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I saw Jim Clark (of SGI and Netscape fame) talk one time about his new healthcare startup (Healtheon). He said something insightful that captures a lot of why i

I saw Jim Clark (of SGI and Netscape fame) talk one time about his new healthcare startup (Healtheon). He said something insightful that captures a lot of why it's hard to get things done in general: one person's inefficiency is someone else's bottom line.

hibikir 2mo ago
The flip side of Bezos' "your margin is my opportunity". But that's for competitive markets, not for heavily regulated multi-party setups with minimal competition. That's the real wonder of American healthcare, as it manages to neither be a good market, nor to have regulator mercilessly going after the largest profit centers. Near the worst of both worlds.
root_axis 2mo ago
And someone else's bottom line is also the wages of friends and neighbors. Last I heard healthcare is like the only employment sector that's seeing real growth right now.
- rswail 2mo ago
  Actual healthcare delivery is a growing field because boomers are getting old and dying and advances in health care mean that people that would otherwise die (eg people with cancers) are now receiving treatments that keep them alive. Note that this is a Good Thing. The issue with US (and privatized) healthcare delivery is that there is an incentive (by insurers) to deny treatment, as well as an incentive for healthcare suppliers (hospitals, doctors) to over-deliver treatment, as well as incentives to use more expensive solutions. Demand in healthcare is inelastic, no one is ever "too healthy". Supply is always insufficient, so there needs to be a mechanism to resolve that. In the US, that mechanism is money, or the cost of insurance etc to provide a restriction on demand. In universal healthcare, that mechanism is a combination of subsidizing medications based on results and waiting lists for limited supplies, prioritized by need (eg surgeries).
  - ggm 2mo ago
    Is there any reason to believe less healthcare professionals would be employed under a universal system? Insurance claims adjusters and call centre scripted finance deciders, sure. But actual health delivery agents?
    - rswail 2mo ago
      No, if anything there will be more because some of the funds freed up can be spent on healthcare delivery. But you will lose endless billing departments at general/specialist practices, hospitals etc, because actual consumers would not engage. Hospital administrations will be driven by the government setting reimbursement rates for services that are transparent, so the argy-bargy between someone paying cash, someone getting insurance etc will disappear (mostly). I'm in Australia, and the billing departments, even at private hospitals are minimal. Ditto at general practices. Reimbursements for GP/specialists that are not "bulk billed" (ie paid at the government rate) are automated into a nominated bank account and are usually instant. Medicare for All in the US would move the 2/3rds that are not covered by Medicare, VA, etc into the same systems, with the reduction in overhead from 10-20% to the 2-5% of the current government run health systems. Allowing Medicare to negotiate both drug prices (as a large purchaser) and health services will also dramatically reduce costs, because the government has the purchasing power to drive hard bargains.
      - ggm 2mo ago
        I was responding to a thread I thought implied economic downside in employment, as a fellow Australian I'm a strong believer in national health.
    - arh5451 2mo ago
      The UK has a "universal system" as does Germany and the inevitable reality is that if administration does not limit/deny overuse of the system then it requires setting prices artifically low to limit costs. --> Causes Doctors to earn less wages and be overworked (many med cases). Ultimately, less doctors. =(

hibikir 2mo ago

The flip side of Bezos' "your margin is my opportunity". But that's for competitive markets, not for heavily regulated multi-party setups with minimal competition. That's the real wonder of American healthcare, as it manages to neither be a good market, nor to have regulator mercilessly going after the largest profit centers. Near the worst of both worlds.

root_axis 2mo ago

And someone else's bottom line is also the wages of friends and neighbors. Last I heard healthcare is like the only employment sector that's seeing real growth right now.

rswail 2mo ago
Actual healthcare delivery is a growing field because boomers are getting old and dying and advances in health care mean that people that would otherwise die (eg people with cancers) are now receiving treatments that keep them alive. Note that this is a Good Thing. The issue with US (and privatized) healthcare delivery is that there is an incentive (by insurers) to deny treatment, as well as an incentive for healthcare suppliers (hospitals, doctors) to over-deliver treatment, as well as incentives to use more expensive solutions. Demand in healthcare is inelastic, no one is ever "too healthy". Supply is always insufficient, so there needs to be a mechanism to resolve that. In the US, that mechanism is money, or the cost of insurance etc to provide a restriction on demand. In universal healthcare, that mechanism is a combination of subsidizing medications based on results and waiting lists for limited supplies, prioritized by need (eg surgeries).
- ggm 2mo ago
  Is there any reason to believe less healthcare professionals would be employed under a universal system? Insurance claims adjusters and call centre scripted finance deciders, sure. But actual health delivery agents?
  - rswail 2mo ago
    No, if anything there will be more because some of the funds freed up can be spent on healthcare delivery. But you will lose endless billing departments at general/specialist practices, hospitals etc, because actual consumers would not engage. Hospital administrations will be driven by the government setting reimbursement rates for services that are transparent, so the argy-bargy between someone paying cash, someone getting insurance etc will disappear (mostly). I'm in Australia, and the billing departments, even at private hospitals are minimal. Ditto at general practices. Reimbursements for GP/specialists that are not "bulk billed" (ie paid at the government rate) are automated into a nominated bank account and are usually instant. Medicare for All in the US would move the 2/3rds that are not covered by Medicare, VA, etc into the same systems, with the reduction in overhead from 10-20% to the 2-5% of the current government run health systems. Allowing Medicare to negotiate both drug prices (as a large purchaser) and health services will also dramatically reduce costs, because the government has the purchasing power to drive hard bargains.
    - ggm 2mo ago
      I was responding to a thread I thought implied economic downside in employment, as a fellow Australian I'm a strong believer in national health.
  - arh5451 2mo ago
    The UK has a "universal system" as does Germany and the inevitable reality is that if administration does not limit/deny overuse of the system then it requires setting prices artifically low to limit costs. --> Causes Doctors to earn less wages and be overworked (many med cases). Ultimately, less doctors. =(