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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#231

Post by Futurebot »

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…

58% of Americans support universal health care: http://www.gallup.com/poll/191504/majority-support-idea-fed-...

Re: YC Research: Universal Healthcare

#232

Post by SilasX »

waffle_ss wrote: post #218
chriskanan wrote: post #124

Earlier quoted context omitted.

>> 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…

If there really is excess demand for a kind of labor, then the labor can borrow enough to pay for it; it wouldn't make sense to blame an insufficient subsidy as a bottleneck.

Re: YC Research: Universal Healthcare

#233

Post by finnh »

refurb wrote: post #207
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?…

Why is a third party negotiating for Medicare 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…

> 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?

Those statements are only true for drugs with no alternatives - which doesn't apply to all (most?) drugs. And, even for those, couldn't the government say "we're not going to pay $(RANSOMPRICE) for drug X. If you insist that we do, we will not buy any other drugs from you but will instead source from your competitors at all times."

Re: YC Research: Universal Healthcare

#234

Post by rayiner »

warcher wrote: post #33
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…

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...

You're trivializing what is actually a very complicated economic issue. Medicare negotiating drug prices raises a serious buyer-side market power concern: https://en.wikipedia.org/wiki/Monopsony. You can't have a "real market" where something like Medicare exists. So you design the rules to try to mitigate various exercises of market power. That's really hard to do.

Of course, you can say "who cares if Medicare drives prices too low, the drug companies will just have to deal with it." But in the long term, that's bad for the customer. All around the country you can see regulated rates that are too low and drive out investment. A great example is water utilities. Almost everywhere, water rates are far lower than they should be, and as a result water infrastructure is crumbling, customers are drinking water through lead pipes that haven't been replaced in a century, etc.

Re: YC Research: Universal Healthcare

#235

Post by rayiner »

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?

A complex tango between drug companies that want to maintain their margins, and European governments that want to drive drug prices artificially low to force American payers to make up the difference.

Re: YC Research: Universal Healthcare

#236

Post by tcbawo »

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…

Do you have any idea of the distribution of vacine prices between providers (ie hospital networks vs private practices)? Is there a large discrepancy, or do hospitals use this as a 'loss leader'?

Re: YC Research: Universal Healthcare

#237

Post by markroseman »

soperj wrote: post #103
esfandia wrote: post #39

Healthcare definitely seems like the land of process inefficiency, even in developed countries like here in Canada, so there's plenty of opportunity for major improvement. There's still plenty of paperwork done on... paper, information that constantly has to be repeated when you go from one provider to another, and plenty of mistakes made. Some time ago Ontario spent a massive amount of money on computerizing healthc…

What are you basing the yielded nothing on? Canada is well on it's way to Electronic Health Records.

Not so much. There are pockets, with poor interoperability between them. Multiply this by the different health systems (one per province, plus assorted others) and it's still a mess unfortunately.

Re: YC Research: Universal Healthcare

#239

Post by DanBC »

arohner wrote: post #227
DanBC wrote: post #174

Earlier quoted context omitted.

> 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…

You are literally creating a monopoly (one hospital) to justify that will produce lower prices. Please give me one other example in an unregulated market where your MRI machine example makes sense. It sounds good on paper, but that doesn't happen in any other market in the western world. If there are two competing gas stations, prices get cheaper. Two competing airlines, prices get cheaper.

I don't agree with it!

I'm literally quoting the Americans who support certificate of need laws.

Re: YC Research: Universal Healthcare

#240

Post by certifiedloud »

rsync wrote: post #181

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 advertis…

I'd be interested to see a source on this, if you have one at hand.
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