YC Research: Universal Healthcare

> 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?

The vaccine itself. Medicare and Medicaid are notorious for this, as they have no mandate to cover marginal costs of supplies (and they have the ability to force providers to accept less than that).

So, depending on the practice, those providers could very well be losing money on every Medicare patient they treat before they even have a chance to think about paying for their office space, paying their staff, etc.

The number of positive results found by the RAND experiment is completely in line with what you'd expect from false positives from multiple comparisons, particularly given that these results were all found in non-preregistered segments.

nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury you won't get a timeout to make choices about which emergency room offers the best bang for the buck.

The vast majority of medicine is not emergency medicine. This idea that patients are unable to price shop and compare providers is completely debunked. India's free market health system represents 1/6 of the world and Indians do this every day.

Like any sane person I want to minimize the overall cost of healthcare, but I also want to minimize avoidable suffering.

As RAND and Oregon show, free and reduced cost healthcare do not minimize avoidable suffering (at least suffering caused by medical conditions) any better than high marginal cost plans.

This isn't just a matter of altruism or anxiety about high healthcare costs; if you have a maximally efficient healthcare delivery system then it's likely to fail in the event of a black swan public health crisis because all the gains from efficiency have already been booked for profit.

Can you provide an argument why a more efficient medical system - specifically one where patients don't visit the doctor for frivolous/moral hazard reasons - would be somehow susceptible to black swan events?

You may be right about medical innovation being partly driven by the profit and cost-heavy US healthcare system. We need to get comfortable with the idea that economic, profit-driven interest is less important than using our considerable resources to rebalance the care for everyone in a more equitable process. I am willing to slow down the pace of innovation for this goal, and I hope others are, too. This directly parallels environmental concerns, where we as a species are destroying habitat, driving species extinct, and negatively impacting the climate, so we can enjoy many unnatural conveniences. We have to take a step back and realize that fixing these fundamental issues is more important than innovation and technological progress.

Next time a non-human asks me where it can find a doctor, I'll take it to the vet myself.

How much of the problem is actually the way (big) pharma conducts research? ( I know that I am over simplifying and dozens of startups are focused on improving the way research is done)

From a manf process standpoint, there are cheaper ways to create these compounds. Generic drug manufacturers have proved that ignoring the cost of research, the drug itself costs next to nothing to make, market and sell.

From an economics standpoint, healthcare costs are a significant part of GDP. In an ideal model if all research is funded directly via government grants and the key research is licensed through a free licensing - It should create a very competitive drug cost model.For a healthcare practice standpoint, legislation can really help. Stripping down some of the malpractice laws are a good starting point.

Additionally, the monopoly on medical education should be broken - Making medical education a national priority is a key step. We also need to make sure, that doctors are not the only healthcare providers. Enabling entrepreneurship among non doctor(nurses, mid wives etc) medical practioners can increase the market supply.

These 2 actions in theory should create more doctors and reduce the cost of practicing medicine.