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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#181

Post by rsync »

If you went back in time - say, 20 or 25 years ago - and you picked up a progressive, left leaning magazine - say, adbusters or mother jones - you would very regularly read warnings about the manufactured needs of medicine and healthcare and pharmaceuticals.

Barely an issue of such a periodical could pass without dire warnings of a future in which big pharma and insurance interests would convince us, through advertising, that we were foremost consumers of "healthcare".

What happened ?

The progressive left is now fully, fervently convinced that "healthcare" is a basic priority of human life. It is a rampant consumerism that reaches far beyond - and profoundly deeper - than the fears that good people have always had.

It didn't have to be this way.

Re: YC Research: Universal Healthcare

#182

Post by drewrv »

Kluny wrote: post #167

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 databa…

I see two problems, one is that consumers don't buy health insurance, their employers do. So the insurance company that is willing to deny legitimate claims and kick sick people off its rolls in order to lower its costs will win.

The bigger issue is that insurance is the wrong business model. Insurance is supposed to protect against a catastrophic risk, like a car crash or an earthquake, but we use health insurance in this country to cover routine and ongoing care. Whether there even is a "business model" to treat people is debatable. Sick people as a group tend to earn less than the healthy.

Re: YC Research: Universal Healthcare

#183

Post by tclAmockingbird »

chimeracoder wrote: post #171
tcbawo wrote: post #161

Earlier quoted context omitted.

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.

> 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…

Yes, in my relative's case (being peds) it is Medicaid.

It's a really frustrating thing, as a physician you want to treat everyone, but accepting Medicare and Medicaid can really hurt the operation of your business.

Re: YC Research: Universal Healthcare

#184

Post by cookiecaper »

wvenable wrote: post #154
cookiecaper wrote: post #57

Earlier quoted context omitted.

"Universal" means goverment-paid. It means that we have officially accepted that healthcare is so unfathomably impossible for a normal person to afford that the government has to inflate the cost out of existence. This is obviously not a sustainable or mature solution to the problem, but it's a band-aid that appears to relieve much of the burden involved for patients. I broke it out once and my net salary would be ab…

Because every doctors visit would cost money, people wouldn't get regular checkups and catch issues when they are cheap and easily dealt with. So now more pressure is put on that catastrophic medical insurance or government provided catastrophic health care. That kind of system promotes poor and expensive health.

>Because every doctors visit would cost money

Yes, services and goods procured, even necessary services and goods like food, clothing and housing, cost money.

If you're arguing that no life necessities should cost money, I'm afraid you're not going to get anywhere with the non-socialist crowd. Since most Americans are non-socialist, this is not a politically tenable position. Do you have an objection that isn't "it should cost literally no money"?

Re: YC Research: Universal Healthcare

#185

Post by yummyfajitas »

whyileft wrote: post #135
yummyfajitas wrote: post #90

Interestingly, we already discovered a mechanism for drastically reducing the cost of healthcare back in 1986. It's a way of crowdsourcing the problem called high copays . Basically, you have to pay out of pocket for 90% of your health care up to a (high) cap. It turns out that patients are very good at figuring out which health care will improve health and which won't - the high copay group had no statistically sign…

Almost smells like the ACA, doesn't it? Edit: My apologies for sounding a bit antagonistic. The ACA is currently making use of high copays for that reason and more. It also hopes to force more transparency as well as most people want more than a icd-10 code when they have to write a check for $4k.

There are a wide variety of routine (STD tests, birth control pills) and completely predictable (pregnancy) services where the ACA explicitly prohibits copays.

I've been told Singapore's forced savings + cat coverage plans are reasonably close to this, however. Hardly surprising given how well Singapore tends to govern.

But your broader point (or perhaps my steelman of it) that high copays are not incompatible with socialized medicine is absolutely correct.

Re: YC Research: Universal Healthcare

#186

Post by Thriptic »

Retric wrote: post #155
beambot wrote: post #151

Earlier quoted context omitted.

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

Corruption. However, the line is generally described as: If companies can't discount per country then all countries end up paying high prices without discounts. However, if they can discount prices in some countries then that maximizes profits which increasing the customer base.

It's much more complicated than that. Sales in the US where they can charge more are what actually offer pharma companies good ROI. Effectively the US is subsidizing R&D for the rest of the world.

Re: YC Research: Universal Healthcare

#187

Post by Animats »

"For the initial project, Watsi will fund primary healthcare for a community in the developing world and build a platform to run the system transparently."

Start with Tuskegee, Alabama, poorest town in the United States.

Re: YC Research: Universal Healthcare

#188

Post by ameister14 »

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.

That's the simplest way to do it, sure. Not the best, the most efficient, or really workable, but simple.

Re: YC Research: Universal Healthcare

#189

Post by ameister14 »

lumberjack wrote: post #159

Universal healthcare is already much more cost effective than fully or semi-privitised health care. Sorry, I forgot to pretend that all the other developed countries haven't figured out healthcare already. Geez. ---------------- Oh and btw, when you have a universal healthcare system payed by taxes (none of that bullshit insurance crap that only ends up being costly regulation/financial bloat) you can have entire and…

>Universal healthcare is already much more cost effective than fully or semi-privitised health care.

That's not true. Most developed countries have some form of privatized system, falling into your 'semi-privatized' definition. It's more cost-effective.

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