intraoperative blood pressure every 10 seconds is most valuable to a plaintiffs lawyer. This stuff is complex and EHRs struggle to meet the complexity challenge.
In addition to eliminating barriers to market entry, it would be beneficial to be able to have more than mid-October to early December to make decisions. The market should be fluid and open to change in plan at any time. Especially when carriers sell portions of their portfolios to third parties whose pricing is different from the carrier you think you have.
With respect to payment reform, an important tweak to the direct primary care argument goes like this: Insurance is about pooling risks associated with somewhat rare adverse outcomes. Primary care is consumption. It's not relatively rare, it's not adverse. It is entirely predictable. It needs be taken completely out of the "insurance" definition. It's as if your auto insurance provided unlimited gas and car washes. From this change, we might see primary care delivery escape the expensive platform of hospitals. Why isn't my primary care doctor affiliated with my gym? Or why can't my gym create a simple primary care subscription model?
In the USA we have something called Medicare that provides very good coverage post age 65. Therefore, the effect of what I said would be extremely profound: It will eliminate the inability of 30m people to get reasonable care (until Medicare kicks in). It solves the biggest problem with an insurance system: self-selection preventing individual carriers offering this socially costless solution.
You mentioned the few questions to ask anybody and I have asked many times why it is so complicated and obtuse. It never made common sense why my medical history has to be repeated in nauseating detail with every new provider. A hospital CFO told me that healthcare systems want to be siloed to form a barrier to entry. Seems like a prevailing theme that the federal government also provides those barriers, the big systems can afford the expensive lobbyists.
I'm afraid that Joe Lonsdale's partner's ideas do not impress me.
So far, all that has been accomplished by the electronic medical records drive has been to put small physician practices out of business. They have not been able to absorb the overhead involved in implementing these symptoms, so that they have been forced to lose their independence, primarily to hospital-owned conglomerates.
The other ideas also are beside the point. If you change the metrics for compensating health care providers, in the end all you do is give them a different system to be gamed. What you have to do is reduce the incentive for *consumers* to obtain procedures that have high costs and low benefits. That means doing something unpopular, like making them pay out of pocket for a higher share of spending or else denying them coverage for some procedures.
All good points, but how about questioning how much "treatment" may be unnecessary? My own experience is that many physicians, by way of generating more office revenue for their practice, may tend to over-treat, requesting more visits than necessary, more drugs than necessary, and so forth. My sense is that this is a result of their training in medical school, as well as the need for CYA in the case of potential legal liability in our litigious culture. More treatment, whether paid out-of-pocket or federal and/or insurance subsidies, doesn't make us healthier.
You've hit the nail on the head. Recall that health insurance became married to a person's employer during WWII, an arrangement where "business" people effectively became involved in medical care in the HR office, and later in the doctor's office.
Frankly, the modern health insurance system has become a Soviet-style jobs program that otherwise captures, and shares, peoples' very sensitive personal information. In hindsight it appears that, generations ago, the insurance industry mapped out a long game to accomplish these ends.
Doctors are told by the tech industry that the tech industry understands that electronic records permanently complicates and slows down the work of a doctor. Coming to the rescue of the tech industry are lawyers who argue that the 2% improvement in safety offered by electrical systems is worth the gazillions of dollars that patients pay to subsidize the work of tech/insurance workers in a hospital.
The tiny-percent improvement in patient safety offered by tech workers in the hospital is more than completely offset by all the increased disease burden and death associated with jumping through insurance and computer-system hoops. This is easy for a doctor to see who has practiced in countries with neither insurance companies or computerized record systems. This is impossible to accept for tech people who cannot see, or routinely do not care about, what is on the other side of their paycheck.
Take home point: if the healthcare industry does not purge tech and clerk jobs, losing them permanently, then any other measure is just reshuffling unnecessary workers in a system where they are ultimately harmful. Such a purge, though, obviously would cause larger economy problems. And so, we effectively kill lots of patients so that healthy tech workers and clerks have a job in a hospital, or in an insurance cubicle somewhere. Soviet Union 2.0
Yes and in WWII, the adoption of untaxed health insurance was to circumvent government price controls. Employment is a terrible way to define risk pools. After all, what event does a pre-existing condition pre-exist? Date of hire. Nobody seems to know this basic fact.
And with employer provided health insurance we fund our health care system for the ages 18-64 with what amounts to a VAT. So in the Obamacare debates you had Republicans defending a VAT!! WTF??? So when you purchase a good or service in America you are paying for someone else’s health care coats!! This Substack subscriber is paying for the Substack executives’ health care!!
With respect to electronic health records, few step back to look at the information half life of data in an EHR. A Lp(a) result may be relevant for life. A month old pregnancy test is useless if you're about to have surgery. The intraoperative blood pressure every 10 seconds is most valuable to a plaintiffs lawyer. This stuff is complex and EHRs struggle to meet the complexity challenge.
Start with keeping private equity out of healthcare.
In addition to eliminating barriers to market entry, it would be beneficial to be able to have more than mid-October to early December to make decisions. The market should be fluid and open to change in plan at any time. Especially when carriers sell portions of their portfolios to third parties whose pricing is different from the carrier you think you have.
With respect to payment reform, an important tweak to the direct primary care argument goes like this: Insurance is about pooling risks associated with somewhat rare adverse outcomes. Primary care is consumption. It's not relatively rare, it's not adverse. It is entirely predictable. It needs be taken completely out of the "insurance" definition. It's as if your auto insurance provided unlimited gas and car washes. From this change, we might see primary care delivery escape the expensive platform of hospitals. Why isn't my primary care doctor affiliated with my gym? Or why can't my gym create a simple primary care subscription model?
My response was intended to fall under B2bdna's post.
Joe: Why not extend COBRA from 18 months to up to Medicare eligibility age?
Great point! That way the person on COBRA can go through all of the retirement savings and be forced to work past 65!! 😉
In the USA we have something called Medicare that provides very good coverage post age 65. Therefore, the effect of what I said would be extremely profound: It will eliminate the inability of 30m people to get reasonable care (until Medicare kicks in). It solves the biggest problem with an insurance system: self-selection preventing individual carriers offering this socially costless solution.
You mentioned the few questions to ask anybody and I have asked many times why it is so complicated and obtuse. It never made common sense why my medical history has to be repeated in nauseating detail with every new provider. A hospital CFO told me that healthcare systems want to be siloed to form a barrier to entry. Seems like a prevailing theme that the federal government also provides those barriers, the big systems can afford the expensive lobbyists.