6 ms·

Healthcare

78 points by llambda 15y ago

OstiaAntica 15y ago
Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthcare innovation will remain low, and costs will continue to grow at double digits, until America passes real healthcare reform. Allow insurance competition across state lines, give private individuals the same tax treatment as employers when buying healthcare, and allow individuals to form groups to purchase health care (e.g. alumni groups, church groups, etc). Those three steps would go a long way to opening up the industry to the web and to innovative, competitive forces.
- prodigal_erik 15y ago
  I don't think more small risk pools are a good solution, due to adverse selection. The very sick or old often need more treatment than they can possibly afford (because what we develop isn't limited to the value of the typical patient's labor, which is a good thing!) so our choices are to let them die through triage, or to subsidize their treatment by preventing the well and young from gravitating into cheaper risk pools which find ways to exclude the sick or old. Tax-funded Medicare and Medicaid are effectively additional risk pools you're paying for even when they aren't covering you, and yet they aren't really acting as insurers of last resort (except for certain people who meet the criteria).
- pinaceae 15y ago
  or, those individuals could form an even larger group to ensure equal coverage for all people. could call it a state or a country or civilization. the government is people.
- jacoblyles 15y ago
  Fortunately for students education had fewer licensing requirements than healthcare. This allowed for the home school loophole, and for a network of alternative education providers to slowly grow and flourish outside of government control. Healthcare faces much stricter regulations as to who can provide care and how they administer it, so I expect much less change and improvement.
- MJR 15y ago
  First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad brush statements like "allow insurance competition across state lines", the complexities of that single issue alone are staggering. Are you aware that the strength of most in-state insurance carriers is their in-state network. An insurance company IS it's network. In addition each individual state has a Department of Insurance which also regulates all carriers in that state. DOI rules and regulations vary from state to state. Expanding your coverage to another state is a very complex undertaking. Also, Individual groups do have the ability to purchase healthcare - see many professional organizations(AIGA, etc) as working examples of this today. In either case, making those changes won't just magically open the industry to "the web and to innovative, competitive forces". There are already competitive forces at play. Any new player attempting to join the fray faces an uphill battle just in the regulatory aspects of the business alone. What do the advantages of the web and new technologies bring to insurance? How do these changes the provider networks which are the backbone of major insurance coverage today? These are the types of questions which need to be posed, and the people in the best position to answer these questions and change the game are insurers themselves. There are many smart and talented people working in insurance. The recent proposed Healthcare changes have helped to begin the process of moving forward and thinking differently, but with an industry like this it will take time. It is happening, insurance providers are looking at new technologies and ways to provide the coverage that people expect, for lower costs, in new and different ways.
  - jacoblyles 15y ago
    >"The government currently does not regulate individual/employer coverage." Are you sure about that? Last I checked, the feds mandate an immense number of details about how private insurance is provided, and that is only growing with the new health care law. >"I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean?" 1 of every 2 dollars spent in health care in the US is spent by the government. These three programs are clearly the 800 pound gorillas in the room. Medicare's price controls directly drive shortages and oversupply, and its billing practices set the standard for the rest of the industry.
- marshallp 15y ago
  clayton christensen advises that the solution to healthcare is personalized medicine, technologies like portable diabetes monitors. Imagine if you needed surgery, a robot comes to your house and performs it, much cheaper than doctors and hospitals. such system are currently being developed with military funding - battlefield telerobotic surgery
  - nradov 15y ago
    WTF? My house is pretty far from being a sterile environment.
    - marshallp 15y ago
      creating a small area of sterility isn't a impossible task, if you can create large one in an operating room, creating a smaller one can't be all that hard (with robotic equipment)
      - nradov 15y ago
        Creating even a small sterile environment is actually quite hard. What is the robot going to do, autoclave or boil everything in my bedroom? The main reason that most patients actually survive surgery now is that a huge amount of effort goes into keeping operating rooms sterile.
        rsheridan6 15y ago
        The robot would probably bring its own portable sterile bubble.
- maxxxxx 15y ago
  Group insurance should be abolished. Take the whole country as one big group. It doesn't make sense to have small groups negotiate their coverage.
