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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#121

Post by dragonwriter »

quickben wrote: post #107
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.

Interestingly enough, as a non American poster I find it amusing with the US posters having predominantly this type of selfish response. Every time healthcare is discussed on reddit, slashdot, etc, most of the people commenting on us healthcare debate it in the form of : "not with my hard earned money, you lazy commies, why don't you start working". What's interesting is that it isn't their fault. From the outside, t…

The amazing part is that Americans broken, non-universal, mostly-private but largely-public system spends more taxpayer money (per capita, for sure, but even as a share of GDP) than some countries that provide universal, mostly-to-entirely public, healthcare.

So it's not even saving your tax money to avoid universal coverage.

Re: YC Research: Universal Healthcare

#122

Post by PKop »

jartelt wrote: post #113
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…

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 t…

And if more and more people were not going to the doctor, the providers would lower the price (to some degree no?)

Re: YC Research: Universal Healthcare

#123

Post by intrasight »

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies

Your inefficiencies are someone else's revenue.

Or to say another way:

Healthcare is ~20% of US GDP

Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

Re: YC Research: Universal Healthcare

#124

Post by chriskanan »

8ytecoder wrote: post #50
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…

Exactly! Hospitals don't care about inefficiencies because insurance pays for it. Patients don't care either again because insurance pays for it. Insurance can't negotiate with hospitals as patients don't ever want to lose their doctors and revolt if insurance even brings up dropping a hospital for charging exorbitant rates. Add to it an insane 4 years in college + 4 years med school curriculum that does not incentiv…

>> Add to it an insane 4 years in college + 4 years med school curriculum that does not incentivize more people to even attempt getting into med school.

While I agree with your points in general, this point is wrong. There are far more applicants for medical school (both MD and DO programs) than there are slots. I've been told this was done by the AMA to keep the supply of physicians in the US low to maintain high wages (and arguably high quality).

I do think we could allow students to go to medical school directly after high school, which is what some nations do.

Re: YC Research: Universal Healthcare

#125

Post by sbierwagen »

refurb wrote: post #46
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...

That's a vast over simplification of the issue and ignores issues around implementation. First off, Medicare Part D plans are run by private insurers and they certainly do negotiate on price. In fact, they tend to get better prices than commercial plans. Those savings are used to compete for Medicare dollars to cover those patients (i.e. savings are passed on to Medicare). Second, physician administered drugs are pai…

  Medicare Part D plans are run by private insurers and 
  they certainly do negotiate on price.
Why is a third party negotiating for Medicare, rather than Medicare negotiating directly? Because they're smaller, and have less leverage.

  physician administered drugs are paid for at a rate 
  that is the average of what private payers pay.
Why is a third party negotiating for Medicare, rather than Medicare negotiating directly? Because they're smaller, and have less leverage.

From http://www.cnn.com/2015/09/28/health/us-pays-more-for-drugs/

-- Gleevec (a cancer treatment): $6,214 (per month/per customer) in the United States, compared to $1,141 in Canada and $2,697 in England.

-- Humira (for rheumatoid arthritis): $2,246 in the United States, compared to $881 in Switzerland and $1,102 in England.

-- Cymbalta (for depression): $194 in the United States, compared to $46 in England and $52 in the Netherlands. In fact, there is also a generic version of Cymbalta so these prices reflect having a cheaper alternative.

Some molecule. Different price.

Re: YC Research: Universal Healthcare

#127

Post by dragonwriter »

intrasight wrote: post #123

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

> Reduce spending by 40% would reduce US GDP by almost 10%.

No, it wouldn't, because most of that would go straight back to labor and result primarily in increased consumer spending, and secondarily in increased consumer investment (which leads to increased business spending.)

It's not like the money not being spent on healthcare inefficiencies is going to just vanish out of the system.

Re: YC Research: Universal Healthcare

#128

Post by aleksei »

intrasight wrote: post #123

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

I doubt the money not spent on inefficiencies would equate to money effectively burnt away. That 40% would probably be spent in other, more productive ways.

Not to mention you're actually making a point for not giving GDP too high a value when looking at economies.

Re: YC Research: Universal Healthcare

#129

Post by conanbatt »

intrasight wrote: post #123

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

Its a great sale, it means american citizens will be vastly richer. Its also a great incentive for lobby, but politically its tremendously good.

Re: YC Research: Universal Healthcare

#130

Post by HarryHirsch »

CaptSpify wrote: post #108
HarryHirsch wrote: post #66

Earlier quoted context omitted.

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…

> In the US you get to see the cost of care every time you have reason to see the physician I feel it's important to point out that you see the cost in the bill . There's no reliable way to see the cost beforehand.

What's seeing the expenses going to do, what mechanism is supposed to lower cost? When you need healthcare you need healthcare. No one goes to the physician for fun, elective procedures like breast enlargement or Lasik excepted.
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