YC: Requests for Startups

ELIMINATING MIDDLEMEN IN HEALTHCARE

by creating another middleman in healthcare. This was first proposed by Jim Clark's Healtheon. "We want to empower the doctors and the patients and get all the other assholes out of the way." … "Except for us. One asshole in the middle." — The New New Thing, Michael Lewis.

The reason we spend so much is that public healthcare is a public good and private companies aren't good at managing public goods. They're good at making money which is a different purpose (which has probably served most people reading this very well). We need Single Payer. Indeed we have Single Payer in Medicare and TriCare and other areas. It works pretty well. We need to eliminate middlemen in healthcare by actually eliminating rent seeking middlemen in healthcare.

Yeah, this one is weird, the middlemen are there because we allow rent-seeking behaviour whether by insurance companies, complex corporate structures that have taken over practices, PBMs, etc. etc. Those aren't going away if we make things "more efficient" with technology, there is too much money to be made in the inefficiencies.

There’s only one way to ‘eliminate the middle man’, and that’s universal health care

So there are no middle(people) in Medicare? Or the defense industry? Single payer may just as likely future calcify the structures.

Healthcare is not a public good. It is both excludable and rivalrous. In fact, it is the exact opposite of a public good.

https://en.wikipedia.org/wiki/Public_good_(economics)

Single Payer would go a long way towards making our healthcare system non-excludable and non-rivalrous. What we have, the MIDDLEMEN which the post complains about, are rent seekers.

No it wouldn’t. That makes no sense. You have no idea what “excludable” and “rivalrous” mean. Please read a few Wikipedia articles.

>The reason we spend so much is that public healthcare is ... We need Single Payer.

Lots of countries do not have single payer healthcare, and have an insurance system that resembles America's, yet they don't have America's ridiculous prices.

> So there are no middle(people) in Medicare? Or the defense industry?

Sooooo close to getting it.

I checked out "How does Medicare work?" [1] and, wow, that's so much more complicated than healthcare in Canada. A big part of the problem is that Medicare has to work within the current broken structure of the US health care system and pay those same middlemen.

> Single payer may just as likely future calcif[ied] the structures.

But what the US has is so much worse than the how the rest of the developed world has "calcify the structures".

[1] https://www.medicare.gov/basics/get-started-with-medicare/me...

The healthcare industry will never be "revolutionized" by just a few million dollars in venture funding. The core revenue backbone of healthcare is not healthcare itself, but rather "bureaucracy as a service." A true revolution in healthcare would involve a brutally simplified exposure of costs and impact, divided between each individual element and organization in the invoice.

No country in the world can address this without a government organization. You start by telling patients where their money goes in a transparent way and which organizations benefit from it. That is it.

The problem is the trust aspect of this level of transparency. There is so much money (large insurance and healthcare groups) and chaos (biotech stocks), making it extremely difficult for businesses to be reliable to individuals as a business. To run a business, you need money, and to operate a business like this, you need an unconditional amount of money for the long term. VCs can take care of the unconditional giving of money, but they are never long-term. They will badger the investee to join the darkside of healthcare because they need an answer in 5 years of series A whether the startup is going to be a unicorn or not.

Good to know.

It does sound strange to me. Other countries have much lower healthcare costs per capita than the US. They achieved that without any need for groundbreaking VC-funded startups. Perhaps there are some lower-hanging fruits here.

The US has a lot higher labor costs than nost other countries and healthcare is labor intensive, per capita costs should be higher ib the US.

OTOH, US costs are higher than that would explain, much higher than most other countries on a share of GDP basis even. So, yeah, there's some low hanging fruit, much of it in public policy around healthcare financing.

Maybe you can rephrase in a way us peasants understand your point as well without a dictionary?

> Lots of countries do not have single payer healthcare, and have an insurance system that resembles America's,

No, they don't, beyond “private insurance exists”. The US has the largest share of the population uncovered by health insurance in the OECD besides Mexico, and that's after improving considerably because of the ACA.

Excludable = you can exclude people from benefiting from it. (E.g., Fixing global warming is not excludable while temperature control in your own house is.)

Rivalrous = more people getting it leads to less for others. (E.g., Software is not rivalrous, but hardware is.)

>No, they don't, beyond “private insurance exists”.

Yes, they do. Here in Japan, everyone is covered by either government insurance, or private insurance that's partially paid by their employer. Sound familiar? Germany's system is similar. These are not single-payer systems.

I wanted a rephrased statement, not a dictionary extract. Because I still have no clue what your piont is.

My point is just that the words this guy is using have commonly-accepted meanings and he’s using them wrong.