dmk23 15y ago
The problem with venturing into healthcare is dealing with highly regulated industry and wrong incentives for most of the players. "Large networks of engaged users" do exist, but the ones who control real money (doctors, hospitals, insurers and pharmas / device makers) are highly suspicious of outsiders. Every one of them has the incentive to not share their data with the competition, even though they will all publicly pay lip service to doing this in the name of "improving patient care". If you look at patients / consumers, you can roughly divide them into the healthy and the sick. The healthy ones generally speaking do not want to invest time and effort into their health, unless it overlaps with lifestyle / food / entertainment - well covered by ventures we do not normally put into "healthcare" category. If you look at the sick ones, they tend to skew to the older demographic with lower online literacy. Even when you pick out the ones active online who care enough about their conditions what you get at best is small niche communities like PatientsLikeMe.com that are at best able to function as support networks and clinical trial recruiting sites. Did I forget to mention that pharmas and device makers are mortally scared of participating in social media because of FDA? They are in business where even acknowledging any adverse event could make them liable for billions. This is a great example of why for most of the healthcare industry social media is all downside and very little upside.
- mjbellantoni 15y ago
  "[...]the ones who control real money (doctors, hospitals, insurers and pharmas / device makers) are highly suspicious of outsiders." And each other.
absconditus 15y ago
I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are "enterprise" sales). There are many different standards for data transmission, but none of them are required and most people see them as more of a recommendation. Non-technical people are put in charge of technical projects. That being said, it is not a technologically challenging industry at the moment. Most of the work that is being done is just automating existing paper-based systems. The regulations that everyone worries about are really not very onerous. Complying with HIPAA is mostly common sense and the FDA does not yet regulate most information systems unless they control medical devices or provide specific types of alerting (vendors are preparing for the day when they do). Two of the biggest challenges that I see are the caliber of the technologists in the industry and the absolutely disgusting new interoperability standards that are being developed by people with questionable technical skills. The company to watch at this point is Epic (I do not work for Epic). They are really crushing a lot of other companies and they are somewhat progressive. http://www.epic.com/ http://www.epic.com/ If people are interested in some of the technology that is being used in the industry outside of the standard .Net and Java stuff take a look at InterSystems. They even have all of their product documentation online, which is a bit of a rarity for enterprise vendors. http://www.intersystems.com/ http://www.intersystems.com/
- rdl 15y ago
  I agree, especially about EPIC, but I think some of the integrated providers (like Kaiser) are themselves better at innovation than most of the software/services companies in the space.
  - absconditus 15y ago
    Kaiser and Mayo are definitely doing things better than most other providers. Unfortunately the government is encouraging other providers to cargo-cult them by providing ARRA funds for copying some small part of what they do.
cletus 15y ago
Personally I believe the problems with healthcare and education are largely the domain of government to fix. I actually believe in the (now-dead) Republican policy that, in the US at least, education is a state not Federal issue. By making it a Federal issue, we're just creating one giant bureaucracy and we all know how good those are at solving problems. We should probably have a model like some European countries where the money follows the student and what school a student can go to isn't restricted by some arbitrary boundary on a map. Likewise the tenure system has to go. What was imagined as a means of allowing academic freedom has become a recipe for entrenched mediocrity and stagnation. Also, it's a problem that schools are largely funded by property taxes. This alone ensures a better education for the rich. I'm not sure what the alternative is but we need one. As for healthcare, IMHO we're largely in this position because of the "blank check" model for health insurance and because of pharmaceutical patents. Each country has different laws about what is patentable and what isn't. In the US, for example, nuclear technology is expressly forbidden from being patented as it is seen as a matter of national security. In India, health care is seen likewise so pharma patents aren't allowed, providing for cheap generic medicine. I foresee a day when the US will swing in India's direction. Not that I necessarily think this is all good. The fact is, drugs are expensive to develop but it's also true that the pharmaceutical industry spends more on marketing than anything else (basically getting doctors and hospitals to use their drugs). Also, litigation is a problem for health care. We all pay for outrageous punitive damage awards. Lastly, it's a problem that insurance in the US is essentially tied to employment and large employers get that substantially cheaper than smaller employers (let alone individuals). And of course the complexity and administrative overhead are huge problems, which is probably the one area that could be disrupted without government intervention. But it doesn't help that part of the reason things are so complex is essentially to deny coverage.
