Why should healthcare be tied to employment? "Quit fucking around" and institute a national, single-payer plan that covers everyone, like every other modern industrialized country.
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Why YC went to DC
361–370 of 407 posts
Re: Why YC went to DC
#362Earlier quoted context omitted.
The UK's 12% is fairly typical, and a similar percentage funds (mostly better) systems in many Western European countries. Singapore has an excellent system costing about half the proportion of GDP.
The UK does some things well but they are behind the USA (and other developed countries) in cancer survival rates. https://www.theguardian.com/society/2024/jan/11/uk-cancer-su... Singapore has an authoritarian police state which prevents many of the chronic substance abuse problems that drive a significant fraction of US healthcare spending. I don't think Americans would be willing to accept that trade-off. Singapore…
An interesting aspect of cancer survivability is the jump in cancer rates in the US right around age 65. The implication is people aren't being seen until they qualify for Medicare, pointing to preventative healthcare access problems.
Re: Why YC went to DC
#363Earlier quoted context omitted.
> I don’t see how the issue of repackaging CDS and related products by a financial rating agency has anything to go with the government. The financial rating agencies are creatures of government regulation. > If you’re saying that the government forced buyers to abandon due diligence I said no such thing. I said that government regulations forced lenders to accept more default risk--meaning they were forced to lend t…
> said that government regulations forced lenders to accept more default risk--meaning they were forced to lend to people they would not otherwise have lent to because the risk of default was too high. That's what "subprime mortgages" means, and those were a huge contributor to the crash. The ratings agencies are free to rate things as they wish - unless maybe you’re saying there’s a government directive to misrate t…
It's a half truth; the truth is somewhere in the middle of this and another theory. I'm not an economist, but the start of my professional life was marred by the experience of 2008 so I spent a lot of my time reading about it.
A source from the other side of this equation: https://www.cbsnews.com/news/heres-what-really-caused-housin...
In reality, there were a lot more sub-prime loans but only one of those lenders was actually expected to take on sub-prime loans. That's to say, taking on more sub-prime loans was a choice reflected in an ecosystem of incentives where profits were falling because a few lenders started a campaign to lower borrowing standards and the rest of the herd followed to stay afloat. What also happened was that lenders were essentially over weighting sub-prime loans into these packages and then using their relationships with the privately controlled ratings agencies to rate them the way that would be if they were filled with primes. If you read between the lines lenders found the solution to their profit problem and were trying to justify its stability post-hoc through package ratings. The reality is that sub-primes are highly profitable when they work out because they have high interest rates. When they don't they're not that expensive because generally the property is offloaded but this only works up to a magical threshold depending on a lot of risk variables. Once you go beyond that threshold and the dominos begin to fall, they all fall spectacularly. Risk traditionally should be leveled by packaging them with less risky loans.
Re: Why YC went to DC
#364Earlier quoted context omitted.
Read 26 CFR section 1.174-2. “Activities intended to discover information that will eliminate uncertainly concerning the development or improvement of a product.” Specifically, check out example three in this section. I would be very careful about sweeping all my expenses in this category, but my familiarity with this part of the law is not deep. I’d love a 174 practitioner to jump in here but that might be asking a…
Not a practitioner, just a startup cofounder affected by these changes.. not legal or tax advice. You can read the applicable text here: https://www.law.cornell.edu/uscode/text/26/174 Section 174(c)(3) ``` (3) Software development For purposes of this section, any amount paid or incurred in connection with the development of any software shall be treated as a research or experimental expenditure. ``` That being said.…
Super post, thank you.
As to software “development,” when you finish your software and publish it and get customer installs, then what happens? More software development? Or is ongoing operation/bug fixes still R&D under (c)(3)? I think your average software person has a strong belief about the answer to this question but having read some of the code® in the area, I share your opinion that this section needs more detail.
Re: Why YC went to DC
#365Earlier quoted context omitted.
The UK's 12% is fairly typical, and a similar percentage funds (mostly better) systems in many Western European countries. Singapore has an excellent system costing about half the proportion of GDP.
Just to add to the nuance, you're comparing a country with 6MM people to one with 370MM people. What dynamics do you think that difference of scale has on the overall healthcare outcome?
and with counrties in between.
I very much doubt there are either large economies or diseconomies of scale in healthcare. Certainly no indication of it in spend western Europe I can see.
The UK has IMO created diseconomies of scale by having a monolithic system.
Re: Why YC went to DC
#366Capture those regulators and get the bag!
Re: Why YC went to DC
#367Earlier quoted context omitted.
How about health insurance not being tied to profits. Startups pay the full brunt of health insurance since they don't have real profits they have nothing to write off. Meanwhile large orgs get to write off a ton of profits as Healthcare costs for employees. So startups tend to have real garbage insurance. As someone older with kids startups are getting more and more prohibitive because I need that Healthcare. Maybe…
Radical suggestion (maybe I'm too British): health insurance not being tied to employment or work whatsoever?
Here’s a radical suggestion: stop calling welfare-for-doctors insurance. If you want insurance, those are known as major-medical policies under which the sniffle visits are still the patient’s responsibility — just like how insured car owners pay for their own oil changes.
With “health” “insurance,” neither side has price sensitivity. Patients ask whether it’s covered and if so, back the truck up to get as much as possible. Physicians see enormous pots of money in tax-favored plans and seek to scoop out as much as they can. The inevitable result of such an awful system — that traces back to workarounds on executive pay limits imposed during the FDR administration — is unbounded price increases. Politicians scream about getting spending under control, and regulators impose rationing. This is a terrible system, but it’s a self-inflicted wound.
In the U.S., at least, we’re seeing cash-only practices become more common. Their fees are affordable because their customers pay out of pocket and because they don’t have to hire entire departments just to deal with “insurance” providers.
Re: Why YC went to DC
#368Earlier quoted context omitted.
Just to add to the nuance, you're comparing a country with 6MM people to one with 370MM people. What dynamics do you think that difference of scale has on the overall healthcare outcome?
and with counrties in between. I very much doubt there are either large economies or diseconomies of scale in healthcare. Certainly no indication of it in spend western Europe I can see. The UK has IMO created diseconomies of scale by having a monolithic system.
I think there is some evidence of economies of scale. For example, Medicare can negotiate for better prices due to sheer number of patients covered.
Re: Why YC went to DC
#369Earlier quoted context omitted.
No one cares because most software developers are employed at big companies that can amortize. Even YC will probably just increase its seed instead of complain and consider it a "cost of business". This affects only marginal people. I am interested to talk with you about this if you want (feel free to reach, my email is in my profile).
> Even YC will probably just increase its seed instead of complain Does it even impact these type of companies? 90% of the time at this stage you'll have very little income compared to expenses.
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Re: Why YC went to DC
#370Earlier quoted context omitted.
Could someone elaborate this for an uninformed like me? Does it mean if you (a company) pay $1M as salary this year, only $0.2M can be treated as cost?
Essentially. An extremely oversimplified scenario: On paper if you made $1M in revenue, and had $1M in salary expenses that were all R&D, you would deduct $200k of that salary and be left with $800,000 in "profit" that you have to pay taxes on. Except you don't have $800k. You have $0k.
Why would that be counted as profit at all, if it was spent?