Update: we just deployed a fix for this, thanks for reporting! (We recently enabled Cloudflare caching which exposed a pre-existing CSRF issue, now fixed)
1,798 karma · joined September 26, 2008
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ex-Ridejoy (YC S11), a community marketplace for sharing rides.
"A review across 23 LMICs found that low-complexity surgeries (e.g., appendectomy, hernia repair) cost only about ~$17 per DALY, whereas even complex procedures were often cost-effective" (Most surgeries on Watsi are low-complexity)
"Reports from the WHO and Lancet Commission consistently emphasize that investing in surgical capacity has high value, in many cases, more than essential drugs or vaccines on a per-DALY basis"
Both quotes from: https://link.springer.com/article/10.1186/s12893-025-03204-0
If you'd like to see an example of what Watsi's about, check out Philip's profile: https://watsi.org/profile/2286cb03a5bd-philip
Also, fun fact: 619 of our current "Universal Fund" monthly donors first made a donation 10 or more years ago, and I'm pretty sure many of those were/are Hacker News readers.
If you're interested, see https://watsi.org/universal-fund
For anyone starting a mission-driven company, there's not really any practical downside to incorporating as a PBC, though it's still relatively new and untested. It's much less effort than becoming a B Corp, which you can choose to do afterward.
I see some confusion on terms--
PBC: legal corporate structure in 25+ states and growing, but still uncommon
B Corp: a more widely known certification from B Lab
You can be a PBC without being a B Corp but all B Corps need to become PBCs by a certain year iirc
(We incorporated Nava PBC as the first, and I think only, government contractor that's also a PBC.)
We went with Captain401 (a YC startup) because we needed a fast turnaround and they had amazing service. Too early to render judgement otherwise. OctaveWealth is another seemingly competent YC 401k startup. If you're not in a rush and don't want to trust a startup with your company's 401k plan (though assets are safe regardless), Vanguard is great, and would have been our backup option.
They obviously don't offer identical functionality, but they're getting more similar now so this is a comparison of where they overlap.
Customer support: Both Zenefits and Zenpayroll are very responsive, but Zenefits provides significantly less helpful responses, the kind you'd expect from first-level big-corporation support. Zenpayroll is much better on this front.
Software: Zenefits is clearly not a startup driven by product or engineering. It's fine given it's free, but still has tons of rough edges and bugs everywhere (e.g. it's easy to click submit twice all over the site and create duplicate entries.) I know it's better than the incumbents, but Zenpayroll has a far better product and it really shows even in basic usage-- it's kind of amazing this level of quality now exists for payroll.
Health insurance: If you have an extremely simple situation and are a startup in CA, Zenefits is probably fine. We have about a dozen employees based in DC, SF, and NYC. Instead of telling us to go elsewhere, Zenefits spent two months and dozens of hours/email threads/phone calls making slow "progress", telling me information that ended up being inaccurate, omitting critical information, replying to one out of every three questions, saying repeatedly it would get done, and finally telling me they just couldn't do it.
The Zenefits rep could not have been worse-- if he'd been actively hostile or more clearly ignorant, that would have been better since we would have short-circuited sooner. (Yes, I did complain about the rep... they routed me right back to him on the same call.) Afterward, I called Zenpayroll and their rep was super knowledgeable and set expectations clearly. It was night and day. We also tried talking to Zenefits' partner Ubiquity for a 401k, and had a negative experience there as well.
We've now heard many, many versions of our story above. I wish Zenefits all the best since they've made a lot of startup founders' lives easier (including ours, for new hire onboarding), but boy do they have scaling issues... all I'm saying is, if you have the option of both Zenefits and Gusto for a particular service, 100% go with Gusto.
Piling on: If you're interested in being an early employee at a growth startup working with the government, check out Nava! (I work for Nava)
Our hiring post: https://news.ycombinator.com/item?id=10001189
I'm part of a small team of engineers from Silicon Valley that came out to DC last year to help fix Healthcare.gov. It turns out there’s a lot more to fix. And it’s surprising how much can be fixed by a small group of resourceful people with a Silicon Valley mindset, deep technical experience, and the willingness to work closely with dedicated civil servants in government.
