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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#91

Post by nightski »

ones_and_zeros wrote: post #34
tyre wrote: post #30

We sell to governments, which is similar to healthcare. I cannot stress this enough: technology is not the hard part. Do they have outdated software? Yes. Can you build better software? Yes. None of that matters if you can't get it into their hands. Procurement is the hard part. Can you empathize with the needs, fears, desires, quirks, and crazy of ten different stakeholders? Pry proprietary API specs from the cold-d…

I think the point of this project is to replace the people, not necessarily to make software for people to use. Software is just means to an end.

If that is true, how is a pilot project in the developing world going to help at all in that sense? It doesn't seem like it is particularly relevant to the goal of reducing bureaucracy in the United States. Or do they really believe making a software platform is the missing piece here?

Re: YC Research: Universal Healthcare

#92

Post by temp-dude-87844 »

I applaud this initiative of collecting more data on this, by starting a small trial in an area with fewer confounding factors, and later applying those lessons learned in places with more interconnected systems in place.

One unfortunate fact is that a small proportion of people 'consume' most of the medical care. Operational inefficiencies, the concept of health insurance, a byzantine cost structure, and in the US, after-the-fact billing conceal -- or at least spread out over time -- some of the financial pain of care. This is a sort of societal compromise to avoid confronting the problem: a society either shoulders (i.e. subsidizes) the cost of care for its most unhealthy, or lets them perish outright.

Today, most civilized societies tiptoe around this subject by subsidizing medical care for the elderly for political expediency, where the marginal benefits (even for the particular individual) of life extension until funds finally run out quickly diminish, while leaving folks of prime working age bear a large portion of their own costs in case of misfortune, to say nothing of underserved minorities and the economic poor.

Perhaps the best value of conducting this trial in a developing country isn't solely to get away from the political machinery of a mature healthcare system, but to escape the political baggage of a post-industrial society and see if technological solutions can work if morals and politics aren't in the way.

Re: YC Research: Universal Healthcare

#93

Post by chimeracoder »

dragonwriter wrote: post #84
chimeracoder wrote: post #77

Earlier quoted context omitted.

> 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/Med…

> Staff isn't shared between the hospitals day-to-day It probably is; it's quite common for fair numbers of hospital staff (e.g., OR staff that are needed only for certain types of procedures), AFAIK, to be provided by third-party contractors that provide service to multiple hospitals in the same area, and the same staff may work at different hospitals on different days based on need.

> It probably is; it's quite common for fair numbers of hospital staff

Sort of, yes - in NYC, nurses are almost all members of 1199SEIU, for example, and the shift-work nature of nursing makes it easy for them to be employed simultaneously by multiple hospitals. Though my point is that this is usually handled on an individual level (by the nurses who choose where to work), rather than the hospitals themselves directly coordinating staff schedules in tandem.

Re: YC Research: Universal Healthcare

#94

Post by nickff »

chimeracoder wrote: post #86
nickff wrote: post #75

Earlier quoted context omitted.

Doctors without borders disagrees with your assessment in the USA.[1] [1] https://www.theatlantic.com/health/archive/2014/11/doctors-w...

> Doctors without borders disagrees with your assessment in the USA. Not really - I didn't say that the barriers don't exist. I said that doctors aren't the ones responsible for them. Requiring one year of residency in the US is not an unreasonable requirement, for a number of reasons. But the bottleneck in the number of residency slots is the funding for them (which is subsidized by Medicare), and doctors aren't eve…

Saying that doctors are not responsible for restrictions on physician training and certification is like saying that banks are not responsible for credit card and payment processing restrictions and regulations. The government is enacting and enforcing the restrictions, but the doctors are campaigning for them (under many different justifications and tactics).

The AMA is like many other trade organizations, in that it often acts as one of many lobbyists for industry interests.

Re: YC Research: Universal Healthcare

#95

Post by ska »

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.

That doesn't match any of the research I've seen on the subject, and I've looked quite a bit. Granted it's a tricky thing to study.

Do you have any citations from (competent, peer reviewed) journals?

Re: YC Research: Universal Healthcare

#96

Post by dikdik »

mikekij wrote: post #51

Founder of healthcare startup here too: This sounds like a great project. I love the idea of building technology for healthcare in a small, controlled, active care environment, and then scaling those tools to a larger audience. The bigger issue in healthcare IMHO is that the American healthcare model, while hugely inefficient, seems to be the system that best incentivizes innovation. We pay 10x what Sweden pays for m…

> We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable.

Lies, lies, lies, and more lies. This is always quoted, especially in the context of pharma. It's wrong. Americans pay for advertising (which is illegal in most first world countries) and for the yachts and islands of the big healthcare execs.

I work at the intersection of biotech and healthcare. Currently working on a healthcare product that will be rolled out in the EU before the US and will be profitable from day 1 without being "subsidized" by Americans.

Re: YC Research: Universal Healthcare

#97

Post by scarmig »

SilasX wrote: post #89
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...

If you think that policy is pure benefit for consumers and the only costs are to greedy mustache-twirling men, then there may be another bubble going on. It would mean that the US uses its leverage to push drug prices down to marginal costs, which would almost be the last domino in payers willing to pay for something like the value of new drugs. But drug development doesn't make sense if you can only charge marginal…

Funding research through banning a buyer from negotiating with its suppliers is pretty much the definition of a Rube Goldberg device.

I don't think anyone would dispute that that's a major way that research is currently funded, but it's fundamentally stupid. You've got a bunch of free riders, and it obscures where and why costs are actually incurred.

Allow negotiation, and then figure out clear, rational funding mechanisms.

Re: YC Research: Universal Healthcare

#98

Post by chimeracoder »

fencepost wrote: post #80
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…

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.

> 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.

Yes, private insurers don't pay entirely what they're billed. Though they still pay significantly more than Medicare pays. The negotiated agreements between private insurers and hospitals are almost always pegged at multiples of Medicare (e.g. "200% or 350% of Medicare rates for $X service").

Re: YC Research: Universal Healthcare

#99

Post by mikekij »

dikdik wrote: post #96
mikekij wrote: post #51

Founder of healthcare startup here too: This sounds like a great project. I love the idea of building technology for healthcare in a small, controlled, active care environment, and then scaling those tools to a larger audience. The bigger issue in healthcare IMHO is that the American healthcare model, while hugely inefficient, seems to be the system that best incentivizes innovation. We pay 10x what Sweden pays for m…

> We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. Lies, lies, lies, and more lies. This is always quoted, especially in the context of pharma. It's wrong. Americans pay for advertising (which is illegal in most first world countries) and for the yachts and islands of the big healthcare execs. I work at the intersection of biotech and heal…

Being intimately familiar with the COGS and Average Selling Prices of more than a few devices in various geographies, I respectfully disagree. That's not to say you can't have a profitable EU-first product. It's just easier to be profitable with US-first at the moment.

Re: YC Research: Universal Healthcare

#100

Post by mikekij »

dflock wrote: post #60
mikekij wrote: post #51

Founder of healthcare startup here too: This sounds like a great project. I love the idea of building technology for healthcare in a small, controlled, active care environment, and then scaling those tools to a larger audience. The bigger issue in healthcare IMHO is that the American healthcare model, while hugely inefficient, seems to be the system that best incentivizes innovation. We pay 10x what Sweden pays for m…

There are 9.5 million people in Sweden and 320 million in the US - the huge market size in the US would still be a big incentive, whatever else you did.

Not if your margins are negative.
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