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Re: Healthcare

#11

Post by mjbellantoni »

dmk23 wrote: post #3

The problem with venturing into healthcare is dealing with highly regulated industry and wrong incentives for most of the players. "Large networks of engaged users" do exist, but the ones who control real money (doctors, hospitals, insurers and pharmas / device makers) are highly suspicious of outsiders. Every one of them has the incentive to not share their data with the competition, even though they will all public…

"[...]the ones who control real money (doctors, hospitals, insurers and pharmas / device makers) are highly suspicious of outsiders."

And each other.

Re: Healthcare

#12

Post by cletus »

Personally I believe the problems with healthcare and education are largely the domain of government to fix.

I actually believe in the (now-dead) Republican policy that, in the US at least, education is a state not Federal issue. By making it a Federal issue, we're just creating one giant bureaucracy and we all know how good those are at solving problems.

We should probably have a model like some European countries where the money follows the student and what school a student can go to isn't restricted by some arbitrary boundary on a map.

Likewise the tenure system has to go. What was imagined as a means of allowing academic freedom has become a recipe for entrenched mediocrity and stagnation.

Also, it's a problem that schools are largely funded by property taxes. This alone ensures a better education for the rich. I'm not sure what the alternative is but we need one.

As for healthcare, IMHO we're largely in this position because of the "blank check" model for health insurance and because of pharmaceutical patents.

Each country has different laws about what is patentable and what isn't. In the US, for example, nuclear technology is expressly forbidden from being patented as it is seen as a matter of national security. In India, health care is seen likewise so pharma patents aren't allowed, providing for cheap generic medicine.

I foresee a day when the US will swing in India's direction. Not that I necessarily think this is all good. The fact is, drugs are expensive to develop but it's also true that the pharmaceutical industry spends more on marketing than anything else (basically getting doctors and hospitals to use their drugs).

Also, litigation is a problem for health care. We all pay for outrageous punitive damage awards.

Lastly, it's a problem that insurance in the US is essentially tied to employment and large employers get that substantially cheaper than smaller employers (let alone individuals).

And of course the complexity and administrative overhead are huge problems, which is probably the one area that could be disrupted without government intervention. But it doesn't help that part of the reason things are so complex is essentially to deny coverage.

Re: Healthcare

#13

Post by OstiaAntica »

MJR wrote: post #8
OstiaAntica wrote: post #2

Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…

First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad br…

It is a common tactic for people invested in a broken status quo to dismiss critics as "not understanding the complexities". Which insurance company or regulator do you work for? I've worked on health care policy professionally, I assure you I understand the issues.

Much of the distortion in the current system come from the fact that employers can deduct health care expenses, which means that you save around 15-30% versus buying healthcare as an individual with aftertax dollars. That single policy is what ties health care to your employers-- in my mind, a kind of serfdom that keeps people tied to jobs simply because of health care insurance.

So getting tax equality by eliminating the deduction, or extending it to individuals, would rock the market. Beyond that, it actually is as simple as allowing interstate competition, which will allow people to escape all of the insane state regulations, and lack of choice, that drive up costs.

And groups can't organize to purchase health care-- I'm talking about a world where my university alumni association or church has a plan, and I could choose that for life, and it has the same tax and regulatory treatment as my employer's health care offering. I want vastly more diverse delivery mechanisms, all competing for my business, and ideally with a long-term relationship that would naturally incentivize preventative care.

Re: Healthcare

#14

Post by rdl »

absconditus wrote: post #5

I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are…

I agree, especially about EPIC, but I think some of the integrated providers (like Kaiser) are themselves better at innovation than most of the software/services companies in the space.

Re: Healthcare

#15

Post by absconditus »

rdl wrote: post #14
absconditus wrote: post #5

I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are…

I agree, especially about EPIC, but I think some of the integrated providers (like Kaiser) are themselves better at innovation than most of the software/services companies in the space.

Kaiser and Mayo are definitely doing things better than most other providers. Unfortunately the government is encouraging other providers to cargo-cult them by providing ARRA funds for copying some small part of what they do.

Re: Healthcare

#16

Post by 10100101001 »

OstiaAntica wrote: post #13
MJR wrote: post #8

Earlier quoted context omitted.

First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad br…

It is a common tactic for people invested in a broken status quo to dismiss critics as "not understanding the complexities". Which insurance company or regulator do you work for? I've worked on health care policy professionally, I assure you I understand the issues. Much of the distortion in the current system come from the fact that employers can deduct health care expenses, which means that you save around 15-30% v…

Listen, you don't understand the complexities...

Re: Healthcare

#17

Post by adolph »

MJR wrote: post #8
OstiaAntica wrote: post #2

Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…

First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad br…

Medicare and Medicaid are such large payers that the decisions they make move the rest of the market. Second, at some point most Americans are eligible for one program or the other if for no other reason than the good fortune of old age.

Re: Healthcare

#18

Post by maxxxxx »

OstiaAntica wrote: post #2

Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthca…

Group insurance should be abolished. Take the whole country as one big group. It doesn't make sense to have small groups negotiate their coverage.

Re: Healthcare

#19

Post by plink »

cletus wrote: post #12

Personally I believe the problems with healthcare and education are largely the domain of government to fix. I actually believe in the (now-dead) Republican policy that, in the US at least, education is a state not Federal issue. By making it a Federal issue, we're just creating one giant bureaucracy and we all know how good those are at solving problems. We should probably have a model like some European countries w…

If money were to follow the student free from map restrictions, then how can education be contained by state governance?

Re: Healthcare

#20

Post by zdw »

absconditus wrote: post #5

I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are…

Epic's software looks and (according to the doctors that have to use it) works like a bad 1990's database program written in Access. I work with a hospital that has it implemented. It's inflexible crap, where their idea of someone using it on a tablet is "get one with windows, or here's a RDP session you can get to through a VPN". One doctor I know said it took him 17 clicks and both reading help and contacting the help desk to enter simple information, which turned out to be in a totally nonintuitive way.

We need the SMTP of medical communications, not the Microsoft Exchange. Epic's system is very like the latter.

All medical software suffers from the problem of all software where the end user and the creator of software isn't the same person - it just doesn't work in a way that makes sense.

The problem, for medical software at least, is that once you've one of the very few people who have a medical degree, you're often in demand to the point that deciding to 1. write software at a competent level and 2. have the business moxie to turn it into a decent business, the talent pool is basically nil.

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