YC: Requests for Startups

"ELIMINATING MIDDLEMEN IN HEALTHCARE"

I honestly am game for this even though I have zero experience in healthcare but as a consumer, where do I start how bad it is. I would do anything to change our shitty healthcare system where there are so many middlemen b/w me and my doctor.

Recent event: Went to ER because my toddler son spilled hot coffee on him (thankfully he is ok and wasn't as terrible as it could have been). There was a pediatrician on call who looked at him for like 2 mins and then left. A nurse came in and most of her questions were about "insurance details".

Then they didn't tell me what the heck was going on and after pressing, they said "we are getting stuff for him. wait". Then after almost 1.5 hours of waiting where my son is wailing, they got some bandage (I kid you not) with some Over the counter stuff (bacytracin) and applied it on the burn. Then we went home.

Bill = $2000 after Insurance coverage. Our premium for family is $1800+/month btw . Then there is the deductible. Supposedly, the insurance company only partially approved the claim. Whatever the f that means.

If you don't see a problem with this whole cycle of experience, I don't know what else to say. And no, don't tell me to get better insurance. I want to get rid of all these middlemen mafia.

This is almost certainly not a healthcare issue, but a political/lobbying issue. Solutions will happen in the political/lobbying space. We will need to fix shit like:

* very fast, arbitrary disapprovals of healthcare-- requiring 6 weeks of physical therapy before ordering a test of what is almost certainly a torn ligament or other thing is stupid and directly harms patient outcomes;

* enforcement of mental healthcare equality-- hospitals should have equal beds, equal availability, equal pay for workers, and insurance companies should also be paying equally for mental and body health;

* forcing the hands of drug price fixers-- that's right, it's not just insurance, or pharmaceuticals, it's a shitty middleman between them all that rolls up and sets prices on both sides, things like e.g. medicare negotiating drug prices directly will disrupt these fuckos

* DOCTOR OWNED HOSPITALS MUST COME BACK-- no more vulture finance that literally made this illegal

* hospital geographic monopolies must be eliminated-- that's right, hospitals can ban competition! No more of this!

* SAFE STAFFING RATIOS

* releasing the budget on residency-- that's right, the government sets how much money they are willing to put towards new doctors!

* jail time for negligent insurance decisions-- we know that insurance companies will slow-walk bureaucracy lifesaving healthcare to desperately ill, disabled people in the hopes they will die before the approval goes through

I agree that it is more of a political issue at this point because the middlemen are way too powerful and would fight tooth and nail to keep raking in the moolah.

Yes, I think some kind of technology that explicitly targets/disrupts the way lobbying works would be huge. I just don't think this is healthcare-specific unfortunately.

Let me pitch an idea that I've long been noodling on that I think gen AI finally enables -- automated healthcare patient billing support for individuals. In essence, when you get that bill in the mail, you can fight with the hospital to decrease it, fight with your insurer to cover more of it, or not pay it and fight with a debt collector down the line. Maybe there's an alternative world where an AI agent does this for you, helping you negotiate down your medical bills and in return taking some percentage cut of the savings? There have been businesses like this before but hit some issues with 1) cost of employing humans to fight these bills, 2) customer acquisitions costs, 3) heavy churn/non-recurring customer base which goes along with 2

Fully agree with the experience, but I don't understand this call to action from a logical point. If you build something to make this better for patients, then... you are the middleman. Sure you might start off with morally good ambitions, but your company has to turn profit to keep running, I feel like you end up in the classic "grow big enough to see yourself become the villain" situation.

The fundamental problem is that the facilitator cannot be a for-profit entity, which is why universal healthcare in other countries are run by the government.

SO I am not totally against Universal healthcare idea Heck, anytihng will be worth tyring compared to what we do today. But US is a very large country and we already have Medicare program which is full or fraud and abuse and pork. I am not one of those "GOvt is bad in everything" but I am suspicious of Govt. being able to run most things efficiently.

I personally think if you calculate the cost of healthcare paid by an individual/family to Insurance companies and take most of that way by getting rid of insurance in EVERYTHING, even paying out of pocket for most visits will be cheaper overall. Keep Insurance only for catastrophic stuff like a major illness, accident, surgery, cancer etc.

A good compromise/balance would be "get rid of insurance premiums/deductibles/copays for general stuff" and let people pay out of pocket. Govt can subsidize those who cannot afford even the lower out of pocket costs (may be baswed on income etc).

I'm also interested in this one, though I lack specific experience in the healthcare industry to understand the problems.

Does anyone have good resources to understanding the bloat of the industry as well as the regulatory constraints? I realize that the complexity here is almost infinite, but I do think you can potentially find inroads and compete along those.

I also don't think being a more efficient "middleman" is a bad thing. There are always going to be providers of services that are incentivized by making money. The key in my mind is to keep it in a respectable/realistic place for customers, as well as eliminate toil/confusion. It feels like you could get both outcomes and also align for better patient care/experience. For example everyone loves Costco, yet they still are a "middleman" between you and the goods you want.

This is called a robo lawyer, there was an YC startup (whose name I don't remember any more) who tried this and basically had to shut down for obvious reasons.

Companies don't want poor people to have easy access to this stuff.

> SO I am not totally against Universal healthcare idea Heck, anytihng will be worth tyring compared to what we do today. But US is a very large country and we already have Medicare program which is full or fraud and abuse and pork. I am not one of those "GOvt is bad in everything" but I am suspicious of Govt. being able to run most things efficiently.

US Health care is so massively inefficient (results per dollar per capita) that this reluctance to switch to single payer like the rest of the developed world is a level of cognitive dissonance that continues to flabbergast me.