The US spent $2 Trillion dollars on Medicare and Medicaid in 2024 [1][2]. If the US spent this money as efficiently as Japan (or UK [3], ...) it could pay for Healthcare for every single resident with this $2 Trillion dollars.
America’s decision to make healthcare a for profit industry is the root of all of this.
The obvious points are medicines and equipment. To some degree, these are actually the most justifiable parts of the industry that should be for profit.
The parts that are far less justified:
- The insurance industry surrounding healthcare. Obamacare brought in some regulation that drastically slowed the growth of healthcare costs.
- The education industry surrounding healthcare. Becoming a doctor in the U.S. is incredibly expensive. You rack up massive loans, you’re racking up interest on those loans for years, well into your late 20s (including the loans you racked up for your undergrad), and then you’re spending the first decade of your career all the way to the late 30s, just paying those loans back. You’re one of the most sought after professional in the world and yet it takes you until your late 30s to basically break even. The upshot of that is you charge a ton not just to pay back your loans but to justify spending so much time and energy on a career that means you start being money positive for the first time in your late 30s.
- Insurance. The American legal system that does not place any penalty on frivolous lawsuits essentially inserts a significant cost due to bad actors on everyone. Personally, I’m not clear on what this cost actually is and how significant it is, but if you talk to doctors and hospital administrators, they seem to believe it’s incredibly high.
- Hospitals being for profit. I actually think for profit hospitals are more efficient than non profit ones, but the problem here is what they prioritize. A non profit hospital system may prioritize family care and regular checkups to keep people healthy and prevent them from falling sick in the first place. A for profit hospital probably prioritizes surgeries and elaborate procedures that make a lot of money. And that’s before we get to spending on customer acquisition, either due to fancy buildings etc or just straight up advertisement and marketing.
The Seven-Times Markup: The Johns Hopkins study analyzed the nation's top 100 hospitals by revenue and found that their "chargemaster" prices (the initial sticker price) averaged 700% of the actual cost of providing the service.
We could end the Triffin dilemma by no longer maintaining the dollar as the unit of international reserve. This would eliminate the biggest driver of the trade deficit and via a reversing of the Baumol effect, lower the price of health care and education.
The only problem? No one has the political will to do it.
> Someone is charging way too much for goods and services
It's more money chasing meager supply. They're charging market rates. However when the market is distorted through the described arrangement, it's clear what has to change - the structure of international finance.
Americans are getting actual products and services in return for depreciating IOUs.
It’s like a loan where the lender pays interest.
Why would anyone be against that?
Note: This is different from the strategic interest in maintaining domestic industries. That’s very defensible. But I don’t understand the fear of a trade deficit denominated in your own currency (other countries have bigger genuine concerns with a dollar denominated trade deficit, because if their currency falls against the dollar suddenly, they’re kind of screwed, at least in the short term).
IMO, there's an interesting opportunity for AI to make healthcare deflationary.
For example, Medicare is launching a new program in July that pays a fixed rate for achieving defined outcomes, like lowering blood pressure or cholesterol. Medicare's explicit goal here is to create incentives to automate the repetitive parts of care delivery with software. (Much of preventive cardiology is surprisingly algorithmic and guideline-driven, so this is more plausible than it seems.)
This reverses the incentives of the current system, where CPT codes incentivize doing more "stuff" (but not necesarily delivering the most effective care efficiently).
If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.
> IMO, there's an interesting opportunity for AI to make healthcare deflationary.
How many times have I heard this, about how many techs. But this time for real?
Health spending in the us is too tied up with the country’s economy for it to ever be reduced. Same goes for housing. The cost of both of these will continue to increase. As long as the investor class is satisfied, this is all that matters.
> Health spending in the us is too tied up with the country’s economy for it to ever be reduced. Same goes for housing
These are massively incomparable. Most householders live in homes they own. Those homes, moreover, are usually a substantial if not dominating fraction of their net worth. And they're leveraged. This produces a broad level of interest in maintaning or raising home prices.
