YC: Requests for Startups

I spent a great while inside of medical during the pandemic and it was… interesting.

There are some incredibly large interests in the space that wield intense power and control over various markets. There is also a profound degree of inefficiency in a lot of what’s happening.

The question is whether many of those inefficiencies are technology problems or if they are intentionally constructed for the many reasons these things are created.

I feel like there needs to be almost a Walmart size company pushing down on prices with that kind of scale before many of these structures will be broken, and unfortunately that doesn’t appear to be the direction most things are going (oh they exist in scale, just not direction). I was hoping Amazon’s entry into the market would do it. It didn’t.

Might be time for a different direction in health care entirely. Kaiser had it right, but I don’t think they executed well and they are largely a company rooted in past thinking in how they are structured.

Combining health care and subscription with ongoing medical care is definitely the direction of things to come. The fundamental shift needs to be moving the system from fixing problems to keeping people actually healthy, and that means that healthy people need to pay for the system or the entire thing gets it’s incentives inverted (as it is now). This is a fundamental shift, but if it were done right it would be a massive company and really change the world. I’ve been looking in to how to build this over the last year and know I want to go in this direction.

And there is also a ton of interesting businesses in generics.

Just some thoughts from someone who has been in many aspects of the medical industry over my career. Hope it inspires some good discussion with my favorite community.

In many parts of the US, you can only construct a hospital if the other hospitals in the area agree that yes, the area could use another hospital. Imagine how easy it would be to get them to agree to let you open your hospital if they know you are a huge company trying to undercut them in price, through any technological or organizational edge.

Basically every healthcare reform would be positive, either towards single payer or towards markets, as the current equilibrium is just optimizing extraction. See how the ACA, which was attempting to let insurers force prices of medical services down, led to hospitals buying out massive amounts of private practices, as it's easy to bully 5 doctors, but not a hospital system that is at the same time negotiating for a lot of primary care, specialists, and ar least a third of hospital capacity in the city.

This is precisely it. This is how you end up with this colossally large ecosystem where things like surgery centers proliferate — with every specialist operating as an outside extension or even an inside extension and costs skyrocket for customers because you just have some many people involved in the chain of care. To boot, a lot of these networks operate their partner organizations through backend ownership groups.

Obamacare tried to fix this by making the entire chain of care responsible for patient satisfaction and outcome and making rate payment contingent, but it really ended up consolidating so much of the industry into integrated and profit maximized network-of-relationships so that the downside can be managed (and the backend financing consolidated similarly, though in many different ways). All of them, to your point, really optimized for extraction.

I spent some time looking into generic drugs and compounding operations as well and we really don’t have many left in the West. It’s concerning. No money left for the basics and the system isn’t very robustly built for basic operations (read the boring, lower paying part of medicine that keeps us all alive every day).

I can’t edit. Let’s ask this: what does the rebel’s guide to medical care look like?