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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#271

Post by topspin »

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…

> a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution

The system embodies large amounts of collective dissonance; a natural reaction to the soft corruption that has to be practiced to satisfy policy. Cost shifting is among the most pernicious causes of this; there is little to no correspondence remaining between actual service and the fee that gets billed; it's all about who the patient's payer happens to be, what policies are in play and how much providers can get away with in each case. The seemingly arbitrary outcomes have to get reconciled somewhere and in the doing of that we build up a lot of scar tissue.

Re: YC Research: Universal Healthcare

#272

Post by chimeracoder »

will_brown wrote: post #265
chimeracoder wrote: post #195

Earlier quoted context omitted.

> 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). Alter…

> Patients like Medicare Part D

I'm talking about Medicare Advantage, not Medicare Part D. Most Medicare Advantage plans do include a Part D plan, but not all do.

> not because of insurance companies or the market is privatized.

People like Medicare Advantage because they are actually able to book appointments without horrendous wait times, and they're able to see a better selection of higher-quality doctors. And the outcomes back this up - Medicare Advantage consistently outperforms Original Medicare on medical outcomes, not just on patient satisfaction.

Re: YC Research: Universal Healthcare

#273

Post by tcbawo »

djrogers wrote: post #260
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.

> Most people seem to like Medicare. Except for the doctors that can't afford to treat Medicare patients due to the criminally low/skewed reimbursement rates for some services. There's a reason so many private practices don't take Medicare patients...

On another thread, it was explained to me that Medicare reimbursement for a vaccine doesn't even cover the cost of the vaccine itself. I'm sure there is a Byzantine reimbursement model, but something tells me that if the entire country switched over to Medicare overnight, vaccines would quickly get much more affordable.

Re: YC Research: Universal Healthcare

#274

Post by chimeracoder »

gnopgnip wrote: post #266
tclAmockingbird wrote: post #131

Earlier quoted context omitted.

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?

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

Doctors take home a lot less than people think.

The "salary" numbers you usually see cited aren't comparable to salaries in fields like software engineering, because doctors still have to cover their own business costs (the big one is malpractice insurance, but other expenses like CME, etc. are all on their own dime). And these are almost invariably not tax-deductible, because AMT doesn't allow for deductions for business expenses.

In any case, physicians' earnings account for only about 10% of total medical spending in the country. In other words, even if every doctor decided to work for free and pay for all their business expenses out of their savings... we'd still be spending 90% of what we currently are.

Re: YC Research: Universal Healthcare

#275

Post by tcbawo »

prawn wrote: post #243
ones_and_zeros wrote: post #34

Earlier quoted context omitted.

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.

This does seem like the way things will need to go. The system may need to break down completely in order to be recreated. Perhaps it will start in a state with sufficient size to achieve price bargaining power.

Perhaps some combination of eliminating medical school tuition, exemption from liability, and long term contracts could be used to recruit the talent.

Re: YC Research: Universal Healthcare

#276

Post by mgkimsal »

triangleman wrote: post #120
chicagobob wrote: post #40

Earlier quoted context omitted.

Only partially. Often at the time of consumption cost isn't something one can use to make decisions. But for those other times, sure it would help. Speaking of lack of info about pricing you might find this interesting: https://www.statnews.com/2017/02/06/health-insurance-high-de...

Great article. It's not just about pricing info, it's about the nationwide move to HDHP's and HSA's. Personally I'm pretty happy with my HSA, because now the list of things I can spend my healthcare dollar on is much longer: https://www.irs.gov/pub/irs-pdf/p502.pdf Lots of those things would not be covered by a traditional health insurance plan. But of course, it means we have chosen to forego health care and service…

"because now the list of things I can spend my healthcare dollar on is much longer:"

Longer than what? 8 years ago, I could use HSA funds to pay for over the counter medications. Not anymore, and OTC is generally the first step before visiting a dr or clinic, but OTC is not HSA-usable.

Re: YC Research: Universal Healthcare

#277

Post by lkbm »

mikekij wrote: post #100
dflock wrote: post #60

Earlier quoted context omitted.

There are 9.5 million people in Sweden and 320 million in the US - the huge market size in the US would still be a big incentive, whatever else you did.

Not if your margins are negative.

Negative margins are a result of starting_cost/n + unit_costn > unit_pricen.

If unit_cost > unit_price, then increasing n hurts, but in cases where unit_cost > unit_price, increasing n moves your margins to the positive, unless marginal costs increase--which is admittedly sometimes the case, but in many cases they go down.

Re: YC Research: Universal Healthcare

#278

Post by chimeracoder »

rayiner wrote: post #235
beambot wrote: post #151

Earlier quoted context omitted.

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.

You're getting downvoted, but you're right. Currently, the US is implicitly subsidizing other countries in this regard. If we removed the trade barriers for prescription drugs, US prices would fall and other countries would end up paying more.

Re: YC Research: Universal Healthcare

#279

Post by HarryHirsch »

yummyfajitas wrote: post #90

Interestingly, we already discovered a mechanism for drastically reducing the cost of healthcare back in 1986. It's a way of crowdsourcing the problem called high copays . Basically, you have to pay out of pocket for 90% of your health care up to a (high) cap. It turns out that patients are very good at figuring out which health care will improve health and which won't - the high copay group had no statistically sign…

You would predict that discouraging healthcare "consumption" through higher co-pays would cut down on office visits for minor problems, but not for major issues, because with major health issues you have no choice not to go.

How much is an office visit for runny nose? USD 50, USD 100? And how many frequent flyers are thee in the population, one out of ten, perhaps? It's just not plausible that it's the doctor-fetishists that cause US healthcare to be 4 times as expensive as the rest of the developed world.

Re: YC Research: Universal Healthcare

#280

Post by chimeracoder »

spangry wrote: post #257
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?

England has a single-payer (the NHS) and a population of 53m people. So I guess the answer is England?

> England has a single-payer (the NHS) and a population of 53m people. So I guess the answer is England?

GP was being rhetorical, but if you really want to know, Medicare has 55 million beneficiaries in the US.

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