When good ideas make bad business • Hacker News Board

Re: When good ideas make bad business

#321

Post by gonational » Sat, Jan 04, 2020, 4:30 AM UTC

jacobr1 wrote: post #308

gonational wrote: post #250

Earlier quoted context omitted.

Take all my karma... Implementing something like what you describe, IMHO, would have the greatest positive impact on the health and welfare of Americans, of anything this century. I have a friend who is very high up in one of the largest health insurance providers in the US, and I have often debated over the years with this person that same point, that the insurance layer is what creates the model for inefficiency, a…

Take a look at some of the "universal catastrophic coverage" proposals. The ideas is to BOTH socialize and increase market competition for healthcare at the same time. Universal care if you get cancer or for other chronic/terminal conditions. Then have a real market and competition for everything else. Regulate safety but not pricing or delivery. (Many of these plans also call for universal preventative services that…

It’s an interesting concept. The primary concern is that most of the costs for catastrophic medical problems will be incurred due to things like obesity, smoking, heavy drinking, dangerous lifestyles, etc. This creates one of two problems (or both?): either I’m left with the bill for others’ bad choices, or individual agency is under state / democratic control (e.g., salty foods banned, dessert banned, drinking banned, etc.).

Neither of those scenarios are ideal.

If the only question was genetic differences, that’s a risk I think a lot of people would be willing to take (e.g., that I might be healthy until 100 and then die in your sleep, theretofore paying constantly for others who have had medical problems for 70 years straight). I myself would be willing to take that risk / pay for that style of universal coverage, if not for the aforementioned choice part (smoking, etc.) playing so heavily into the cost, in practice.

Re: When good ideas make bad business

#322

Post by thundergolfer » Sat, Jan 04, 2020, 4:34 AM UTC

_bxg1 wrote: post #262

> “And that isn’t worth something? Prescribing better treatments?” > “Hmmmm,” she said, picking at her fingernails. “Not directly. Of course I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, r…

If this thing works as a better search engine for medicine, then I'd want my doctor using it. Could this person have trialled it in a healthcare system with a public-option?

Convince the government your product is a benefit to their doctors and by extension their citizens, and a good government should pay you for it after a proper trial.

Instead he walked into a situation where the incentives are utterly fucked by an atomised, privatised, and consumer-oriented healthcare system.

Re: When good ideas make bad business

#323

Post by dreary_dugong » Sat, Jan 04, 2020, 5:25 AM UTC

wayoutthere wrote: post #317

Buge wrote: post #284

Earlier quoted context omitted.

If American consumers stop subsidizing health care R&D costs, what will happen to the R&D? Will it decrease? Will health care costs in other countries increase as they start to bear some of it?

I assume it will continue because the drug companies need products to sell. It's not like they're just going to close up shop, but it may be the end of windfall profits. The other problem right now is that it's not profitable to create drugs that actually cure anything. It's far more profitable to research drugs that help control chronic conditions (like diabetes, hypertension or Alzheimers) rather than drugs that ca…

As stated in a thread above, while it is not directly profitable for drug companies to cure diseases, it is profitable for their insurance agency cohorts. The current system does not totally dis-incentivize cures.

Re: When good ideas make bad business

#324

Post by duelingjello » Sat, Jan 04, 2020, 5:35 AM UTC

Falling in love with an idea plus ignoring reality is the surest road to hubris and failure. Be religious about results, customer value, profitability and employee welfare, not ideas. Ideas are a dime a dozen; executing and pivoting into what works too often is stymied by ego and thousands of other self-destructive tendencies that increase the likelihood failure in millions of ways. There are very few ways to succeed, with a little help from happy accidents and flexible resilience under pressure.

Re: When good ideas make bad business

#325

Post by riazrizvi » Sat, Jan 04, 2020, 6:46 AM UTC

gkoberger wrote: post #38

I'm so confused by the tone of this article. Obviously some of the jokes are parodying startup culture and are meant to be funny, however I think the "fantastic idea" stuff is meant seriously? "So I built something people wanted. Consumers wanted it, doctors wanted it, I wanted it. Where did I go wrong?" As far as I can tell, nobody wanted it except the author. The one doctor he talked to didn't, and no consumer ever…

He’s laughing at his naïveté. Like many people who will one day come back from their failure older and wiser for a second attempt.

Re: When good ideas make bad business

#326

Post by reilly3000 » Sat, Jan 04, 2020, 6:54 AM UTC

Healthcare startups are a like a 'land war in Asia'... "only a fool would make such a blunder" (via The Princess Bride, perhaps the best film of the 1980's.)

