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Re: Healthcare

#21

Post by WildUtah »

adolph wrote: post #17
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…

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.

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. (or poverty)

Those lucky duckies! http://en.wikipedia.org/wiki/Lucky_duckies

Re: Healthcare

#22

Post by chintan »

Speaking from a Web/Healthcare IT startup experience: The BIGGEST challenge is that your buyer, user and payer are 3 different entities. Every budding healthcare entrepreneur wants to "disrupt" this somehow, but eventually almost everyone gives up and they either die or become yet-another-enterprisey software company that everyone loves to hate.

You can make a decent, linearly growing business if you can survive 2-3 years long sales cycles. So it makes sense that VC's don't want to venture into this space.

Re: Healthcare

#23

Post by Duff »

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…

Most Americans aren't Medicare or Medicaid beneficiaries, but we're all affected by these programs. Medicare sets a price floor on all procedures covered by the program.

Also, Medicare will not compensate providers for bad outcomes, but Medicaid is state-administered and usually just pays claims blindly. Entitlement arbitrage is bankrupting many states, but that's a whole other issue.

IMO, we've created a multi-headed hydra, where the only winners are the mandarins who understand the arcane regulatory structure.

Re: Healthcare

#24

Post by absconditus »

zdw wrote: post #20
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 h…

As bad as Epic's software might be, the rest of the software in the industry is worse.

Re: Healthcare

#25

Post by 10100101001 »

10100101001 wrote: post #16
OstiaAntica wrote: post #13

Earlier quoted context omitted.

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...

Is humour not allowed?

Re: Healthcare

#27

Post by bdr »

10100101001 wrote: post #25
10100101001 wrote: post #16

Earlier quoted context omitted.

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

Is humour not allowed?

It's not forbidden. It's just rarely considered worth the space. I hate to say "lurk more", but you are new here, and you don't yet understand the complexities.

Re: Healthcare

#28

Post by jberryman »

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…

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

I'm not an expert, but I think it's very important for us (normal citizens) to be skeptical of these kinds of claims:

http://en.wikipedia.org/wiki/Tort_reform#Healthcare_industry

Large corporations have created a mythology of an epidemic of frivolous lawsuits that Americans have completely internalized: those women weren't sexually harassed they just wanted to be bought off, or: she probably spilled coffee on herself on purpose.

Also, you mention government bureaucracy and efficiency: I think it's worth pointing out that you can have a large amount of inefficient private sector bureaucracy, where the government could step in and create a more efficient system. The highway system is one obvious example. I think healthcare is also in this category.

Re: Healthcare

#29

Post by nradov »

marshallp wrote: post #10
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…

clayton christensen advises that the solution to healthcare is personalized medicine, technologies like portable diabetes monitors. Imagine if you needed surgery, a robot comes to your house and performs it, much cheaper than doctors and hospitals. such system are currently being developed with military funding - battlefield telerobotic surgery

WTF? My house is pretty far from being a sterile environment.

Re: Healthcare

#30

Post by nradov »

zdw wrote: post #20
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 h…

NwHIN Direct is specifically trying to become the SMTP of medical communications. Which is fine as far as it goes, but covers only a few limited use cases.

http://wiki.directproject.org/

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