Our revamped Healthcare.gov application has been used by millions, converts 35% better, and halves the completion time. The login system we rebuilt is about two orders of magnitude more reliable and two orders of magnitude less expensive; for example, it’s about $70M less per year to operate. We’re just getting started, and we’ve started Nava to help fix everything else. [0]
People die because the Veteran's Administration is months behind in processing claims. The Social Security Administration pays benefits to millions of deceased Americans. $80 billion is spent every year on federal IT contracting, and 96% of projects are deemed failures [1].
That’s not because there’s some conspiracy or because government is inherently incapable of doing it right. These are complicated legacy systems and processes, and there are very few people with modern tech industry experience who are aware of these problems and willing to help fix them. You can help change that.
Our team is 10 people (Stanford, Google, YC alums), and we plan to bring on a few people every month through 2015.
We’re looking for: - experienced full-stack engineers - experienced devops engineers - a product manager with a technical background - a hyper-resourceful operations person
We have a social mission (we just incorporated as a public benefit corporation (PBC) this week), but we pay market compensation (above market, for DC) and equity (above market).
If you'd like to build software and infrastructure that radically improves how our government serves people, we’d love to hear from you at jobs@navahq.com.
*Not in DC / able to relocate, but intrigued and in SF? Talk to us.
[0] http://www.fastcodesign.com/3047856/innovation-by-design/mee...
[1] http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/22/t...
Based on my experience in the last year working on healthcare.gov etc., I think it's become increasingly clear that the implementation of well-meaning policies intended to separate the deserving from the undeserving ends up adding an incredible amount of complexity and overhead, along with unintentional side effects, edge cases, and bad incentives.
That said, there's no way politically a basic income is going to fly in the US anytime soon. So since this is HN... is there any way to get to an MVP without having a sovereign state to experiment with? Or is this solely in the realm of public policy?
(I asked this a while back on another BI thread, trying again)
PSA: I know it's not easy to tell from the outside, or from a website, but this is the real deal. Things are starting to change; by government standards, at ludicrous speed. The Healthcare.gov crisis really started a useful fire.
Todd Park, Mikey Dickerson, and the team he's building at USDS and the people he's placing into new "digital services" teams at other agencies like the VA-- if you meet them you'll quickly find out why they were superstars at their tech companies.
One important thing to understand is: yes, things really can be vastly improved IRL, not just in theory. It's not that government IT services ("IT") suck because the people responsible for it don't care. They're just in a completely different world, expectations and otherwise, and don't know how much better it could be.
E.g., they don't know there exists a hosting option that is more secure, more reliable, and less risky (and costs 90%/$90M less per year). Or that there exist software people who can build a far better user experience (#1: the worst UX is downtime, #2: product lead needs a) exist, and b) fight for the user on every decision), while still meeting all business requirements (for 80%/$20M less per year).
Some people do know, but they can't do it themselves [0], and they also don't have access to the right people to do it for them; their practical options are Lockheed Martin's "small-business" subsidiary, or ACRONYM's federal IT division.
USDS and 18F are fixing this, and much more. They need your help. I'm not sure what's public, but the progress is incredible. It's still going to take a long time. Most of all it's going to take more software engineers, designers, PMs, etc. The tech gap between Silicon Valley and DC is unbelievable until you've experienced it. Go east! (Or west [1])
It's definitely frustrating to work for/with the government (not sure how it compares to other institutions that provide many real-world services to a diverse 300+ million population), but if you're put in a position where you can actually change things, the impact is enormous. And now you can do that as a software engineer/technologist with no existing clue about government, because USDS/18F has leverage and the ability to place you where you can make that impact. [2]
The federal government deeply impacts all of our lives [3] and whether you think it should do more or less, there's no reason for what exists to be so incredibly inefficient and customer-unfriendly, especially when there's a huge pool of tech people with the skills needed to fix it, and now, a pipeline that can get them (you!) to the right place. Please apply!
