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What Happens When a Healthcare Startup Leaves You With the Bill

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Re: What Happens When a Healthcare Startup Leaves You With the Bill

#41

Post by xienze »

bbarn wrote: post #5

I find the phrase "Don't A/B test with people's lives" to be in search of something catchy, or a zinger. The reality of big insurance has always been to be paid more than they pay out. Simple. You've always been a number to an insurance company.

> The reality of big insurance has always been to be paid more than they pay out.

Well yes, that's how a company stays solvent...

The problem with health insurance is that it's been perverted into a discount club rather than being insurance for catastrophic occurrences. It divorces consumers from the true cost of services and hence service providers are free to play with the costs all they want. Hell, you can't even really get an upfront estimate for a procedure...

Car insurance covers accidents, theft, etc. That's it. Can you imagine how much e.g., an oil change would cost if it were commonplace to use car insurance for such routine maintenance? That's what really went wrong with health insurance in the US, and we're too far down that road to fix it.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#42

Post by jjoonathan »

kjjw wrote: post #24

"So I went to my new Oscar-­approved doctor, who recommended routine blood work. The hospital called up Oscar and Oscar's operations department assured both the in-­hospital labs and administrators that this blood work would be covered by my plan so we went ahead with it." Urgh American health care is just so weird . It makes my skin crawl.

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 before we add it to the list of exceptions?

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.

http://healthcarereform.procon.org/view.resource.php?resourc...

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#43

Post by commandar »

famousactress wrote: post #30
eggbrain wrote: post #12

I had a conversation with a friend recently who was a doctor. He was telling me that he had 3 patients in a fairly short period of time that had come in with mysterious symptoms (they were all in their 70's) and that had died soon after being admitted. While he knew that he had technically done everything by the book to treat them, he worried that he had made a mistake along the way that possibly could have been the…

Absolutely. I've been in healthcare for a bunch of years (I dunno, sheesh, I guess like 14?). For a big stint of that I built systems that aim to prevent medication errors in hospitals by telling clinicians when doses were due, etc. I know of at least two incidents where code that I wrote failed in a way that (due to some edge-case concurrency in one case, and daylight savings time in another case) didn't make it cle…

Also in the industry, but on the HL7 interface side.

I think you've hit the nail on the head. I've seen studies that suggest, for example, a 75-90% reduction in med error rates in hospitals that have gone to computerized barcode systems. So there's a tremendous amount of good to be done in the field.

But, as you point out, the potential damage that can be done by mistakes makes for a fair bit of anxiety at times. Fortunately, it's been my experience that people in the field tend to take testing very seriously as a result.

Another interesting thing on that aspect - I'm one of the only people in my department that doesn't have a prior clinical background. I almost wonder if the fact that they're less trusting of the technology at times is a good thing to some extent.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#44

Post by Shivetya »

cryoshon wrote: post #38
kjjw wrote: post #24

"So I went to my new Oscar-­approved doctor, who recommended routine blood work. The hospital called up Oscar and Oscar's operations department assured both the in-­hospital labs and administrators that this blood work would be covered by my plan so we went ahead with it." Urgh American health care is just so weird . It makes my skin crawl.

If by weird you mean terrible and dehumanizing, you're entirely right. It's designed to rape the most money away from sick people while providing them just enough care to keep them alive and needing more care, and thus spending more money. It's also designed to be extremely expensive even for those who are healthy by artificially inflating the costs of routine stay-well procedures and testing on top of the ridiculous…

the design is handed down by government mostly, because of the bewildering number of laws, regulations, and such, that have wrecked havoc in health care for years. Then to top off whatever mess the Federal government makes each state just has to be enough different that what you bought in one state might not be exactly the same in other; used to be (and might still be) that you could not shop across state lines because of government.

Then once you pass that insurance hurdle that regulation/regulators/insurance companies put up its off to the races with the doctors and facilities who may both not be covered by policies again because of the weird way regulations and such work. What can and cannot be performed by who and where it can and cannot be performed.

The the kicker, using low payouts of medicare and such because the government knows the insurance companies and hospitals will make it up on people who can pay thereby redirecting the ire

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#45

Post by commandar »

flatline wrote: post #22
shepardrtc wrote: post #11

This seems similar to third-party warranty companies. They offer full coverage for low amounts, but when the time comes for them to pay up, they're impossible to deal with. Can't reach them on the phone, they need things to be faxed(!) over, and then because of so-and-so reason, it won't be covered. Healthcare shouldn't be handled by startups. Its too expensive and there's too much riding on it for something that cou…

I've talked to a couple health-care startups on the East Coast that have started by tackling one small aspect of healthcare and built off of that. Prescription drug tracking. OR procedures and checklists. There are tons of companies in the medical startup space that are doing good work, there are tons of areas that traditional big tech companies have failed to innovate in that are ripe for being upset. Playing fast a…

>I've talked to a couple health-care startups on the East Coast that have started by tackling one small aspect of healthcare and built off of that. Prescription drug tracking. OR procedures and checklists. There are tons of companies in the medical startup space that are doing good work, there are tons of areas that traditional big tech companies have failed to innovate in that are ripe for being upset.

