20 ms·

YC Research: Universal Healthcare

576 points by craigcannon 10y ago

toomuchtodo 10y ago
This is fantastic news. Congrats Watsi! It has always seemed like this was the end goal; to build a proof of concept healthcare delivery platform for the third world. Very exciting! EDIT: Sidenote: Thanks YC for funding Watsi as your first non-profit and attempting to tackle a hard social problem.
benologist 10y ago
I read the other day that here in Costa Rica the health care 'caja' has 1 employee per 85 people, it's more like working there is the plan. I can't wait to see what Watsi does next.
judah 10y ago
Love the ambition. Bring some transparency, reduce fraud, use technology to reduce cost where possible. Great idea, hope it works. I'm skeptical it could reduce healthcare costs significantly simply because of the massive effort required to change the healthcare behemoth in even small ways. However, given the exorbitant costs of healthcare (currently paying $1800/month for a family of 4), it's worth certainly trying. Is there a time frame on this experiment?
dpflan 10y ago
Cool and interesting. I'm not very familiar with Watsi, but is its innovation mainly in business processes for healthcare non-profits - mainly improving information and resources flows?
- toomuchtodo 10y ago
  https://watsi.org/about https://watsi.org/about They accept donations to fund healthcare for people in the third world, while being radically transparent (there is a Google Docs link out there with the details for every procedure they've funded). They're also exceedingly good at weeding out fraud, and are transparent about that as well (when fraud has occurred, the resolution, and how they fix the problem moving forward). They are, quite frankly, how you would build a single payer healthcare system as a startup.
  - dpflan 10y ago
    Thanks for the information! Your concluding sentence is really interesting.
tabeth 10y ago
Great news. Once it gets going I'd be interested in seeing the strategy to make it sustainable. I believe donation models are inherently unsustainable so it'll be a challenge.
dkonofalski 10y ago
I wonder what the long-term on this is going to look like. It would seem to me like an amazing irony if the receiving nation ended up with better and cheaper healthcare than the US considering that YC and Watsi call the US home.
- maxerickson 10y ago
  I imagine they will discover that many efficiencies correlate with individuals as much as with processes and then run out of funding.
koolba 10y ago
> For the initial project, Watsi will fund primary healthcare for a community in the developing world and build a platform to run the system transparently. Have they decided what country (or countries) in which this will take place? While I'm sure there are many worthy candidates worldwide, applying the same type of program to under served communities within the USA would be great as well.
whb07 10y ago
Unless you remove people out of the equation, universal healthcare will never work. There's no incentive for anyone to be efficient, more frugal, work harder, provide a better service in universal healthcare. Humans arent wired for this.
- CPLX 10y ago
  Somebody better tell all those non-humans in Western Europe about this.
  - alienjr 10y ago
    Except for Switzerland, Western (not to speak about Eastern) Europe's universal healthcare means universal high taxes, universal low quality of treatment and universal access to waiting queues.
    - thatfrenchguy 10y ago
      Been to hospitals in France and the Czech republic. They were pretty nice.
    - erispoe 10y ago
      Do you have a source for your claim of "low quality of treatment"?
    - deleted 10y ago
      [deleted]
    - ska 10y ago
      That doesn't match any of the research I've seen on the subject, and I've looked quite a bit. Granted it's a tricky thing to study. Do you have any citations from (competent, peer reviewed) journals?
    - wvenable 10y ago
      You don't have to look further than Canada to know that isn't true. My taxes are not significantly different from yours and I don't have to pay for insanely high medical insurance on top of that. Quality of treatment is fine and wait times aren't significantly different (but vary according to need). I don't know how anyone can with a straight face argue that the US healthcare system is efficient with regards to money, time, or outcome compared to most single payer systems.
dominotw 10y ago
Why can't we import more doctors like UK and other countries in EU. Isn't that a low hanging fruit?
- nickff 10y ago
  Because scarcity raises doctor salaries, and healthcare professionals are very good at organizing and negotiating. HN always gets riled about how H1B visas may lower wages, but doctors actively prevent foreigners from being allowed to practice medicine in their jurisdiction.
  - chimeracoder 10y ago
    > healthcare professionals are very good at organizing and negotiating Hardly - if that were the case, we wouldn't see so many private practices (and even hospitals) going straight out of business. > but doctors actively prevent foreigners from being allowed to practice medicine in their jurisdiction. This isn't really true either - it's true that there are restrictions around practicing (e.g.) in the US without completing a residency here. But contrary to popular belief, that restriction isn't within the control of physicians or any representative body of physicians. And physicians are generally rather apathetic about the topic - they don't like the idea any more than HN likes the idea of foreign developers working in the US, but physicians themselves aren't inclined to take much action on the topic.
    - nickff 10y ago
      Doctors without borders disagrees with your assessment in the USA.[1] [1] https://www.theatlantic.com/health/archive/2014/11/doctors-with-borders-how-the-us-shuts-out-foreign-physicians/382723/ https://www.theatlantic.com/health/archive/2014/11/doctors-w...
      - chimeracoder 10y ago
        > Doctors without borders disagrees with your assessment in the USA. Not really - I didn't say that the barriers don't exist. I said that doctors aren't the ones responsible for them. Requiring one year of residency in the US is not an unreasonable requirement, for a number of reasons. But the bottleneck in the number of residency slots is the funding for them (which is subsidized by Medicare), and doctors aren't even responsible for this requirement anyway. The AMA, by the way, is not a representative body of doctors - only 25% of doctors actually belong to the AMA.
xyzzy4 10y ago
Healthcare isn't truly 'universal' until it is also applied to non-humans.
- Kevin_S 10y ago
  Uh.... can we go over what you mean here?
  - striking 10y ago
    Perhaps the parent poster meant aliens. As a play on words from "Universal". Or maybe parent poster is a member of PETA. In any case I think it was intended as a joke.
  - xyzzy4 10y ago
    Animals
    - deleted 10y ago
      [deleted]
    - InitialLastName 10y ago
      Next time a non-human asks me where it can find a doctor, I'll take it to the vet myself.
      - xyzzy4 10y ago
        Do infants ask?
        InitialLastName 10y ago
        Infants usually have individuals called "guardians" who we accept as responsible for their healthcare. The ones that don't probably have bigger problems than access to healthcare.
    - Apocryphon 10y ago
TuringNYC 10y ago
(Full-time co-founder of a healthcare startup here): W/r/t the US specifically: it seems there is no shortage of inefficiencies and obvious solutions to the inefficiencies in the US healthcare system. To me, the real problem seems to be a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution. Specifically-- patients, payers, physicians, pharma, facilities and insurers almost all have indirect but competing interests much like the Dining Philosopher's problem we're familiar with in Computer Science. I'm not sure what the solution is short of a total swamp draining, but our startup went overseas to develop/trial our product in a country with a single payer system. Not perfect, but much more amenable to finding efficiencies.
- maxerickson 10y ago
  I bet making structural changes so that cost of care is more visible to patients would help a lot in the US. Of course this means disincentivizing health care as a benefit rather than incentivizing it, so it will never happen. It is kind of happening with things like HSAs, but not really. We should also work on removing arbitrary barriers to entering the supply side of the market. Not just for individuals that want to be a doctor or other sort of provider, but certificates of need and such too. Currently, lots of states dictate who can operate a CT scanner.
  - TuringNYC 10y ago
    I agree, opacity is a big part of the problem. I'm super-excited about Castlight Health (http://www.castlighthealth.com/ http://www.castlighthealth.com/) and how they approach the problem (by presenting cost/value scatters and other ways)...but...how obscene is it that we as a country should even need such a service!?
    - huangwei_chang 10y ago
      Good point. I am a bit sad that Castlight seems to be struggling and the stock price is pretty low. I thought it had a good mission and solution.
    - 10y ago
tyre 10y ago
We sell to governments, which is similar to healthcare. I cannot stress this enough: technology is not the hard part. Do they have outdated software? Yes. Can you build better software? Yes. None of that matters if you can't get it into their hands. Procurement is the hard part. Can you empathize with the needs, fears, desires, quirks, and crazy of ten different stakeholders? Pry proprietary API specs from the cold-dead hands of one-off contractors? Educate users who's technological proficiency peaked at SMS to manage a full-featured SaaS product in 2017? Don't focus on the software. That isn't the hard part. People are the hard part. People are always the hard part.
- ones_and_zeros 10y ago
  I think the point of this project is to replace the people, not necessarily to make software for people to use. Software is just means to an end.
  - nightski 10y ago
    If that is true, how is a pilot project in the developing world going to help at all in that sense? It doesn't seem like it is particularly relevant to the goal of reducing bureaucracy in the United States. Or do they really believe making a software platform is the missing piece here?
    - dagss 10y ago
      Nothing in the OP mentions US at all. It explicitly says "governments" in plural.
    - dsjoerg 10y ago
      I didn't see anything in OP about the goal being to reduce bureaucracy in the United States. Everything in OP seems explicitly global.
  - toomuchtodo 10y ago
    > I think the point of this project is to replace the people No. Not at all. The point of this project is to create trust; trust that healthcare consumers can get the services they need, and trust that government will spend healthcare dollars judiciously.
X86BSD 10y ago
I love this, its like Kiva but for third world healthcare procedures, just fantastic. They need to make browsing for potential patients easier. After 22 pages of "View more patients" my browser starts to bog down. A search would be good. As well as a map to select a country to view those in need. IMO. But really great startup!
esfandia 10y ago