(There's also small teams of engineers [4] on the inside tackling this problem, if you prefer that (less direct, but avoids gov. pay being capped at ~$150k or so and the strict background checks.) Contact me if you want more details.)
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[0] They're also too busy trying to keep their heads above water in a bureaucratic system that seems to function only because many of the people in it work so hard, but I digress.
[1] AFAIK, USDS is based in DC (and I think has positions in Boston), 18F is mostly in SF (Civic Center) and DC, with a few remote people around the US.
[2] Imagine if you could direct and organize a team of people to rescue expanded healthcare coverage in the US (oops, Mikey did that already)
Imagine if you could help 22 million veterans get the care they deserve on time, instead of hundreds of days late
Imagine if you could help "fix" the IRS with auto-prepped tax returns (definitely seems like the hardest one on this list-- but it's also one that everyone wants to see happen. And yes it's a policy problem, but it's also a technical problem-- imagine policymakers having to trust the system that resulted in the original healthcare.gov. And informed engineering opinions have much more weight than you'd imagine.)
[3] Yes I know there's a whole world outside of the US, especially on the Internet :)
[4] "startups" and "small businesses" both have connotations on HN that I'm trying to avoid...
They could have viewed this as a distraction to expanding its existing dedicated-driver model, in order to better compete against Uber. (Lyft Line is just multiple passengers; Sidecar already does "driver destination" aka real carpooling, but they're also playing a different game focusing on drivers in general, and don't have the scale Lyft does)
If they can get traction, they'll have cracked a problem that many people have tried to solve and failed at: how do you get Americans to carpool?
Context: Lyft's founders pivoted into Lyft from Zimride after five years of building white-labeled carpool sites for colleges/companies + a public long-distance carpool/rideshare board, and discovering that a) that's not a VC-scale business, and b) 90% of Americans don't "do" traditional carpooling and they're not about to start
Anyway, I use Lyft over Uber when possible for many reasons, but this is one-- they started out trying to improve society in a particular way, and still are, even as they've changed their approach. And I think they should be commended for setting an example for how to achieve an activist-y goal through a startup/company. Or since it's not achieved yet, at least trying.
(I have no affiliation with Lyft, see my profile.)
We're a team of a dozen or so software engineers (many ex-Google and YC) who've been working on fixing Healthcare.gov for the future, since December. We're actively looking for experienced software engineers. Several have joined in the past few months.
(If you've seen this comment before, we were looking, but now we're very-much looking.)
The external environment may be frustrating compared to what we're all used to, but internally and day-to-day we're running like a startup-- github/node/backbone/AWS/asana/standups/etc. We're finally shipping and we're going to keep shipping.
Change starts with a small group of thoughtful, committed software engineers (...paraphrasing...) and there are many groups now seeding different parts of the system; our area is Healthcare.gov and associated systems. Because we began in a crisis situation, and other unique factors, some of the usual downsides mentioned in this thread don't apply to us.
Email us! We can also refer you to the other groups referenced in the OP if they make more sense for you.
A side question, for any doctors on HN-- I'm really curious, what do you think about the Blood Tests section? That is, the benefits of monthly blood testing. From talking to one earlier today about related topics (coincidentally!) I could imagine the following response:
1. The ideal ranges for each value on your blood test do not necessarily represent the ideal range for you personally -- and not only do they not necessarily represent the ideal range for you, if your number is outside them and you're otherwise asymptomatic, your number is likely already "healthy" (with very few major exceptions like blood pressure and cholesterol.)
2. So by doing this, you aren't actually tracking things that need to be improved, or rather, you have no way of knowing if you'd be "more healthy" by being within range
3. So, getting monthly blood tests is useless, and any changes detected would also be useless
4. (And as an aside, annual physicals for young healthy people are not beneficial (and can be harmful) to health)
Is this right? Was I just talking to a curmudgeon? Tech-optimistic doctors, what do you think?
