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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#61

Post by chimeracoder »

maxerickson wrote: post #26
TuringNYC wrote: post #18

(Full-time co-founder of a healthcare startup here): W/r/t the US specifically: it seems there is no shortage of inefficiencies and obvious solutions to the inefficiencies in the US healthcare system. To me, the real problem seems to be a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution. Specifically-- patients, payers, physicians, pharma, f…

I bet making structural changes so that cost of care is more visible to patients would help a lot in the US. Of course this means disincentivizing health care as a benefit rather than incentivizing it, so it will never happen. It is kind of happening with things like HSAs, but not really. We should also work on removing arbitrary barriers to entering the supply side of the market. Not just for individuals that want t…

> I bet making structural changes so that cost of care is more visible to patients would help a lot in the US.

It would, but it would be politically infeasible. Medicare would never let it happen, because providing price transparency in the private market would undermine the convoluted system that allows them to use private insurers to subsidize the care of Medicare patients.

Re: YC Research: Universal Healthcare

#62

Post by khuey »

chimeracoder wrote: post #44
warcher wrote: post #33

Earlier quoted context omitted.

In the united states we can't successfully implement negotiation on drug prices for MediCare . They literally can't negotiate with their suppliers. By law. Anybody thinking software is going to solve that is way in a bubble. http://healthaffairs.org/blog/2016/09/19/the-politics-of-med...

> In the united states we can't successfully implement negotiation on drug prices for MediCare. They literally can't negotiate with their suppliers. By law. On the flip side, Medicare sets reimbursement rates for services essentially by fiat[0], which can be below the marginal costs of providing service. Most providers cannot legally refuse to treat Medicare patients, so they are forced to accept the rates that Medic…

> Most providers cannot legally refuse to treat Medicare patients

My understanding is that doctors can choose not to take Medicare patients. Do you have a link or something that explains this?

Re: YC Research: Universal Healthcare

#63

Post by thatfrenchguy »

alienjr wrote: post #54
CPLX wrote: post #12

Earlier quoted context omitted.

Somebody better tell all those non-humans in Western Europe about this.

Except for Switzerland, Western (not to speak about Eastern) Europe's universal healthcare means universal high taxes, universal low quality of treatment and universal access to waiting queues.

Been to hospitals in France and the Czech republic. They were pretty nice.

Re: YC Research: Universal Healthcare

#65

Post by tcbawo »

chimeracoder wrote: post #44
warcher wrote: post #33

Earlier quoted context omitted.

In the united states we can't successfully implement negotiation on drug prices for MediCare . They literally can't negotiate with their suppliers. By law. Anybody thinking software is going to solve that is way in a bubble. http://healthaffairs.org/blog/2016/09/19/the-politics-of-med...

> In the united states we can't successfully implement negotiation on drug prices for MediCare. They literally can't negotiate with their suppliers. By law. On the flip side, Medicare sets reimbursement rates for services essentially by fiat[0], which can be below the marginal costs of providing service. Most providers cannot legally refuse to treat Medicare patients, so they are forced to accept the rates that Medic…

I see this argument in many places. Who dictates the cost of providing services? Why are these costs so high? My pet theory is the insane costs (money, time, high selectivity) of medical training and office overhead. Medical professionals feel entitled to $$ for their risk. Perhaps older specialists who didn't have these costs are spoiled. I would love to see how tuition amnesty would affect price elasticity.

Re: YC Research: Universal Healthcare

#66

Post by HarryHirsch »

maxerickson wrote: post #26
TuringNYC wrote: post #18

(Full-time co-founder of a healthcare startup here): W/r/t the US specifically: it seems there is no shortage of inefficiencies and obvious solutions to the inefficiencies in the US healthcare system. To me, the real problem seems to be a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution. Specifically-- patients, payers, physicians, pharma, f…

I bet making structural changes so that cost of care is more visible to patients would help a lot in the US. Of course this means disincentivizing health care as a benefit rather than incentivizing it, so it will never happen. It is kind of happening with things like HSAs, but not really. We should also work on removing arbitrary barriers to entering the supply side of the market. Not just for individuals that want t…

cost of care is more visible to patients

In the US you get to see the cost of care every time you have reason to see the physician - there's the copay for the physician visit and medications, and then there's the explanation of benefits, where you, as a patient, get to reconcile accounts. In NIH Britain OTOH, you get to see nothing of that sort (except a small copay for medication), and healthcare costs are better contained. It's the US that is the outlier, and shifting even more burden on the patient won't fix matters, it hasn't fixed matters in the past.

