Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Brave Care Has Closed

bravecare.com

Post reply on HN
Print view View original

101–110 of 160 posts

Re: Brave Care Has Closed

#101

Post by ketzu »

jackcosgrove wrote: post #95

I have heard conflicting accounts of inefficiencies in the US healthcare system. One account is that the US has too many medical facilities in urban areas. In other words, there might be five hospitals each with its own radiology equipment. That equipment is idle some of the time, so you could close some of the imaging departments and leave just one or two for the metro area. That would obviously inconvenience some p…

> One account is that the US has too many medical facilities in urban areas. In other words, there might be five hospitals each with its own radiology equipment. That equipment is idle some of the time, so you could close some of the imaging departments and leave just one or two for the metro area. That would obviously inconvenience some people, but the gist of the criticism is that the US duplicates medical capacity for the sake of convenience.

> The other criticism is that there are too few clinics and such. That's why there was a big push to open health clinics in pharmacies and urgent care locations recently.

Funny enough, germany has the exact same two problems.

* Too many small urban hospitals do too many things, but have no speciality, leading to high cost, underutilization and higher risk procedures.

* Too few specialist doctors for checkups leading to long waiting times.

Re: Brave Care Has Closed

#102

Post by helsinkiandrew »

IG_Semmelweiss wrote: post #17
toomuchtodo wrote: post #2

Kudos to their founders and team for trying to disrupt this space. https://www.ycombinator.com/companies/brave-care https://www.bizjournals.com/portland/news/2021/10/07/brave-c... | https://archive.today/Qd8fQ https://techcrunch.com/2019/09/09/yc-backed-brave-care-raise...

Most people outside of healthcare will have a hard time disrupting anything until they realize the goverment has tilted the rules in favor of status-quo. Healthcare insurance in the US is heavily subsidized, and no number of revolutionary care delivery models will put you on level terms with the behemoth of US govt insurance subsidies. Your only hope as a non-provider is to come in with your own a-la-carte insurance…

> .. they realize the goverment has tilted the rules in favor of status-quo

Or is it that the Healthcare industry has tilted the government into making rules that favor the status-quo?

Re: Brave Care Has Closed

#103

Post by robertlagrant »

vasco wrote: post #11
donw wrote: post #10

Earlier quoted context omitted.

... are you joking? Healthcare is one of the most regulated industries in the United States. Want to be a doctor? You've got the aptitude, the knowledge, the mindset, and the will, but a government-guaranteed cartel of medical schools won't let you in, so too damn bad. Learn to code. Want to open a clinic? You really only need about a half-million in hardware to operate at the level of a 1980s hospital, but regulator…

How come it's cheaper in places where everyone has insurance?

> How come it's cheaper in places where everyone has insurance?

Those places don't have a hellish Frankenstein's monster combination of public and private and a load of regulations at the federal and state levels all adding up to high costs that have to be passed on to the consumer, but also weird niches of market inefficiencies that can be exploited by anyone who's managed to luck or judge their way into an advantageous position.

They also don't fund most of the world's healthcare advancements, which the US does.

They also cut off care at a certain point, whereas in the US you not only have access to most of the cutting edge treatments in the world that just aren't available on single payer systems, as they don't provide enough value, you also can find someone to pay to do it. You can bankrupt yourself on cutting edge treatments if you like.

I don't know what the answer is, other than "try again" and have a nice multi-insurer model, which I think one of the Scandies has, that just competes on efficiency and has its payouts and insurables defined by government, or maybe a single payer model. Or make healthcare a state-level problem and have each state solve it differently without federal overhead.

Re: Brave Care Has Closed

#104

Post by robertlagrant »

skissane wrote: post #35
ipaddr wrote: post #33

Earlier quoted context omitted.

Most Americans don't want equitable healthcare they want the best they can afford and they want the newest treatments available. The waiting for the patent to expire and buying in bulk keep down the costs down works. The US couldn't use the generic strategy because the drug companies get funded and create the new drugs this way. Cutting off the funding would mean no new drugs to copy so no new generics. Australia wou…

> The waiting for the patent to expire That's not what the Australian government does. Even for prescription drugs still under patent, the federal government negotiating on behalf of the whole country as a monopsony purchaser can demand (and get) much bigger discounts. (A monopoly is when a market effectively has only one seller, a monopsony is when a market effectively has only one buyer.) Whereas, in the US, each i…

> But I think that's part of a broader economic problem with Australian underspending on R&D (both public and private) which goes beyond just health.

That doesn't matter to this point. What matters is the US pays for the R&D that Australia gets to benefit from. You can stop R&D and drive down prices, as long as you're comfortable making world drug discovery grind to a halt.

Re: Brave Care Has Closed

#105

Post by robertlagrant »

thrance wrote: post #83
missedthecue wrote: post #63

Earlier quoted context omitted.

I don't think it's settled fact that the US has worse health outcomes. In fact, most data I see points to the opposite. Some people point out very lazy metrics like life expectancy while ignoring that 72% of Americans are overweight or obese according to the CDC. Rearrange healthcare/government insurance models all you want; it can't fix that.

Life expectancy is still lower in the US than in western Europe.

But engage with the point OP's making. That is despite spending far more on healthcare, so maybe the problem isn't the healthcare?

