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Comment by ChuckMcM | Hacker News Reader

These are questions that are worth delving into more deeply. In my brief period at IBM I was adjacent to the Watson Health folks and the challenge, to my unsophisticated eye, was greed. Basically the "Health Care System" in the US appears to be completely corrupt[1]. Thus any proposed change the is presented based on how it will "Improve the system" is immediately suspect by those for whom the unimproved system is paying them a hefty paycheck. In the two (and be aware there were thousands so this is an anecodtal sized sample set) engagements I had visibility into with Watson Health teams, the one that went in with "This will improve patient outcomes" got shut out, and the one that went in with "This will increase your net margins" was welcomed with open arms.

I'm not sure how one unties that particular knot.

[1] Corruption here being that the primary mission is the collection of monies and health outcomes are a tolerated side effect of that.

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> Thus any proposed change the is presented based on how it will "Improve the system" is immediately suspect by those for whom the unimproved system is paying them a hefty paycheck

Sadly, my observation is that this is the rule (and not the exception) in many industries.

In my view it's not a problem specific to any industry or domain, but a fundamental problem of social organizations: the clash between individual (employee) interests and organization interests.

This also seems to be the problem of government.

Government is an organization

The interests of the state and its citizens do not always align.

When I tell my wife about something like this conversation goes something like ... Wife: Why would they do something like that Me: You know why Wife (sheepishly): Money Me: ding, ding, ding

"It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones."

From _The Prince_ by Machiavelli

A classic quote that everyone should keep in mind.

This is why the industry is gradually shifting from a fee-for-service model to a value-based care model. It doesn't make sense to pay providers for performing procedures. Instead they need to bear some financial risk and focus on producing positive outcomes.

The long term trend is towards consolidation into combined payer + provider organizations like Kaiser Permanente. All the large medical insurers are hiring or acquiring more doctors to bring member care in house and better align the financial incentives.

Outcomes are tied to margins in the end anyway. This was part of the ACA for improving readmission rates. Vertical integration works as well if you look at a place like Kaiser as well does that.

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