Healthcare is more narrowly owned. It's not as leveraged. And very few housholds have a commanding fraction of their net worth in healthcare assets.
It is however a highly inelastic good and some of the most expensive care happens when the person who ends up paying isn’t in the state of mind to make decisions such as being unconscious for emergency care, or late in life when dealing with dementia and other diseases that rob you of your faculties. It’s primed to be able to extract everything because most people value being alive above everything else.
> the person who ends up paying isn’t in the state of mind to make decisions such as being unconscious for emergency care, or late in life when dealing with dementia and other diseases that rob you of your faculties
Most healthcare in America isn't paid for by the patient.
> If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.
do you have thoughts on what that looks like? what does the hiring landscape look like?
There is so much to be done and it is not going to be solved by any one thing. That in mind, something like an independent third party patient advocates / advisors would be great. It is hard to be an informed patient these days, Navigating insurance and paperwork is tough and getting second opinions is sometimes had.
Fascinating. I feel like smart person + data (context such as health records, labs, insurance docs, etc.) + LLM -> some helpful tips for navigating the process. However, evaluating the tips on whether they are helpful or not would be hard for a smart person without the expertise.
Or put another way - how does a smart lay person evaluate the independent advocates? Do incentives align?
Right now lots of good health companies hiring, including my own (Empirical). https://www.workatastartup.com/ lets you filter YC companies to see health startups, by stage and location (or remote).
"AI will solve this deeply rooted social problem" is, and forgive my bluntness, is one of the most idiotic AI opinions I've seen this week.
The only thing that will fix American healthcare is absolute abolishment of private insurance. That's it. No amount of gentle incentive tweaking or whizbang technology is going to solve the fundamental problem of human greed and immorality.
Allowing private health insurance to exist is inhumane and can only result in profit extraction and exploitation of the most vulnerable members of society whose only options are literally to pay up or die.
That's the break. We've allowed profit-seeking individuals to stand in between citizens and literal life saving medicine. And you think the solution to that is to add more middlemen and profiteering exploitative corporations. Utter insanity.
The solution is to make it illegal for anyone to say "no, you may not have this life saving medication or proceedure". The solution is to remove profit from medicine. To allow profiteering and gatekeeping of people's very lives is immoral in the extreme. Giving more private corporations more influence is insanity. The solution is less private influence of medicine, not more.
How exactly do you propose to "remove profit from medicine?" If someone wants to have a procedure done and their insurance doesn't want to pay, they can still pay the doctor to get it done themselves. And it will still be very expensive because doctors in the US are used to charging very high salaries and using medical equipment and medicines that cost a lot of money. Insurance companies are required by law to use 80 percent of their income to pay claims out to their customers already. Medicine costs a lot.
The insurance companies should allow for dental or medical tourism. Let’s put the people who haven’t had to compete globally get a chance to. If you have enough money you can do it yourself but that doesn’t help poor folks
Even if you eliminate private insurance, the amount of money that the country is willing to spend on medicine is finite. Someone is still making the decisions of what they'll pay for and what they won't. The difference is that it would be a faceless government bureaucrat instead of a faceless private insurance bureaucrat.
How much of that spending is continuously treating symptoms vs. finding and curing root causes? At what point do the pentagon and other agencies step in and treat this like an unsustainable existential threat to the country?
The US spent $2 Trillion dollars on Medicare and Medicaid in 2024 [1][2]. If the US spent this money as efficiently as Japan (or UK [3], ...) it could pay for Healthcare for every single resident with this $2 Trillion dollars.
[1] https://www.kff.org/medicaid/medicaid-financing-the-basics/#...
[2] https://usafacts.org/answers/how-much-does-medicare-cost-the...
[3] https://www.bbc.com/news/articles/cwy7zvp5xrqo
America’s decision to make healthcare a for profit industry is the root of all of this.
