YC Research: Universal Healthcare • Hacker News Board

Re: YC Research: Universal Healthcare

#191

Post by maxerickson » Tue, Feb 07, 2017, 10:03 PM UTC

DanBC wrote: post #174

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…

> but certificates of need But they came about to protect the consumer from high prices. If I own a hospital and buy a $300,000 MRI machine I need to make that money back over the 10 year life of the machine. I charge one price if it's used by 10 people a day; I need to charge double if it's only used by 5 people a day. The extra supply reduces demand and thus increases prices to the customer. And it's unethical to j…

Sure, in theory. In practice it just means that hospitals that do not have local competition use them as a revenue center (MRIs in the US often cost $1000-$2000...paying off your 10 year machine in a few months with 5 patients a day).

The US Federal government tried them in the 1980s and quickly decided they were counterproductive.

Re: YC Research: Universal Healthcare

#192

Post by TillE » Tue, Feb 07, 2017, 10:03 PM UTC

alexmingoia wrote: post #109

What does this have to do with universal healthcare? We know how to make healthcare more efficient. We know how to remove the administrative overhead. Other countries already have these systems in place. Look at Taiwan for one example. They have digital medical records and an extremely low administrative overhead because of universal care. Healthcare will continue to be broken no matter how many YC research programs…

If you look at polls that go issue by issue, you inevitably come to the conclusion that the "US population" at large (55-60%) would support a broad agenda of social democracy.

The problem isn't the people, it's the politicians. Specifically the Democrats, who refuse to push for anything but the weakest, most ineffective compromise policies.

Re: YC Research: Universal Healthcare

#193

Post by problems » Tue, Feb 07, 2017, 10:05 PM UTC

DanBC wrote: post #152

problems wrote: post #105

Earlier quoted context omitted.

Yeah, there's definitely some things to consider here. Despite all the plusses of universal health care which others have already gone into - many people in Canada go to the US to get tests done faster because they can just pay for them, sometimes you're stuck waiting months. The US is also pretty much the world capital for a number of drug development and medical research areas simply because it's much more profitab…

I'm under the impression that Canada disallows private care. That doesn't have to be the case. You could have a system like the UK with both private and public care. If you want to skip the queue you pay for it.

Yeah, something like that might be a totally reasonable solution. There's lots of options to discuss to get better public and private care, but discussions on them are so partisan and bogged down that nothing is likely to get done.

Re: YC Research: Universal Healthcare

#194

Post by 6502nerdface » Tue, Feb 07, 2017, 10:05 PM UTC

HarryHirsch wrote: post #130

CaptSpify wrote: post #108

Earlier quoted context omitted.

> 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.

For non-emergency care, knowing the cost beforehand means you can:

* Shop around

* Plan your cashflow around the healthcare expense

Re: YC Research: Universal Healthcare

#195

Post by chimeracoder » Tue, Feb 07, 2017, 10:07 PM UTC

will_brown wrote: post #132

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...

I think in many respects Medicare is a prime example of how easily the US might/can jumble up a single payer system. Medicare is socialized medicine, and should be single payer, yet insurance still manages to get in the middle and increase costs while reducing patient outcomes. Specific example that almost no one talks about: Medicare Insurers come to town and start buying up primary care practices, then, then the In…

> Medicare is socialized medicine, and should be single payer, yet insurance still manages to get in the middle and increase costs while reducing patient outcomes.

Wait, what? Medicare Advantage (the portion of Medicare that is privatized) consistently beats Original Medicare on cost, medical outcomes, and patient satisfaction scores.

Amusingly, when people talk about the high patient satisfaction of Medicare, they're talking about the high patient satisfaction of privately-insured Medicare patients, because even the very lowest satisfaction score of all the major injurers who provide Medicare plans is still higher than Original Medicare's satisfaction rates.

http://thehill.com/policy/healthcare/237492-poll-seniors-mor...

Re: YC Research: Universal Healthcare

#196

Post by icantdrive55 » Tue, Feb 07, 2017, 10:09 PM UTC

JacobJans wrote: post #162

beambot wrote: post #151

Earlier quoted context omitted.