- plink 15y ago
  If money were to follow the student free from map restrictions, then how can education be contained by state governance?
- jberryman 15y ago
  > Also, litigation is a problem for health care. We all pay for outrageous punitive damage awards. I'm not an expert, but I think it's very important for us (normal citizens) to be skeptical of these kinds of claims: http://en.wikipedia.org/wiki/Tort_reform#Healthcare_industry http://en.wikipedia.org/wiki/Tort_reform#Healthcare_industry Large corporations have created a mythology of an epidemic of frivolous lawsuits that Americans have completely internalized: those women weren't sexually harassed they just wanted to be bought off, or: she probably spilled coffee on herself on purpose. Also, you mention government bureaucracy and efficiency: I think it's worth pointing out that you can have a large amount of inefficient private sector bureaucracy, where the government could step in and create a more efficient system. The highway system is one obvious example. I think healthcare is also in this category.
chintan 15y ago
Speaking from a Web/Healthcare IT startup experience: The BIGGEST challenge is that your buyer, user and payer are 3 different entities. Every budding healthcare entrepreneur wants to "disrupt" this somehow, but eventually almost everyone gives up and they either die or become yet-another-enterprisey software company that everyone loves to hate. You can make a decent, linearly growing business if you can survive 2-3 years long sales cycles. So it makes sense that VC's don't want to venture into this space.
deleted 15y ago
[deleted]
notJim 15y ago
The baffling thing to me about healthcare in the US is that there are a number of models[1] from other nations that have desirable characteristics, and yet everyone is the US seems to think it's this huge problem that is brand new and that no one has ever looked at before. It should be well known by now that most developed countries spend less money on healthcare and get higher coverage rates and better outcomes. Surely the sane thing to do would be to research those models and figure out which one seems the best fit to us and then adapt it. I'm not opposed to innovation, but our approach to solving the healthcare problem seems seriously fettered by a bad case of not-invented-here syndrome. 1: What I mean by this idea of different models is that everyone seems to assume that all universal healthcare schemes are created equal, but this is simply untrue. Some examples: - Potential single-payer systems proposed in the US are most often compared to the Canadian system, but Canada actually has one of the worse systems (according to my previous metrics) among OECD countries. - People also assume that a single-payer system is the only way to achieve efficiency, but Germany has a very effective healthcare system which is not single-payer. Of course, even setting aside that we seem bad at considering the details of a solution to this problem, the real problem, in my opinion is that we can't even agree on what role government should play. If we can't even agree that the government should solve the healthcare problem, how can we even begin to agree on a solution?
buff-a 15y ago
When we look at healthcare, what's wrong with it, and what needs to happen to fix it, we can't see as clearly how the web, technology, and large networks of engaged users can impact healthcare in a positive way. Because we are not allowed to. I can't even write an iOS app that shows images if they happen to be X-Rays.[1] Its a group of giant monopolies and special interests who as an industry spend more on lobbying than any other industry ($250m in 2010)[2] And they need to. The industry is ripe for disruption. It amazes me that we allow utterly fallible human beings to attempt to diagnose in a 5 minute appointment conditions that they may never have heard of. And we talk of older doctors having more experience, but only more experience in the stuff they see everyday. Meanwhile computers can diagnose conditions more accurately than humans [3] but we'll see how far the AMA lets that go. Probably require an extra specially trained doctor to operate it. They'll probably require a man to run in front of it with a flag lest this dangerous machine hurt a patient. [1] http://www.macworld.com/article/161397/2011/07/fda_regulations_for_ios_apps.html http://www.macworld.com/article/161397/2011/07/fda_regulatio... [2] http://www.opensecrets.org/lobby/top.php?showYear=2010&indexType=i http://www.opensecrets.org/lobby/top.php?showYear=2010&i... [3] http://news.ycombinator.com/item?id=3219909 http://news.ycombinator.com/item?id=3219909
- marshallp 15y ago
  This is so true. The AMA and FDA are really the enemies of the public, countless suffering has occurred because of them.
  - disgruntledphd2 15y ago
    And yet we haven't had another thalidomide scandal since the FDA introduced mandatory clinical trials for new treatments. http://en.wikipedia.org/wiki/Thalidomide http://en.wikipedia.org/wiki/Thalidomide I'm not saying you're entirely wrong, just that its not a simple as you make out.
    - marshallp 15y ago
      people have looked at this before, the net effect is negative, (sorry no sources off-hand)