The obvious points are medicines and equipment. To some degree, these are actually the most justifiable parts of the industry that should be for profit.
The parts that are far less justified: - The insurance industry surrounding healthcare. Obamacare brought in some regulation that drastically slowed the growth of healthcare costs. - The education industry surrounding healthcare. Becoming a doctor in the U.S. is incredibly expensive. You rack up massive loans, you’re racking up interest on those loans for years, well into your late 20s (including the loans you racked up for your undergrad), and then you’re spending the first decade of your career all the way to the late 30s, just paying those loans back. You’re one of the most sought after professional in the world and yet it takes you until your late 30s to basically break even. The upshot of that is you charge a ton not just to pay back your loans but to justify spending so much time and energy on a career that means you start being money positive for the first time in your late 30s. - Insurance. The American legal system that does not place any penalty on frivolous lawsuits essentially inserts a significant cost due to bad actors on everyone. Personally, I’m not clear on what this cost actually is and how significant it is, but if you talk to doctors and hospital administrators, they seem to believe it’s incredibly high. - Hospitals being for profit. I actually think for profit hospitals are more efficient than non profit ones, but the problem here is what they prioritize. A non profit hospital system may prioritize family care and regular checkups to keep people healthy and prevent them from falling sick in the first place. A for profit hospital probably prioritizes surgeries and elaborate procedures that make a lot of money. And that’s before we get to spending on customer acquisition, either due to fancy buildings etc or just straight up advertisement and marketing.
$16,500 per person is insane. Someone is charging way too much for goods and services, and someone is paying it with no questions asked.
The Seven-Times Markup: The Johns Hopkins study analyzed the nation's top 100 hospitals by revenue and found that their "chargemaster" prices (the initial sticker price) averaged 700% of the actual cost of providing the service.
https://www.beckershospitalreview.com/finance/top-100-us-hos...
We could end the Triffin dilemma by no longer maintaining the dollar as the unit of international reserve. This would eliminate the biggest driver of the trade deficit and via a reversing of the Baumol effect, lower the price of health care and education.
The only problem? No one has the political will to do it.
> Someone is charging way too much for goods and services
It's more money chasing meager supply. They're charging market rates. However when the market is distorted through the described arrangement, it's clear what has to change - the structure of international finance.
What’s the problem with the trade deficit?
Americans are getting actual products and services in return for depreciating IOUs.
It’s like a loan where the lender pays interest.
Why would anyone be against that?
Note: This is different from the strategic interest in maintaining domestic industries. That’s very defensible. But I don’t understand the fear of a trade deficit denominated in your own currency (other countries have bigger genuine concerns with a dollar denominated trade deficit, because if their currency falls against the dollar suddenly, they’re kind of screwed, at least in the short term).
IMO, there's an interesting opportunity for AI to make healthcare deflationary.
For example, Medicare is launching a new program in July that pays a fixed rate for achieving defined outcomes, like lowering blood pressure or cholesterol. Medicare's explicit goal here is to create incentives to automate the repetitive parts of care delivery with software. (Much of preventive cardiology is surprisingly algorithmic and guideline-driven, so this is more plausible than it seems.)
This reverses the incentives of the current system, where CPT codes incentivize doing more "stuff" (but not necesarily delivering the most effective care efficiently).
If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.
> IMO, there's an interesting opportunity for AI to make healthcare deflationary.
How many times have I heard this, about how many techs. But this time for real?
Health spending in the us is too tied up with the country’s economy for it to ever be reduced. Same goes for housing. The cost of both of these will continue to increase. As long as the investor class is satisfied, this is all that matters.
> Health spending in the us is too tied up with the country’s economy for it to ever be reduced. Same goes for housing
These are massively incomparable. Most householders live in homes they own. Those homes, moreover, are usually a substantial if not dominating fraction of their net worth. And they're leveraged. This produces a broad level of interest in maintaning or raising home prices.
Healthcare is more narrowly owned. It's not as leveraged. And very few housholds have a commanding fraction of their net worth in healthcare assets.