Re: YC Research: Universal Healthcare

#67

Post by will_pseudonym »

cma wrote: post #31
will_pseudonym wrote: post #27

Earlier quoted context omitted.

Don't forget farm subsidies dumping cheap corn syrup into the bellies of our entire populace. Health care in the USA must deal with the reality of our obese and overweight masses (no pun intended). Mental health in this country is similarly crippled by rapid societal changes, but that would take longer to explain in detail.

I thought subsidies for corn-based ethanol and tariffs on sugar (lowering sweetener supply) made corn syrup more expensive.

* Tariffs on sugar increase demand for corn.

* Subsidies for ethanol increases the cost of all food, including corn.

* Subsidies for corn for lots of other things[0][1] decrease the direct price of corn to consumers and food manufacturers.

As a single data point, I come from Kansas, from a family of farmers. It used to be known as the "Breadbasket of America" because of all the wheat that they grew. Its number one crop is now corn[2].

[0] https://farm.ewg.org/progdetail.php?fips=00000&progcode=corn

[1] https://en.wikipedia.org/wiki/Agricultural_subsidy#United_St...

[2] https://www.nass.usda.gov/Statistics_by_State/Kansas/Publica...

Re: YC Research: Universal Healthcare

#68

Post by warcher »

chimeracoder wrote: post #44
warcher wrote: post #33

Earlier quoted context omitted.

In the united states we can't successfully implement negotiation on drug prices for MediCare . They literally can't negotiate with their suppliers. By law. Anybody thinking software is going to solve that is way in a bubble. http://healthaffairs.org/blog/2016/09/19/the-politics-of-med...

> In the united states we can't successfully implement negotiation on drug prices for MediCare. They literally can't negotiate with their suppliers. By law. On the flip side, Medicare sets reimbursement rates for services essentially by fiat[0], which can be below the marginal costs of providing service. Most providers cannot legally refuse to treat Medicare patients, so they are forced to accept the rates that Medic…

Oh it's absolutely complicated, but hilariously inefficient and corrupt on both a macro and a micro level. On every level you examine the system it's a bugfuck.

Re: YC Research: Universal Healthcare

#69

Post by erispoe »

alienjr wrote: post #54
CPLX wrote: post #12

Earlier quoted context omitted.

Somebody better tell all those non-humans in Western Europe about this.

Except for Switzerland, Western (not to speak about Eastern) Europe's universal healthcare means universal high taxes, universal low quality of treatment and universal access to waiting queues.

Do you have a source for your claim of "low quality of treatment"?

Re: YC Research: Universal Healthcare

#70

Post by djsumdog »

dragonwriter wrote: post #24
whb07 wrote: post #10

Unless you remove people out of the equation, universal healthcare will never work. There's no incentive for anyone to be efficient, more frugal, work harder, provide a better service in universal healthcare. Humans arent wired for this.

> Unless you remove people out of the equation, universal healthcare will never work. Every OECD nation except the US has universal healthcare; many have generally comparable outcomes and all have lower costs (both per capita and as a share of GDP) when compared to the US. So, I'm not sure what your binary standard of "work/not work" is, but universal healthcare can and often does work better than what we have in the…

America is really interesting in that it traps people in jobs via healthcare (and other things, but health care is a big one).

I spent over a year backpacking after being out of the US for four years. I never worried too much about health care, because the few times I needed to go to a doctor, they'd tell me prices up front for uninsured foreigners. In one country, even though I wasn't a resident, my work visa did give me a discount.

I've been back in the US for a year and want to go a big road trip. I have a ton of savings, but my health care is terrible. I got a contract job with a $19/week "minimal effective coverage" plan (preventative only; the 'legal for less' type car insurance plan that is ACA approved).

After three months they gave me the PPO plan options which started at $400/month. Thankfully I haven't broken an arm, but in the 12 months working and not getting on that overpriced PPO plan, I've saved enough money even after tax that I could probably pay for a broken arm out of pocket.

I looked at ACA plans, but they were $200+/month with $6k deductibles. By not going that route, I've saved enough to actually pay that deductible.

When I quit my job this spring, I might be able to get a real plan by saying my yearly income was what I earned up to that point. But I don't plan on staying in this state at all, or any state for more than 2 ~ 3 weeks after. Since so many of these plans are tied to states/networks, what good is that anyway?

In the US you have to work .. work work work just to have basic health care. Either that or just be desperately poor. No other high income country requires this. They take care of all their people.

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