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Comment by wantsanagent | Hacker News Reader

I've encountered this in the Pittsburgh area with AHN. Trying to get a provider results in printed lists of outdated numbers, practices not accepting patients, etc.

Frankly I think we need to start breaking laws. A startup needs to offer straight up good care and fuck the web of infinite regulations which support America's for profit health failure.

Doctors can lose their licenses pretty easily so it's going to have to be a straight tech play. Offer as-good-as-possible care entirely outside of the medical profession. AIs are getting good enough that despite the obvious errors they make they are still better than the nothing-burger of care we get here.

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I don't see how the law is the problem here. The problem sounds like insurance companies that dodge their duties. We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down - which they are partly responsible for due to throwing up so many barriers for them to actually pay for anything.

Steelmanning the OP (which I’m not sure I agree with), it’s possible they are alluding to regulatory capture, implying the laws are crafted to benefit for-profit companies first and patients second.

However, I’m not sure going in the direction of less regulation would help. It’s like saying “The for-profit healthcare companies have too much power, so let’s just give them more power.”

It's not so much a capture as a hodgepodge. There are a great many interests, and even in a good faith environment it would be a challenge to get everything right.

Add to that the fact that it's not a good faith environment. There are many forces, not even connected to the industry, who fight to lower prices at any cost. Even if it means finding out too late that you're not actually buying anything at all.

The laws and regulatory environment are "the best compromise people were able to get at the time" rather than any kind of cogent plan.

> We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down

These two statements are at odds with each other.

> responsible for due to throwing up so many barriers

To me, it's obviously lack of competition that's the problem, you don't want to punish crappy providers, you want to subsidize new ones so the market is flooded with options.

Which can be done right after we solve the monopolization problem in health care service providers, medical equipment providers, and "pharmacy benefit managers."

My dream project is a non-profit smart-contract based insurance system: with double blind analysis of claims by doctors who have nothing to win from approving/rejecting a specific claim, a system were there is no asshole middleman insurance racket company.

I know this tech is disliked in HN, but I am positive that it is possible build something like that, due to the "trustlessness" capabilities.

It's not like starting up a food truck. A health care operation is vast, and no existing providers are going to break the law and risk losing their licences.

You would need to create an entire parallel network. It would cost tens of billions, possibly hundreds.

> offer straight up good care and fuck the web of infinite regulations which support America's for profit health failur

they'd get immediately sued out of existence by the large vested interests

> Frankly I think we need to start breaking laws.

Who's stopping you? I don't pay my medical bills by default, unless it's my dentist or my primary care provider.

Everyone else can go to hell until the system breaks.

Most large systems can absorb a certain level of free-loaders and remain stable by shifting that burden to other people. What you’re advocating is a collective action problem and will just make matters worse for everyone else. Unless you have a way to create a critical mass of similar behavior, it’s tantamount to a selfish action that benefits you to the expense of others.

Unless the system gets worse, there will never be enough willpower to change it for the better.

As it stands, the system is already awful for the majority of people, with outcomes like this that become commonplace.

> it’s tantamount to a selfish action that benefits you to the expense of others.

Not unlike having great insurance paid for by your company, while others (just at the cutoff of govt subsidy for the plan) suffer the most and have to pay thousands of dollars for routine care.

It's the ultimate "fuck you got mine", only applied to something that most people can't live without. And while "fuck you got mine" is okay in the context of luxury items, it is not in the case of medicine/housing/food.

So maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment. But again, keeping the status quo is just letting the wound fester at this point.

>maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment.

The point was that your approach won’t change the status quo, just makes it a little more expensive for everyone else.

I'm all ears for an alternate approach that:

1. Changes the status quo

2. Provides more health care to more people at lower costs (this requires health insurance folks to lose their jobs en masse. Sorry not sorry kind of a thing)

3. Is politically tenable to be enacted within the current generation (e.g. in time for Millenials to benefit from it in retirement)

Me too, I just don’t think what you suggested is it (or a net positive for anyone but yourself).

My current preference is to 1) start with covering veterans completely at the VA and 2) have Medicare for all phased in over decades by gradually lowering the qualifying age. The first is generally politically feasible and will help identify appropriate problems of scale and the second is slow enough to allow the system to adapt but also help the current generation of younger workers by the time they tend to need more healthcare

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