Selling anything to medical practices is remarkably difficult, due to the difficulty of getting a meeting. They may have to lose $250 in billable time to meet with you, and they are bombarded with sales calls from everybody under the sun. Getting adoption is worse, with overworked staff actively hostile to change. I watched a friend sink his heart and cash into a medical research survey system only to find out how impossible of a market it is to break into.

And it is a land war. Selling into large companies is hard fought, but possible. The long tail is practically impenetrable for a software system, not when they could allocate capital to revenue generating marketing, equipment, and staff. I worked at trying to market a low priced medical supply item into a long tail of allied healthcare professionals and found that there is virtually no network effect. That is to say, people who share the same medical profession have very little interconnected outside of a very local level, and the work they perform is so physically and mentally draining that they don't really want to spend a lot of time online after hours talking about vendors, or talking with others in their field at all. Durable medical equipment and consumables sales are really driven by incumbent field sales reps more than ecommerce, even still in 2020. Land war.

Look at how difficult a time big tech has had taking on electronic medical records systems. Technology is not the bottleneck.

There are plenty of health tech startups finding traction, and I do believe medical professionals want to continually improve themselves and their practices with whatever tools and information is available to them. The fact is, $40K isn't enough capital to win a land war, no matter how great the solution is (and its looks great). I'm sorry OP had to find that out the hard way.

PS. There is a growing array of health focused startup accelerators that can provide seed money, but more importantly the expertise to navigate the sales and regulatory challenges unique to healthcare.

Re: When good ideas make bad business

#327

Post by donaltroddyn » Sat, Jan 04, 2020, 9:15 AM UTC

gonational wrote: post #321

jacobr1 wrote: post #308

Earlier quoted context omitted.

Take a look at some of the "universal catastrophic coverage" proposals. The ideas is to BOTH socialize and increase market competition for healthcare at the same time. Universal care if you get cancer or for other chronic/terminal conditions. Then have a real market and competition for everything else. Regulate safety but not pricing or delivery. (Many of these plans also call for universal preventative services that…

It’s an interesting concept. The primary concern is that most of the costs for catastrophic medical problems will be incurred due to things like obesity, smoking, heavy drinking, dangerous lifestyles, etc. This creates one of two problems (or both?): either I’m left with the bill for others’ bad choices, or individual agency is under state / democratic control (e.g., salty foods banned, dessert banned, drinking banne…

This is a shockingly uncompassionate perspective - is it satire?

Assuming it's genuine, it's also misguided. Almost no-one wants to be obese, alcoholic, etc - accessible healthcare will reduce the incidence of all of these, which in turn will reduce the externalities associated with them.

You also don't need further state control to discourage smoking, drinking, junk food, etc - taxation is the mechanism used globally to discourage undesirable behaviour.

Re: When good ideas make bad business

#328

Post by AlexCoventry » Sat, Jan 04, 2020, 9:22 AM UTC

gringoDan wrote: post #105

legitster wrote: post #89

I wish he could have invested more in the idea - I think it's an amazing concept but the creator pulled the plug too early. Sales cycles in B2B can take months, and in healthcare they can take years. Especially the doctor's feedback, she described the possibility of changing her habits slowly as she got used to using the tool. Unrelated: "I always have the best interests of my patients in mind, but, you know, it’s no…

Sounds like there's an opportunity to have insurance companies pay for the product. This would directly align incentives and lead to overall cheaper care for the patients.

Actuaries employed by insurance companies are probably already better at this kind of analysis than he is, though.

Re: When good ideas make bad business

#329

Post by flarg » Sat, Jan 04, 2020, 9:41 AM UTC

omegaworks wrote: post #187

wayoutthere wrote: post #178

Earlier quoted context omitted.

From a business standpoint, saving lives can actually be expensive. The longer someone lives, the more healthcare they consume. Health insurance companies are very aware of this, which is why they so frequently deny coverage for various life-saving cancer treatments. If you die while waiting for treatment, not only do they save the cost of the treatment, but also the entire cost of ongoing screening / care during rem…

This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.

No it isn't. Even in the UK the much vaunted GP will reject any health initiatives unless they help improve their bottom line. And the initiatives are from the NHS and are free!

Re: When good ideas make bad business

#330

Post by andrey_utkin » Sat, Jan 04, 2020, 10:05 AM UTC

zndr wrote: post #199

omegaworks wrote: post #187

Earlier quoted context omitted.

This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.

So, this is why, at least in the US, EU and a few other countries, we have orphan drug policies. If you don't know orphan drugs are drugs that could be a life saving medical necessity for rare diseases that do not have a large enough base of users to make the drugs affordable. I'm not talking about Shkreli "affordable", but it's literally not feasible to spin up manufacturing, or final trials, or educational material…

You do realise that every dollar invested into low scale consumption matter is a dollar not invested into high scale consumption matter?