When good ideas make bad business • Hacker News Board

Re: When good ideas make bad business

#341

Post by rtikulit » Sat, Jan 04, 2020, 1:34 PM UTC

planetzero wrote: post #209

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.

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to p…

I have worked in government (twice) and large and small companies, now working in the private sector for the last 20 years. There are structural inefficiencies and perverse incentives in both domains, though they are very different in style and visibility.

In magnitude, not so much.

Re: When good ideas make bad business

#342

Post by ci5er » Sat, Jan 04, 2020, 1:35 PM 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.

What is the proper value of human life? Does it change over time?

And is the budget-wise national-healthcare-system administrator qualified to make that determination for you?

And, if they do not want you to get better while waiting on line (most people do bet better for most things, except, broken legs, without treatment) or want you to die while waiting on line, why are the lines so long?

In any case, even in Singapore, with arguably the best-balanced system in the world, things are complicated, when people's lives are on the line...

https://faculty.chicagobooth.edu/john.cochrane/research/pape...

Re: When good ideas make bad business

#343

Post by rsp1984 » Sat, Jan 04, 2020, 1:39 PM UTC

wayoutthere wrote: post #316

rsp1984 wrote: post #311

Earlier quoted context omitted.

There's barely anything more frustrating than a fascinating discussion on HN and then folks start kicking around lingo and acronyms that you can't even Google because they could mean a million things. So please, have mercy and cure my ignorance and explain what EMR means.

EMR is basically anything and everything related to the operation of a doctor's office and/or hospital. Think scheduling, patient records, ordering lab tests, sending prescriptions to the pharmacy, billing.... all of it. It's what your doctor is furiously typing data in to during your visit. They also include a lot of functionality designed to, among other things, make sure your doctor doesn't write you prescriptions…

Sure. Thank you for the explanation!

Re: When good ideas make bad business

#344

Post by rtikulit » Sat, Jan 04, 2020, 1:48 PM 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…

The costs vs. outcomes analysis across health care systems suggest that your personal lifetime expected return on investment (likelihood * (value/cost)) of a universal health care system with a single large national risk pool will be higher than your lifetime ROI in the current US system.

You are probably underestimating your own unknown non-lifestyle associated risk, along with the risks your offspring represent.

It also costs a lot to detect and judge risk factors, manage individual risk pools, assure compliance, etc. You save a lot of money by simply not bothering to risk-qualify eligibility and this offsets the costs associated with carrying lifestyle risks in a single large pool.

Re: When good ideas make bad business

#345

Post by rtikulit » Sat, Jan 04, 2020, 2:01 PM UTC

achillesheels wrote: post #271

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…

“Consumer driven healthcare” as the academic researchers call it. It is bewildering why we don’t have diagnostic labs doing email marketing campaigns, for instance. This is driven, I think, by an outmoded concept of the security of doctor’s knowledge. Now, doctors are so behind the ball and play defensive to protect themselves from malpractice. The idea that an individual cannot make educated decisions which are mark…

With respect to health care, you may be able to make such educated decisions, almost no one else can. There isn't enough signal, and almost no one has the ability to distinguish signal from noise, and correctly interpret it.

What happens is that when given the opportunity, business will pollute the market with proxy signals (like brand trust, or fear based selling) that people instinctively respond to.

These proxy signals will be subject to manipulation by well-capitalized actors and will not in general reflect outcomes or value. They will interfere with the fundamental signal, making it even harder to detect and interpret.

Therefore the market will not work, in the sense of delivering the best outcomes for costs.

(Note that I am strictly speaking of healthcare, where even experts are often unsure of causal relationships and the relative value of various therapies. In general I think markets are a wonderful thing. Here is an experiment to try... take a mild condition treatable by OTC medication, such as the symptoms of colds, allergies, etc, and see how long it takes you to identify, characterize and factor the available therapies, and then map this to available products. Evaluate interactions, cautions, effectiveness, risk, convenience, costs, etc. Now ask yourself, where did you get your information? Who did you have to trust? Why did you trust them? Is the basis for your trust and understanding available to the average person?

