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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#71

Post by will_pseudonym »

kiba wrote: post #53
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.

More like, there's too much sugar that people are using. It's doesn't matter if it's corn syrup or not.

Yes, but I would posit that the greatest reason that it has become such a problem is because of the subsidization that makes corn syrup so inexpensive. It's a massive negative externality that is completely unpriced.

Re: YC Research: Universal Healthcare

#72

Post by cookiecaper »

unityByFreedom wrote: post #25
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.

There could certainly be a base level of care, with private insurance for additional levels. That's how it works in Taiwan. Calling all universal healthcare non-competitive is like calling building roads non-competitive. We have government roads and private toll roads. The same goes for many services we take for granted. A more advanced basic level of healthcare is something we are able to achieve because of our weal…

>Calling all universal healthcare non-competitive is like calling building roads non-competitive. We have government roads and private toll roads. The same goes for many services we take for granted.

Roads are a major one-time investment with occasional upkeep. Everyone can use the road without the permission or assistance of anyone else. If we develop fully robotic medical treatment, this analogy may work, but as long as medicine requires direct, many:one human interaction to be worth anything to anyone, it's not a piece of infrastructure.

>A more advanced basic level of healthcare is something we are able to achieve because of our wealth and success. We already have sanitary toilets, housing, heating, clean water. Every generation has built upon what we can join together as a society to provide in order to promote our health.

We have sanitary toilets, housing, heating, and water without nationalizing home builders, plumbers, or utility companies. All of these things are subject to sensible regulations like municipal building and zoning codes, licensing, and local utility oversight boards that have arguably done a lot to keep the little guy from getting fleeced. Maybe we could take that approach, which is a bit short of writing a blank check or setting fixed prices for all medical providers nationwide?

>In my opinion, Buffet, Gates etc. are the heroes of our time for standing up as rich folks to advocate giving back more to society. They don't view government as the enemy; rather, it is the result of our working together.

Look under the veneer on Buffet, Gates, etc. They like government because it furthers their business interests (this is especially true in the case of Buffet) and because it's easier to exercise control over money sitting in a bureaucrat's coffers, especially when you're a big name like Gates or Buffet, than money that is dispersed among the private citizenry, who really don't have any special reason to care about your opinions.

It's also very useful PR to go on TV as the richest man in the world and say "I need to give the government more of my money". What would the backlash be if he said the opposite?

While Gates and Buffet surely have legitimately laudable humanitarian interests, it's misleading to pretend that they're saints. They are free to donate to the government as they wish. Suggesting that everyone else be forced to match them percentage-wise is a different story.

Re: YC Research: Universal Healthcare

#73

Post by [deleted] »

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.

[deleted]

Re: YC Research: Universal Healthcare

#75

Post by nickff »

chimeracoder wrote: post #56
nickff wrote: post #49

Earlier quoted context omitted.

Because scarcity raises doctor salaries, and healthcare professionals are very good at organizing and negotiating. HN always gets riled about how H1B visas may lower wages, but doctors actively prevent foreigners from being allowed to practice medicine in their jurisdiction.

> healthcare professionals are very good at organizing and negotiating Hardly - if that were the case, we wouldn't see so many private practices (and even hospitals) going straight out of business. > but doctors actively prevent foreigners from being allowed to practice medicine in their jurisdiction. This isn't really true either - it's true that there are restrictions around practicing (e.g.) in the US without comp…

Doctors without borders disagrees with your assessment in the USA.[1]

[1] https://www.theatlantic.com/health/archive/2014/11/doctors-w...

Re: YC Research: Universal Healthcare

#76

Post by jrowley »

jclos wrote: post #58

Pardon my cynicism, but I don't like the idea of choosing a patient you're going to "spend your money on" as a replacement for a basic universal healthcare. Healthcare shouldn't be a popularity contest. As an addition to a normal "basic" healthcare it's fine, but please don't replace existing systems with this stuff.

I urge you to read the announcement. Watsi is going into a different space than before - integrated healthcare (including preventive action) as opposed to their traditional funding a single patient model.

Re: YC Research: Universal Healthcare

#77

Post by chimeracoder »

khuey wrote: post #62
chimeracoder wrote: post #44

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. 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?

> My understanding is that doctors can choose not to take Medicare patients.

Sort of. For example, most emergency rooms in which physicians have admitting privileges to an associated hospital are required to take Medicare[0]. And those emergency rooms are prohibited from refusing patients based on insurance status. So right off the bat, that's an enormous source of patients who could be publicly insured (Medicare/Medicaid) or uninsured, and they have no legal way to refuse them. (Once a patient is in the ER, if they need to be admitted, you can't (legally!) refuse to admit them based on their insurance status).

I'm kind of oversimplifying, because there are a lot of tricks that hospitals try to use to stop the bleeding - for example, Bellevue is a public hospital, and it operates an emergency room, but its private counterpart that is literally across the street does not. NYU can do some (perfectly legal) maneuvering to keep most of the patient population of Langone limited to privately-insured patients. As a result, Langone has undeniably better[1] care, despite having access to the same set of medical staff[2] and being associated with the same medical college.

It's true that private practices can refuse Medicare for outpatient services easily. And incidentally, many do. There's a reason that, except in "critical access" areas[3], most of the top physicians who operate purely private practices don't accept Medicare. However, private practices are a dying breed, so that's a moot point in 2017.

[0] Conversely, free-standing emergency rooms are prohibited from accepting Medicare. A rather cynical view of this would be that Medicare does not want to encourage free-standing emergency rooms, because it's much more difficult to use private emergency care to subsidize Medicare care than it is to use private inpatient care to subsidize Medicare care (the orders of magnitude in costs are vastly different).

[1] More expensive, but vastly better

[2] Well, sort of. Staff isn't shared between the hospitals day-to-day (a nurse at Langone will typically only work at Langone unless he or she also has a job at Bellevue), but the allocation draws from the same pool a priori.

[3] Rural hospitals that Medicare pays handsomely, because otherwise those regions would have no medical access at all.

Re: YC Research: Universal Healthcare

#78

Post by refurb »

khuey wrote: post #62
chimeracoder wrote: post #44

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. 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?

They can refused to treat any Medicare patients, but they can't pick on chose which Medicare patients their serve.

Re: YC Research: Universal Healthcare

#79

Post by maxerickson »

HarryHirsch wrote: post #66
maxerickson wrote: post #26

Earlier quoted context omitted.

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 co…

People with employer provided insurance don't have much reason to figure out how much their employer is kicking in for the insurance and if they have a modest deductible they also won't care a great deal about the EOB.

I do agree that a single payer system that mandated prices would also likely result in lower prices, but I think that is less likely for the US than incremental changes to our current system.

Re: YC Research: Universal Healthcare

#80

Post by fencepost »

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…

It's important to realize that what private insurance is billed is the same as what uninsured/self-pay patients are billed, but what private insurance pays is negotiated rates that are often pretty close to what Medicare is paying. There's a certain level of shell game going on in there.
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