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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#161

Post by tcbawo »

tclAmockingbird wrote: post #131
tcbawo wrote: post #65

Earlier quoted context omitted.

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.

Physician and staff salaries (outside of staff to manage insurance companies) are not what drive increasing medical costs. Most physicians don't make that much money, all things considered. An insurer last month for a relative's pediatrics practice announced that they were having difficulties with their accounting system and so they would only be making a half payment on their outstanding AR (and naturally, they ann…

When you say insurance isn't paying what it costs for a vaccination, what determines the cost of the procedure? Is it the vaccine itself? Office overhead? Liability insurance? I know pediatricians are generally overworked and underpaid. But, it seems we desperately need innovation on the cost side.

Maybe we need to drop kiosks into pharmacies that can read biometric markers, get doctor approval, and deliver vaccines.

Re: YC Research: Universal Healthcare

#162

Post by JacobJans »

beambot wrote: post #151
sbierwagen wrote: post #125

Earlier quoted context omitted.

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?…

What is preventing legislation that simply opens borders / trade for filling prescriptions?

This ammendment almost made it to the floor:

https://www.congress.gov/amendment/115th-congress/senate-ame...

You can see who voted for / against it: https://www.congress.gov/amendment/115th-congress/senate-ame...

Re: YC Research: Universal Healthcare

#163

Post by rtstreak »

thereisnospork wrote: post #142
Arnt wrote: post #134

Earlier quoted context omitted.

Switzerland, England, Canada, the Netherlands... which negotiator in any of those countries is not smaller than Medicare?

well none of them, since Medicare isn't a negotiator?

It actually is based on their integrity.

Re: YC Research: Universal Healthcare

#164

Post by DanBC »

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.

Universal healthcare is not "free money, do what you like".

Have a look at the English NHS. You have a national organisation providing best current practice guidance (NICE.org). You have the Department of Health that funds NHS England, who fund the Clinical Commissioning Groups. The CCGs buy services from health trusts. The CCGs don't have to buy from NHS providers, they could buy from private providers. (See some inpatient eating disorder services; some forensic units; for examples of private providers commissioned by the NHS).

English health care workers are dedicated, skilled, hard working people.

Re: YC Research: Universal Healthcare

#165

Post by marcell »

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…

Not disagreeing, but could you provide a few examples of inneficiencies that you see? I'm not familiar with the field.

Re: YC Research: Universal Healthcare

#166

Post by tcbawo »

refurb wrote: post #83
tcbawo wrote: post #65

Earlier quoted context omitted.

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.

The costs you typically see quoted are from the chargemaster that hospitals are required to keep. That's not what's actually paid, but rather the starting point for a negotiation (or what you are billed if uninsured). One reason for the inflated chargemaster prices (e.g. $100 for a tylenol) is that payers (Medicare is a big one) simply negotiate by saying "I'll pay you 50% of your chargemaster". Then when the hospita…

Perhaps we need to borrow a tactic from countries fighting currency inflation and introduce an alternate 'chargemaster' with more realistic (ideally public) prices.

Re: YC Research: Universal Healthcare

#167

Post by Kluny »

I was thinking about this lately. Can universal health care be solved by the free market, if the free market decides to enforce checks and balances on itself?

That is to say, could someone start a not-for-profit health insurance company that offers excellent coverage for affordable rates, and build it from the ground up with a culture of clarity and transparency? At a bare minimum they should have a searchable database where you can type in "broken arm" and find out what price this company has negotiated for casts, x-rays, and doctor time, and what it will cost you in co-pay.

It seems like insurance companies are so universally bad and corrupt that there would be no trouble signing up a critical mass of users by simply being a little better than the norm, and once it's the biggest insurance provider in the US, start applying muscle to hospital administration.

Yes, I know I'm oversimplifying it. Can anyone think of a way that it might be possible, though?

Re: YC Research: Universal Healthcare

#168

Post by edblarney »

beambot wrote: post #151
sbierwagen wrote: post #125

Earlier quoted context omitted.

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?…

What is preventing legislation that simply opens borders / trade for filling prescriptions?

"What is preventing legislation that simply opens borders / trade for filling prescriptions?"

US suppliers sell to Canada at a different price than they sell in the US.

If 'borders were open' - the price in US would go down, the price in Canada would go up, roughly to the same price.

I understand that it seems odd, but I reject the idea that it's 'corrupt' to sell to one country at a different price than another.

Drugs are essentially IP, so it would be like the US selling Canada the 'Superbowl' and then Canada selling and broadcasting it to the rest of the world at a discount.

I think something should be done about that - but drugs are not like most goods. And of course, many goods have different controls and regimes.

Another aspect: it's not really 'free trade' when a government entirely regulates the economy for a good. So when gov of Canada 'sets prices' for a good, it kind of flies in the face of regular trade rules and potentially gives one side or another advantages, so it really doesn't fit well under things like WTO or NAFTA.

Surely we could have some new thinking about this though ...

Re: YC Research: Universal Healthcare

#169

Post by a3n »

> Once the platform is in place, Watsi will start to experiment with improving the quality of care and reducing the cost – e.g., by streamlining operations, minimizing waste and fraud, and identifying medical errors in real-time.

That sounds like any politician ever, campaigning for office by promising to do the above, for government in general, the Defense or Energy or Education department, etc.

Good luck, and I sincerely hope it works. This time.

Re: YC Research: Universal Healthcare

#170

Post by abalone »

> Watsi’s goal is to improve the efficiency of funding, making universal healthcare possible.

Universal healthcare is already possible.[1] Reducing waste is a noble goal but this is a startling sentence from a health tech startup team. It implies that the primary obstacle to universal care is cost, not political will, which fails to comprehend how universal care was achieved in most of the industrialized world.

[1] https://en.m.wikipedia.org/wiki/List_of_countries_with_unive...

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