78 points by llambda 15y ago

Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthcare innovation will remain low, and costs will continue to grow at double digits, until America passes real healthcare reform. Allow insurance competition across state lines, give private individuals the same tax treatment as employers when buying healthcare, and allow individuals to form groups to purchase health care (e.g. alumni groups, church groups, etc). Those three steps would go a long way to opening up the industry to the web and to innovative, competitive forces.

prodigal_erik 15y ago
I don't think more small risk pools are a good solution, due to adverse selection. The very sick or old often need more treatment than they can possibly afford (because what we develop isn't limited to the value of the typical patient's labor, which is a good thing!) so our choices are to let them die through triage, or to subsidize their treatment by preventing the well and young from gravitating into cheaper risk pools which find ways to exclude the sick or old. Tax-funded Medicare and Medicaid are effectively additional risk pools you're paying for even when they aren't covering you, and yet they aren't really acting as insurers of last resort (except for certain people who meet the criteria).
pinaceae 15y ago
or, those individuals could form an even larger group to ensure equal coverage for all people. could call it a state or a country or civilization. the government is people.
jacoblyles 15y ago
Fortunately for students education had fewer licensing requirements than healthcare. This allowed for the home school loophole, and for a network of alternative education providers to slowly grow and flourish outside of government control. Healthcare faces much stricter regulations as to who can provide care and how they administer it, so I expect much less change and improvement.
MJR 15y ago
First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad brush statements like "allow insurance competition across state lines", the complexities of that single issue alone are staggering. Are you aware that the strength of most in-state insurance carriers is their in-state network. An insurance company IS it's network. In addition each individual state has a Department of Insurance which also regulates all carriers in that state. DOI rules and regulations vary from state to state. Expanding your coverage to another state is a very complex undertaking. Also, Individual groups do have the ability to purchase healthcare - see many professional organizations(AIGA, etc) as working examples of this today. In either case, making those changes won't just magically open the industry to "the web and to innovative, competitive forces". There are already competitive forces at play. Any new player attempting to join the fray faces an uphill battle just in the regulatory aspects of the business alone. What do the advantages of the web and new technologies bring to insurance? How do these changes the provider networks which are the backbone of major insurance coverage today? These are the types of questions which need to be posed, and the people in the best position to answer these questions and change the game are insurers themselves. There are many smart and talented people working in insurance. The recent proposed Healthcare changes have helped to begin the process of moving forward and thinking differently, but with an industry like this it will take time. It is happening, insurance providers are looking at new technologies and ways to provide the coverage that people expect, for lower costs, in new and different ways.
- jacoblyles 15y ago
  >"The government currently does not regulate individual/employer coverage." Are you sure about that? Last I checked, the feds mandate an immense number of details about how private insurance is provided, and that is only growing with the new health care law. >"I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean?" 1 of every 2 dollars spent in health care in the US is spent by the government. These three programs are clearly the 800 pound gorillas in the room. Medicare's price controls directly drive shortages and oversupply, and its billing practices set the standard for the rest of the industry.
marshallp 15y ago
clayton christensen advises that the solution to healthcare is personalized medicine, technologies like portable diabetes monitors. Imagine if you needed surgery, a robot comes to your house and performs it, much cheaper than doctors and hospitals. such system are currently being developed with military funding - battlefield telerobotic surgery
- nradov 15y ago
  WTF? My house is pretty far from being a sterile environment.
  - marshallp 15y ago
    creating a small area of sterility isn't a impossible task, if you can create large one in an operating room, creating a smaller one can't be all that hard (with robotic equipment)
    - nradov 15y ago
      Creating even a small sterile environment is actually quite hard. What is the robot going to do, autoclave or boil everything in my bedroom? The main reason that most patients actually survive surgery now is that a huge amount of effort goes into keeping operating rooms sterile.
      - rsheridan6 15y ago
        The robot would probably bring its own portable sterile bubble.
maxxxxx 15y ago
Group insurance should be abolished. Take the whole country as one big group. It doesn't make sense to have small groups negotiate their coverage.