Healthcare definitely seems like the land of process inefficiency, even in developed countries like here in Canada, so there's plenty of opportunity for major improvement. There's still plenty of paperwork done on... paper, information that constantly has to be repeated when you go from one provider to another, and plenty of mistakes made. Some time ago Ontario spent a massive amount of money on computerizing healthcare and it yielded nothing. I figure all the regulations, privacy issues, and overall complexity of the system makes it a tough Goliath to handle. And whatever happened to Google Health? I feel that the solution has to come from the grassroots: get a bunch of health care providers to sync up for certain simple services, and go from there. Keep adding features little by little, keep expanding the number of participants. Do it using published and open source APIs and software. Don't try to be everything to everyone. Break a few rules, ignore some complicated standards if it can help get you there quicker. Hmmm, maybe for the latter to be possible it makes sense to start in less sue-happy countries.
- soperj 10y ago
  What are you basing the yielded nothing on? Canada is well on it's way to Electronic Health Records.
  - esfandia 10y ago
    It was a big time scandal in around 2009: http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-waste-auditor-1.808640 http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-w... Things may have changed since.
    - soperj 10y ago
      There was a scandal only in Ontario, doesn't mean that good work hasn't been done in that province, or other provinces.
  - markroseman 10y ago
    Not so much. There are pockets, with poor interoperability between them. Multiply this by the different health systems (one per province, plus assorted others) and it's still a mess unfortunately.
egonschiele 10y ago
I love this idea, and this seems like the right way to do it. Operational inefficiencies are a huge burden and it would be great to find a solution for it. I really like the idea of starting this in a small community and scaling up.
mikekij 10y ago
Founder of healthcare startup here too: This sounds like a great project. I love the idea of building technology for healthcare in a small, controlled, active care environment, and then scaling those tools to a larger audience. The bigger issue in healthcare IMHO is that the American healthcare model, while hugely inefficient, seems to be the system that best incentivizes innovation. We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. If we move to a single-payer system in the US, the economic incentives for innovation go way down. If someone can figure out how to lower costs, while still providing a profitable market in which drug and device companies can innovate, we'll all benefit.
- dflock 10y ago
  There are 9.5 million people in Sweden and 320 million in the US - the huge market size in the US would still be a big incentive, whatever else you did.
  - mikekij 10y ago
    Not if your margins are negative.
    - lkbm 10y ago
      Negative margins are a result of starting_cost/n + unit_costn > unit_pricen. If unit_cost > unit_price, then increasing n hurts, but in cases where unit_cost > unit_price, increasing n moves your margins to the positive, unless marginal costs increase--which is admittedly sometimes the case, but in many cases they go down.
- dikdik 10y ago
  > We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. Lies, lies, lies, and more lies. This is always quoted, especially in the context of pharma. It's wrong. Americans pay for advertising (which is illegal in most first world countries) and for the yachts and islands of the big healthcare execs. I work at the intersection of biotech and healthcare. Currently working on a healthcare product that will be rolled out in the EU before the US and will be profitable from day 1 without being "subsidized" by Americans.
jankotek 10y ago
In Central Europe triple bypass hearth surgery costs ~ $6000. Until you fix the cost, there is no help.
jclos 10y ago
Pardon my cynicism, but I don't like the idea of choosing a patient you're going to "spend your money on" as a replacement for a basic universal healthcare. Healthcare shouldn't be a popularity contest. As an addition to a normal "basic" healthcare it's fine, but please don't replace existing systems with this stuff.
- jrowley 10y ago
  I urge you to read the announcement. Watsi is going into a different space than before - integrated healthcare (including preventive action) as opposed to their traditional funding a single patient model.
  - jclos 10y ago
    You're right, I got the bad habit of skipping blog posts and going directly to the main website when the announcement was the actual news.
bawana 10y ago
hospitals are BIG business. They will never let their inefficiencies be addressed by an external force. They do not even share their price lists. Can you imagine going going into best buy and not knowing what anything costs? But having to get the price by researching it on the net?
deleted 10y ago
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joshuaheard 10y ago
I think the problem with our health care system is economic and political, not technological; unless you are talking about some new revolutionary technology like this: https://www.sciencedaily.com/releases/2017/02/170207092724.htm https://www.sciencedaily.com/releases/2017/02/170207092724.h...
EGreg 10y ago
I have argued in favor of Single Payer systems on the basis of https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony . When buyers don't compete on price, then the price goes down. This is also known as "collective bargaining power". You can see this borne out in the fact every developed country with a universal healthcare plan gets cheaper prices, often for the same or better outcomes than the USA. Including number of doctors per capita, which disproves the "shortages" myth. Domestically in the USA, Medicare squeezes doctors far more than other insurance companies. A "medicare for all" would do even better. After the libertarians and anarcho-capitalists try to claim superior economic knowledge eventually they must admit simple supply and demand drives prices down in a single payer system. But then I get the following objection: what about all the R&D that we do? Perhaps all that expensive health care in the USA results in better procedures and medical equipment, better trained doctors etc. ? To this I say ... OPEN SOURCE DRUGS! http://magarshak.com/blog/?p=93 http://magarshak.com/blog/?p=93 If you can introduce a patentleft movement in drugs the same as you have done in software, then innovations can come from anywhere. And failing that, we can always do this compensation model: https://qbix.com/blog/index.php/2016/11/properly-valuing-contributions/ https://qbix.com/blog/index.php/2016/11/properly-valuing-con...
kumarski 10y ago
I'm a patient with an auto-immune disorder. I'm going to share some of my lessons/surprising things I learned in healthcare/drug discovery. I did YC fellowship with a healthcare startup in the clinical trials space. I am one of Watsi's biggest fans(zero hedge) and excited to see them go after this. Here's some hard things I learned over 8 months entrenched in industry, meeting everyone from Hospital execs to drug development experts. * The top of the funnel is screwed by food environments in the USA. Completely preventable metabolic syndrome accounts for a large percentage of clinical trials research. * One of the unfortunate realities in the USA is that a lot of our advanced drug research is financed by metabolic syndrome related drugs. There's 8K clinical trials a year and a non-trivial percentage are from metabolic syndrome related problems. * We have a patent system that encourages developing drugs that interact with a small number of enzymes and molecules that we already know and understand how they operate. Low, if not zero risk. * The rules around patenting pathways, treatment methodologies, research tools, and assays are flawed/seem poorly designed. As an outsider looking in, these things seem like a paralyzing bottleneck for the industry. These need to be looked at much closer. * GPO Squeezing. The manner in which GPOs squeeze medical device companies to create an artificial monopoly and drive prices up has to be examined in a much closer way. * Ground game & Synthetic chemistry- The reason startups in the pharma space get acquired based on my dicussions with R&D folks at multiple Fortune 500 pharma companies is two fold. 1/ The drug companies have enough sales reps to push product fast. There's massive room for some sort of disruption here to allow small scale medical device and pharma startups to push product. 2/ This one's tough, but the large pharma companies have enough money to do all the synthetic chemistry to go from lab to scale. That's changing though. What used to be a $400M requirement has shifted to a $100M requirement, but we'll see how this evolves. It's a lot different from software. The know-how is extremely well hidden behind private walls. * Aggregated healthcare and genomic data has little value. There's 68,000 genetic marker tests on the market and 8-10 new ones come out each day. Knowing what they do and/or how they create proteins that block/assist efforts is a monstrously tough problem that isn't waiting for computation, but is waiting for actual experiments on humans. * The mathematical complexity of drug discovery is hard. Even if the data is maximized, the throughput of discovery is low. We have 7Bn people, 15K diseases, and 3Bn genetic base pairs. Bonferonni Corrections and Family wise error rate abound. We're not waiting for super computers or for an ease of aggregating data. * The tricky part of selling to hospitals is that you have to create ROI within 6 months. If anyone here is building a healthcare venture or drug discovery venture and believes I can help, don't hesitate to reach out. Godspeed.
yummyfajitas 10y ago
Interestingly, we already discovered a mechanism for drastically reducing the cost of healthcare back in 1986. It's a way of crowdsourcing the problem called high copays. Basically, you have to pay out of pocket for 90% of your health care up to a (high) cap. It turns out that patients are very good at figuring out which health care will improve health and which won't - the high copay group had no statistically significant difference in health from the low copay group, and spent about 30% less money. What a crazy magic bullet, huh? http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html We ran a directionally similar experiment in 2008, and got much the same result: low copayment causes people to consume a lot more medicine, but with no objectively measurable improvement in health. (Subjectively, people with insurance feel healthier even if they never go to the doctor.) https://www.nber.org/oregon/ https://www.nber.org/oregon/ In both cases we ignored the result because we don't like it.
- anigbrowl 10y ago
  A one-sided presentation of the conclusions. From the RAND study: Cost sharing in general had no adverse effects on participant health, but there were exceptions: free care led to improvements in hypertension, dental health, vision, and selected serious symptoms. These improvements were concentrated among the sickest and poorest patients. Personally speaking, I'm very much in favor of concentrating benefits among the sickest and poorest patients so as to minimize avoidable suffering. The pursuit of economic equilibrium on healthcare is a chimera because the conditions for perfect competition do not apply; patients cannot choose when to be sick, and thus lack the discretion on when they enter or exit the market; nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury you won't get a timeout to make choices about which emergency room offers the best bang for the buck. Like any sane person I want to minimize the overall cost of healthcare, but I also want to minimize avoidable suffering. I would much rather pay a bit more in tax and have a system that was somewhat less fiscally efficient but more accessible to those in the greatest need. This isn't just a matter of altruism or anxiety about high healthcare costs; if you have a maximally efficient healthcare delivery system then it's likely to fail in the event of a black swan public health crisis because all the gains from efficiency have already been booked for profit.
