[jackgavigan]

There is, sometimes, a tendency on the part of young, ambitious entrepreneurs, to be overly optimistic and assume that they can gatecrash an industry they know nothing about, set up a slick website and disrupt the big, bloated, uncool incumbents.

Sometimes that works out but I believe that a new entrants chances of success are a lot higher if they have somebody on board who is actually familiar with the industry sector they're trying to disrupt.

None of Oscar's founders have worked in health insurance previously. They come from tech entrepreneur/VC, consulting and technology backgrounds.

Edit: Here's a good example of where some industry expertise might have been useful: "..it was a design decision to limit the information presented to hospital's on what is covered in detail (like in­house labs)."

There's currently a big trend in design towards making things simple. But there's a difference between making stuff simple and dumbing it down. Sometimes, stuff looks complicated because it's complicated.

[brandnewlow]

I think that's an overly generous assessment. Oscar's founders have invested incredible sums of money into the company and are very well connected. If they've not hired people who know the insurance industry, it's safe to assume it's because they chose not to. This is not a small scrappy startup. This is a company started by powerful people looking to get into an opening they saw.

[lsc]

I have Kaiser. It's vastly simplified because the people paying for my care are the same people who are providing my care. They also seem to have a real "get you up and running so you can get back to work" kind of attitude, which meshes well with my own values.

I mean, consider for a moment how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled. Multiply that by the complexity of medicine, and... yeah. You can see how it would get complex fast.

Maybe this is an area where horizontal integration is the order of the day?

[debacle]

> how much of a pain in the ass it is to get an insurance claim on your house or your car or whatever filled.

I have had nothing but excellent experiences with both my car insurance company and my homeowners insurance company.

The trick to having a good relationship with your insurance company is to have a good insurance company.

[jjoonathan]

Have you ever filed a claim that would would send the expected value of your account negative? Since that's a tricky calculation, here's an alternative: have you ever made a claim that (even momentarily) sent the value of your account negative?

Insurance companies are always polite, efficient, and tolerant when they're taking your money (including making small payouts). Why wouldn't they be? But that's not where they add value to the equation. If it was, everyone would just self-insure. They add value when they have to pay out a lot of money for an unlikely adverse event. By definition, only a small fraction of customers ever get to judge this part of their insurance company, even though doing so is really the only way to judge the quality of the product they were paying for.

[001sky]

They should force sales and claims to be the same person. Problem solved. Right now, its good cop/ bad cop. Insurance only works in this framework if you have a lawyer to advocate for you...otherwises its endless dark-pattern fighting. Its truly atrocious.

[chaostheory]

Kaiser is great. The problem is with Kaiser is that it's not available nationwide. If I remember, it's only available in big metros.

[wdr1]

> I have Kaiser. It's vastly simplified because the people paying for my care are the same people who are providing my care. They also seem to have a real "get you up and running so you can get back to work" kind of attitude, which meshes well with my own values.

I'm glad that was your experience with Kaiser, because it certainly wasn't mine.

I had herniated disc that ultimately required surgery. It was bad enough that I couldn't sit at all & couldn't stand for more than a few a few minutes.

Laying flat would take away some pain but not all. It would roughly 8 weeks before I would know again what it was like to be pain-free.

During that time obviously I couldn't go into work. Even the basics -- showering & going to the bathroom -- were a challenge. I quickly found vicodin didn't do anything for my pain, but I continued to take it simply because it kept me constipated. (One bad bathroom trip was better than several.)

I saw 4 different doctors in my first weeks. Initially I was giving a variety of pain killers & muscle relaxers. We asked about an MRI each time & was told it was unnecessary.

Eventually we worked our way through the Kaiser system & started to get to specialists who knew more about what they were talking about. Each one regarded my situation as one of the most severe they'd seen & refer to the specialist that was the next level up.

We finally got one to request an MRI. That request was "lost." We called several times, each time being told they'll take care of it & to call back in 24 hours. Finally the next doctor sent in another request, and told us to personally contact her in 24 hours (giving us her cell!) if it wasn't scheduled.

One of the biggest challenges was that each specialist was in a different department. Meaning it would be 1-2 weeks of waiting for the next appointment in that department. Absolutely no consideration is given to the length to how long I'd had my current condition.

Eventually we did to a surgeon -- a really good one. He took pity on both the severity of my situation & the length to move things around & fit me in earlier. The crazy thing being, it could have been even longer if he hadn't.

Without question, the worst 8 weeks of my life.

When an entity like Kaiser can't control costs by deciding what claims they'll approve, it seems they'll instead control costs by deciding what access to care you'll receive.

Honestly, I'm not sure that's much better.

[michaelochurch]

There is, sometimes, a tendency on the part of young, ambitious entrepreneurs, to be overly optimistic and assume that they can gatecrash an industry they know nothing about, set up a slick website and disrupt the big, bloated, uncool incumbents.

Also, disrupting American health insurance is like "disrupting" terrorism. (It took 10 years to get one guy.) It's not something you can pull off in an afternoon. You're facing evil. Not irritating inefficiencies, but an adversary with a history of killing people to further its own ends.

Startup people think that the natives in whatever they want to "disrupt" are stupid. That they're facing accidental inefficiency instead of malignancy. In fact, the bad guys have just as many smart people as we do in tech. It's just that their smart people have been focused on building relationships, people-hacking, negotiation, litigation and loophole-finding, while we've been reading papers about category theory. Underestimating them is a bad call. Engineers turned founders make the same mistakes with "dumb" VCs and lose their shirts.

[nostrademons]

I think that it's generally a good assumption, anywhere in business (and most places in life), that whoever you're talking to is self-interested. Not evil, not even necessarily selfish, but it's a good bet that their world revolves around them.

And once you've got this principle ingrained in your mind, navigating the big scary world of business, or VC, or Google, or health insurance, or any other industry becomes much easier. Because you start to look for what people's incentives are, and don't ask them to do things that are against their own incentives. People are much more inclined to cooperate with you when it doesn't hurt their own interests.

People who actually "disrupt" industries, rather than just talk about it, do so by finding loopholes in other folks' incentive structures. They figure out other ways of doing things that incentivize everybody involved to cooperate with them, and that's how they revolutionize things.

[jackgavigan]

+1.

The parent talked about fighting evil but the vast majority of people who work in industries like health aren'e evil - they're merely acting in their own self-interest within a system/industry that has evolved, over time, to exploit the vulnerable.