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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#111

Post by vondur »

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…

Seems like in the US the easiest way for universal healthcare would be to extend Medicare to all. Most people seem to like Medicare. I'm sure their would be some tax increases, but I'm sure overall it would lower health care costs for everyone.

Re: YC Research: Universal Healthcare

#112

Post by triangleman »

chimeracoder wrote: post #61
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…

> 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.

Explain how. I thought Medicare was rife with fraud and overbilling, so that they end up subsidizing private payers.

Re: YC Research: Universal Healthcare

#113

Post by jartelt »

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…

Maybe it would help, or maybe it would do the opposite. Having an HSA and seeing prices upfront can also make one not go to doctor because they do not want to drain their HSA. This can cause people to skip preventative care steps and to not nip potential problems in the bud before they get bad (and expensive). A lot of diseases/conditions are much cheaper to cure/fix if you catch them early, so maybe you don't want to incentivize people to stay away from the doctor.

Re: YC Research: Universal Healthcare

#114

Post by toomuchtodo »

vondur wrote: post #111
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…

Seems like in the US the easiest way for universal healthcare would be to extend Medicare to all. Most people seem to like Medicare. I'm sure their would be some tax increases, but I'm sure overall it would lower health care costs for everyone.

https://www.congress.gov/bill/114th-congress/house-bill/676/...

Re: YC Research: Universal Healthcare

#115

Post by anigbrowl »

warcher wrote: post #33
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…

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...

Agreed. US healthcare is a horribly corrupt system designed to redistribute wealth from the most vulnerable into as few hands as possible. It is one of the few industries where I think expropriation and corporate dissolution is entirely justifiable.

Re: YC Research: Universal Healthcare

#116

Post by monk_e_boy »

temp-dude-87844 wrote: post #92

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,…

> civilized societies tiptoe around this subject > by subsidizing medical care for the elderly for > political expediency

It is the same with car insurance. The elderly are almost as bad as drunk drivers for accidents.

Re: YC Research: Universal Healthcare

#117

Post by SilasX »

scarmig wrote: post #97
SilasX wrote: post #89

Earlier quoted context omitted.

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 mech…

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

It's exactly how normal (non-monopsony) markets work in every context, including markets for intellectual works/IP.

Note: in this context, "negotiating" means "turning the national market into a monopsony". It's generally recognized as not-a-pure-good-thing when e.g. Walmart comes close to doing that and forces sellers to nearly take a loss in return for access to Walmart's market.

(And before anyone makes the obvious point, yes, I know "health care ain't a can of beans etc etc etc". But with respect to the dangers of monopsonies, it's close enough.)

Re: YC Research: Universal Healthcare

#119

Post by will_pseudonym »

dv_dt wrote: post #85
will_pseudonym wrote: post #71

Earlier quoted context omitted.

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.

In part, but there is sugar or corn syrup in so many products, especially US products, where there is really no good reason for either.

They're cheap, addictive calories. HFCS and sucrose also don't trigger our satiety responses well, so that also allows us to eat more than our body needs[0]. It's a battle over space in our stomachs, and sugars are a massive weapon in that competition. Food science is practiced by food companies not to make us healthier, but to ingest more.

[0] https://www.ncbi.nlm.nih.gov/m/pubmed/18065574/

Re: YC Research: Universal Healthcare

#120

Post by triangleman »

chicagobob wrote: post #40
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…

Only partially. Often at the time of consumption cost isn't something one can use to make decisions. But for those other times, sure it would help. Speaking of lack of info about pricing you might find this interesting: https://www.statnews.com/2017/02/06/health-insurance-high-de...

Great article. It's not just about pricing info, it's about the nationwide move to HDHP's and HSA's.

Personally I'm pretty happy with my HSA, because now the list of things I can spend my healthcare dollar on is much longer:

https://www.irs.gov/pub/irs-pdf/p502.pdf

Lots of those things would not be covered by a traditional health insurance plan.

But of course, it means we have chosen to forego health care and services in some cases, like the author of the article above. In one case we turned down an ambulance and drove ourselves to the hospital, which saved some money.

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