I've done the experiment. My conclusion is that healthcare large and small is not like other goods.)

Re: When good ideas make bad business

#346

Post by wayoutthere » Sat, Jan 04, 2020, 3:50 PM UTC

dreary_dugong wrote: post #323

wayoutthere wrote: post #317

Earlier quoted context omitted.

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.

The problem is that those drugs never even make it into the pipeline because they don't get investment in the first place. The big drug companies aren't the ones actually developing new drugs; that's done by biotech startups. If a drug shows promise, big pharma buys the company and pays for stage 2+ clinical trials.

A friend of mine works in pharmaceutical marketing, and the big revelation I got from him was that the marketing departments run the drug companies from the top to the bottom. If marketing doesn't see a billion dollar market for a new drug, it won't even be considered for clinical trials. The VC in biotech knows this, so they won't fund startups that don't have this potential.

There was a HN thread on this recently in relation to antibiotics. [1] Antibiotics are a special case for their own reasons, but ultimately if the potential for insane windfalls isn't there, big pharma is not interested.

[1] https://news.ycombinator.com/item?id=21782994

Re: When good ideas make bad business

#347

Post by wayoutthere » Sat, Jan 04, 2020, 4:05 PM UTC

donaltroddyn wrote: post #327

gonational wrote: post #321

Earlier quoted context omitted.

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 globall…

Anarcho-capitalism -- er, "libertarianism" -- at its finest. It's a deeply nihilistic worldview.

Almost all these things are biologically addictive, and furthermore the companies selling them have long known about their addictive qualities and then built marketing campaigns to ensure the public was not aware of the risks.

Taxation is how you recognize the externalities of this behavior while maintaining a free-market system.

Re: When good ideas make bad business

#348

Post by prithsr » Sat, Jan 04, 2020, 4:31 PM UTC

Barring any advice or input on the idea (which I do think is solid), this was a really fun read.

Re: When good ideas make bad business

#349

Post by thebean11 » Sat, Jan 04, 2020, 4:56 PM UTC

goatlover wrote: post #337

nodemaker wrote: post #295

Earlier quoted context omitted.

The government runs a lot of things better than the private sector. Even in the US, the government loosely or strongly manages Police, National Defense, Garbage Disposal, Water managenemt, Power Management, Internet infrastructure, Education, Telephone, Mail and many more. Any service that every citizen needs to live a healthy life is better and more cost effectively run by the government.

Some of those are run by monopolies such as power, telephone and internet providers.

Telephone and internet are usually run by private companies no? I think the post meant that the few government run alternatives that exist tend to be better (cheaper, faster, better service etc).

Re: When good ideas make bad business

#350

Post by achillesheels » Sat, Jan 04, 2020, 5:02 PM UTC

rtikulit wrote: post #345

achillesheels wrote: post #271

Earlier quoted context omitted.

“Consumer driven healthcare” as the academic researchers call it. It is bewildering why we don’t have diagnostic labs doing email marketing campaigns, for instance. This is driven, I think, by an outmoded concept of the security of doctor’s knowledge. Now, doctors are so behind the ball and play defensive to protect themselves from malpractice. The idea that an individual cannot make educated decisions which are mark…

With respect to health care, you may be able to make such educated decisions, almost no one else can. There isn't enough signal, and almost no one has the ability to distinguish signal from noise, and correctly interpret it. What happens is that when given the opportunity, business will pollute the market with proxy signals (like brand trust, or fear based selling) that people instinctively respond to. These proxy si…

You assume medical bureaucracies are needed to protect from self-harm; ironically the current healthcare state is harmful!

I have firm belief in the fact that the market can more efficiently aggregate medical information but above all else create more rapid responsiveness to care. Bad products and actors are always seeded out over time in a society.