This is just my experience after working for ~1000 hours on healthcare.gov w/other YC alumni (relatively nonideological-liberal-or-libertarian engineer bias), but I think it's become increasingly clear to all of us that the implementation of well-meaning policies intended to separate the deserving from the undeserving ends up adding an incredible amount of complexity and overhead, along with unintentional side effects, edge cases, and bad incentives.
(This isn't why healthcare.gov had major issues, it's just another problem.)
That said, there's no way politically a basic income is going to fly anytime soon. So since this is HN... is there any way to get to an MVP without having a sovereign state to experiment with? Or is this solely in the realm of public policy?
To clarify, you don't need to be able to commit long term-- if you can take leave from what you're otherwise doing for a few months, that's enough.
If you want to work on something with real impact and help change the culture of government technology, email Brandon above! We're actively looking for a few good people.
1. We didn't see any desire even when all the right pieces were in place (origin, destination, timing match, long distance + high cost of parking, compatible and networked ridesharers -- they still couldn't be bothered).
2. In Europe, where ridesharing is catching on, it competes with bus and train travel which is expensive, not car travel. In the US, ridesharing is competing with going in your own car (or nothing) and it isn't very competitive. The costs of car travel are not significant enough (yes yes I know that it is 18% of household income and $8k per year -- remember, I spent lots of money and a couple of years on this business).
3. For short trips, it'll never work because the cost of any minutes of delay just aren't worth the reduced cost of travel to the driver.
4. As I'm sure you are thinking about dynamic real-time ridesharing -- everyone is -- answer this when you set about building your network: Robin driver posts her trip once, twice, four times (?), maybe keeps an open trip pending and gets no response. She stops posting and doesn't tell anyone about what a great service/app/method you are running. Ditto passengers. When you move to real time, you have reduced the likelihood of getting a match because now the window of opportunity is 5-10 minutes (if we couldn't find a match when we said any time you ever go to NYC email me, why would you find one if I said anyone wanna go in the next 5 minutes?)
5. Look at all the past efforts, and figure out honestly why your idea is different. Everyone so far has failed. Smart phone apps, social network connections, through employers, on narrow corridors, etc etc.
Driving is still too cheap in the US. People still aren't willing to make the effort in adequate numbers to make it work.
Sorry to be such a downer but I get asked this all the time. So many people starting and thinking about this space."
Note that she's using rideshare in the traditional sense, before Lyft/etc. took over the word within the tech community. (Lyft is awesome! Just different, for now.) So for short trips, using pseudo-hired drivers on shifts a la Lyft, it obviously works well, just like taxis work well.
A lot of other bigger consequences too! See Quora for a great answer on societal changes.
Edit: +1 to patio11
I love Couchsurfing-- and it "works fine"-- but I was also glad to see Airbnb succeed.
It also has InstantCab/Uber/Sidecar integration now so you can compare $ and time across options.
Combine that with driving+parking, bicycling, and personal calendar data, and it'd be the killer one-click transit app I've always wanted. Can't wait to see you all build this out!
Of course, you should also support Watsi because as they succeed and drive a ton of extra contributions toward program-costs-only, even if there isn't enough existing overhead covered, there "should" be strategic donors who see this happening and decide to fund it.
This is all assuming Watsi's average partner is interchangeable with PIH, along with the treatments you'd be funding, which of course they aren't. Based on Chase's comment on Bageshwori, it may be very different-- it sounds like by directly funding PIH you'd be contributing to basic (though still potentially lifesaving) care through PIH, whereas with Watsi-via-PIH you have the option of (and often are?) contributing to more difficult, expensive, and perhaps otherwise-even-more-unavailable care.
If you're feeling generous, support both :)
(PIH spends a remarkably high 94% of its donations on program expenses, fyi: http://www.charitynavigator.org/index.cfm?bay=search.summary..., though there's long been a philanthropy-wide consensus that over-focusing on overhead is common and unhelpful: http://blog.givewell.org/2009/12/01/the-worst-way-to-pick-a-...)
Also be sure to check out givewell.org for very HN-friendly (rational/research-driven) tips on how you might think about giving in general.