12 ms·

"Dangerous and Alarming" - it tough; healthcare is needs disruption but unlike many places to target for disruption, the risk is life and death. It strikes me t

• bandrami 9mo ago
  Why does healthcare "need disruption"?
  • miltonlost 9mo ago
    The part that needs disrupting is the billionaires who own insurance companies and demand profit from people's health .
    • zdragnar 9mo ago
      The profit in insurance is the volume, not the margin. Disrupting it will not dramatically change outcomes, and will require changes to regulation, not business policy.
      • kunai 9mo ago
        Agreed. I'd also argue that there will always be the issue of adverse selection, which in any system that doesn't mandate that all individuals be covered for healthcare regardless of risk profile, will continue to raise costs regardless of whether or not margins are good or bad. That dream died with the individual mandate, and if the nation moves even further away from universal healthcare, we will only see costs rise and not fall as companies shoulder more and more of the relative risk.
    • eru 9mo ago
      Profit is a small part of overall revenue.
  • wswin 9mo ago
    It's inefficient and not living to its potential
    • bandrami 9mo ago
      And "disruption" (a pretty ill-defined term) is the solution to that?
      • __loam 9mo ago
        The solution is single payer. Any attempt to solve this with technological band aids is completely futile. We know what the solution is because we see it work in every other developed nation. We don't have it because a class of billionaire doners doesn't want to pay into the system that allowed them to become fabulously wealthy. People who are claiming AI is the solution to healthcare access and affordability are delusional or lying to you.
        • gradus_ad 9mo ago
          There are good reasons to think single payer systems are not the answer. The numerous documented inefficiencies and inconveniences they suffer from don't need repeating here. And many single payer systems around the world only appear to work as well as they do because the US effectively subsidizes medical costs through its own out of control prices.
          • __loam 9mo ago
            We'd rather have medical bankruptcy than a functional system.
          • ikr678 9mo ago
            Maybe for R&D but your outsized costs are also due to your liability environment and direct incentives against preventative healthcare.
    • plagiarist 9mo ago
      The inefficiency is the buying of yachts for billionaires.
  • dyauspitr 9mo ago
    Seriously? Spending a night in a hospital results in a $10,000 bill (though the real out of pocket is significantly cheaper. God help you if you have no insurance though). Healthcare in the US is the thing that needs the biggest disruption.
    • gmueckl 9mo ago
      But no business is going to fix it. The market is captured. Only a radical change of insurance laws is going to have any impact. Mandate that insurance must be not for profit. Mandate at least decent minimal coverage standards and large insurance pools that must span age groups and risk groups.
      • eru 9mo ago
        Many hospitals are already non-profit. That doesn't seem to bring down prices. Why would you think that this would work for insurance? Profit isn't even a big part of the overall revenue. > Mandate at least decent minimal coverage standards I assume you want higher coverage standards than what currently exists? Independently of whether that would be the morally right thing to do (or not), it would definitely increase prices. > and large insurance pools that must span age groups and risk groups. Why does your insurance need a pool? An actuary can tell you the risk, and you can price according to that. No need for any pooling. Pooling is just something you do, when you don't have good models (or when regulations forces you).
        • FireBeyond 9mo ago
          > Why does your insurance need a pool? An actuary can tell you the risk, and you can price according to that. No need for any pooling. Pooling is just something you do, when you don't have good models (or when regulations forces you). Wuh? The more diverse the pool, the lower the risk. Your way of thinking will very quickly lead to "LiveCheap: the health insurance for fit, healthy under 30s only" for dollars a month, and "SucksToBeYou: the health insurance for the geriatric and chronically disabled" for the low low cost of "everything you have to give".
  • harpratap 9mo ago
    Because insurance companies incentivize upward price momentum. The ones who innovate and bring the prices down are not rewarded for their efforts. Health inflation is higher than headline inflation because of this absence of price pressure
    • eru 9mo ago
      I sympthatise with the argument. We should test it against real world data. Eg your argument would predict that healthcare price inflation is not as bad in areas with less insurance coverage. Eg for dental work (which is less often covered as far as I can tell), for (vanity) plastic surgery, or we can even check healthcare price inflation for vet care for pets.
