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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#261

Post by cal5k »

wvenable wrote: post #140
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…

Something has changed recently because it seems almost everything is electronic now. A few years ago I even subscribed to get all my test results online; I avoided an unnecessary doctor's appointment because I could see the results myself.

This is entirely because of the private sector... the two largest lab companies, Dynacare and LifeLabs, have a duopoly on the lab testing market (at least in Ontario). They may have received some incentives to do this but afaik there was no big policy objective behind it.

Re: YC Research: Universal Healthcare

#262

Post by cal5k »

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…

Founder of Akira here (www.akira.md in case you weren't familiar).

We try not to break any rules, but you're spot on about the grassroots thing. We decided we couldn't wait for the policy to catch up to the serious problems with our healthcare system and decided to tackle them head-on!

Has it been easy? Not at all. Is progress being made? Absolutely!

Re: YC Research: Universal Healthcare

#263

Post by djrogers »

TheSmiddy wrote: post #215
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 individu…

Would that website also compare wait times for procedures, referrals, and imaging? The average wait time for an MRI in Canada is almost 3 times as long as commonly found MRI injuries (take a stress fracture for example) take to heal.

So in Canada, I'd be jogging on a busted knee making it worse for 12 weeks, after I got to see an orthopedist (after a 20 week referral wait), before I found out I had destroyed my knee by not resting for 6 weeks.

Our system here in the US is really screwed up, but it does have its advantages (if you can afford it).

Re: YC Research: Universal Healthcare

#264

Post by cma »

will_pseudonym wrote: post #67
cma wrote: post #31

Earlier quoted context omitted.

I thought subsidies for corn-based ethanol and tariffs on sugar (lowering sweetener supply) made corn syrup more expensive.

* Tariffs on sugar increase demand for corn. * Subsidies for ethanol increases the cost of all food, including corn. * Subsidies for corn for lots of other things[0][1] decrease the direct price of corn to consumers and food manufacturers. As a single data point, I come from Kansas, from a family of farmers. It used to be known as the "Breadbasket of America" because of all the wheat that they grew. Its number one cr…

That chart shows around 7 billion for corn. The text later says:

> US corn ethanol subsidies are between $5.5 billion and $7.3 billion per year.

Doesn't that mean most non-ethanol uses of corn aren't really subsidized too much?

It does also list: "Feed grains, mostly corn 2,841" (million)

Am I right that that is just $9 subsidy per citizen, and lots of it is going to feed farm animals?

The numbers are all from different years so there could have been some major changes.

Re: YC Research: Universal Healthcare

#265

Post by will_brown »

chimeracoder wrote: post #195
will_brown wrote: post #132

Earlier quoted context omitted.

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'r…

Patients like Medicare Part D because millions of patients couldn't afford their drugs and now they can, not because of insurance companies or the market is privatized.

Ironically it was GW Bush who got Medicare Part D done (which is the antithesis of fiscal conservatism, and many might remember Bush losing a lot of support from his own party, though many say it was just politicians in the pockets of insurers). Alternatively, Obama originally wanted to do away with Part D because of the cost/waste (forcing millions into situations where again they would lose drug coverage would have been the antithesis of social liberalism, for this reason it was controversial within the party). Luckily there was compromise and instead of dismantling Part D Obama tried to flush out the waste using tools like Star Ratings and mandates to insurers to provide services like Medication Therapy Management to Advantage Chronic Care Patients, which alone has had substantial positive impact on patient outcomes, costs, and the competitive nature of the insurance markets (now insurers are rated based on quality metrics, insurers lose contracts with Medicare due to poor outcomes and only those with the best metrics and ratings can serve the market year round). Still its an inefficient system because of these middlemen, in fact it is arguable many of the "quality metrics" that give insurers better ratings are actually the things leading to bad behavior like buying up medical practices and cancelling contracts with other primary cares in the area to drive down the cost of care.

Re: YC Research: Universal Healthcare

#266

Post by gnopgnip »

tclAmockingbird wrote: post #131
tcbawo wrote: post #65

Earlier quoted context omitted.

I see this argument in many places. Who dictates the cost of providing services? Why are these costs so high? My pet theory is the insane costs (money, time, high selectivity) of medical training and office overhead. Medical professionals feel entitled to $$ for their risk. Perhaps older specialists who didn't have these costs are spoiled. I would love to see how tuition amnesty would affect price elasticity.

Physician and staff salaries (outside of staff to manage insurance companies) are not what drive increasing medical costs. Most physicians don't make that much money, all things considered. An insurer last month for a relative's pediatrics practice announced that they were having difficulties with their accounting system and so they would only be making a half payment on their outstanding AR (and naturally, they ann…

Practicing physicians are the most highly paid workers in America. In what way do they not make that much money?

Re: YC Research: Universal Healthcare

#267

Post by pharrlax »

TillE wrote: post #192
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.

>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 Democrats, who refuse to push for anything but the weakest, most ineffective compromise policies.

Might these two things be linked, though? If a specific policy is not often seriously proposed, it will be more rarely attacked, and therefore not tainted by the political back-and-forth that colors proposed legislation that has a more serious chance at becoming law.

Re: YC Research: Universal Healthcare

#268

Post by hackuser »

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…

Healthcare has long been seen as a basic right in many places and even the Republican Party in the U.S. now supports health insurance for everyone.

The parent seems to conflate healthcare with pharmaceuticals and other specific forms of healthcare. IIRC, the warnings were that big pharma was pushing pills on people, something that has some evidence behind it. As an analogy, I think an effective military also is essential, but that doesn't mean I don't think big military contractors don't push needless or dangerous products on the public.

Re: YC Research: Universal Healthcare

#269

Post by intrasight »

aleksei wrote: post #128
intrasight wrote: post #123

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

I doubt the money not spent on inefficiencies would equate to money effectively burnt away. That 40% would probably be spent in other, more productive ways. Not to mention you're actually making a point for not giving GDP too high a value when looking at economies.

GDP is like capitalism - a terrible measure but better than all the alternatives.

Re: YC Research: Universal Healthcare

#270

Post by intrasight »

dragonwriter wrote: post #127
intrasight wrote: post #123

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

> Reduce spending by 40% would reduce US GDP by almost 10%. No, it wouldn't, because most of that would go straight back to labor and result primarily in increased consumer spending, and secondarily in increased consumer investment (which leads to increased business spending.) It's not like the money not being spent on healthcare inefficiencies is going to just vanish out of the system.

I'm not sure. At what point does automation lead to a big drop in GDP?
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