Why not link directly to the article than that slow feed site? http://valleywag.gawker.com/what-happens-when-a-healthcare-s...
Because valleywag is a banned domain on HN for some reason
What Happens When a Healthcare Startup Leaves You With the Bill
81–90 of 96 posts
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#82The problem with insurance companies is that they are fundamentally conflicted. As for-profit businesses they have a fiduciary responsibility to maximize profits. Unfortunately the only way to maximize profits is to decline coverage. The problem with Obamacare is that it does nothing to fix this problem. Who wants to be the guy responsible for that many lost jobs?? So, instead they propped up the insurance companies…
This myth that businesses have a fiduciary responsibility to maximize profits has to die :-)
Fortunately there is now (since 2012 in fact) a book that explains it very well in terms that almost anyone can understand, certainly anyone here on HN:
The Shareholder Value Myth: How Putting Shareholders First Harms Investors, Corporations, and the Public http://www.amazon.co.uk/Shareholder-Value-Myth-Shareholders-...
Don't even need to read it all, the first few chapters are more than enough IMHO
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#83Earlier quoted context omitted.
Corporations do not have the responsibility to maximize profits. Why do people keep saying this? They have a responsibility to do what is best for the corporation. Sometimes that means spending more on health coverage to retain employees, or give to charity or other programs. It's not all about money. Often, it's almost all about the money:(
What about Dodge v. Ford Motor Company?
I highly recommend to just get the book [1], it's written very well and in layman terms but here's an extract taken from a review [2] of the same:
"Stout traces the birth of this “fable” to the “oversized effects of a single outdated and widely misunderstood judicial opinion.” Dodge v. Ford Motor Company was a 1919 decision of the Michigan Supreme Court. The opinion’s status as a meaningful legal precedent on the issue of corporate purpose is tenuous at best. Yet, its facts “are familiar to virtually every student who has taken a course in corporate law.” As Stout has observed in the past, “[t]he case is old, it hails from a state court that plays only a marginal role in the corporate law arena, and it involves a conflict between controlling and minority shareholders” more than an issue of corporate purpose generally.[11] The chapter explains quite well that any idea that corporate law, as a positive matter, affirmatively requires companies to maximize shareholder wealth turns out to be spurious. In fact, none of the three sources of corporate law (internal corporate law, state statutes and judicial opinions) expressly require shareholder primacy as most typically describe it. To the contrary, through the routine application of the business judgment rule, courts regularly provide prophylactic protection for the informed and non-conflicted decisions of corporate boards"
[1] "The Shareholder Value Myth: How Putting Shareholders First Harms Investors, Corportations, and the Public" by Lynn Stout http://www.amazon.co.uk/The-Shareholder-Value-Myth-Sharehold...
[2] http://arizonastatelawjournal.org/book-review-the-shareholde...
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#84Earlier quoted context omitted.
It's evil, inconvenient, and (amazingly) it's even less efficient that its government-run counterparts both inside and outside the US: http://healthcarereform.procon.org/view.resource.php?resourc... What will it take to convince people of this? Our society already accepts that markets aren't a suitable medium for every human endeavor, how long must we continue to experiment with private (basic) health insurance befor…
> If our health sector ran as efficiently as everyone else's (as a fraction of GDP/capita), the money we currently pay for medicare and medicaid would suffice to provide universal coverage for every single person in the US. This isn't an apples-to-apples comparison for several reasons (some which overstate the amount of money, some which understate). One, there are a number of things which fall under Medicare's budge…
Hospital operating margins are decent. They are stuck in the same trap as higher ed. Immense investments in tangentially related infrastructure.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#85Earlier quoted context omitted.
>This isn't an apples-to-apples comparison. It really is, and has nothing to do with the current state of Medicare and what it covers. Our per-capita government health care expenditures are far higher than systems that both have better outcomes and that also don't charge at the point of delivery. Our doctors make twice as much as everyone else's doctors, and that is only sustained because they are both protected from…
Your drugs are expensive because the rest of the world freeloads by artificially restricting the selling price of drugs, leaving the US to bear the brunt of the R&D costs. Your FDA and legal system pushes up the price of medical devices. But yes, you have the most unnecessarily complex and convoluted health care administrative structure known to man.
Often times there are very good reasons for those restrictions, especially when pricing for a drug deviates dramatically from actual R&D / operations costs. Take the case of orphan drugs:
http://www.forbes.com/sites/johnlamattina/2013/10/05/are-300...
Besides runaway pricing, many drugs for which companies are given patents and sole-distribution rights, have already been on the market for decades, just never with proper FDA approval. There are other tax incentives and grants provided as well for reintroducing "new" drugs that were already on the market.
http://apps.seattletimes.com/reports/pharma-windfall/2013/no...