temp-dude-87844 10y ago
I applaud this initiative of collecting more data on this, by starting a small trial in an area with fewer confounding factors, and later applying those lessons learned in places with more interconnected systems in place. One unfortunate fact is that a small proportion of people 'consume' most of the medical care. Operational inefficiencies, the concept of health insurance, a byzantine cost structure, and in the US, after-the-fact billing conceal -- or at least spread out over time -- some of the financial pain of care. This is a sort of societal compromise to avoid confronting the problem: a society either shoulders (i.e. subsidizes) the cost of care for its most unhealthy, or lets them perish outright. Today, most civilized societies tiptoe around this subject by subsidizing medical care for the elderly for political expediency, where the marginal benefits (even for the particular individual) of life extension until funds finally run out quickly diminish, while leaving folks of prime working age bear a large portion of their own costs in case of misfortune, to say nothing of underserved minorities and the economic poor. Perhaps the best value of conducting this trial in a developing country isn't solely to get away from the political machinery of a mature healthcare system, but to escape the political baggage of a post-industrial society and see if technological solutions can work if morals and politics aren't in the way.
- monk_e_boy 10y ago
  > civilized societies tiptoe around this subject > by subsidizing medical care for the elderly for > political expediency It is the same with car insurance. The elderly are almost as bad as drunk drivers for accidents.
mkaziz 10y ago
I really wish Congressmen didn't have federal healthcare, and they had to use the same insurance us plebeians use. That would help them fix up the system real fast.
- dragonwriter 10y ago
  > I really wish Congressmen didn't have federal healthcare, and they had to use the same insurance us plebeians use. They do; through 2014, like other federal employees (and most employees of large businesses) they had a choice of the private plans contracted by their employer. Since 2015, they've been limited to ACA exchange plans. http://www.factcheck.org/2009/08/health-care-for-members-of-congress/ http://www.factcheck.org/2009/08/health-care-for-members-of-...
  - deleted 10y ago
    [deleted]
  - mkaziz 10y ago
    Ah I didn't know that. Super cool, thanks for sharing
alexmingoia 10y ago
What does this have to do with universal healthcare? We know how to make healthcare more efficient. We know how to remove the administrative overhead. Other countries already have these systems in place. Look at Taiwan for one example. They have digital medical records and an extremely low administrative overhead because of universal care. Healthcare will continue to be broken no matter how many YC research programs there are - because the US population lacks the desire and political will for universal healthcare.
- rocky1138 10y ago
  > because the US population lacks the desire and political will for universal healthcare. Nailed it.
- TillE 10y ago
  If you look at polls that go issue by issue, you inevitably come to the conclusion that the "US population" at large (55-60%) would support a broad agenda of social democracy. The problem isn't the people, it's the politicians. Specifically the Democrats, who refuse to push for anything but the weakest, most ineffective compromise policies.
  - pharrlax 10y ago
    >If you look at polls that go issue by issue, you inevitably come to the conclusion that the "US population" at large (55-60%) would support a broad agenda of social democracy . . . the Democrats, who refuse to push for anything but the weakest, most ineffective compromise policies. Might these two things be linked, though? If a specific policy is not often seriously proposed, it will be more rarely attacked, and therefore not tainted by the political back-and-forth that colors proposed legislation that has a more serious chance at becoming law.
  - Al-Khwarizmi 10y ago
    Then why did people vote for Hillary Clinton and not Bernie Sanders in the primaries? Honest question from a non-American (in the social democrat Europe, Sanders seemed like the no-brainer option to like 99% of the people I know...).
pebblexe 10y ago
GNU health is a good starting place
intrasight 10y ago
>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.
- dragonwriter 10y ago
  > Reduce spending by 40% would reduce US GDP by almost 10%. No, it wouldn't, because most of that would go straight back to labor and result primarily in increased consumer spending, and secondarily in increased consumer investment (which leads to increased business spending.) It's not like the money not being spent on healthcare inefficiencies is going to just vanish out of the system.
  - intrasight 10y ago
    I'm not sure. At what point does automation lead to a big drop in GDP?
    - dragonwriter 10y ago
      Never; except perhaps when the fact that it results in greater concentration of wealth isn't mitigated and leads to destructive, violent revolution, which cuts GDP. But that's not really analogous to eliminating health care inefficiencies.
- aleksei 10y ago
  I doubt the money not spent on inefficiencies would equate to money effectively burnt away. That 40% would probably be spent in other, more productive ways. Not to mention you're actually making a point for not giving GDP too high a value when looking at economies.
  - intrasight 10y ago
    GDP is like capitalism - a terrible measure but better than all the alternatives.
dfyzrbsvb4r5tv 10y ago
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Eliezer 10y ago
It boots nothing to subsidize that which is in restricted supply. So long as there are only 350 othodontists allowed to graduate per year, there's a corresponding limit on how many patients are allowed to have straight teeth regardless of who pays for what or what software is used. Improve the software, and the price of orthodontia must still equalize demand to the limited supply. Offer free dollar bills, and a line will form until the cost of staying in line burns more than $1. Medicine isn't costly because it's inefficient, rather it can end up inefficient because the limited supply means it must somehow end up costly. It is not possible to solve the healthcare crisis without somewhat deregulating the supply of healthcare and allowing it to increase. Until then, every subsidy just raises the price, and every efficiency improvement just creates room for more inefficiency elsewhere. You can't solve the housing problem in San Francisco by building more efficient software for selling houses. Only interventions that somehow increase the total supply of living space can cause more total people to be able to live there.
- lkbm 10y ago
  The article claims that 40% of the cost is operational inefficiencies, fraud, and ineffective care citing [0]. If all orthodontists are fully occupied and there's no demand being cut, then yes, removing those inefficiencies will just boost orthodontic pay. But it sounds like at least some of those inefficiencies involve: 1. People getting unnecessary orthodontic treatments (eliminating those cuts demand [not just quantity demanded]) 2. People getting ineffective treatments and needing a second treatment (same as 1) 3. Orthodontists being allocated in a way that lowers their overall productivity--empty time in their schedules, doing stuff they're less skilled at, etc. If my orthodontist spends less time on administrivia or repeat procedures, he can fix more people's teeth without us training a second orthodontist. Similarly, if there are apartments sitting empty for a month because it's hard to match people with apartments, better software can fit more people into San Francisco. (Going deeper, my bedroom is empty 12+ hours a day. I could totally sublet it to someone who works the night shift. I just need an efficient system to find such a person who's as interested in saving money as much as I am. Or as much as I was a few years ago. Now, I might not opt for this plan.) [0] http://www.who.int/whr/2010/10_summary_en.pdf?ua=1 http://www.who.int/whr/2010/10_summary_en.pdf?ua=1
- 10y ago
20years 10y ago
I would love to see more transparency in where the costs for dr visits is going. A recent 1/2 hour visit to my daughters doctor for a basic checkup and a couple of shots resulted in a $1500 bill to the insurance company. We paid a fraction of that but it still blows my mind that the bill was so high. I am assuming most of that was for the shots. If watsi can develop software that makes these costs more transparent maybe then we can address ways to lower them.
lumberjack 10y ago
Universal healthcare is already much more cost effective than fully or semi-privitised health care. Sorry, I forgot to pretend that all the other developed countries haven't figured out healthcare already. Geez. ---------------- Oh and btw, when you have a universal healthcare system payed by taxes (none of that bullshit insurance crap that only ends up being costly regulation/financial bloat) you can have entire and fully private hospitals and health clinics where you can get service for cash, and surprise, surprise, it's ridiculously cheap because it has to compete with the effectively free public healthcare system.
- ameister14 10y ago
  >Universal healthcare is already much more cost effective than fully or semi-privitised health care. That's not true. Most developed countries have some form of privatized system, falling into your 'semi-privatized' definition. It's more cost-effective.
  - TheSmiddy 10y ago
    In Australia we have a universal healthcare system for everybody and a private system that runs alongside that essentially gets you a more comfortable bed and the ability to jump the queue for non-critical surgery.
    - ameister14 10y ago
      Exactly what I'm talking about
    - dguaraglia 10y ago
      Even an economic nightmare like Argentina manages to run on the same idea (I grew up there.) The level of complexity and inane amount of paperwork you have to do in the US to get the simplest care is still baffling to me. I get it that it's the inefficiencies that make this system profitable to some, and that's why you might get the "best doctors in the world", but it could definitely use some modernization.
Kluny 10y ago
I was thinking about this lately. Can universal health care be solved by the free market, if the free market decides to enforce checks and balances on itself? That is to say, could someone start a not-for-profit health insurance company that offers excellent coverage for affordable rates, and build it from the ground up with a culture of clarity and transparency? At a bare minimum they should have a searchable database where you can type in "broken arm" and find out what price this company has negotiated for casts, x-rays, and doctor time, and what it will cost you in co-pay. It seems like insurance companies are so universally bad and corrupt that there would be no trouble signing up a critical mass of users by simply being a little better than the norm, and once it's the biggest insurance provider in the US, start applying muscle to hospital administration. Yes, I know I'm oversimplifying it. Can anyone think of a way that it might be possible, though?
- drewrv 10y ago
