| > If you want to "hack" healthcare and fix the problem, get involved in government and get single payer done. So we can turn what health technology gets developed into even more of a political game? Building a board of government insiders as opposed to scientists and clinical experts is exactly the kind of move that would work especially well in a single payer system. You want to know what healthcare would look like when governments were the only payors worldwide? Look at defense contracting. Or aerospace. He who had the best lobbyist would win. If I could change one thing about the commenting on the state of our health care system it would be to require everyone who says "oh we just need single payer" to spend a year working for an insurer, a hospital, and a health technology manufacturer. Then come tell me that changing who pays will fix all problems. Here is a following not-comprehensive list of things that would not be fixed just be going to single payer: - the US subsidizing all health tech (drug/device) development - fee-for-service payment structure leading to perverse incentives - malpractice fears leading to risk-averse, defensive medicine - poor reimbursement rates yielding waiting lists to be seen by a doctor - bureaucrats in CMS (the payors) exerting influence on the FDA to not approve new technology because they feel it is too similar to existing technology - regulators creating vague rules that get applied differently from case to case, making them impossible to plan for I could go on. I do agree with you that a lot of startups in the space are putting a bandaid on a bleeding jugular. But saying "let's get government more involved" neglects the fact that we're in this problem in part because government is very involved and has been since WWII. There are three ways you can make healthcare better and cheaper for everyone: - Make health technology cheaper - Change the way health care is paid for (I credit Oscar for trying to make it in this space but for various reasons think they're unlikely to succeed) - Change the way that health care is delivered There are a number of startups tackling the latter (telemedicine, doctors on demand, drugs delivered to you, etc). Unfortunately the Affordable Care Act has many provisions that make it difficult to innovate in this space, because of the view that it's much easier to control costs when the point-of-care is controlled by a few big hospital systems. I run a startup that's trying to tackle my first solution: making health tech cheaper by making it easier for startups to get their products through regulators and disrupt incumbents. But even if we're wildly successful and can start lowering health tech costs across the board, the problem won't be fixed until we fix the payment structure, which will require innovation in payment models, not a one-size-fits-all government plan. |
Living decades in a "single payer" country gives you another outlook: that's a solved problem. You're just doing it wrong. Everybody that has seen it working knows it's wrong and will shrug off whatever ellaborate argumentation you choose.