How to Build a Healthcare Unicorn?
The private insurance system we have in the USA creates such a tightly-packed nightmare-maze of adverse incentives that the only non-government solution is for a company to grow so large it can fully vertically-integrate, from private medical schools all the way to hospitals, labs and clinics, then once it has a total monopoly, convert to a non-profit and slash prices across the board.<p>Anything else is a half-measure doomed to failure. The AMA limits how many doctors can graduate, medical schools charge enormous prices, limited supply and huge debt means doctors can command incredibly high fees, so hospitals send massive bills to insurance companies and sue the non-payers and yet remain barely solvent. Insurance companies add a profit margin and charge $10,000pp+ annual premiums to employers, who pass on some % to the employees.<p>Any one part of this is integrated with the whole and can&#x27;t be easily fixed.<p>- Hospitals can&#x27;t just charge less to insurance, because every part of care is so expensive.<p>- Care is expensive because doctors have debt to pay off, and we can&#x27;t pay them less or else med-school enrollment will fall of a cliff because why rack up $400k in debt if you won&#x27;t be earning 6 figures after you graduate? Not when FAANG will pay new grads $120k plus for half the school-time, and most of the students going to med school are smart+motivated enough to get those jobs.<p>- Insurance companies are making billions, so they aren&#x27;t going anywhere anytime soon short of massive government policy shift<p>- Medical device and supply manufacturers make bank for the same reasons, American syringes can cost a fortune because all the prices for everything have been dialed up to 11.<p>On top of all of that, there&#x27;s the infinitude of nitpicky soft and technical problems that would require a successful-startup&#x27;s worth of effort and luck to solve, like HIPAA, coding nonsense, and many others.<p>Honestly sometimes it feels like the only way to &quot;improve&quot; the USA healthcare system really is just to pass Medicare for All and drop a bomb on the whole thing.