While this is true, one of the problems currently being faced by the industry right now is that all of these niche vendors have their own ideas about how data should be handled, and it's resulted in a fair amount of balkanization of the healthcare IT industry.

It's getting better, and HITECH and the ACA are finally pushing toward real standardization and data interchange, but from where I'm sitting (working in healthcare integration), it's probably going to take us another decade to sort out the mess things are in today.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#46

Post by famousactress »

commandar wrote: post #43
famousactress wrote: post #30

Earlier quoted context omitted.

Absolutely. I've been in healthcare for a bunch of years (I dunno, sheesh, I guess like 14?). For a big stint of that I built systems that aim to prevent medication errors in hospitals by telling clinicians when doses were due, etc. I know of at least two incidents where code that I wrote failed in a way that (due to some edge-case concurrency in one case, and daylight savings time in another case) didn't make it cle…

Also in the industry, but on the HL7 interface side. I think you've hit the nail on the head. I've seen studies that suggest, for example, a 75-90% reduction in med error rates in hospitals that have gone to computerized barcode systems. So there's a tremendous amount of good to be done in the field. But, as you point out, the potential damage that can be done by mistakes makes for a fair bit of anxiety at times. For…

>I'm one of the only people in my department that doesn't have a prior clinical background. I almost wonder if the fact that they're less trusting of the technology at times is a good thing to some extent.

I totally agree. Over time I've come to really value working with teams made up of a variety of backgrounds. I think it's incredibly valuable to not end up in group-think on either end of the spectrum when it comes to how to approach problems, assessing risk, and healthy cynicism about technology.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#47

Post by wernercd »

jjoonathan wrote: post #42
kjjw wrote: post #24

"So I went to my new Oscar-­approved doctor, who recommended routine blood work. The hospital called up Oscar and Oscar's operations department assured both the in-­hospital labs and administrators that this blood work would be covered by my plan so we went ahead with it." Urgh American health care is just so weird . It makes my skin crawl.

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…

"it's even less efficient that its government-run counterparts" Because the VA System is so lean, mean and well run. All health care should be modeled after the gubberment Rolls eyes

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#48

Post by brandnewlow »

jackgavigan wrote: post #32

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. Sometimes that works out but I believe that a new entrants chances of success are a lot higher if they have somebody on board who is actually familiar with the industry sect…

I think that's an overly generous assessment. Oscar's founders have invested incredible sums of money into the company and are very well connected. If they've not hired people who know the insurance industry, it's safe to assume it's because they chose not to. This is not a small scrappy startup. This is a company started by powerful people looking to get into an opening they saw.

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#49

Post by joshfraser »

canvia wrote: post #39
joshfraser wrote: post #23

The 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…

I always see this claim that companies have to try and maximize profits. Where does that originate? I see many companies like Costco take long term paths to sustainable growth and success without trying to wring every penny of profit out of the business. In my opinion customer satisfaction, quality products, and employee growth and retention are far more beneficial goals than short term profit taking.

The law’s basic position on corporate social responsibility famously was articulated in Dodge v. Ford Motor Co. In 1916, Henry Ford owned 58% of the stock of Ford Motor Co. The Dodge brothers owned 10%. The remainder was owned by five other individuals. Beginning in 1908, Ford Motor paid a regular annual dividend of $1.2 million. Between 1911 and 1915 Ford Motor also regularly paid huge “special dividends,” totaling over $40 million. In 1916, Henry Ford announced that the company would stop paying special dividends. Instead, the firm’s financial resources would be devoted to expanding its business. Ford also continued the company’s policy of lowering prices, while improving quality. The Dodge brothers sued, asking the court to order Ford Motor to resume paying the special dividends and to enjoin the proposed expansion of the firm’s operations. At trial, Ford testified to his belief that the company made too much money and had an obligation to benefit the public and the firm’s workers and customers.

The plaintiff Dodge brothers contended an improper altruism towards his workers and customers motivated Ford. The court agreed, strongly rebuking Ford:

"A business corporation is organized and carried on primarily for the profit of the stockholders. The powers of the directors are to be employed for that end. The discretion of directors is to be exercised in the choice of means to attain that end, and does not extend to a change in the end itself, to the reduction of profits, or to the nondistribution of profits among stockholders in order to devote them to other purposes."

http://www.professorbainbridge.com/professorbainbridgecom/20...

Re: What Happens When a Healthcare Startup Leaves You With the Bill

#50

Post by jimktrains2 »

joshfraser wrote: post #23

The 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…

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:(

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