dmk23 15y ago

The problem with venturing into healthcare is dealing with highly regulated industry and wrong incentives for most of the players. "Large networks of engaged users" do exist, but the ones who control real money (doctors, hospitals, insurers and pharmas / device makers) are highly suspicious of outsiders. Every one of them has the incentive to not share their data with the competition, even though they will all publicly pay lip service to doing this in the name of "improving patient care". If you look at patients / consumers, you can roughly divide them into the healthy and the sick. The healthy ones generally speaking do not want to invest time and effort into their health, unless it overlaps with lifestyle / food / entertainment - well covered by ventures we do not normally put into "healthcare" category. If you look at the sick ones, they tend to skew to the older demographic with lower online literacy. Even when you pick out the ones active online who care enough about their conditions what you get at best is small niche communities like PatientsLikeMe.com that are at best able to function as support networks and clinical trial recruiting sites. Did I forget to mention that pharmas and device makers are mortally scared of participating in social media because of FDA? They are in business where even acknowledging any adverse event could make them liable for billions. This is a great example of why for most of the healthcare industry social media is all downside and very little upside.

mjbellantoni 15y ago
"[...]the ones who control real money (doctors, hospitals, insurers and pharmas / device makers) are highly suspicious of outsiders." And each other.

absconditus 15y ago

I have worked on healthcare software for the last decade. Healthcare technology is really not something that one can understand from the outside. It is also not an area where web startup knowledge is as applicable (eventual consistency is entirely unacceptable, any caching of data must be very precise to avoid showing stale data to users and is generally not done, all sales to hospitals and most physician groups are "enterprise" sales). There are many different standards for data transmission, but none of them are required and most people see them as more of a recommendation. Non-technical people are put in charge of technical projects. That being said, it is not a technologically challenging industry at the moment. Most of the work that is being done is just automating existing paper-based systems. The regulations that everyone worries about are really not very onerous. Complying with HIPAA is mostly common sense and the FDA does not yet regulate most information systems unless they control medical devices or provide specific types of alerting (vendors are preparing for the day when they do). Two of the biggest challenges that I see are the caliber of the technologists in the industry and the absolutely disgusting new interoperability standards that are being developed by people with questionable technical skills. The company to watch at this point is Epic (I do not work for Epic). They are really crushing a lot of other companies and they are somewhat progressive. http://www.epic.com/ http://www.epic.com/ If people are interested in some of the technology that is being used in the industry outside of the standard .Net and Java stuff take a look at InterSystems. They even have all of their product documentation online, which is a bit of a rarity for enterprise vendors. http://www.intersystems.com/ http://www.intersystems.com/

rdl 15y ago
I agree, especially about EPIC, but I think some of the integrated providers (like Kaiser) are themselves better at innovation than most of the software/services companies in the space.
- absconditus 15y ago
  Kaiser and Mayo are definitely doing things better than most other providers. Unfortunately the government is encouraging other providers to cargo-cult them by providing ARRA funds for copying some small part of what they do.

cletus 15y ago

Personally I believe the problems with healthcare and education are largely the domain of government to fix. I actually believe in the (now-dead) Republican policy that, in the US at least, education is a state not Federal issue. By making it a Federal issue, we're just creating one giant bureaucracy and we all know how good those are at solving problems. We should probably have a model like some European countries where the money follows the student and what school a student can go to isn't restricted by some arbitrary boundary on a map. Likewise the tenure system has to go. What was imagined as a means of allowing academic freedom has become a recipe for entrenched mediocrity and stagnation. Also, it's a problem that schools are largely funded by property taxes. This alone ensures a better education for the rich. I'm not sure what the alternative is but we need one. As for healthcare, IMHO we're largely in this position because of the "blank check" model for health insurance and because of pharmaceutical patents. Each country has different laws about what is patentable and what isn't. In the US, for example, nuclear technology is expressly forbidden from being patented as it is seen as a matter of national security. In India, health care is seen likewise so pharma patents aren't allowed, providing for cheap generic medicine. I foresee a day when the US will swing in India's direction. Not that I necessarily think this is all good. The fact is, drugs are expensive to develop but it's also true that the pharmaceutical industry spends more on marketing than anything else (basically getting doctors and hospitals to use their drugs). Also, litigation is a problem for health care. We all pay for outrageous punitive damage awards. Lastly, it's a problem that insurance in the US is essentially tied to employment and large employers get that substantially cheaper than smaller employers (let alone individuals). And of course the complexity and administrative overhead are huge problems, which is probably the one area that could be disrupted without government intervention. But it doesn't help that part of the reason things are so complex is essentially to deny coverage.

