It's a fantastic list; I'd like to comment on how some of the problems are already solved (outside the U.S.) or not cast properly.
> Healthcare in the United States is badly broken. We are getting close to spending 20% of our GDP on healthcare; this is unsustainable.
That's mostly a policy problem, not a technology problem. Countries with single-payer healthcare spend massively less on it per % of GDP than the United States with its pro-profit healthcare system, and American doctors and healthcare corporations end up being fabulously more rich than in those countries. (And they still have private healthcare, like in Sweden, which competes with public healthcare organizations.) The other reason healthcare costs are getting higher is that people are getting older and thus more sick. That's a generational bump, there's very little we can do about that. Not that I'm opposing the types of ideas YC is after in this sector (preventative medicine and better sensing/monitoring), just that the premise is wrong that it's a technological problem.
> At some point, we are going to have problems with food and water availability.
That's because we dedicate most of our water and land resources to feeding cattle that we then eat. Innovations that will have the most impact in that sector will involve weaning people from animal products. Stuff like Beyond Eggs and lab-grown meat.
> It’s not a secret that saving money is hard, and that people tend to be bad at doing it. The personal savings rate has largely been falling since the early 80s.
Sure, some super-low-cost index funds would help, but the main problem here is two-fold: 1) real incomes are stagnant, due to government policies favouring corporations and 2) government/pension funds are much better at providing good ROI on investment than individuals can. Once again policy change is much more likely to have a massive impact than trying to improve the individual worker's investment returns. Collect retirement contributions at the source, and have the best investors in the country manage them. Without taking a profit for themselves. It's done elsewhere.
To quote the article: http://finance.yahoo.com/news/pf_article_109143.html
"A study done at Harvard University indicates that this is the biggest cause of bankruptcy, representing 62% of all personal bankruptcies. One of the interesting caveats of this study shows that 78% of filers had some form of health insurance, thus bucking the myth that medical bills affect only the uninsured. "
So yea, fixing healthcare will also fix a lot of America's debt problem. There are only a couple ways to do that - decrease the costs or have a single payor. We've tried the 'decrease costs' part with college funding. That didn't work, because any time we subsidize funding to colleges, they request more money. College debt is huge now. So going the medical route and just subsidizing a broken system isn't going to fix it. It will only make the problem worse. We need to have medicare for everyone, and it should start before birth. If someone wants a college education, allow them to get it, only paying to re-take classes. That would wipe out most people's debts.
Note the Harvard study is from 2010. The Affordable Care Act (Obamacare) passed in 2010, started going into effect in 2014, and bans lifetime caps on health insurance payouts. The intent was to address exactly that problem--medical bankruptcies.
So the big policy change the parent asks for has already happened, and the U.S. will gain universal insurance coverage over the next couple years.
If we want to see healthcare costs drop in cost beyond that policy change, it's almost certainly going to need to be driven by technology in some way.
Yeah, but people being is debt is great for the part of the financial services industry that they owe money to, often with ridiculous and crippling interest rates (compare to the interest rates these players get from the government when they borrow, which is essentially 0% -- which is nice, for them). This is especially true when it comes to student debt, which can't ever be discharged. And these companies have a ton of political power (money begets power begets money).
Which all is to say I agree with frandroid. The root problem here is our political system is almost completely broken due to lobbying and lack of meaningful campaign finance laws and the best way to actually fix some of the issues listed here is fixing those core government/policy problems, but those problems aren't technical in nature and won't be fixed with a Ruby on Rails app.
Software may be eating the world, but if your only options for government leadership are (to put it in South Park terms) a "turd" or a "douche", both of which are controlled by big money whose interests are at odds with the overall populace then there are a lot of core problems that there will never be a software fix for (short of the call for better AI going really well and having a benevolent SkyNet take over).
I came here to say exactly that. The new projects YC wants to see are great and are defiantly problems worthy of effort, but the more pressing problems seem structural at the moment.
I also agree with your final conclusion ("skynet") and think it is inevitable given time. Remove human corruptibility from governance. Efficiency... it is selected for.