  I see two problems, one is that consumers don't buy health insurance, their employers do. So the insurance company that is willing to deny legitimate claims and kick sick people off its rolls in order to lower its costs will win. The bigger issue is that insurance is the wrong business model. Insurance is supposed to protect against a catastrophic risk, like a car crash or an earthquake, but we use health insurance in this country to cover routine and ongoing care. Whether there even is a "business model" to treat people is debatable. Sick people as a group tend to earn less than the healthy.
- sean_appleby 10y ago
  I'm not at all an expert, but from my limited perspective this looks like a problem that blockchain could potentially help with in the future. It seems like someone could implement an open source system of smart contracts that automatically pay out healthcare costs and distribute expenses in a transparent and agreed upon way. The organization could have an extremely decreased overhead compared to a physical company because it would need almost no staff or infrastructure, and if everyone can see the source for how money moves as well as the distributed ledger for how spending works it would be highly corruption resistant while still allowing for security of doctor-patient confidentiality due to the encrypted nature of blockchain. Of course it would by default being extremely susceptible to external abuse, would have a ton of complexities in interfacing with the healthcare system, and wouldn't be viable until/unless blockchain and related tech matures and gains mass market acceptance. I could be totally wrong about the approach, but I'm really hopeful for the tech world to be able to make a dent in this mess. Hopefully some people with more experience have better ideas.
a3n 10y ago
> Once the platform is in place, Watsi will start to experiment with improving the quality of care and reducing the cost – e.g., by streamlining operations, minimizing waste and fraud, and identifying medical errors in real-time. That sounds like any politician ever, campaigning for office by promising to do the above, for government in general, the Defense or Energy or Education department, etc. Good luck, and I sincerely hope it works. This time.
abalone 10y ago
> Watsi’s goal is to improve the efficiency of funding, making universal healthcare possible. Universal healthcare is already possible.[1] Reducing waste is a noble goal but this is a startling sentence from a health tech startup team. It implies that the primary obstacle to universal care is cost, not political will, which fails to comprehend how universal care was achieved in most of the industrialized world. [1] https://en.m.wikipedia.org/wiki/List_of_countries_with_universal_health_care https://en.m.wikipedia.org/wiki/List_of_countries_with_unive...
Jyefet 10y ago
Invest in value-based healthcare - it's the future (in like 15-20 years, that is)
KeepTalking 10y ago
How much of the problem is actually the way (big) pharma conducts research? ( I know that I am over simplifying and dozens of startups are focused on improving the way research is done) From a manf process standpoint, there are cheaper ways to create these compounds. Generic drug manufacturers have proved that ignoring the cost of research, the drug itself costs next to nothing to make, market and sell. From an economics standpoint, healthcare costs are a significant part of GDP. In an ideal model if all research is funded directly via government grants and the key research is licensed through a free licensing - It should create a very competitive drug cost model.For a healthcare practice standpoint, legislation can really help. Stripping down some of the malpractice laws are a good starting point. Additionally, the monopoly on medical education should be broken - Making medical education a national priority is a key step. We also need to make sure, that doctors are not the only healthcare providers. Enabling entrepreneurship among non doctor(nurses, mid wives etc) medical practioners can increase the market supply. These 2 actions in theory should create more doctors and reduce the cost of practicing medicine.
- temp-dude-87844 10y ago
  Research is expensive because it is conducted by well-paying professionals over multiple years, then taken to several rounds drug trials, which come with risks of serious side effects. Negative outcomes resulting from drug trials -- as well as approved drugs -- are routinely litigated by the aggrieved parties, which result in expensive settlements or the risk of high damages (in some cases, punitive). Further, to promote public interest, patent protections on medication in most countries usually expire after 20 years, which limits the window of time in which the makers can recoup the cost. 'Tort reform' proposes (among others) to reduce the monetary risks associated with drug trials by limiting lawsuit payouts of limiting grounds to sue -- to its promoters, this benefits society at large (and the drug companies) while hurting a few individuals who happen to have found themselves embroiled in such a case. To its opponents, tort reform is an instrument to dismantle regulatory protections and results in little to no societal benefit, perversely incentivizing drugmakers to both a higher absolute quantity of drugs to drive overall revenues, while reducing the average quality of drugs to be less safe, and leave seriously injured people with no viable recourse. It's a complex problem with no easy answers.
rsync 10y ago
If you went back in time - say, 20 or 25 years ago - and you picked up a progressive, left leaning magazine - say, adbusters or mother jones - you would very regularly read warnings about the manufactured needs of medicine and healthcare and pharmaceuticals. Barely an issue of such a periodical could pass without dire warnings of a future in which big pharma and insurance interests would convince us, through advertising, that we were foremost consumers of "healthcare". What happened ? The progressive left is now fully, fervently convinced that "healthcare" is a basic priority of human life. It is a rampant consumerism that reaches far beyond - and profoundly deeper - than the fears that good people have always had. It didn't have to be this way.
- certifiedloud 10y ago
  I'd be interested to see a source on this, if you have one at hand.
- hackuser 10y ago
  Healthcare has long been seen as a basic right in many places and even the Republican Party in the U.S. now supports health insurance for everyone. The parent seems to conflate healthcare with pharmaceuticals and other specific forms of healthcare. IIRC, the warnings were that big pharma was pushing pills on people, something that has some evidence behind it. As an analogy, I think an effective military also is essential, but that doesn't mean I don't think big military contractors don't push needless or dangerous products on the public.
Animats 10y ago
"For the initial project, Watsi will fund primary healthcare for a community in the developing world and build a platform to run the system transparently." Start with Tuskegee, Alabama, poorest town in the United States.
WalterBright 10y ago
> up to 40% of all healthcare funding is wasted on operational inefficiencies, fraud, and ineffective care. Any system where the consumers, the providers, and the payers are not accountable to each other is never going to operate efficiently.
buyx 10y ago
The article doesn't mention which developing country the trial will be in, but South Africa would make an interesting candidate. It has a public healthcare system that's in shocking condition, and a world-class private healthcare system, funded by health insurance, that's becoming more unaffordable (despite being funded and mandated by employers) each year because of high medical inflation. There are clear parallels to the US healthcare system, and the commodities downturn has stymied the government efforts to introduce universal healthcare, so there would be an ideological willingness to experiment.
maceo 10y ago
US spends over $8,000 per capita on healthcare, compared to about $4,000 in UK and Japan, both of which have universal health care. This isn't a problem tech can solve. It's a problem only politics can solve.
kriro 10y ago
Good choice for YC research investment. I hope they don't try to reinvent the wheel in some areas (sounds like it from the post). It would probably be a good idea to benchmark how hard it is to set up a functioning and operational GNU Health system in community X for example. There's a lot of potential for replacing nothing/no doctors with machine learning, especially in developing countries. Especially in areas where mobile phones are spread I can think of a couple of use cases. Take a picture of your swelling/strange looking skin/whatever and have a classifier tell you what it could be. Last time I checked the algorithms actually beat expert panels (for skin cancer). Could probably be coupled with a "doctor as a service" system that optimizes routes based on this sort of data. The more I think about it the more I should catapult working in this area up my job application list :)
alkonaut 10y ago
Would there be legal issues (apart from political will) with forming a publicly owned health insurance company for the general public in the US, rather than a subset like Medicare etc? It seems that if you just form a large enough public insurer it could soon start undercutting the prices of the private insures.
narrator 10y ago
The prices in the U.S system are wildly divergent from the rest of the world and enhancing international competition is a good way to remedy this. Thus, one way to implement universal health care is to allow import of any prescribed drug and the government will pay for any medical procedure + plane ticket if that cost is less than it is in the U.S. Perhaps a doctor visa would also help with costs.
- dandare 10y ago
  doctor visa is a terrible idea, a) it would undermine the salaries of US doctors, b) it would drain doctors from poor countries where they are needed more than in the US.
  - devwastaken 10y ago
    IIRC, doctors already work on visas, and I don't think you would be 'pulling' doctors from other countries, not unless you're really good, which at that point you're only staying in your home country because you want to, not because you need to.
  - narrator 10y ago
    A) Lowering doctor salaries is part of the solution to health care costs. You could do this by educating them outside the U.S so they would have much lower student debt. B) More people will enter the health care professions globally if there's a bigger market for their services.
dandare 10y ago
TIL: US healthcare is completely nuts
mtrn 10y ago
Glad to live in a country that has something close to universal health care. Everybody needs to contribute a monthly share (independent of their condition) which amounts to over 200B per year in total. This seems enough for modern infrastructure, equipment, prophylaxis, medication. That said, it's not super efficient and the incomes vary greatly between employees with strong lobby groups and laborers covered by legislation only.
fuzzfactor 10y ago
Universal Healthcare is when a society is actually "rich" or "wealthy" in terms of truly having more than enough resources to perform essential care wholesale at no cost to patients, and after that, when society chooses to prioritize the health care of all its citizens high enough to give equal care to all. This doesn't usually happen, even in societies where the consistent waste of resources exceeds the total cost of universal healthcare. Considering the resource shortage or surplus, when healing treatments are not denied to any needy members of society, that could be a fundamental marker of civilization, and an obvious measure of which societies are more advanced and which are more retarded.