plink 15y ago
If money were to follow the student free from map restrictions, then how can education be contained by state governance?
jberryman 15y ago
> Also, litigation is a problem for health care. We all pay for outrageous punitive damage awards. I'm not an expert, but I think it's very important for us (normal citizens) to be skeptical of these kinds of claims: http://en.wikipedia.org/wiki/Tort_reform#Healthcare_industry http://en.wikipedia.org/wiki/Tort_reform#Healthcare_industry Large corporations have created a mythology of an epidemic of frivolous lawsuits that Americans have completely internalized: those women weren't sexually harassed they just wanted to be bought off, or: she probably spilled coffee on herself on purpose. Also, you mention government bureaucracy and efficiency: I think it's worth pointing out that you can have a large amount of inefficient private sector bureaucracy, where the government could step in and create a more efficient system. The highway system is one obvious example. I think healthcare is also in this category.

chintan 15y ago

Speaking from a Web/Healthcare IT startup experience: The BIGGEST challenge is that your buyer, user and payer are 3 different entities. Every budding healthcare entrepreneur wants to "disrupt" this somehow, but eventually almost everyone gives up and they either die or become yet-another-enterprisey software company that everyone loves to hate. You can make a decent, linearly growing business if you can survive 2-3 years long sales cycles. So it makes sense that VC's don't want to venture into this space.

deleted 15y ago

[deleted]

notJim 15y ago

The baffling thing to me about healthcare in the US is that there are a number of models[1] from other nations that have desirable characteristics, and yet everyone is the US seems to think it's this huge problem that is brand new and that no one has ever looked at before. It should be well known by now that most developed countries spend less money on healthcare and get higher coverage rates and better outcomes. Surely the sane thing to do would be to research those models and figure out which one seems the best fit to us and then adapt it. I'm not opposed to innovation, but our approach to solving the healthcare problem seems seriously fettered by a bad case of not-invented-here syndrome. 1: What I mean by this idea of different models is that everyone seems to assume that all universal healthcare schemes are created equal, but this is simply untrue. Some examples: - Potential single-payer systems proposed in the US are most often compared to the Canadian system, but Canada actually has one of the worse systems (according to my previous metrics) among OECD countries. - People also assume that a single-payer system is the only way to achieve efficiency, but Germany has a very effective healthcare system which is not single-payer. Of course, even setting aside that we seem bad at considering the details of a solution to this problem, the real problem, in my opinion is that we can't even agree on what role government should play. If we can't even agree that the government should solve the healthcare problem, how can we even begin to agree on a solution?

buff-a 15y ago

When we look at healthcare, what's wrong with it, and what needs to happen to fix it, we can't see as clearly how the web, technology, and large networks of engaged users can impact healthcare in a positive way. Because we are not allowed to. I can't even write an iOS app that shows images if they happen to be X-Rays.[1] Its a group of giant monopolies and special interests who as an industry spend more on lobbying than any other industry ($250m in 2010)[2] And they need to. The industry is ripe for disruption. It amazes me that we allow utterly fallible human beings to attempt to diagnose in a 5 minute appointment conditions that they may never have heard of. And we talk of older doctors having more experience, but only more experience in the stuff they see everyday. Meanwhile computers can diagnose conditions more accurately than humans [3] but we'll see how far the AMA lets that go. Probably require an extra specially trained doctor to operate it. They'll probably require a man to run in front of it with a flag lest this dangerous machine hurt a patient. [1] http://www.macworld.com/article/161397/2011/07/fda_regulations_for_ios_apps.html http://www.macworld.com/article/161397/2011/07/fda_regulatio... [2] http://www.opensecrets.org/lobby/top.php?showYear=2010&indexType=i http://www.opensecrets.org/lobby/top.php?showYear=2010&i... [3] http://news.ycombinator.com/item?id=3219909 http://news.ycombinator.com/item?id=3219909

marshallp 15y ago
This is so true. The AMA and FDA are really the enemies of the public, countless suffering has occurred because of them.
- disgruntledphd2 15y ago
  And yet we haven't had another thalidomide scandal since the FDA introduced mandatory clinical trials for new treatments. http://en.wikipedia.org/wiki/Thalidomide http://en.wikipedia.org/wiki/Thalidomide I'm not saying you're entirely wrong, just that its not a simple as you make out.
  - marshallp 15y ago
    people have looked at this before, the net effect is negative, (sorry no sources off-hand)