Thread by @ASlavitt

BREAKING HC NEWS: CVS announced it is buying Aetna. If interest, I will offer some takes later.

I have gotten a lot of questions.

This thread will take me a while. I promised to take my teenage son somewhere tonight-- since I still travel to DC a lot-- so I will post tomorrow in order to get it right.

Apologies.

There are lots of reasons not to read this thread.

To begin with it's long.
Also I'm using 280 and I hate 280.
Also if you're very sophisticated, you may find it too simplistic.

But there are also other, more important reasons not to read this.3/

Many people are rightly frustrated about health care-- our ability to give ppl what they need, the politics; the profit, the administrative hassle.

Mergers allow people to point out many of those things.

This thread will fail to focus on some of the most important questions.4/

First is to say there are a lot of big unanswered questions in health care. To pick a few--

How will we make sure everyone gets covered?
What's should be the role of private sector? Role of Govt?
Influence of profits/money?

Mostly how do we fix all of this?5/

Depending on your view of those questions, you may automatically hate this merger on some of those grounds.

Or, not feel like anything makes sense until there is transformative change.6/

In early in 2018 expect to see an entire initiative around these questions. (That's a teaser...)

Because those are very reasonable views which I will address those areas more separately. But not here.7/

The thread is for 2 people:

-Ordinary consumers who are asking how this might affect them
-Reporters and others curious about the implications and potential trends for the future 8/

The questions I will try to address are:

Why would they want to do this?
What is it likely to mean for real people?
What does it imply about the future in health care?
How should this be judged? 9/

More to come later today but I will pause so as not to crowd up anyone's timeline.

Stick around if interested. Otherwise ignore. 10/

Ready to tweet another 10 or so of this thread. 11/

Health care has developed and works in silos.

Fall sick- go to the hospital. Insurance for a claim. Something wrong- find a specialist. Take a drug to ease the pain. Deal with it all separately.

But 80% of health care is chronic disease & we aren't built around patients. 12/

Companies like Kaiser have always combined more things under one roof. You buy their insurance, go to their clinics, go to their hospitals.

It's popular & considered successful but it's not for everyone. It's cheaper & convenient but limits choice. Will come back to that.13/

This is in some ways a move to a Kaiser like company to cover more ground, build relationships with consumers & grow it. And by doing it without hospitals, there is more focus on keeping people well than making money when they're sick.14/

There are differences-- plenty of them, including that Kaiser is a non-profit.

But an important point. Kaiser makes money by keeping ppl healthy not having them have more visits and tests. CVS should now as an insurer have incentive to use their resources this way.15/

To state the obvious they want more people who shop in their stores to buy their insurance & vice versa. Will come back to that.

But they probably also hope to build long term relationships w consumers, use this to coordinate care better & collect data to do it smarter.16/

What does this mean for ordinary people? I think people's needs in health care are simple-- we want good service, our questions answered & affordable costs. Also a trusted relationship.

A lot of people don't find they get that any more-- if they ever did.17/

Will the company provide good service. I can't answer this.

But I will say it's the first company that is a retailer in health insurance & so they could make h care more convenient, online, etc.

Also Amazon rumored 2 be entering pharmacy so focus on consumer could increase.18/

For anyone still with me, I'm going to tweet next about cost and affordability and how to judge the merger but not for a little bit.

Sorry this is so long. Hard topic.