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...

40 Rebublicans said No

12 Democrats said No

Feinstein (D), Sessions (R) refused to vote.

(Roughly)

Re: YC Research: Universal Healthcare

#197

Post by temp-dude-87844 » Tue, Feb 07, 2017, 10:12 PM UTC

KeepTalking wrote: post #179

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 econo…

Research is expensive because it is conducted by well-paying professionals over multiple years, then taken to several rounds drug trials, which come with risks of serious side effects.

Negative outcomes resulting from drug trials -- as well as approved drugs -- are routinely litigated by the aggrieved parties, which result in expensive settlements or the risk of high damages (in some cases, punitive).

Further, to promote public interest, patent protections on medication in most countries usually expire after 20 years, which limits the window of time in which the makers can recoup the cost.

'Tort reform' proposes (among others) to reduce the monetary risks associated with drug trials by limiting lawsuit payouts of limiting grounds to sue -- to its promoters, this benefits society at large (and the drug companies) while hurting a few individuals who happen to have found themselves embroiled in such a case.

To its opponents, tort reform is an instrument to dismantle regulatory protections and results in little to no societal benefit, perversely incentivizing drugmakers to both a higher absolute quantity of drugs to drive overall revenues, while reducing the average quality of drugs to be less safe, and leave seriously injured people with no viable recourse. It's a complex problem with no easy answers.

Re: YC Research: Universal Healthcare

#198

Post by bluGill » Tue, Feb 07, 2017, 10:15 PM UTC

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…

You forget one part: patients do not care what insurance costs because their employer chooses what they use and what price they pay.

If I could buy health insurance separately from my company I'd look into it. I know my company pays at least as much as I do for my insurance, but if I go off the company plan I can't get that money to use for insurance I like.

The result of this is I have incentive to not care what anyone charges. The only thing I can do is lower my satisfaction job rating if the doctor I want to go to isn't covered by my plan. If I actually could choose insurance I would would look into cheaper plans - if they tell me the doctor I want is more expensive so I need a more expensive plan to cover using him I would then have incentive to choose: see if I like a cheaper doctor, or pay more for the one I like.

The result of employer providing my health insurance is a large source of dysfunction in the health care market. I illustrated one, but there are others. (Note, there are other dysfunctions in the health care market - always it is complex)

Re: YC Research: Universal Healthcare

#199

Post by bluGill » Tue, Feb 07, 2017, 10:21 PM UTC

MR4D wrote: post #38

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 agree wholeheartedly. One thing that bugs me is how limited my choices are. I believe that over-regulation drives that. Getting an x-ray for my dog is much, much cheaper than me getting one, which is just one example of an unregulated market (relatively, obviously there are licensing & safety standards) Seems that this would be a shot. If it doesn't work, lets try something different. I'm not wedded to any solution…

Be careful about this though. We generally place a higher value on human life than on a dogs life. If the x-ray used on your dog sometimes kills a dog it is not the disaster that it would be if a human was killed. Thus we spend a lot more on quality control for medical devices for humans.

You might not agree, but that is how society see it.

Re: YC Research: Universal Healthcare

#200

Post by toomuchtodo » Tue, Feb 07, 2017, 10:22 PM UTC

ones_and_zeros wrote: post #34

tyre wrote: post #30

We sell to governments, which is similar to healthcare. I cannot stress this enough: technology is not the hard part. Do they have outdated software? Yes. Can you build better software? Yes. None of that matters if you can't get it into their hands. Procurement is the hard part. Can you empathize with the needs, fears, desires, quirks, and crazy of ten different stakeholders? Pry proprietary API specs from the cold-d…

I think the point of this project is to replace the people, not necessarily to make software for people to use. Software is just means to an end.

> I think the point of this project is to replace the people

No. Not at all.

The point of this project is to create trust; trust that healthcare consumers can get the services they need, and trust that government will spend healthcare dollars judiciously.