Short insurer tenures discourage investment in prevention

Transcript

Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there.

1. 27:25

   I kind of look at the the biggest issues for affordability for people in the U.S. right now. It's, you know, buying a home, dealing with your educational costs, and then health care costs is the top three. I feel like we can solve education costs and we can solve home costs with certain market incentives that have been distorted. But health care is much more complex. As you look at the U.S. system, beyond just kind of preventative care, the cost for servicing patients in a hospital, like why is it $15,000?

2. 28:00

   dollars to get stitches at an ER? You know, why is it $20,000 to get a drug that costs 30 bucks to make? You know, why when the doctor is making 200 grand a year, does the doctor seeing me for eight minutes cost my insurance company $6,000? I mean, what is going on from your view that extends beyond like get in front of all of the catch up problems and so on? But what's structurally going on with the healthcare system in the US? And if you were emperor of the US for a day, and you got to say you could do anything you wanted, what are the top kind of three things that we're missing that maybe Neko doesn't necessarily address today, but are kind of things that you would recommend we fix? Well, I mean, again, I'm definitely not an expert on the US healthcare system. But for me, it is like the show me the outcome, I'll show you the incentive.

3. 28:52

   It's one of those classical problems. And if you really, really think about it at the moment, the entire system is predicated on, and the healthcare system was built around a time when we were dealing with infectious disease. That was how the healthcare system was built and dealt with. So all the incentives are really around that, which means we're fixing you acutely when there's massive amounts of symptoms. So where we have to go is we have to go to the healthcare system being preventative. That means it has to be way more long-term today. So I'll just mention one One of the problems that exists is because normally your health care is tied to your employment in one shape or form, and because the average tenure of your employment is not that very long, it means that you may have only two, three years at one employer, and

4. 29:41

   then you switch. And when you switch, you switch insurers too. So one of the questions then, if you're that insurer, should you invest in something where the payback time may be 10 or 15 or 20 years to do that? Those are just some of those sort of incentive things, like how do we look at the ROI of some investments that may be 10, 15, 20 years into the future, and who takes those investments? These are not easy things to answer, and I don't claim to have all the answers to them.

5. 30:13

   But one of the things we're trying to do in that is we're just trying to bring the cost down so that the ROI doesn't have to be that we have to invest or the insurance industry have to invest or employers have to invest millions of dollars speculatively, hoping to get it back in 20 years time with very little data. So our view is like, if we lower it, so it may not be a million dollars, it may be, you know, make it up tens of thousands of dollars. Even if that payback time was 10 or 20 years, I think that there will be a higher propensity and likelihood for a pickup on that. And then the second thing we're trying to do, obviously, is we're trying to add more data to the system. And if we had more data, then it's much more likely with these multimodal longitudinal data sets to be able to actually see, well, what's the efficacy of

6. 31:03

   these things over time. This is also part of the reason, by the way, why we are investing in releasing our data every year of what we're finding so that people can see, okay, well, What happens both on an aggregate NECO population, which is also super cool because normally in healthcare systems, they're very country specific, right?