YC Research: Universal Healthcare

The US has a (admittedly obfuscated) fee based health care system. However, if one necessarily needs medical treatment, you can go to an ER it will be provided to you. You might end up with a debt that you can never pay but you won't be turned away. These emergency visits actually account for a large amount of the US government health care costs.

So if your society accepts that all people will be treated regardless of their ability pay then you might as well start looking at better and cheaper ways of doing that. Waiting till someone is so sick that they need the ER is a huge waste and bogs down the entire system; even for paying users! By comparison, simple doctors visits are considerably less expensive and produce better outcomes than waiting until people have no other option.

As for socialism, your society doesn't want to let people starve either and provides plenty of mechanisms to prevent that too. Socialism is automatically baked into any society that won't let the poorest or the sickest simply die.

It seems like someone could implement an open source system of smart contracts that automatically pay out healthcare costs and distribute expenses in a transparent and agreed upon way. The organization could have an extremely decreased overhead compared to a physical company because it would need almost no staff or infrastructure, and if everyone can see the source for how money moves as well as the distributed ledger for how spending works it would be highly corruption resistant while still allowing for security of doctor-patient confidentiality due to the encrypted nature of blockchain.

Of course it would by default being extremely susceptible to external abuse, would have a ton of complexities in interfacing with the healthcare system, and wouldn't be viable until/unless blockchain and related tech matures and gains mass market acceptance.

I could be totally wrong about the approach, but I'm really hopeful for the tech world to be able to make a dent in this mess. Hopefully some people with more experience have better ideas.

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.

Unless you're poor or chronically sick. You have made it abundantly clear time and again on HN that you do not believe in altruism but think that all economic decisions should be made on the basis of self-interest; I think that approach is bunk and so we are not going to agree on a common goal any time soon.

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?

If you're maximally efficient there's nothing to cut when the shit hits the fan. I think critical systems should include some excess carrying capacity (ie waste) because it's faster to reallocate resources internally than to get additional resources under time pressure.

As a simple example (from which I am not attempting to generalize to the secotr as a whole and which I am not going to get into any nitpicky arguments about), there's a good argument that we have a bit of a doctor shortage these days: https://www.quora.com/Why-dont-we-train-more-doctors

It would be rather inefficient to have a public health system with too many doctors and nurse practitioners. They wouldn't be as busy and wouldn't make as much money as they could at equilibrium, and you can easily imagine various second-order effects of such an inefficiency, and the fact of a cumulative social cost.

But if there is a public-health crisis, would you rather meet it with too many doctors or too few?

Look back at the last paragraph in my response above. Medicare is required to cover a number of classes of drugs. they can't say "no, we're not paying for it."

As a result, Medicare has no negotiating power. Unless you can walk away from the table, why would drug companies budge?

And if Medicare did have the power to say "no", how would that work politically? I'm guessing the AARP would be up in arms if Medicare said "no, we're not paying for that drug, find an alternative."

And the price you quote are comparing list prices in the US to net prices (that's usually what's published in the EU and Canada).

Humira is significantly discounted in the US. 40 to 50% discounts are not unusual for large payers.

A great example are the HCV drugs. When a 2nd class of products entered the market, the drug manufacturers rushed to discount their products to maintain market share. As a result, the US price is lower than the prices in Europe.[1]

[1]http://www.forbes.com/sites/johnlamattina/2015/12/04/for-hep...