576 points by craigcannon 10y ago

This is fantastic news. Congrats Watsi! It has always seemed like this was the end goal; to build a proof of concept healthcare delivery platform for the third world. Very exciting! EDIT: Sidenote: Thanks YC for funding Watsi as your first non-profit and attempting to tackle a hard social problem.

benologist 10y ago

I read the other day that here in Costa Rica the health care 'caja' has 1 employee per 85 people, it's more like working there is the plan. I can't wait to see what Watsi does next.

judah 10y ago

Love the ambition. Bring some transparency, reduce fraud, use technology to reduce cost where possible. Great idea, hope it works. I'm skeptical it could reduce healthcare costs significantly simply because of the massive effort required to change the healthcare behemoth in even small ways. However, given the exorbitant costs of healthcare (currently paying $1800/month for a family of 4), it's worth certainly trying. Is there a time frame on this experiment?

dpflan 10y ago

Cool and interesting. I'm not very familiar with Watsi, but is its innovation mainly in business processes for healthcare non-profits - mainly improving information and resources flows?

toomuchtodo 10y ago
https://watsi.org/about https://watsi.org/about They accept donations to fund healthcare for people in the third world, while being radically transparent (there is a Google Docs link out there with the details for every procedure they've funded). They're also exceedingly good at weeding out fraud, and are transparent about that as well (when fraud has occurred, the resolution, and how they fix the problem moving forward). They are, quite frankly, how you would build a single payer healthcare system as a startup.
- dpflan 10y ago
  Thanks for the information! Your concluding sentence is really interesting.

tabeth 10y ago

Great news. Once it gets going I'd be interested in seeing the strategy to make it sustainable. I believe donation models are inherently unsustainable so it'll be a challenge.

dkonofalski 10y ago

I wonder what the long-term on this is going to look like. It would seem to me like an amazing irony if the receiving nation ended up with better and cheaper healthcare than the US considering that YC and Watsi call the US home.

maxerickson 10y ago
I imagine they will discover that many efficiencies correlate with individuals as much as with processes and then run out of funding.

koolba 10y ago

> For the initial project, Watsi will fund primary healthcare for a community in the developing world and build a platform to run the system transparently. Have they decided what country (or countries) in which this will take place? While I'm sure there are many worthy candidates worldwide, applying the same type of program to under served communities within the USA would be great as well.

whb07 10y ago

Unless you remove people out of the equation, universal healthcare will never work. There's no incentive for anyone to be efficient, more frugal, work harder, provide a better service in universal healthcare. Humans arent wired for this.

CPLX 10y ago
Somebody better tell all those non-humans in Western Europe about this.
- alienjr 10y ago
  Except for Switzerland, Western (not to speak about Eastern) Europe's universal healthcare means universal high taxes, universal low quality of treatment and universal access to waiting queues.
  - thatfrenchguy 10y ago
    Been to hospitals in France and the Czech republic. They were pretty nice.
  - erispoe 10y ago
    Do you have a source for your claim of "low quality of treatment"?
  - deleted 10y ago
    [deleted]
  - ska 10y ago
    That doesn't match any of the research I've seen on the subject, and I've looked quite a bit. Granted it's a tricky thing to study. Do you have any citations from (competent, peer reviewed) journals?
  - wvenable 10y ago
    You don't have to look further than Canada to know that isn't true. My taxes are not significantly different from yours and I don't have to pay for insanely high medical insurance on top of that. Quality of treatment is fine and wait times aren't significantly different (but vary according to need). I don't know how anyone can with a straight face argue that the US healthcare system is efficient with regards to money, time, or outcome compared to most single payer systems.

dominotw 10y ago

Why can't we import more doctors like UK and other countries in EU. Isn't that a low hanging fruit?

nickff 10y ago
Because scarcity raises doctor salaries, and healthcare professionals are very good at organizing and negotiating. HN always gets riled about how H1B visas may lower wages, but doctors actively prevent foreigners from being allowed to practice medicine in their jurisdiction.
- chimeracoder 10y ago
  > healthcare professionals are very good at organizing and negotiating Hardly - if that were the case, we wouldn't see so many private practices (and even hospitals) going straight out of business. > but doctors actively prevent foreigners from being allowed to practice medicine in their jurisdiction. This isn't really true either - it's true that there are restrictions around practicing (e.g.) in the US without completing a residency here. But contrary to popular belief, that restriction isn't within the control of physicians or any representative body of physicians. And physicians are generally rather apathetic about the topic - they don't like the idea any more than HN likes the idea of foreign developers working in the US, but physicians themselves aren't inclined to take much action on the topic.
  - nickff 10y ago
    Doctors without borders disagrees with your assessment in the USA.[1] [1] https://www.theatlantic.com/health/archive/2014/11/doctors-with-borders-how-the-us-shuts-out-foreign-physicians/382723/ https://www.theatlantic.com/health/archive/2014/11/doctors-w...
    - chimeracoder 10y ago
      > Doctors without borders disagrees with your assessment in the USA. Not really - I didn't say that the barriers don't exist. I said that doctors aren't the ones responsible for them. Requiring one year of residency in the US is not an unreasonable requirement, for a number of reasons. But the bottleneck in the number of residency slots is the funding for them (which is subsidized by Medicare), and doctors aren't even responsible for this requirement anyway. The AMA, by the way, is not a representative body of doctors - only 25% of doctors actually belong to the AMA.

xyzzy4 10y ago

Healthcare isn't truly 'universal' until it is also applied to non-humans.

Kevin_S 10y ago
Uh.... can we go over what you mean here?
- striking 10y ago
  Perhaps the parent poster meant aliens. As a play on words from "Universal". Or maybe parent poster is a member of PETA. In any case I think it was intended as a joke.
- xyzzy4 10y ago
  Animals
  - deleted 10y ago
    [deleted]
  - InitialLastName 10y ago
    Next time a non-human asks me where it can find a doctor, I'll take it to the vet myself.
    - xyzzy4 10y ago
      Do infants ask?
      - InitialLastName 10y ago
        Infants usually have individuals called "guardians" who we accept as responsible for their healthcare. The ones that don't probably have bigger problems than access to healthcare.
  - Apocryphon 10y ago

TuringNYC 10y ago

(Full-time co-founder of a healthcare startup here): W/r/t the US specifically: it seems there is no shortage of inefficiencies and obvious solutions to the inefficiencies in the US healthcare system. To me, the real problem seems to be a system that has almost diabolically evolved to create competing interests that deadlock all sides into a sub-optimal solution. Specifically-- patients, payers, physicians, pharma, facilities and insurers almost all have indirect but competing interests much like the Dining Philosopher's problem we're familiar with in Computer Science. I'm not sure what the solution is short of a total swamp draining, but our startup went overseas to develop/trial our product in a country with a single payer system. Not perfect, but much more amenable to finding efficiencies.

maxerickson 10y ago
I bet making structural changes so that cost of care is more visible to patients would help a lot in the US. Of course this means disincentivizing health care as a benefit rather than incentivizing it, so it will never happen. It is kind of happening with things like HSAs, but not really. We should also work on removing arbitrary barriers to entering the supply side of the market. Not just for individuals that want to be a doctor or other sort of provider, but certificates of need and such too. Currently, lots of states dictate who can operate a CT scanner.
- TuringNYC 10y ago
  I agree, opacity is a big part of the problem. I'm super-excited about Castlight Health (http://www.castlighthealth.com/ http://www.castlighthealth.com/) and how they approach the problem (by presenting cost/value scatters and other ways)...but...how obscene is it that we as a country should even need such a service!?
  - huangwei_chang 10y ago
    Good point. I am a bit sad that Castlight seems to be struggling and the stock price is pretty low. I thought it had a good mission and solution.
  - 10y ago

tyre 10y ago

We sell to governments, which is similar to healthcare. I cannot stress this enough: technology is not the hard part. Do they have outdated software? Yes. Can you build better software? Yes. None of that matters if you can't get it into their hands. Procurement is the hard part. Can you empathize with the needs, fears, desires, quirks, and crazy of ten different stakeholders? Pry proprietary API specs from the cold-dead hands of one-off contractors? Educate users who's technological proficiency peaked at SMS to manage a full-featured SaaS product in 2017? Don't focus on the software. That isn't the hard part. People are the hard part. People are always the hard part.

ones_and_zeros 10y ago
I think the point of this project is to replace the people, not necessarily to make software for people to use. Software is just means to an end.
- nightski 10y ago
  If that is true, how is a pilot project in the developing world going to help at all in that sense? It doesn't seem like it is particularly relevant to the goal of reducing bureaucracy in the United States. Or do they really believe making a software platform is the missing piece here?
  - dagss 10y ago
    Nothing in the OP mentions US at all. It explicitly says "governments" in plural.
  - dsjoerg 10y ago
    I didn't see anything in OP about the goal being to reduce bureaucracy in the United States. Everything in OP seems explicitly global.
- toomuchtodo 10y ago
  > I think the point of this project is to replace the people No. Not at all. The point of this project is to create trust; trust that healthcare consumers can get the services they need, and trust that government will spend healthcare dollars judiciously.

