Comment by snarf21 | Hacker News Reader

Comment by snarf21 | Hacker News Reader

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I agree with your comments about how EMRs are bought by executives not doctors. This is exactly the same as companies buying SAP and then everyone else is stuck implementing it for 2 years and then hates using it daily. I work in healthcare and have literally never met a single person who uses Epic not absolutely HATE it!

Healthcare can't be fixed with software or cloud providers. Healthcare is a problem of four groups with misaligned incentives. Any "solution" usually only considers one or two of these groups. The only way to solve healthcare in the US is to push regulations via CMS (Medicare). Medicare is such a huge piece of the pie that they drive the ship. Anything they mandate will move to commercial payors since they need to implement it everywhere anyway.

Healthcare is like homelessness. It is a political problem not a technical problem without solutions. We know what will fix it, we just don't have the will to do so.

I'm in healthcare software, worked for epic, and now am trying to solve part of the problem. If love to learn more about what you think are the 4 corners thar need to be solved.

The four groups are the payors, the health systems/providers, the employers and the patients(employees). It is almost impossible to balance four competing goals.

The solution is to make it fewer competing concerns. We need to make employer provided healthcare illegal (go back to pre WWII) and force competition on the open market. We can still have you buy your own with HSA pre-tax dollars. We need to move to reference based pricing. Payors can't charge more than 1.3 * Medicare. This also solves the "out of network" bullshit, it is all the same so just pay. We also need to separate wellness/preventative from "health insurance". The one you know you will and should perform annually and the other is against catastrophe. Unfortunately, today we treat them as the same thing. I don't think a Medicare for all works but I do think it might work if it was for primary care only. Specialty care and Urgent/Emergency care could be handle by private payors.

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