Life expectancy in general in the US could also be due to the amount of gun violence, as well. Nothing to do with the quality of healthcare.

Re: Brave Care Has Closed

#106

Post by swores »

tonyedgecombe wrote: post #91
asadotzler wrote: post #90

Earlier quoted context omitted.

There was a study comparing Kaiser Permanente with the UK's National Health Service (NHS) that found Kaiser achieved better performance at roughly the same cost. If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape. Eliminate other private health insurance and if people want above and beyond service they can negotiate directl…

>If we could use tax dollars to make Kaiser national, and scale that large without losing the efficiency and results, we'd be in darned good shape. It's hard to do that without turning it into the NHS.

As a Brit, that sounds like a positive not a negative, though I appreciate that in the US it might be a political negative.

Re: Brave Care Has Closed

#107

Post by rscho »

doctorpangloss wrote: post #99
blindriver wrote: post #66

Earlier quoted context omitted.

Dump $1 trillion into Kaiser and push it out to all 50 states. I have it in Bay Area and it’s mostly been great for me. It’s not the best but it also gets 90% of things right.

Asking doctors about Kaiser will be an eye opening experience for you.

In what way? I'm curious, because I'm a European doc, and things are gravitating towards the US model around here.

Re: Brave Care Has Closed

#108

Post by inferiorhuman »

jackcosgrove wrote: post #95

I have heard conflicting accounts of inefficiencies in the US healthcare system. One account is that the US has too many medical facilities in urban areas. In other words, there might be five hospitals each with its own radiology equipment. That equipment is idle some of the time, so you could close some of the imaging departments and leave just one or two for the metro area. That would obviously inconvenience some p…

  I'm curious what the truth is regarding the number and character
  of brick-and-mortar healthcare facilities in the US: too many?
  too few? Because it looks like this company was opening physical
  clinics.
Services are unevenly distributed and I wouldn't say there's too many providers in urban areas. Rural areas are underserved though (off the top of my head I can think of a movie and a TV series whose premise is rooted in lack of rural care).

Even within urban areas care is uneven. Hospitals are concentrated in the more wealthy parts of San Francisco and the poorer (e.g. southeastern) parts see sparse coverage. One of the big points of contention when Sutter Health bought out St Luke's hospital in SF was that Sutter wanted to transition from primary care to more profitable specialties. This would've left the neighborhood bereft of primary care.

In more rural areas you'll find that funding is a political football. As that funding wanes so does the level of care. On top of that the post-Roe v Wade environment encourages some folks to migrate towards urban areas in more "permissive" states.

In terms of too much urban coverage. When I needed an ultrasound through UCSF I had to book it out months in advance. It's not clear to me that there is a ton of duplication there — more the point if I'd looked elsewhere I would've had to figure out what was/wasn't in network with my insurance provider. Last I looked Kaiser has a grand total of eight urgent care clinics in the Bay Area. There are nine counties in the Bay Area. That's efficient from a business standpoint but leaves plenty of customers out in the cold as Kaiser covers out-of-network services in very limited circumstances. Likewise, try to find a GP that accepts insurance and is taking new patience. When I checked eons ago UCSF had a nearly year long wait.

Re: Brave Care Has Closed

#109

Post by inferiorhuman »

jmye wrote: post #45
IG_Semmelweiss wrote: post #17

Earlier quoted context omitted.

Most people outside of healthcare will have a hard time disrupting anything until they realize the goverment has tilted the rules in favor of status-quo. Healthcare insurance in the US is heavily subsidized, and no number of revolutionary care delivery models will put you on level terms with the behemoth of US govt insurance subsidies. Your only hope as a non-provider is to come in with your own a-la-carte insurance…

You will still lose on the insurance front. If you’re on the exchange, you’ll get absolutely hammered by risk-adjustment. If you’re not, you’ll never be able to sell to anyone. You’ll have to lock up huge amounts of capital, which will grow as you grow, that you can’t invest or use. It will just sit in an account in case you can’t pay claims. You’ll have to accept horrible contracts with provider systems in order to…

  Health insurance is undisruptable
Medical practices that may charge an annual fee but don't accept insurance — so-called concierge care are a thing. Not accepting insurance means you can operate with a significantly smaller support staff. Patients with a PPO style insurance plan may even have some of the expenses covered.

Re: Brave Care Has Closed

#110

Post by llamaimperative »

missedthecue wrote: post #63
llamaimperative wrote: post #61

Earlier quoted context omitted.

What on earth We get a lot more care, pay higher rates, and have worse outcomes. That last bit is why people are pissed.

I don't think it's settled fact that the US has worse health outcomes. In fact, most data I see points to the opposite. Some people point out very lazy metrics like life expectancy while ignoring that 72% of Americans are overweight or obese according to the CDC. Rearrange healthcare/government insurance models all you want; it can't fix that.

Uhhhhh obviously managing chronic disease burden is a core feature of a functional healthcare system.

One of the strongest levers we have to improve the “inputs” you’re describing is a better primary care system. America’s has been absolutely gutted over the last 20 years by interactions of various economic and regulatory dynamics including (notably) the anti-competitive vertical integration of pay-viders and pay-vider+PBMs like UnitedHealth Group.

It is absolutely not true there aren’t system-level changes we can make in healthcare and insurance to help address this.

Post reply on HN