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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#241

Post by prawn »

cmollis wrote: post #217
MR4D wrote: post #42

Earlier quoted context omitted.

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) indica…

That sounds brutally frustrating, distressing (given your child was involved) and an epic waste of time. And that's on top of paying $1k/mo for insurance.

Re: YC Research: Universal Healthcare

#242

Post by Sanddancer »

refurb wrote: post #46
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...

That's a vast over simplification of the issue and ignores issues around implementation. First off, Medicare Part D plans are run by private insurers and they certainly do negotiate on price. In fact, they tend to get better prices than commercial plans. Those savings are used to compete for Medicare dollars to cover those patients (i.e. savings are passed on to Medicare). Second, physician administered drugs are pai…

I would argue that having Part D coverage handled directly by medicare, with the power to negotiate prices, would have a positive effect on prices for Part B medication as well. By having Medicare only provide certain medications, it makes it more difficult to bring proper purchasing power. It would also make it a lot easier on people who are on disability to manage their health. I'm on disability, and when I have a problem with a prescription, it's an absolute mess trying to figure out if I need to contact Medicare, or if I need to contact my Part D provider. To make things more complicated, there are times I need to contact Medi-Cal, because I have a certain amount of my coverage handled under Medicaid.

Re: YC Research: Universal Healthcare

#243

Post by prawn »

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.

Ideally, I think you need to replace both concurrently. Consider Uber for example. They didn't sell the app concept to the existing taxi companies and the taxi companies didn't hire piecemeal staff, it was a complete alternative.

Might not be a way in all cases, but if you offer people a new system (people and software) that is a viable alternative, they will start to jump ship.

Re: YC Research: Universal Healthcare

#244

Post by Sanddancer »

SilasX wrote: post #89
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...

If you think that policy is pure benefit for consumers and the only costs are to greedy mustache-twirling men, then there may be another bubble going on. It would mean that the US uses its leverage to push drug prices down to marginal costs, which would almost be the last domino in payers willing to pay for something like the value of new drugs. But drug development doesn't make sense if you can only charge marginal…

Or we could start funding medical research through our system of universities and the like. We have immense public and non-profit institutions that can take over. Maybe we'll even be able to see more benefit in treatment of rare and neglected diseases that way.

It also means that a large number of people could actually afford medication, doctors, etc. I have friends who can't afford going to the doctor, can't afford medication, so go without. Their quality of life would greatly improve by them being able to get into the system.

Re: YC Research: Universal Healthcare

#245

Post by Sanddancer »

6502nerdface wrote: post #194
HarryHirsch wrote: post #130

Earlier quoted context omitted.

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

Some of us have more significant medical expenses than others. My prescription medications alone would be $2k/month if I had to pay it out of pocket, and that amount's pretty set in stone. The alternatives, which I've tried, don't work for me, or make symptoms worse. Shopping around wouldn't do anything for me.

Re: YC Research: Universal Healthcare

#246

Post by anigbrowl »

yummyfajitas wrote: post #230
anigbrowl wrote: post #205

Earlier quoted context omitted.

The vast majority of emergency medicine is not emergency medicine, but emergencies are among the most likely things to have a catastrophic impact at the individual level. I cannot possibly treat the entire complexity of healthcare in a single comment and neither can you. That's why I'm offering a limited specific counterexample to your general argument, to point out the existence of fundamental economic problems in h…

The vast majority of emergency medicine is not emergency medicine, but emergencies are among the most likely things to have a catastrophic impact at the individual level. And this is handled by the high copay, high cap model proposed by RAND, Singapore and myself. You still have not identified any "fundamental economic problems" or misrepresentations of the behavior of the healthcare market. Unless you're poor or chr…

I just can't be bothered to go around this today since we're not going to agree anyway. On altruism, I was thinking of a specific comment you made a while back about being rationally focused on your interests, reproductive ability and descendants (qua biology rather than social attitude, but I think it's consistent with your expressed libertarian viewpoint. I don't remember enough to successfully look it up right now.

I think this encapsulates a key difference in our worldview:

As for things like maintaining an excess supply of medical pros to handle crises, if that's necessary I don't think it should be provided via random inefficiency. It should be explicitly planned in.

I used to think that, but now I favor a little general random inefficiency because we don't know what we don't know. My inclinations are utilitarian, but sadly my ability to predict the future is limited so I systematically distrust my own utility calculus.

Re: YC Research: Universal Healthcare

#247

Post by Sanddancer »

PKop wrote: post #122
jartelt wrote: post #113

Earlier quoted context omitted.

Maybe it would help, or maybe it would do the opposite. Having an HSA and seeing prices upfront can also make one not go to doctor because they do not want to drain their HSA. This can cause people to skip preventative care steps and to not nip potential problems in the bud before they get bad (and expensive). A lot of diseases/conditions are much cheaper to cure/fix if you catch them early, so maybe you don't want t…

And if more and more people were not going to the doctor, the providers would lower the price (to some degree no?)

Or they raise their prices to get money out of a smaller pool of subscribers. Medical care has a pretty inelastic demand curve.

Re: YC Research: Universal Healthcare

#248

Post by maceo »

US spends over $8,000 per capita on healthcare, compared to about $4,000 in UK and Japan, both of which have universal health care.

This isn't a problem tech can solve. It's a problem only politics can solve.

Re: YC Research: Universal Healthcare

#249

Post by dikdik »

mikekij wrote: post #99
dikdik wrote: post #96

Earlier quoted context omitted.

> We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. Lies, lies, lies, and more lies. This is always quoted, especially in the context of pharma. It's wrong. Americans pay for advertising (which is illegal in most first world countries) and for the yachts and islands of the big healthcare execs. I work at the intersection of biotech and heal…

Being intimately familiar with the COGS and Average Selling Prices of more than a few devices in various geographies, I respectfully disagree. That's not to say you can't have a profitable EU-first product. It's just easier to be profitable with US-first at the moment.

Disagree with rolling out a product EU first or disagree that companies need the American healthcare industry to become profitable?

I can't go too much into the product, but there is a solid strategy behind the rollout.

And of course it's easier to be profitable in the US, there is a gravy train of money in healthcare here. While great for healthcare companies, it is AWFUL for consumers.

With respect to the initial comment I replied to, everyone (ie government officials and business owners) claims that changing the US healthcare industry will decimate innovation and every pharma/medical device/etc company will utterly fail!

I've been in this industry less than a decade and have experienced this rhetoric often whenever certain bills come up at the federal and state levels. Everyone freaks out! And then the bill passes....and everything is fine. We just have to innovate a little more, which is a great thing for the consumer!

Re: YC Research: Universal Healthcare

#250

Post by vondur »

ameister14 wrote: post #188
vondur wrote: post #111

Earlier quoted context omitted.

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.

I wouldn't say it's not unworkable, but you are correct, it'd be simple and it's something that most people could understand. No "death panel" discussions.
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