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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#211

Post by TheSmiddy »

ameister14 wrote: post #189
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.

In Australia we have a universal healthcare system for everybody and a private system that runs alongside that essentially gets you a more comfortable bed and the ability to jump the queue for non-critical surgery.

Re: YC Research: Universal Healthcare

#212

Post by refurb »

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?

Why would drug companies allow it? When a lot of Americans were filling their prescriptions in Canada, the drug companies simply applied quotas to their shipments to Canada. They know how big the markets are, so why would they ship 500% of estimated demand to Canada knowing it would flow back into the US?

As a result, a lot of pharmacies (and some gov'ts) restricted sales to out-of-country patients to prevent shortages in their own countries.

Re: YC Research: Universal Healthcare

#213

Post by Godel_unicode »

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?

To extend GPs point, there are negotiators in the US who are bigger and therefore seemingly have more leverage than several of those countries. Therefore, perhaps it's not just a size/leverage thing.

Re: YC Research: Universal Healthcare

#214

Post by [deleted] »

problems wrote: post #193
DanBC wrote: post #152

Earlier quoted context omitted.

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.

[deleted]

Re: YC Research: Universal Healthcare

#215

Post by TheSmiddy »

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…

You could instill the will for universal healthcare.

A website where you upload your medical bills and it compares the costs to costs in other countries (UK, Canada and Australia for example).

The main problem with the attitude in the US seems to be that not only do people not want to pay for other peoples healthcare but they also don't want other people paying for their own healthcare. By comparing both the individual and taxpayers costs across other countries people will see that not only do they pay less, but so does the taxpayer.

Re: YC Research: Universal Healthcare

#216

Post by cookiecaper »

DanBC wrote: post #133
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…

Do you realise that the US government spends more per capita on your current health care than the UK government spends? http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com... Government spending (not including insurance) > Despite less than half of the USA’s total healthcare expenditure coming from government expenditure or compulsory insurance schemes, it still spends more per person on these financing sche…

Yes, but that doesn't mean nationalization/socialization of the health care industry a la NHS is a good solution. It's clear to anyone who is not a political religionist that the U.S. health system is FUBAR'd, both before and after Obamacare, and that it needs to be fixed. However, we can't seem to hold a productive discussion on this, as one extreme virulently insists all medical care must be completely free at the point of sale (see other commenter above), which leaves no option except government payment, and the other extreme virulently insists that American medicine is fine as it was pre-Obamacare. There's practically no one in the middle who a) recognizes there's a problem and b) has a good suggestion that addresses the core causes of the problem instead of trying to cover the cost up by pouring government funds into it.

No one is going after the industrial profiteers and exploiters here. People either want to leave those profiteers completely alone or force them to continue to be paid exorbitant rates by the government (that only look non-exorbitant by comparison to other nations where they're even higher). Those are both bad answers! The marketplace must be kickstarted so it can stay in the hands of the people, surrendered to neither government bureaucrats (as proposed by pro-universal healthcare advocates) nor heartless capitalists (as is mostly the current state).

We need to start from first principles here and say "What does a sick person need to get better, and how can we provide that in a cost-efficient way that allows medicine to be like all the rest of our industries: open to competition, appropriately regulated, and run by fair and competitive private enterprises?"

Re: YC Research: Universal Healthcare

#217

Post by cmollis »

MR4D wrote: post #42
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…

This, times 1,000 !! Imagine you go in for an oil change. You ask how much it costs, and find out it's $20. Great. You get the oil change. One month later you get a bill for "environmental disposal" for $35. The next month you get another bill for "Safety specialist" for $15. This is how healthcare works in the US. If retail worked like this, we'd be in a worldwide depression in about 6 months. Lunacy.

yes.. another 1K. I blame doctors and insurance companies (but mostly the latter.. the former was taken for a ride long ago by the latter). An example of just how ridiculous this is: my son (who is almost 15), was recommended to have a 'pediatric echocardiogram'. The children's hospital that I took him to (a Tier 2 facility in insurance parlance.. which roughly means that my insurance company doesn't own them) indicated that this procedure MIGHT cost up to $5000. So, I asked my insurance company (which I pay 1000 per month to for my three kids and I, in a addition to a 3500 per year deductible), what Tier 1 facility in NJ I could go to, and how much the procedure would cost.

They did not know of a facility where this procedure could be done at first. They had to 'research it'. They found a facility, but when I called, they could not perform the procedure because it called for a 'pediatric echo', which they were NOT allowed to do (mind you, it's like the same echocardiogram that you and I would receive). When I presented this information to my insurance company, they had to again, research it. I ignored it, and found it on my own after calling the heart group at one of the teaching hospitals in my state (NJ). So, I asked my insurance company how much it would cost, they refused to tell me. They indicated that they do not dictate pricing; this is the job of the provider. I noted to them that I did not believe them because I knew that they have contracted rates with all of their Tier1 and Tier 2 facilities and they knew exactly what they would reimburse for. They flatly denied that they had any knowledge of pricing and that this was the responsibility of the provider. My response was a question: so, if the provider charged you 1 MILLION DOLLARS for this procedure, you would, in fact, pay it. They indicated that they did not have any pricing knowledge whatsoever. I ended up getting a second opinion and found out the echo wasn't necessary based on follow up findings. It was one of the most frustrating examples of federally mandated RIPOFF I had ever seen. My son's health was at stake, and they simply wouldn't help me. The doctor's are literally at their mercy because they control the money and EVERYONE lets it fucking slide. It's a crime.

Re: YC Research: Universal Healthcare

#218

Post by waffle_ss »

chriskanan wrote: post #124
8ytecoder wrote: post #50

Earlier quoted context omitted.

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…

>> Add to it an insane 4 years in college + 4 years med school curriculum that does not incentivize more people to even attempt getting into med school. While I agree with your points in general, this point is wrong. There are far more applicants for medical school (both MD and DO programs) than there are slots. I've been told this was done by the AMA to keep the supply of physicians in the US low to maintain high wa…

Residency slots are the limiting factor, not medical school slots. There's no point increasing medical school slots if you're going to create a bunch of people shut out on Match Day with $200K+ in debt. It should be noted that licensing requirements of doctors mean that medical school graduates are also competing against foreign

Blaming the AMA is a dated view. I believe that used to be the case, but certainly isn't any longer. They are in favor of legislation that would increase the number of residency slots.[1]

edit: Forgot to add that US medical school grads aren't only competing against each other for residency slots. Foreign doctors that want to practice in the US also have to do a residency here due to licensing requirements.

[1]: https://www.ama-assn.org/content/ama-applauds-members-congre...

Re: YC Research: Universal Healthcare

#219

Post by ameister14 »

TheSmiddy wrote: post #211
ameister14 wrote: post #189

Earlier quoted context omitted.

>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.

In Australia we have a universal healthcare system for everybody and a private system that runs alongside that essentially gets you a more comfortable bed and the ability to jump the queue for non-critical surgery.

Exactly what I'm talking about

Re: YC Research: Universal Healthcare

#220

Post by irln »

Thriptic wrote: post #186
Retric wrote: post #155

Earlier quoted context omitted.

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.

Agreed. Pharma is managing their expenses and profitability based upon the ability to charge much higher prices in the US. Take that away and suddenly everyone outside the US will have to pay more -or- Pharma will have to rethink their business model. The more this connection is obfuscated the easier it is to confuse decision makers.
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