X86BSD 10y ago

I love this, its like Kiva but for third world healthcare procedures, just fantastic. They need to make browsing for potential patients easier. After 22 pages of "View more patients" my browser starts to bog down. A search would be good. As well as a map to select a country to view those in need. IMO. But really great startup!

esfandia 10y ago

Healthcare definitely seems like the land of process inefficiency, even in developed countries like here in Canada, so there's plenty of opportunity for major improvement. There's still plenty of paperwork done on... paper, information that constantly has to be repeated when you go from one provider to another, and plenty of mistakes made. Some time ago Ontario spent a massive amount of money on computerizing healthcare and it yielded nothing. I figure all the regulations, privacy issues, and overall complexity of the system makes it a tough Goliath to handle. And whatever happened to Google Health? I feel that the solution has to come from the grassroots: get a bunch of health care providers to sync up for certain simple services, and go from there. Keep adding features little by little, keep expanding the number of participants. Do it using published and open source APIs and software. Don't try to be everything to everyone. Break a few rules, ignore some complicated standards if it can help get you there quicker. Hmmm, maybe for the latter to be possible it makes sense to start in less sue-happy countries.

soperj 10y ago
What are you basing the yielded nothing on? Canada is well on it's way to Electronic Health Records.
- esfandia 10y ago
  It was a big time scandal in around 2009: http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-waste-auditor-1.808640 http://www.cbc.ca/news/canada/toronto/ehealth-scandal-a-1b-w... Things may have changed since.
  - soperj 10y ago
    There was a scandal only in Ontario, doesn't mean that good work hasn't been done in that province, or other provinces.
- markroseman 10y ago
  Not so much. There are pockets, with poor interoperability between them. Multiply this by the different health systems (one per province, plus assorted others) and it's still a mess unfortunately.

egonschiele 10y ago

I love this idea, and this seems like the right way to do it. Operational inefficiencies are a huge burden and it would be great to find a solution for it. I really like the idea of starting this in a small community and scaling up.

mikekij 10y ago

Founder of healthcare startup here too: This sounds like a great project. I love the idea of building technology for healthcare in a small, controlled, active care environment, and then scaling those tools to a larger audience. The bigger issue in healthcare IMHO is that the American healthcare model, while hugely inefficient, seems to be the system that best incentivizes innovation. We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. If we move to a single-payer system in the US, the economic incentives for innovation go way down. If someone can figure out how to lower costs, while still providing a profitable market in which drug and device companies can innovate, we'll all benefit.

dflock 10y ago
There are 9.5 million people in Sweden and 320 million in the US - the huge market size in the US would still be a big incentive, whatever else you did.
- mikekij 10y ago
  Not if your margins are negative.
  - lkbm 10y ago
    Negative margins are a result of starting_cost/n + unit_costn > unit_pricen. If unit_cost > unit_price, then increasing n hurts, but in cases where unit_cost > unit_price, increasing n moves your margins to the positive, unless marginal costs increase--which is admittedly sometimes the case, but in many cases they go down.
dikdik 10y ago
> We pay 10x what Sweden pays for medical devices, but the US market is the only reason those device companies can be profitable. Lies, lies, lies, and more lies. This is always quoted, especially in the context of pharma. It's wrong. Americans pay for advertising (which is illegal in most first world countries) and for the yachts and islands of the big healthcare execs. I work at the intersection of biotech and healthcare. Currently working on a healthcare product that will be rolled out in the EU before the US and will be profitable from day 1 without being "subsidized" by Americans.

jankotek 10y ago

In Central Europe triple bypass hearth surgery costs ~ $6000. Until you fix the cost, there is no help.

jclos 10y ago

Pardon my cynicism, but I don't like the idea of choosing a patient you're going to "spend your money on" as a replacement for a basic universal healthcare. Healthcare shouldn't be a popularity contest. As an addition to a normal "basic" healthcare it's fine, but please don't replace existing systems with this stuff.

jrowley 10y ago
I urge you to read the announcement. Watsi is going into a different space than before - integrated healthcare (including preventive action) as opposed to their traditional funding a single patient model.
- jclos 10y ago
  You're right, I got the bad habit of skipping blog posts and going directly to the main website when the announcement was the actual news.

bawana 10y ago

hospitals are BIG business. They will never let their inefficiencies be addressed by an external force. They do not even share their price lists. Can you imagine going going into best buy and not knowing what anything costs? But having to get the price by researching it on the net?

deleted 10y ago

[deleted]

joshuaheard 10y ago

I think the problem with our health care system is economic and political, not technological; unless you are talking about some new revolutionary technology like this: https://www.sciencedaily.com/releases/2017/02/170207092724.htm https://www.sciencedaily.com/releases/2017/02/170207092724.h...

EGreg 10y ago

I have argued in favor of Single Payer systems on the basis of https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony . When buyers don't compete on price, then the price goes down. This is also known as "collective bargaining power". You can see this borne out in the fact every developed country with a universal healthcare plan gets cheaper prices, often for the same or better outcomes than the USA. Including number of doctors per capita, which disproves the "shortages" myth. Domestically in the USA, Medicare squeezes doctors far more than other insurance companies. A "medicare for all" would do even better. After the libertarians and anarcho-capitalists try to claim superior economic knowledge eventually they must admit simple supply and demand drives prices down in a single payer system. But then I get the following objection: what about all the R&D that we do? Perhaps all that expensive health care in the USA results in better procedures and medical equipment, better trained doctors etc. ? To this I say ... OPEN SOURCE DRUGS! http://magarshak.com/blog/?p=93 http://magarshak.com/blog/?p=93 If you can introduce a patentleft movement in drugs the same as you have done in software, then innovations can come from anywhere. And failing that, we can always do this compensation model: https://qbix.com/blog/index.php/2016/11/properly-valuing-contributions/ https://qbix.com/blog/index.php/2016/11/properly-valuing-con...

kumarski 10y ago

I'm a patient with an auto-immune disorder. I'm going to share some of my lessons/surprising things I learned in healthcare/drug discovery. I did YC fellowship with a healthcare startup in the clinical trials space. I am one of Watsi's biggest fans(zero hedge) and excited to see them go after this. Here's some hard things I learned over 8 months entrenched in industry, meeting everyone from Hospital execs to drug development experts. * The top of the funnel is screwed by food environments in the USA. Completely preventable metabolic syndrome accounts for a large percentage of clinical trials research. * One of the unfortunate realities in the USA is that a lot of our advanced drug research is financed by metabolic syndrome related drugs. There's 8K clinical trials a year and a non-trivial percentage are from metabolic syndrome related problems. * We have a patent system that encourages developing drugs that interact with a small number of enzymes and molecules that we already know and understand how they operate. Low, if not zero risk. * The rules around patenting pathways, treatment methodologies, research tools, and assays are flawed/seem poorly designed. As an outsider looking in, these things seem like a paralyzing bottleneck for the industry. These need to be looked at much closer. * GPO Squeezing. The manner in which GPOs squeeze medical device companies to create an artificial monopoly and drive prices up has to be examined in a much closer way. * Ground game & Synthetic chemistry- The reason startups in the pharma space get acquired based on my dicussions with R&D folks at multiple Fortune 500 pharma companies is two fold. 1/ The drug companies have enough sales reps to push product fast. There's massive room for some sort of disruption here to allow small scale medical device and pharma startups to push product. 2/ This one's tough, but the large pharma companies have enough money to do all the synthetic chemistry to go from lab to scale. That's changing though. What used to be a $400M requirement has shifted to a $100M requirement, but we'll see how this evolves. It's a lot different from software. The know-how is extremely well hidden behind private walls. * Aggregated healthcare and genomic data has little value. There's 68,000 genetic marker tests on the market and 8-10 new ones come out each day. Knowing what they do and/or how they create proteins that block/assist efforts is a monstrously tough problem that isn't waiting for computation, but is waiting for actual experiments on humans. * The mathematical complexity of drug discovery is hard. Even if the data is maximized, the throughput of discovery is low. We have 7Bn people, 15K diseases, and 3Bn genetic base pairs. Bonferonni Corrections and Family wise error rate abound. We're not waiting for super computers or for an ease of aggregating data. * The tricky part of selling to hospitals is that you have to create ROI within 6 months. If anyone here is building a healthcare venture or drug discovery venture and believes I can help, don't hesitate to reach out. Godspeed.

yummyfajitas 10y ago

Interestingly, we already discovered a mechanism for drastically reducing the cost of healthcare back in 1986. It's a way of crowdsourcing the problem called high copays. Basically, you have to pay out of pocket for 90% of your health care up to a (high) cap. It turns out that patients are very good at figuring out which health care will improve health and which won't - the high copay group had no statistically significant difference in health from the low copay group, and spent about 30% less money. What a crazy magic bullet, huh? http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html We ran a directionally similar experiment in 2008, and got much the same result: low copayment causes people to consume a lot more medicine, but with no objectively measurable improvement in health. (Subjectively, people with insurance feel healthier even if they never go to the doctor.) https://www.nber.org/oregon/ https://www.nber.org/oregon/ In both cases we ignored the result because we don't like it.

anigbrowl 10y ago
A one-sided presentation of the conclusions. From the RAND study: Cost sharing in general had no adverse effects on participant health, but there were exceptions: free care led to improvements in hypertension, dental health, vision, and selected serious symptoms. These improvements were concentrated among the sickest and poorest patients. Personally speaking, I'm very much in favor of concentrating benefits among the sickest and poorest patients so as to minimize avoidable suffering. The pursuit of economic equilibrium on healthcare is a chimera because the conditions for perfect competition do not apply; patients cannot choose when to be sick, and thus lack the discretion on when they enter or exit the market; nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury you won't get a timeout to make choices about which emergency room offers the best bang for the buck. Like any sane person I want to minimize the overall cost of healthcare, but I also want to minimize avoidable suffering. I would much rather pay a bit more in tax and have a system that was somewhat less fiscally efficient but more accessible to those in the greatest need. This isn't just a matter of altruism or anxiety about high healthcare costs; if you have a maximally efficient healthcare delivery system then it's likely to fail in the event of a black swan public health crisis because all the gains from efficiency have already been booked for profit.