> Countries with single-payer healthcare spend massively less on it per % of GDP than the United States with its pro-profit healthcare system
Countries with universal coverage through other-than-single-payer systems do this, too. (every OECD country other than Mexico and the US has universal coverage -- but not all of them through single-payer -- and every OECD country spends massively less per GDP, let alone per capita, on healthcare than the US does; to the extent that many of those that do have public single-payer universal systems pay less in GDP for that than the US does considering public costs in the US alone, without considering the slightly-higher private costs in the US.)
But those systems tend to look like a "single-payer donkey with a free-market tail stuck on." The government decides the content of the basic packages, funds them for the poor, etc. If that sounds exactly like the ACA, you're correct, but you may have missed a very subtle and very important distinction -- take a closer look.
A friend of mine ran across this in Switzerland. It has a nominally free-market system, but when he moved there, he ended up automatically enrolled in a plan without doing anything at all. He was remiss in reading and translating all his mail upon moving there, and after some months of inaction: 1) he was signed up to a default insurance plan; 2) which was partially subsidized based on his estimated income; and 3) he was billed for the remainder. Nominally private-sector, but still quite state-supervised. There is a minimum standard for plans, you must have one, and subsidies ensure that everyone can afford it. Unlike Obamacare, the "must have one" part is not enforced by fining you $700 on your taxes, either, but rather by actually signing you up for one.
This is how vehicle liability insurance works in Sweden. You must have it, and if you don't, the government will just sign you up for a government-run default insurance pool and bill you for it. Certainly beats having to have "uninsured motorist insurance"...
Well, in the first case you're actually enrolled in a health-insurance plan, whereas in the second case you aren't. This solves many problems; for example, everyone who visits a doctor's office or hospital can be assumed to have insurance coverage, so those institutions aren't left with the mess of what to do with uninsured patients.
> But those systems tend to look like a "single-payer donkey with a free-market tail stuck on."
I wouldn't use either of the terms "single-payer" or "free-market" in describing systems in which there are multiple private sector health insurers (payers), and it is mandatory for individuals to purchase a plan from one, with highly regulated plan provisions and operations.
They don't much look like "single-payer" anything, and don't very much look like any "free-market" bit has been stuck on (there is a market component, but its not free.)
> If that sounds exactly like the ACA, you're correct
The ACA is similar in outline, but the differences aren't particularly subtle (the ACA's isn't universal; the poor, elderly, and disabled -- rather than being subject to the mandate and operating through the same market, potentially with a public subsidy, instead are directed to one [in some cases, both] of two completely separate public insurance systems, etc., etc., etc.)
1 - using buying leverage to negotiate prices, something republicans owned by the drug and device industry specifically banned (see eg [1])
2 - rationality about end of life care, which we spend a lot of money on -- 20%+ off the top of my head. As many doctors have shared, they often choose not to aggressively treat terminal illnesses and focus on quality of life. Unfortunately (remember Sarah Palin's death panels, and let's all thank John McCain for bringing that snowbilly grifter to the national stage), attempts to do things like pay doctors to sit down with patients and have end of life conversations, explaining what is happening have been successfully yet stupidly fought off. Whereas when doctors talk about how they die, they often chose to undergo very little treatment [2,3]
Almost all medical professionals have seen what we call “futile care” being
performed on people. That’s when doctors bring the cutting edge of
technology to bear on a grievously ill person near the end of life. The
patient will get cut open, perforated with tubes, hooked up to machines, and
assaulted with drugs. All of this occurs in the Intensive Care Unit at a
cost of tens of thousands of dollars a day. What it buys is misery we would
not inflict on a terrorist. I cannot count the number of times fellow
physicians have told me, in words that vary only slightly, “Promise me if
you find me like this that you’ll kill me.” They mean it. Some medical
personnel wear medallions stamped “NO CODE” to tell physicians not to
perform CPR on them. I have even seen it as a tattoo. [2]
This doctor summarizes his choices as
my physician has my choices. They were easy to make, as they are for most
physicians. There will be no heroics, and I will go gentle into that good
night. [2]
A different article
Research shows that most Americans do not die well, which is to say they do
not die the way they say they want to — at home, surrounded by the people
who love them. According to data from Medicare, only a third of patients die
this way. More than 50 percent spend their final days in hospitals, often in
intensive care units, tethered to machines and feeding tubes, or in nursing
homes. [3]
There is almost always something that a doctor can do, but patient comfort is approximately priority F.