It is however a highly inelastic good and some of the most expensive care happens when the person who ends up paying isn’t in the state of mind to make decisions such as being unconscious for emergency care, or late in life when dealing with dementia and other diseases that rob you of your faculties. It’s primed to be able to extract everything because most people value being alive above everything else.
> the person who ends up paying isn’t in the state of mind to make decisions such as being unconscious for emergency care, or late in life when dealing with dementia and other diseases that rob you of your faculties
Most healthcare in America isn't paid for by the patient.
Ultimately, but it’s charged to the patient who then has it paid by whatever mechanism (insurance/medicare/medicaid/family/etc)
[dead]
> If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.
do you have thoughts on what that looks like? what does the hiring landscape look like?
do you have thoughts on what that looks like?
There is so much to be done and it is not going to be solved by any one thing. That in mind, something like an independent third party patient advocates / advisors would be great. It is hard to be an informed patient these days, Navigating insurance and paperwork is tough and getting second opinions is sometimes had.
Fascinating. I feel like smart person + data (context such as health records, labs, insurance docs, etc.) + LLM -> some helpful tips for navigating the process. However, evaluating the tips on whether they are helpful or not would be hard for a smart person without the expertise.
Or put another way - how does a smart lay person evaluate the independent advocates? Do incentives align?
Right now lots of good health companies hiring, including my own (Empirical). https://www.workatastartup.com/ lets you filter YC companies to see health startups, by stage and location (or remote).
Any advice for a senior/staff level FAANG dev working in ML tooling but not in the health space interested in this kinda stuff?
What are good things to read, etc?
It depends on who’s using it, and I’d say the doctors can use it more intelligently than the patients.
"AI will solve this deeply rooted social problem" is, and forgive my bluntness, is one of the most idiotic AI opinions I've seen this week.
The only thing that will fix American healthcare is absolute abolishment of private insurance. That's it. No amount of gentle incentive tweaking or whizbang technology is going to solve the fundamental problem of human greed and immorality.
Allowing private health insurance to exist is inhumane and can only result in profit extraction and exploitation of the most vulnerable members of society whose only options are literally to pay up or die.
That's the break. We've allowed profit-seeking individuals to stand in between citizens and literal life saving medicine. And you think the solution to that is to add more middlemen and profiteering exploitative corporations. Utter insanity.
The solution is to make it illegal for anyone to say "no, you may not have this life saving medication or proceedure". The solution is to remove profit from medicine. To allow profiteering and gatekeeping of people's very lives is immoral in the extreme. Giving more private corporations more influence is insanity. The solution is less private influence of medicine, not more.
How exactly do you propose to "remove profit from medicine?" If someone wants to have a procedure done and their insurance doesn't want to pay, they can still pay the doctor to get it done themselves. And it will still be very expensive because doctors in the US are used to charging very high salaries and using medical equipment and medicines that cost a lot of money. Insurance companies are required by law to use 80 percent of their income to pay claims out to their customers already. Medicine costs a lot.
The insurance companies should allow for dental or medical tourism. Let’s put the people who haven’t had to compete globally get a chance to. If you have enough money you can do it yourself but that doesn’t help poor folks
Even if you eliminate private insurance, the amount of money that the country is willing to spend on medicine is finite. Someone is still making the decisions of what they'll pay for and what they won't. The difference is that it would be a faceless government bureaucrat instead of a faceless private insurance bureaucrat.
Would that make it better, or worse? And why?
The plan to extract as much wealth as possible out of families with members near end of life is showing excellent results.
How much of that spending is continuously treating symptoms vs. finding and curing root causes? At what point do the pentagon and other agencies step in and treat this like an unsustainable existential threat to the country?
Never going to happen. Look how people freaked when politely asked to wear a mask.
Surprised a healthcare CEO hasn't tried to bribe the gov to just let them be the only game in town.
Aren't they about the only game in town?
Paywalled.