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Very difficult to disrupt American healthcare when health insurance companies determine your rates, direct pay patients often the most vulnerable, and instead o

• toomuchtodo 2y ago
  Yep. https://news.ycombinator.com/item?id=42495074 https://news.ycombinator.com/item?id=42495074
• donw 2y ago
  ... are you joking? Healthcare is one of the most regulated industries in the United States. Want to be a doctor? You've got the aptitude, the knowledge, the mindset, and the will, but a government-guaranteed cartel of medical schools won't let you in, so too damn bad. Learn to code. Want to open a clinic? You really only need about a half-million in hardware to operate at the level of a 1980s hospital, but regulatory compliance will push your annual opex into the millions as a baseline, not to mention having to deal with the nightmare that is health insurance. Those "massive entities" you mentioned are entirely protected from competition by force of law. You know why healthcare used to be cheap? Nobody had insurance. Anyone that had the aptitude and wanted to be a doctor basically could. You went to the hospital, paid your bill, and that was that. I'm not saying "zero regulation, caveat emptor!", but over the past hundred years, the precise opposite of "deregulation" has happened across every aspect of American life.
  • vasco 2y ago
    How come it's cheaper in places where everyone has insurance?
    • rqtwteye 2y ago
      Because everybody besides the US regulates prices.
    • speakfreely 2y ago
      Because there's a single payor that tells providers how much things are going to cost. The short answer for why US healthcare is so expensive is that Americans are economically disconnected from the price of the healthcare they are consuming. There is absolutely no free market system happening there because almost all the costs are hidden behind insurance schemes.
    • estebarb 2y ago
      The problem is private insurance companies + private hospitals. They shouldn't exist. Healthcare is an inelastic service: people will pay everything to get it. So private hospitals in a free market are pushed to bill their services as higher as possible. Actually, their prices would go to infinity, if not limited by people total savings and earnings. So, here the insurance companies make the problem worse: they give people access to "infinite" credit. So you can pay for those exorbitant prices. But with insurance you just increased the pool of money people can use for health, so private hospitals can and will increase their pricing. Add more free market competition and you get the disaster of the USA healthcare system. Because of that reason, basic economics, is that for profit Healthcare cannot work long term. The only way to make it work is making it a public service. But in USA politicians will cry that is comunism, so they won't do it. And the USA Healthcare problem doesn't limit itself to USA. As americans are unable to pay for healthcare there, they started doing medical tourism, which is making health prices in other countries more expensive too.
      • donw 2y ago
        Japan has private insurance companies and private hospitals, many of them, and does just fine.
• snitty 2y ago
  >Americans have allowed corporations to form massive entities (in health insurance, UHC + optum bank + optima rx comes to mind) This is more an anti-trust problem than deregulation. In the 80s Robert Bork and some others led a charge within the court system to rewrite federal anti-trust law without actually rewriting the laws. The result was that merger/acquisition guidelines were loosened, and the focus was on whether the result would cause the consumer to pay more money. And thanks to the way health care is paid for, it's a little complicated to make that case.
  • dragonwriter 2y ago
    > This is more an anti-trust problem than deregulation Loosened antitrust rules are a subset of deregulation, it can’t be any less deregulation than it is a matter of (too loose) antitrust.
• tyre 2y ago
  If you want to do the hard work of automating and abstracting the "fucking mess" of the financial layer of American healthcare, we're hiring: https://jobs.lever.co/juniperplatform https://jobs.lever.co/juniperplatform Or email me: chris@juniperplatform.com
  • t-writescode 2y ago
    Grr. Genuinely tempting, but I didn't wish it had to be in NY, nor hybrid :(
    • mikebonnell 2y ago
      Huge +1 to that; make remote an option and expand your talent pool
      • tyre 2y ago
        It’s definitely a trade-off. My team at Stripe was scattered all over, during COVID our company was fully remote, and prior to that I worked remotely on a presidential campaign. All of those were great experiences and, in their own ways, necessarily/understandably remote. Compared to the early days at Gusto and my own startup, though, in-person has very real benefits that (in my opinion) are worth the challenges in hiring. I don’t know that it will always be true and can’t rule out that we’re wrong. Having internal users and domain experts there in person makes a huge difference. It’s not impossible to do remotely, and maybe the tradeoff doesn’t make sense forever, but it’s worked well thus far.
        • Aurornis 2y ago
          I’ve felt similarly. In-person has benefits, but across my career it’s been easier to assemble top-tier teams when hiring remote than in-person. For myself, I’m past the point of moving for companies. If they happen to be nearby I’ll make it work. If they’re not nearby, its either remote or I’m not at all interested anymore.
        • t-writescode 2y ago
• tptacek 2y ago
  Providers determine your rates. Insurers are companies providers recruit to collect their bills. In the entire US health care system, the providers are the only ones whose cash flows are capped by statute. A provider can charge whatever it wants; over 80% of an insurers cash flows have to go to the provider by statute. (The health care industry is a mess, I agree!)
  • duk3luk3 2y ago
    You seem to be implying that the providers set the prices, but isn't it true that insurers can pick and choose which providers they cover, and because of the large amount of patients they insure, they have a huge amount of negotiation power to exert downward pressure on what providers charge?
    • tptacek 2y ago
      No, that's not true. All the market power is with the providers, which is why they're responsible for something like 9x total health care spend in the US than all health insurers combined. Medicare is better than private insurers at regulating prices (to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated, and the governor of New York proposed a statute preventing them from doing it). But they still wildly overpay for services; in fact, what they pay is not really materially different from what private insurers do (it's less, but not by that much).
      • duk3luk3 2y ago
        > All the market power is with the providers How does that work? Do the providers have cartels that set prices?
        • tptacek 2y ago
          Yes. I don't know if that's the primary factor that gives them their market power; it might be even simpler than that. But yes, they absolutely do. Unless you're Kaiser, in which case you're the insurer and most of the providers, which is the whole idea behind Kaiser. But every other insurer --- and overwhelmingly, Americans aren't on Kaiser --- is beholden to providers. And of course, Kaiser competes with providers for service providers and vendors.
• Aurornis 2y ago
  > Very difficult to disrupt American healthcare when health insurance companies determine your rates, This isn’t unique to America. In countries with government healthcare, the government determines your rates. Typically government rates are lower than private insurance rates in the US, too. For as much as Americans like to complain about insurance companies, we actually get a lot more care and pay higher rates to providers than other countries. There’s a reason doctor pay in the United States is so much higher, among other things.
  • llamaimperative 2y ago
    What on earth We get a lot more care, pay higher rates, and have worse outcomes. That last bit is why people are pissed.
    • devonkim 2y ago
      I think we should add that the outcomes are worse at _all_ socioeconomic levels. The rich get screwed over as well in this system as well. It's unfortunate that so many of them have better overall outcomes and/or myopic experiences that many are emotionally invested in being _able_ to pay exorbitant amounts for more personalized care - regardless of the societal consequences - as an interpretation of "freedom." But hey, it's not like the US is a democracy exactly given that public opinion generally doesn't translate into policy changes anymore.
    • missedthecue 2y ago
      I don't think it's settled fact that the US has worse health outcomes. In fact, most data I see points to the opposite. Some people point out very lazy metrics like life expectancy while ignoring that 72% of Americans are overweight or obese according to the CDC. Rearrange healthcare/government insurance models all you want; it can't fix that.
      • thrance 2y ago
        Life expectancy is still lower in the US than in western Europe.