temp-dude-87844 10y ago

I applaud this initiative of collecting more data on this, by starting a small trial in an area with fewer confounding factors, and later applying those lessons learned in places with more interconnected systems in place. One unfortunate fact is that a small proportion of people 'consume' most of the medical care. Operational inefficiencies, the concept of health insurance, a byzantine cost structure, and in the US, after-the-fact billing conceal -- or at least spread out over time -- some of the financial pain of care. This is a sort of societal compromise to avoid confronting the problem: a society either shoulders (i.e. subsidizes) the cost of care for its most unhealthy, or lets them perish outright. Today, most civilized societies tiptoe around this subject by subsidizing medical care for the elderly for political expediency, where the marginal benefits (even for the particular individual) of life extension until funds finally run out quickly diminish, while leaving folks of prime working age bear a large portion of their own costs in case of misfortune, to say nothing of underserved minorities and the economic poor. Perhaps the best value of conducting this trial in a developing country isn't solely to get away from the political machinery of a mature healthcare system, but to escape the political baggage of a post-industrial society and see if technological solutions can work if morals and politics aren't in the way.

monk_e_boy 10y ago
> civilized societies tiptoe around this subject > by subsidizing medical care for the elderly for > political expediency It is the same with car insurance. The elderly are almost as bad as drunk drivers for accidents.

mkaziz 10y ago

I really wish Congressmen didn't have federal healthcare, and they had to use the same insurance us plebeians use. That would help them fix up the system real fast.

dragonwriter 10y ago
> I really wish Congressmen didn't have federal healthcare, and they had to use the same insurance us plebeians use. They do; through 2014, like other federal employees (and most employees of large businesses) they had a choice of the private plans contracted by their employer. Since 2015, they've been limited to ACA exchange plans. http://www.factcheck.org/2009/08/health-care-for-members-of-congress/ http://www.factcheck.org/2009/08/health-care-for-members-of-...
- deleted 10y ago
  [deleted]
- mkaziz 10y ago
  Ah I didn't know that. Super cool, thanks for sharing

alexmingoia 10y ago

What does this have to do with universal healthcare? We know how to make healthcare more efficient. We know how to remove the administrative overhead. Other countries already have these systems in place. Look at Taiwan for one example. They have digital medical records and an extremely low administrative overhead because of universal care. Healthcare will continue to be broken no matter how many YC research programs there are - because the US population lacks the desire and political will for universal healthcare.

rocky1138 10y ago
> because the US population lacks the desire and political will for universal healthcare. Nailed it.
TillE 10y ago
If you look at polls that go issue by issue, you inevitably come to the conclusion that the "US population" at large (55-60%) would support a broad agenda of social democracy. The problem isn't the people, it's the politicians. Specifically the Democrats, who refuse to push for anything but the weakest, most ineffective compromise policies.
- pharrlax 10y ago
  >If you look at polls that go issue by issue, you inevitably come to the conclusion that the "US population" at large (55-60%) would support a broad agenda of social democracy . . . the Democrats, who refuse to push for anything but the weakest, most ineffective compromise policies. Might these two things be linked, though? If a specific policy is not often seriously proposed, it will be more rarely attacked, and therefore not tainted by the political back-and-forth that colors proposed legislation that has a more serious chance at becoming law.
- Al-Khwarizmi 10y ago
  Then why did people vote for Hillary Clinton and not Bernie Sanders in the primaries? Honest question from a non-American (in the social democrat Europe, Sanders seemed like the no-brainer option to like 99% of the people I know...).

pebblexe 10y ago

GNU health is a good starting place

intrasight 10y ago

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

dragonwriter 10y ago
> Reduce spending by 40% would reduce US GDP by almost 10%. No, it wouldn't, because most of that would go straight back to labor and result primarily in increased consumer spending, and secondarily in increased consumer investment (which leads to increased business spending.) It's not like the money not being spent on healthcare inefficiencies is going to just vanish out of the system.
- intrasight 10y ago
  I'm not sure. At what point does automation lead to a big drop in GDP?
  - dragonwriter 10y ago
    Never; except perhaps when the fact that it results in greater concentration of wealth isn't mitigated and leads to destructive, violent revolution, which cuts GDP. But that's not really analogous to eliminating health care inefficiencies.
aleksei 10y ago
I doubt the money not spent on inefficiencies would equate to money effectively burnt away. That 40% would probably be spent in other, more productive ways. Not to mention you're actually making a point for not giving GDP too high a value when looking at economies.
- intrasight 10y ago
  GDP is like capitalism - a terrible measure but better than all the alternatives.

dfyzrbsvb4r5tv 10y ago

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Eliezer 10y ago

It boots nothing to subsidize that which is in restricted supply. So long as there are only 350 othodontists allowed to graduate per year, there's a corresponding limit on how many patients are allowed to have straight teeth regardless of who pays for what or what software is used. Improve the software, and the price of orthodontia must still equalize demand to the limited supply. Offer free dollar bills, and a line will form until the cost of staying in line burns more than $1. Medicine isn't costly because it's inefficient, rather it can end up inefficient because the limited supply means it must somehow end up costly. It is not possible to solve the healthcare crisis without somewhat deregulating the supply of healthcare and allowing it to increase. Until then, every subsidy just raises the price, and every efficiency improvement just creates room for more inefficiency elsewhere. You can't solve the housing problem in San Francisco by building more efficient software for selling houses. Only interventions that somehow increase the total supply of living space can cause more total people to be able to live there.

lkbm 10y ago
The article claims that 40% of the cost is operational inefficiencies, fraud, and ineffective care citing [0]. If all orthodontists are fully occupied and there's no demand being cut, then yes, removing those inefficiencies will just boost orthodontic pay. But it sounds like at least some of those inefficiencies involve: 1. People getting unnecessary orthodontic treatments (eliminating those cuts demand [not just quantity demanded]) 2. People getting ineffective treatments and needing a second treatment (same as 1) 3. Orthodontists being allocated in a way that lowers their overall productivity--empty time in their schedules, doing stuff they're less skilled at, etc. If my orthodontist spends less time on administrivia or repeat procedures, he can fix more people's teeth without us training a second orthodontist. Similarly, if there are apartments sitting empty for a month because it's hard to match people with apartments, better software can fit more people into San Francisco. (Going deeper, my bedroom is empty 12+ hours a day. I could totally sublet it to someone who works the night shift. I just need an efficient system to find such a person who's as interested in saving money as much as I am. Or as much as I was a few years ago. Now, I might not opt for this plan.) [0] http://www.who.int/whr/2010/10_summary_en.pdf?ua=1 http://www.who.int/whr/2010/10_summary_en.pdf?ua=1
10y ago

20years 10y ago

I would love to see more transparency in where the costs for dr visits is going. A recent 1/2 hour visit to my daughters doctor for a basic checkup and a couple of shots resulted in a $1500 bill to the insurance company. We paid a fraction of that but it still blows my mind that the bill was so high. I am assuming most of that was for the shots. If watsi can develop software that makes these costs more transparent maybe then we can address ways to lower them.

lumberjack 10y ago

Universal healthcare is already much more cost effective than fully or semi-privitised health care. Sorry, I forgot to pretend that all the other developed countries haven't figured out healthcare already. Geez. ---------------- Oh and btw, when you have a universal healthcare system payed by taxes (none of that bullshit insurance crap that only ends up being costly regulation/financial bloat) you can have entire and fully private hospitals and health clinics where you can get service for cash, and surprise, surprise, it's ridiculously cheap because it has to compete with the effectively free public healthcare system.

ameister14 10y ago
>Universal healthcare is already much more cost effective than fully or semi-privitised health care. That's not true. Most developed countries have some form of privatized system, falling into your 'semi-privatized' definition. It's more cost-effective.
- TheSmiddy 10y ago
  In Australia we have a universal healthcare system for everybody and a private system that runs alongside that essentially gets you a more comfortable bed and the ability to jump the queue for non-critical surgery.
  - ameister14 10y ago
    Exactly what I'm talking about
  - dguaraglia 10y ago
    Even an economic nightmare like Argentina manages to run on the same idea (I grew up there.) The level of complexity and inane amount of paperwork you have to do in the US to get the simplest care is still baffling to me. I get it that it's the inefficiencies that make this system profitable to some, and that's why you might get the "best doctors in the world", but it could definitely use some modernization.

