Comment by codegeek | Hacker News Reader

Comment by codegeek | Hacker News Reader

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In the US, I will start a company that would partner with Doctors/Clinics/Hospitals where they would agree to transparent pricing for simple and routine services (like wellness checkup, simple procedure etc.). In return, the consumers will purchase a service from us (sort of insurance but I hate that word) for a much lower premium/fee per year (say something like 500 a year) where they pay the routine services out of pocket but we cover them for major procedures or catastrophic stuff (like cancer treatment). Each Participating doctor/clinic/hospital gets a cut of the premium that the consumer pays us.

This creates a win-win for all 3 parties. Consumers don't have to pay crazy health insurance premiums (which can be 15K easily for a family of 4 per year), pricing is transparent and even though they pay out of pocket for general services, the total they will spend per year will be MUCH less than average insurance premiums we pay today in the United States. Not to mention that insurance companies don't get to butt in every decision about which service should have been covered and which one not. Doctor gives a bill, patient pays it and all done. Probably will put some medical billing companies out of business too ? Doctors/clinics/hospitals get a cut of the premium from every consumer who participates effectively creating a huge pool/network.

Bonus feature: Our company will create a centralized platform where consumers can login and see their doctor visits and billing all in one place. No more individual health insurance websites or doctor billing websites. I can get a simple statement at the end of the year even if I visited 20 different doctors.

How we make money though with those lower yearly premiums will be a challenge. Btw, this was just a joke and a wishlist. I wish someone would do this.

That’s what “insurance” actually is— protection against unforeseen financial loses. The current idea of “insurance” is more of a health plan than a financial protection scheme.

Car insurance doesn’t pay oil changes because that’s a normal part of owning a car and thus should be budgeted for, but a crash isn’t — this insurance exists to make someone whole after a covered loss.

There's a really great writeup on this in "catastrophic care", a book I'd recommend on this topic.

Rather than "insurance", a better model is that "you'll need to spend a lot with p approaching 1, for some years of your life". So allocating each person a lifetime fixed pool of money (through the tax system) might be a good way to force some cost discipline onto the system, while still ensuring coverage and access are widespread.

What I like about this is that it makes explicit, society's commitment to sharing some of the burden of care. I have a close friend whose wife has Crohn's. It's a real bitch of a disease, essentially no known cure, chronic, you just try to get it "managed" as well as possible. We could probably spend an infinite amount of money trying to improve her quality of life, but that's not fair to society at large. So if we said, here, you get $x, that would encourage the medical system to provide cost-effective management options that would be within some bounded price range everyone agrees would be reasonable.

I think there's a real reluctance to put a precise dollar figure on how far we'll go per person toward "universal coverage of everything", but that's precisely the conversation we need to be having.

'I think there's a real reluctance to put a precise dollar figure on how far we'll go per person toward "universal coverage of everything", but that's precisely the conversation we need to be having.'

This is only a thing in the US.

In the countries with sane public health systems, they have zero problem saying "Look, we've got this much money to spend, we think this way of spending it gets the most bang (roughly speaking, QALY's) for buck, so if you want more coverage hit up the private insurance market" [1].

And you know what, those private insurance markets work great because they actually have to provide meaningful value beyond the public system in order for consumers to bother using them.

As a vaguely relevant side note: Goddam it's difficult for me not to get angry about the diabolical state of the health system in the US and I don't even live there. There should be marches on the streets about this. You could radically improve the lives of the vast majority of 300 million people without spending an extra cent of government money on health if you just stopped being so goddam dumb about it [2].

[1] For instance, here is the website of the public pharmaceutical supplier in my country-- NZ-- who've hired lots of phys and maths grads I know: https://www.pharmac.govt.nz/about/your-guide-to-pharmac/fact....

[2] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

When Obamacare was being debated, the UK was accused of having "death panels", which were basically this: deciding that it was uneconomical to provide certain types of care to certain types of patients where the QALYs achieved would be minimal and excessively expensive.

But that is "communist" and so Americans as a whole could never agree to it. They'd rather squeeze every last day out of someone rich, even with a low or negative quality of life impact, and let the poor die early.

I don't live there and it makes me mad too. It fails the Rawlsian test of ethics (veil of ignorance), which I think is a good way to decide on political issues.

Is this legal in the US anymore? What you're describing in practice isn't so dissimilar from a high-deductible catastrophic insurance plan. I bought one for myself out of college, and it was--at the time--both affordable and helpful. I haven't seen anything like it in practice in years. I'd heard that the ACA effectively phased them out.

How about instead a software system to manage all billing for a hospital owned/ran insurance scheme.

People signup for their favorite hospital. The hospital gets MRR. You set your primary care physician and other providers. They get MRR too per patient who's picked them.

Patient pays 4-6% of their monthly income for insurance.

When patient travels, their local hospital foots the bills. Hopefully this goes national and it lowers costs -- hospitals would negotiate with each other for lower costs instead of insurance companies. They would also have a centralized uniform billing (the biz) that joins everything together and is the glue. As a result each hospital no longer needs medical billers.

Hospitals could join forces to also negotiate in bulk the price of prescription drugs and keep those costs down as well. Since it's income based everyone could afford it, so it's basically privatized universal healthcare.

Covering catastrophic care would probably end up killing this business..

There’s a doctor in my city that started his own practice with a monthly subscription fee and covering basic care.

http://journalstar.com/lifestyles/health-med-fit/health/linc...

wow, love this doctor. I wonder why this stuff is not on mainstream news more often. Yea profitability is the concern with catastrophic insurance. Perhaps Govt. can jump in for that one ? (hint: universal healthcare mixed with some capitalism ?)

I am working on a platform to keep your health proactive, tied to your current ins coverage. you will get notices re: needed checkups, shots, etc. - as if you had a private physician's assistant. It will est what is covered vs out of pocket, recommended vs strongly recommended, etc., and stats. The dashboard is very user friendly - you can keep it simple or load it up with widgets. Notifications etc.

Can't wait to share here in a 2-4 months.

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