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Why does healthcare "need disruption"?
by bandrami 10mo ago
Why does healthcare "need disruption"?
- miltonlost 10mo agoThe part that needs disrupting is the billionaires who own insurance companies and demand profit from people's health .
- zdragnar 10mo agoThe 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 10mo agoAgreed. 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 10mo agoProfit is a small part of overall revenue.
- wswin 10mo agoIt's inefficient and not living to its potential
- bandrami 10mo agoAnd "disruption" (a pretty ill-defined term) is the solution to that?
- __loam 10mo agoThe 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 10mo agoThere 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.
- plagiarist 10mo agoThe inefficiency is the buying of yachts for billionaires.
- eru 10mo agoCompare: Google's founders can buy all the yachts they could possibly eat, yet Google Searches are offered for free. If we could get healthcare to that level, it would be great. For a less extreme example: Wal-Mart and Amazon have made plenty of people very rich, and they charge customers for their goods; but their entrance into the markets have arguable brought down prices.
- __loam 10mo agoAnd Google search, a service on the level of a public utility, has been degrading noticeably for years in the face of shareholders demanding more and more returns.
- eru 10mo agoHow is Google Search a public utility?
- __loam 10mo agoComparing something to a public utility is not me saying it's literally a public utility. Google runs a monopolistic service that is essential to a lot of our public life, in a segment that has high cost of entry and infrastructure cost. They make the service worse to make more money. It should be a regulated utility like electricity or railroads, we should have a public alternative like the post office is to UPS, or it should be nationalized. The situation gets more dire when you consider their browser monopoly.
- eru 10mo agoOther search engines exist. Bing is right there, and Microsoft is more than willing to eat the high cost of entry and infrastructure cost. > It should be a regulated utility like electricity or railroads, we should have a public alternative like the post office is to UPS, or it should be nationalized. I agree that electricity and railroads should be regulated like Google Search. It's really weird that snail mail in the US is a government monopoly. When even social democratic Germany managed to privatise them. > The situation gets more dire when you consider their browser monopoly. Don't a lot of people in the US use iPhones? They don't ship with Chrome as the default browser, do they? (And yes, Safari is built on top of the same open source engine as Chrome. But you can hardly call using the same open source project a 'monopoly'. Literally anyone can fork it.) There's also plenty of other browsers available.
- reaperducer 10mo agoIt's inefficient and not living to its potential Yeah, because we saw what a great job the tech bros did making government more efficient.
- shaky-carrousel 10mo agoThat's because it's incredibly corrupted, not because it needs disruption. Unless the disruption comes in the form of jail time.
- dyauspitr 10mo agoSeriously? 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 10mo agoBut 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 10mo agoMany 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 10mo 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 10mo agoBecause 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 10mo agoI 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 10mo agoI 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 10mo agoI 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...
- sergiotapia 10mo agobecause 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 10mo agoPhysician 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 10mo agoI 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 10mo ago9% is nothing when you consider that these people provide the value. With no physicians, there is no healthcare.
- 10mo ago
- seanmcdirmid 10mo agoMany 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 10mo agoSociety 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 10mo agoIt'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 10mo agoI 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 10mo ago> wronging Not sure if this is a typo (of wringing) or a pun, but it's apt either way.