      • eru 9mo ago
        I just looked it up, and apparently health care costs for pets has gone up in price even faster than for humans. Pets typically don't have medical insurance, and any insurance that does exist there has a radically different regulatory regime than for humans. Since 1980 for the US: CPI has gone up by 3.16% on average per year (x4.17 in total). Human healthcare costs by 4.9% per year (x8.96 in total). And pet healthcare costs by 6.49% (or x17.87 in total).
        • manuelmoreale 9mo ago
          I suspect this has something to do with it: https://www.theatlantic.com/ideas/archive/2024/04/vet-private-equity-industry/678180/ https://www.theatlantic.com/ideas/archive/2024/04/vet-privat...
          • eru 9mo ago
            That could at most explain the last few years of rising vet prices.
            • bandrami 9mo ago
  • sergiotapia 9mo ago
    because in america at least, the supply of doctors is kept artificially low. that combined with exploding administrative headcount, means patients are getting pretty terrible, expensive service.
    • sarchertech 9mo ago
      Physician compensation is around 9% of healthcare spending. The number of non-physician providers (NPs, PAs and specialists like physical therapists and podiatrists) has also exploded over the last 20 years. We have far more overall providers per capita than we did 20 years ago. Lack of providers isn’t what’s driving up costs.
      • derbOac 9mo ago
        I don't think physician compensation per se is a good metric for capturing the effect of lack of providers, because some of the increased costs are due to the bottlenecks in the services per se, in terms of procedure costs and types of procedures offered. I also don't think the number of providers per se under the current regime, without deregulation or reregulation of practice boundaries, is representative of what would happen if there were changes in those boundaries. Adding more optometrists 5 years ago isn't the same as changing what they're allowed to do. It also doesn't address what cost increases would have been without an increase in the number of providers. 9% might also seem pretty big to me if it's out of all spending and doesn't include other provider compensation? What if overall healthcare costs went down, but physician compensation stayed the same? Would that then be a problem because it was an increased proportion of the total costs — fat left to be trimmed, so to speak? There are many problems that don't have anything to do with providers per se, but I also don't think you can glean much by extrapolating to more of the same, especially compensation per se.
        • thepotatodude 9mo ago
          9% is nothing when you consider that these people provide the value. With no physicians, there is no healthcare.
        • 9mo ago
  • seanmcdirmid 9mo ago
    Many people don’t get it, it’s really expensive, even in countries with non broken healthcare systems (not the us) costs increase rapidly and no one is sure how the systems will remain solvent with the same level of care given today. The way things are currently done are entrenched but not sustainable, that’s when disruptions are apt to appear.
    • scarab92 9mo ago
      Society pretends that human doctors are better than they really are, and AI is worse than it really is. It's the self-driving cars debate all over again.
      • thepotatodude 9mo ago
        It's really just not there yet. I've been in medical school for >3 years now and have been using the latest models with good prompting. They have gotten much better, but I still see misses that my classmates would easily catch. This is not acceptable in healthcare. It's certainly not getting 100% on all my assignments, which are a step below the complexity of real-world clinical practice. Before medical school, I was not so sure of the quality of your average doc. Now having spent a year in clinical practice across various settings, I am extremely reassured. I can say with certainty that a US trained doctor is miles ahead of AI right now. The system sucks really bad though and forces physicians to churn patients, giving the impression that physicians don't pay attention/don't care/etc.
    • bandrami 9mo ago
      I mean, if we're talking Christensenian disruption, that happens in neglected markets rather than currently dysfunctional ones. There's no shortage of actors wronging money out of health care so there's not a disruptable space per se.
      • omnicognate 9mo ago
        > wronging Not sure if this is a typo (of wringing) or a pun, but it's apt either way.