Seriously? Spending a night in a hospital results in a $10,000 bill (though the real out of pocket is significantly cheaper. God help you if you have no insurance though). Healthcare in the US is the thing that needs the biggest disruption.

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gmueckl 4 hours ago | parent | next [-]

But no business is going to fix it. The market is captured. Only a radical change of insurance laws is going to have any impact. Mandate that insurance must be not for profit. Mandate at least decent minimal coverage standards and large insurance pools that must span age groups and risk groups.

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eru 4 hours ago | parent | next [-]

Many hospitals are already non-profit. That doesn't seem to bring down prices. Why would you think that this would work for insurance?

Profit isn't even a big part of the overall revenue.

> Mandate at least decent minimal coverage standards

I assume you want higher coverage standards than what currently exists? Independently of whether that would be the morally right thing to do (or not), it would definitely increase prices.

> and large insurance pools that must span age groups and risk groups.

Why does your insurance need a pool? An actuary can tell you the risk, and you can price according to that. No need for any pooling. Pooling is just something you do, when you don't have good models (or when regulations forces you).

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FireBeyond 2 hours ago | parent [-]

> Why does your insurance need a pool? An actuary can tell you the risk, and you can price according to that. No need for any pooling. Pooling is just something you do, when you don't have good models (or when regulations forces you).

Wuh? The more diverse the pool, the lower the risk. Your way of thinking will very quickly lead to "LiveCheap: the health insurance for fit, healthy under 30s only" for dollars a month, and "SucksToBeYou: the health insurance for the geriatric and chronically disabled" for the low low cost of "everything you have to give".

	▲	eru 2 minutes ago \| parent [-]
		You are mixing things up. There's insurance which allows you to convert an uncertain danger into a known payment. And then there's welfare and redistribution. By all means, please run some means testing and give the poor and sick or disabled extra money. Or even just outright pay their insurance premiums. But please finance that from general taxation, which is already progressive. Instead of effectively slapping an arbitrary tax on healthy people, whether they be rich or poor. And please don't give rich people extra stealth welfare, just because they are in less than ideal health, either. Just charge people insurance premiums in line with their expected health outcomes, and help poor people with the premiums using funds from general taxation. (Where poor here means: take their income and make an adjustment for disability etc.) We _want_ the guy who loses 5kg and gives up smoking to get lower insurance premiums. That's how you set incentives right. > The more diverse the pool, the lower the risk. No. The diversification comes from the insurance company running lots of uncorrelated contracts at the same time and having a big balance sheets. For that, it doesn't matter whether it's a pool of similar insurance contracts, or whether they have bets on your insurance contract, and on the price of rice in China, and playing the bookie on some sports outcomes etc. In fact, the more diversified they are, the better (in principle). But that diversification is completely independent of the pricing of your individual insurance contract. Have a look at Warren Buffett's 'March Madness' challenge, where he famously challenges people to predict all 67 outcomes of some basketball games to win a billion dollar. Warren Buffet ain't no fool: he doesn't need a pool, he can price the risk of someone winning this one off challenge. More generally, have a look at Prize indemnity insurance https://en.wikipedia.org/wiki/Prize_indemnity_insurance which helps insure many one-off events.

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kunai 3 hours ago | parent | prev [-]

These solutions are often proposed as easy fixes but I'm skeptical that they actually will do much to reduce healthcare costs. Healthcare is fundamentally expensive. Not-for-profit hospitals and for-profit hospitals don't really substantively differ in terms of out-of-pocket expenditures for patients; I find it difficult to imagine that forcing insurance companies to be nonprofit would do much to reduce costs.

> large insurance pools that must span age groups and risk groups.

What you describe (community rating) has been tried and it works. But it requires that a lot of young, healthy people enroll, and seniors receive most of the care. In an inverted demographic pyramid like most Western economies have, this is a ticking time bomb, so costs will continue to rise.

> Mandate at least decent minimal coverage standards

I think a better solution is to allow the government to threaten in negotiating prices with companies as Canada does; it greatly reduces rent-seeking behavior by pharmaceutical companies while allowing them to continue earning profits and innovating. (I understand a lot of the complaints against big pharma but they are actually one of the few sectors of the economy that doesn't park their wealth and actually uses it for substantive R&D, despite what the media will tell you, and countless lives have been saved because of pharma company profits)

Essentially the gist of what I'm saying, as someone who has been involved with and studied this industry for the better part of five years, is that it's much more complex than what meets the eye.

	▲	bandrami 3 hours ago \| parent [-]
		There are a lot of not-for-profit insurance companies and they aren't noticably cheaper, though I'm not in HR and they may well be cheaper for the employer.

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FireBeyond 2 hours ago | parent | prev | next [-]

My fiance was in hospital recently for a fairly common disease. She arrived at 2200 Wednesday night and was discharged 1000 Saturday morning.

Her bill before "insurance negotiated prices" was $59,000. Effectively $1,000/hr, 24/7.

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kunai 4 hours ago | parent | prev [-]

Disruption, yes, in the sense that the current system needs to be overhauled. But this is a space that's frequented by the SV and VC space and "disruption" has very different connotations, usually in the realm of thought that suggests some SV-brained solution to an existing problem. In some edge cases like Uber/Lyft, this upending of an existing market can yield substantial positive externalities for users. Other "heavy industry" adjacent sectors, not so much. Healthcare and aviation, not so much.

Even SpaceX's vaunted "disruption" is just clever resource allocation; despite their iterative approach to building rockets being truly novel they're not market disruptors in the same way SV usually talks about them. And their approach has some very obvious flaws relative to more traditional companies like BO, which as of now has a lower failure-to-success ratio.

I don't think you'll find many providers clamoring for an AI-assisted app that hallucinates nonexistent diseases, there are plenty of those already out there that draw the ire of many physicians. Where the industry needs to innovate is in the insurance space, which is responsible for the majority of costs, and the captive market and cartel behavior thereof means that this is a policy and government issue, not something that can be solved with rote Silicon Valley style startup-initiated disruption; that I would predict would quickly turn into dysfunction and eventual failure.

Enshittification has done a lot of damage to the concept of "disrupting" markets. It's DOA in risk-averse fields.