Makena scandal:
http://en.wikipedia.org/wiki/KV_Pharmaceutical#Makena_pricin...
Many many other drugs with runaway pricing as well:
Armodafinil and Sodium Oxybate for instance
Europeans decide to enforce price controls? Can't say i blame them.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#86Sorry for over repeating what people always say, but I am genuinely so grateful for the UK's NHS.
I get private healthcare in the UK through my job - the only time we have used it was when my teenage son got his tonsils out. What was amusing was that at one point the anaesthetist came up and said there had been a mistake in the billing and I'd have to pay part of the bill directly. Having heard all the horror stories from the US I was thinking it was going to be a huge amount of money - he very apologetically gav…
You smug bastard. Joking, but i'm in the US and have had so many issues in my life with huge medical bills and debt collectors, denial of care, insurance refusing to pay because a doctor messed up the paperwork, insurance not covering certain medications, or saying the dosage needed to be changed, that i'm almost not. :-p
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#87Earlier quoted context omitted.
I have Kaiser. It's vastly simplified because the people paying for my care are the same people who are providing my care. They also seem to have a real "get you up and running so you can get back to work" kind of attitude, which meshes well with my own values. I mean, consider for a moment how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. Multiply that by the…
> how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. I have had nothing but excellent experiences with both my car insurance company and my homeowners insurance company. The trick to having a good relationship with your insurance company is to have a good insurance company.
Have you ever filed a claim that would would send the expected value of your account negative? Since that's a tricky calculation, here's an alternative: have you ever made a claim that (even momentarily) sent the value of your account negative?
Insurance companies are always polite, efficient, and tolerant when they're taking your money (including making small payouts). Why wouldn't they be? But that's not where they add value to the equation. If it was, everyone would just self-insure. They add value when they have to pay out a lot of money for an unlikely adverse event. By definition, only a small fraction of customers ever get to judge this part of their insurance company, even though doing so is really the only way to judge the quality of the product they were paying for.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#88Earlier quoted context omitted.
There is, sometimes, a tendency on the part of young, ambitious entrepreneurs, to be overly optimistic and assume that they can gatecrash an industry they know nothing about, set up a slick website and disrupt the big, bloated, uncool incumbents. Also, disrupting American health insurance is like "disrupting" terrorism. (It took 10 years to get one guy.) It's not something you can pull off in an afternoon. You're fac…
I think that it's generally a good assumption, anywhere in business (and most places in life), that whoever you're talking to is self-interested . Not evil, not even necessarily selfish, but it's a good bet that their world revolves around them . And once you've got this principle ingrained in your mind, navigating the big scary world of business, or VC, or Google, or health insurance, or any other industry becomes m…
+1.
The parent talked about fighting evil but the vast majority of people who work in industries like health aren'e evil - they're merely acting in their own self-interest within a system/industry that has evolved, over time, to exploit the vulnerable.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#89Earlier quoted context omitted.
> how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. I have had nothing but excellent experiences with both my car insurance company and my homeowners insurance company. The trick to having a good relationship with your insurance company is to have a good insurance company.
Have you ever filed a claim that would would send the expected value of your account negative? Since that's a tricky calculation, here's an alternative: have you ever made a claim that (even momentarily) sent the value of your account negative? Insurance companies are always polite, efficient, and tolerant when they're taking your money (including making small payouts). Why wouldn't they be? But that's not where they…
They should force sales and claims to be the same person. Problem solved. Right now, its good cop/ bad cop. Insurance only works in this framework if you have a lawyer to advocate for you...otherwises its endless dark-pattern fighting. Its truly atrocious.
Re: What Happens When a Healthcare Startup Leaves You With the Bill
#90This story seams par for the course when dealing with insurance companies regardless of if it's startup or not. I've had the same exact issue with everyone from "United" to "Humana" and more recently "HealthNet" You will be told something is in network and it's not, a lab location is listed on their website as in network and then they claim it's not covered later. Sadly, this seems to be an area where legislation nee…
Wish more people knew this. A lot of professionals on here might personally have a stellar health insurance plan through their employer that covers almost anything no questions asked, but those same big insurers will administer cut-rate plans to the majority of plan-holders and deny payment at the drop of a hat, or pick and choose what necessary care / medications they will / won't pay, often after the fact, seemingly arbitrarily or if submitted paperwork isn't flawless.
It's a pretty good racket really; provide quality, hassle-free coverage to the high income, professional class, or anyone else that might have any say or sway or influence in government, and then for the working class majority refuse to ever pay out more per person than you are payed. That way you can cost-save like crazy and make obscene profits, but no one that matters cares and based on their experience it just looks like belly-aching and blowing things out of proportion.