Kluny 10y ago

I was thinking about this lately. Can universal health care be solved by the free market, if the free market decides to enforce checks and balances on itself? That is to say, could someone start a not-for-profit health insurance company that offers excellent coverage for affordable rates, and build it from the ground up with a culture of clarity and transparency? At a bare minimum they should have a searchable database where you can type in "broken arm" and find out what price this company has negotiated for casts, x-rays, and doctor time, and what it will cost you in co-pay. It seems like insurance companies are so universally bad and corrupt that there would be no trouble signing up a critical mass of users by simply being a little better than the norm, and once it's the biggest insurance provider in the US, start applying muscle to hospital administration. Yes, I know I'm oversimplifying it. Can anyone think of a way that it might be possible, though?

drewrv 10y ago
I see two problems, one is that consumers don't buy health insurance, their employers do. So the insurance company that is willing to deny legitimate claims and kick sick people off its rolls in order to lower its costs will win. The bigger issue is that insurance is the wrong business model. Insurance is supposed to protect against a catastrophic risk, like a car crash or an earthquake, but we use health insurance in this country to cover routine and ongoing care. Whether there even is a "business model" to treat people is debatable. Sick people as a group tend to earn less than the healthy.
sean_appleby 10y ago
I'm not at all an expert, but from my limited perspective this looks like a problem that blockchain could potentially help with in the future. It seems like someone could implement an open source system of smart contracts that automatically pay out healthcare costs and distribute expenses in a transparent and agreed upon way. The organization could have an extremely decreased overhead compared to a physical company because it would need almost no staff or infrastructure, and if everyone can see the source for how money moves as well as the distributed ledger for how spending works it would be highly corruption resistant while still allowing for security of doctor-patient confidentiality due to the encrypted nature of blockchain. Of course it would by default being extremely susceptible to external abuse, would have a ton of complexities in interfacing with the healthcare system, and wouldn't be viable until/unless blockchain and related tech matures and gains mass market acceptance. I could be totally wrong about the approach, but I'm really hopeful for the tech world to be able to make a dent in this mess. Hopefully some people with more experience have better ideas.

a3n 10y ago

> Once the platform is in place, Watsi will start to experiment with improving the quality of care and reducing the cost – e.g., by streamlining operations, minimizing waste and fraud, and identifying medical errors in real-time. That sounds like any politician ever, campaigning for office by promising to do the above, for government in general, the Defense or Energy or Education department, etc. Good luck, and I sincerely hope it works. This time.

abalone 10y ago

> Watsi’s goal is to improve the efficiency of funding, making universal healthcare possible. Universal healthcare is already possible.[1] Reducing waste is a noble goal but this is a startling sentence from a health tech startup team. It implies that the primary obstacle to universal care is cost, not political will, which fails to comprehend how universal care was achieved in most of the industrialized world. [1] https://en.m.wikipedia.org/wiki/List_of_countries_with_universal_health_care https://en.m.wikipedia.org/wiki/List_of_countries_with_unive...

Jyefet 10y ago

Invest in value-based healthcare - it's the future (in like 15-20 years, that is)

KeepTalking 10y ago

How much of the problem is actually the way (big) pharma conducts research? ( I know that I am over simplifying and dozens of startups are focused on improving the way research is done) From a manf process standpoint, there are cheaper ways to create these compounds. Generic drug manufacturers have proved that ignoring the cost of research, the drug itself costs next to nothing to make, market and sell. From an economics standpoint, healthcare costs are a significant part of GDP. In an ideal model if all research is funded directly via government grants and the key research is licensed through a free licensing - It should create a very competitive drug cost model.For a healthcare practice standpoint, legislation can really help. Stripping down some of the malpractice laws are a good starting point. Additionally, the monopoly on medical education should be broken - Making medical education a national priority is a key step. We also need to make sure, that doctors are not the only healthcare providers. Enabling entrepreneurship among non doctor(nurses, mid wives etc) medical practioners can increase the market supply. These 2 actions in theory should create more doctors and reduce the cost of practicing medicine.

temp-dude-87844 10y ago
Research is expensive because it is conducted by well-paying professionals over multiple years, then taken to several rounds drug trials, which come with risks of serious side effects. Negative outcomes resulting from drug trials -- as well as approved drugs -- are routinely litigated by the aggrieved parties, which result in expensive settlements or the risk of high damages (in some cases, punitive). Further, to promote public interest, patent protections on medication in most countries usually expire after 20 years, which limits the window of time in which the makers can recoup the cost. 'Tort reform' proposes (among others) to reduce the monetary risks associated with drug trials by limiting lawsuit payouts of limiting grounds to sue -- to its promoters, this benefits society at large (and the drug companies) while hurting a few individuals who happen to have found themselves embroiled in such a case. To its opponents, tort reform is an instrument to dismantle regulatory protections and results in little to no societal benefit, perversely incentivizing drugmakers to both a higher absolute quantity of drugs to drive overall revenues, while reducing the average quality of drugs to be less safe, and leave seriously injured people with no viable recourse. It's a complex problem with no easy answers.

rsync 10y ago

If you went back in time - say, 20 or 25 years ago - and you picked up a progressive, left leaning magazine - say, adbusters or mother jones - you would very regularly read warnings about the manufactured needs of medicine and healthcare and pharmaceuticals. Barely an issue of such a periodical could pass without dire warnings of a future in which big pharma and insurance interests would convince us, through advertising, that we were foremost consumers of "healthcare". What happened ? The progressive left is now fully, fervently convinced that "healthcare" is a basic priority of human life. It is a rampant consumerism that reaches far beyond - and profoundly deeper - than the fears that good people have always had. It didn't have to be this way.

certifiedloud 10y ago
I'd be interested to see a source on this, if you have one at hand.
hackuser 10y ago
Healthcare has long been seen as a basic right in many places and even the Republican Party in the U.S. now supports health insurance for everyone. The parent seems to conflate healthcare with pharmaceuticals and other specific forms of healthcare. IIRC, the warnings were that big pharma was pushing pills on people, something that has some evidence behind it. As an analogy, I think an effective military also is essential, but that doesn't mean I don't think big military contractors don't push needless or dangerous products on the public.

Animats 10y ago

"For the initial project, Watsi will fund primary healthcare for a community in the developing world and build a platform to run the system transparently." Start with Tuskegee, Alabama, poorest town in the United States.

WalterBright 10y ago

> up to 40% of all healthcare funding is wasted on operational inefficiencies, fraud, and ineffective care. Any system where the consumers, the providers, and the payers are not accountable to each other is never going to operate efficiently.

buyx 10y ago

The article doesn't mention which developing country the trial will be in, but South Africa would make an interesting candidate. It has a public healthcare system that's in shocking condition, and a world-class private healthcare system, funded by health insurance, that's becoming more unaffordable (despite being funded and mandated by employers) each year because of high medical inflation. There are clear parallels to the US healthcare system, and the commodities downturn has stymied the government efforts to introduce universal healthcare, so there would be an ideological willingness to experiment.

maceo 10y ago

US spends over $8,000 per capita on healthcare, compared to about $4,000 in UK and Japan, both of which have universal health care. This isn't a problem tech can solve. It's a problem only politics can solve.

kriro 10y ago

Good choice for YC research investment. I hope they don't try to reinvent the wheel in some areas (sounds like it from the post). It would probably be a good idea to benchmark how hard it is to set up a functioning and operational GNU Health system in community X for example. There's a lot of potential for replacing nothing/no doctors with machine learning, especially in developing countries. Especially in areas where mobile phones are spread I can think of a couple of use cases. Take a picture of your swelling/strange looking skin/whatever and have a classifier tell you what it could be. Last time I checked the algorithms actually beat expert panels (for skin cancer). Could probably be coupled with a "doctor as a service" system that optimizes routes based on this sort of data. The more I think about it the more I should catapult working in this area up my job application list :)

alkonaut 10y ago

Would there be legal issues (apart from political will) with forming a publicly owned health insurance company for the general public in the US, rather than a subset like Medicare etc? It seems that if you just form a large enough public insurer it could soon start undercutting the prices of the private insures.

narrator 10y ago

The prices in the U.S system are wildly divergent from the rest of the world and enhancing international competition is a good way to remedy this. Thus, one way to implement universal health care is to allow import of any prescribed drug and the government will pay for any medical procedure + plane ticket if that cost is less than it is in the U.S. Perhaps a doctor visa would also help with costs.

dandare 10y ago
doctor visa is a terrible idea, a) it would undermine the salaries of US doctors, b) it would drain doctors from poor countries where they are needed more than in the US.
- devwastaken 10y ago
  IIRC, doctors already work on visas, and I don't think you would be 'pulling' doctors from other countries, not unless you're really good, which at that point you're only staying in your home country because you want to, not because you need to.
- narrator 10y ago
  A) Lowering doctor salaries is part of the solution to health care costs. You could do this by educating them outside the U.S so they would have much lower student debt. B) More people will enter the health care professions globally if there's a bigger market for their services.

dandare 10y ago

TIL: US healthcare is completely nuts

mtrn 10y ago

Glad to live in a country that has something close to universal health care. Everybody needs to contribute a monthly share (independent of their condition) which amounts to over 200B per year in total. This seems enough for modern infrastructure, equipment, prophylaxis, medication. That said, it's not super efficient and the incomes vary greatly between employees with strong lobby groups and laborers covered by legislation only.

fuzzfactor 10y ago

Universal Healthcare is when a society is actually "rich" or "wealthy" in terms of truly having more than enough resources to perform essential care wholesale at no cost to patients, and after that, when society chooses to prioritize the health care of all its citizens high enough to give equal care to all. This doesn't usually happen, even in societies where the consistent waste of resources exceeds the total cost of universal healthcare. Considering the resource shortage or surplus, when healing treatments are not denied to any needy members of society, that could be a fundamental marker of civilization, and an obvious measure of which societies are more advanced and which are more retarded.