Item — HN Reader

IMO, there's an interesting opportunity for AI to make healthcare deflationary.

For example, Medicare is launching a new program in July that pays a fixed rate for achieving defined outcomes, like lowering blood pressure or cholesterol. Medicare's explicit goal here is to create incentives to automate the repetitive parts of care delivery with software. (Much of preventive cardiology is surprisingly algorithmic and guideline-driven, so this is more plausible than it seems.)

This reverses the incentives of the current system, where CPT codes incentivize doing more "stuff" (but not necesarily delivering the most effective care efficiently).

If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.

4 comments

> IMO, there's an interesting opportunity for AI to make healthcare deflationary.

How many times have I heard this, about how many techs. But this time for real?

Health spending in the us is too tied up with the country’s economy for it to ever be reduced. Same goes for housing. The cost of both of these will continue to increase. As long as the investor class is satisfied, this is all that matters.

> Health spending in the us is too tied up with the country’s economy for it to ever be reduced. Same goes for housing

These are massively incomparable. Most householders live in homes they own. Those homes, moreover, are usually a substantial if not dominating fraction of their net worth. And they're leveraged. This produces a broad level of interest in maintaning or raising home prices.

Healthcare is more narrowly owned. It's not as leveraged. And very few housholds have a commanding fraction of their net worth in healthcare assets.

It is however a highly inelastic good and some of the most expensive care happens when the person who ends up paying isn’t in the state of mind to make decisions such as being unconscious for emergency care, or late in life when dealing with dementia and other diseases that rob you of your faculties. It’s primed to be able to extract everything because most people value being alive above everything else.

> the person who ends up paying isn’t in the state of mind to make decisions such as being unconscious for emergency care, or late in life when dealing with dementia and other diseases that rob you of your faculties

Most healthcare in America isn't paid for by the patient.

Ultimately, but it’s charged to the patient who then has it paid by whatever mechanism (insurance/medicare/medicaid/family/etc)

> If you're a software engineer who cares about health, and have been sitting on the sidelines till now, I think the next few years are a really interesting time to make a contribution.

do you have thoughts on what that looks like? what does the hiring landscape look like?

do you have thoughts on what that looks like?

There is so much to be done and it is not going to be solved by any one thing. That in mind, something like an independent third party patient advocates / advisors would be great. It is hard to be an informed patient these days, Navigating insurance and paperwork is tough and getting second opinions is sometimes had.

Fascinating. I feel like smart person + data (context such as health records, labs, insurance docs, etc.) + LLM -> some helpful tips for navigating the process. However, evaluating the tips on whether they are helpful or not would be hard for a smart person without the expertise.

Or put another way - how does a smart lay person evaluate the independent advocates? Do incentives align?

Right now lots of good health companies hiring, including my own (Empirical). https://www.workatastartup.com/ lets you filter YC companies to see health startups, by stage and location (or remote).

Any advice for a senior/staff level FAANG dev working in ML tooling but not in the health space interested in this kinda stuff?

What are good things to read, etc?

It depends on who’s using it, and I’d say the doctors can use it more intelligently than the patients.

"AI will solve this deeply rooted social problem" is, and forgive my bluntness, is one of the most idiotic AI opinions I've seen this week.

The only thing that will fix American healthcare is absolute abolishment of private insurance. That's it. No amount of gentle incentive tweaking or whizbang technology is going to solve the fundamental problem of human greed and immorality.

Allowing private health insurance to exist is inhumane and can only result in profit extraction and exploitation of the most vulnerable members of society whose only options are literally to pay up or die.

That's the break. We've allowed profit-seeking individuals to stand in between citizens and literal life saving medicine. And you think the solution to that is to add more middlemen and profiteering exploitative corporations. Utter insanity.

The solution is to make it illegal for anyone to say "no, you may not have this life saving medication or proceedure". The solution is to remove profit from medicine. To allow profiteering and gatekeeping of people's very lives is immoral in the extreme. Giving more private corporations more influence is insanity. The solution is less private influence of medicine, not more.

How exactly do you propose to "remove profit from medicine?" If someone wants to have a procedure done and their insurance doesn't want to pay, they can still pay the doctor to get it done themselves. And it will still be very expensive because doctors in the US are used to charging very high salaries and using medical equipment and medicines that cost a lot of money. Insurance companies are required by law to use 80 percent of their income to pay claims out to their customers already. Medicine costs a lot.

In addition to all of the stuff insurance denies, they also won't pay for anything considered elective care (and that's a pretty broad brush). There are ways around this but that's neither here nor there for this discussion.

Like the other commenter suggested, medical tourism is a viable answer. Most Americans have probably heard of Turkey for hair transplants, but the truth is that certain countries specialize in specific procedures, and are the BEST in the world at performing them, and with the best outcomes.

I've done several procedures abroad and saved 70-80% vs the US cost, and that's including the travel and vacation portion. Yes, medicine costs a lot, but most people are ignorant to where most of that money is going to pay for, and how expensive the "system" makes things in the US.

The insurance companies should allow for dental or medical tourism. Let’s put the people who haven’t had to compete globally get a chance to. If you have enough money you can do it yourself but that doesn’t help poor folks

Even if you eliminate private insurance, the amount of money that the country is willing to spend on medicine is finite. Someone is still making the decisions of what they'll pay for and what they won't. The difference is that it would be a faceless government bureaucrat instead of a faceless private insurance bureaucrat.

Would that make it better, or worse? And why?