Thread by @bansisharma

1. On Health Care

Harsh truth is we can only have 2 out of 3:
A. Everyone can afford
B. Everyone is covered for everything
C. Highest quality

2. Obamacare chose B (everyone covered for everything) over A (everyone can afford). That's how we got high deductibles and mandate.

3. Trumpcare (directionally, details still unknown) is trying to choose A (everyone can afford) over B (everyone covered for everything) by having tailored insurance plans, no mandate.

4. Neither Obamacare nor Trumpcare does much of anything to improve quality. No evidence of improvement in national health since implementation of Obamacare.

5. That means there is much room for improving quality of health care, without breaking the bank so to speak, but it will require a Phase 2.

6. If done right, Trumpcare can be an improvement on Obamacare, because it makes no sense to force-fit the entire population into a single plan.

7. It remains to be seen if Trumpcare can make health insurance more affordable. If it does, and people are okay with plan choices, that would be success.

8. Medicare for All makes for nice sloganeering, but it has no chance of materializing in the U.S., as it requires the govt to take over such a large share of the economy (more than twice as much as it already commandeers) that it will kill the golden goose that is U.S. economy.

9. Nirvana for U.S. health care will never be delivered by the govt., nor by tinkering with our current system, which is not even close to being a free market system at all. It is a Rube Goldberg contraption of several parties, with patients and physicians relegated to bit parts.

10. In a free market system the parties with the most say on the cost of a transaction are the buyer (i.e. patient) and the seller/service-provider (i.e. physician).

11. In our convoluted health care system, neither the patient nor the physician has much of a say on the cost of any given interaction. Cost is a function of negotiations between govt, employers, insurance providers, pharmaceutical companies, and a whole host of intermediaries.

12. There are complicated historical reasons for how things came to be this way, but suffice it to say that failures of our healthcare system have nothing to do with the free market and a lot to do with the fact that we have not had a free market in health care since WWII.

13. Be that as it may, there is no easy way to reconfigure this system through central planning. Innovative disruption is the only way.

14. Fortunately, we are approaching a point in technological innovations in the healthcare field which makes me very optimistic that such a disruption is just around the corner.

15. The capability to capture an FDA approved ECG in your wrist-watch and transmit it to your doctor (a feature of the just announced Apple iWatch) gives us an inkling of what's possible and what's sure to come. Just you watch!

16. This is not a pitch for iWatch. It is a pitch for what technology can enable in not too distant a future. How such capabilities will come together remains to be seen, and we can be sure the path from here to there will not be linear.

17. Govt. can help with the transition by being a willing partner for innovative solutions. I know that's too much to ask, considering how Medicare for All is all the rage on the left, but thoughtful people in the industry, govt, and think tanks have much to contribute here.

18. Breakthrough innovation is the only way we will get to a point when maybe we don't have to choose 2 out of 3, and maybe we can have it all -- health care which:
A. Everyone can afford
B. Everyone is covered for everything
C. Is high quality

The End