More typical was an almost eighty-year-old woman at the end of her life,
with irreversible congestive heart failure, who was in the I.C.U. for the
second time in three weeks, drugged to oblivion and tubed in most natural
orifices and a few artificial ones. Or the seventy-year-old with a cancer
that had metastasized to her lungs and bone, and a fungal pneumonia that
arises only in the final phase of the illness. She had chosen to forgo
treatment, but her oncologist pushed her to change her mind, and she was put
on a ventilator and antibiotics. Another woman, in her eighties, with
end-stage respiratory and kidney failure, had been in the unit for two
weeks. Her husband had died after a long illness, with a feeding tube and a
tracheotomy, and she had mentioned that she didn’t want to die that way. But
her children couldn’t let her go, and asked to proceed with the placement of
various devices: a permanent tracheotomy, a feeding tube, and a dialysis
catheter. So now she just lay there tethered to her pumps, drifting in and
out of consciousness. [4]
And finally -- you should read all of [5], though it's heart-wrenching -- many terminal patients don't want to be aggressively treated when outcomes and the experience are fully explained. A close family member had to make similar choices and chose to die at home. The surgeons and oncologist where happy to keep going, but he was dying, and nothing the doctors could do would change that. They could only prolong for another couple months the inevitable, at the price of excruciating pain, repeated surgeries, and drugs that made him feel terrible. He chose to die at home. And not only is this far more humane, but far cheaper.
I also thought the Financial Services section was rather tame and un-disruptive.
The problem is not that it's hard to find good ways to save and invest, although that is a true statement. The problem, at least for most people in the US, is that besides Social Security, "personal saving and investing" is currently the only available way to secure one's future/retirement. An additional, related problem is that the only personal saving and investing option available to most people is "buy one or more Financial Services products": Savings accounts, stocks, bonds, funds, 401(k)s, Roth IRAs, even pensions which are long gone. They're pretty much all the same scam: Hand your own personal money to someone else, and in 50 years, it may end up bigger or smaller or the same, depending mostly on who you chose to give it to, and other factors totally outside of your control. If it ends up bigger, you chose wisely and/or got lucky, and deserve to retire comfortably. If it ends up a lot bigger, you chose brilliantly and/or got really lucky, and deserve to retire in luxury. If it ends up smaller, you chose stupidly and/or got unlucky and deserve to eat dog food when you're old.
Can we get away from "use your own personal money to buy a risky financial services product" being the sensible way to secure one's financial future? Now that would be a worthwhile problem to solve.
Not to mention the fact that "Saving and Investing" is only available to people who can actually afford to save and invest (which is yet another problem that desperately needs solving).
A Roth IRA and a 401k are investment vehicles - stocks, bonds, funds are investments. I don't think you quite understand investing which is why Financial Services needs to be disrupted.
You claim it's all a scam but the market has been going up and up over the last 100 years. The scam lies with the advisors and products that charge high fees and are not transparent. Companies like Betterment and Wealthfront are changing the game buy making these fees transparent and putting you in a good diversified portfolio.
The second problem is that like you mentioned saving and investing is only available to people who can afford to save. This is the same thought that 85% of millennials who don't save feel but the reality is, you can. There is just no easy way to do it...yet
I dunno. Looks a lot like basic income, but it isn't normaly tagerted at retirement.
Or maybe ryandrake had a more "tax the rich" goal, with the usual set of problems. (It's usualy much better to solve the problem that people got rich exploiting [moraly or not], instead of simply taxing them.)
I think startups can prevail in terms of business model and not just technology.
Look at Uber, Uber has an app, but the real issue in Uber is creating a marketplace, managing a brand, managing relationships with drivers, fighting the taxi companies, etc.
Innovations in how health care is organized and delivered are very possible.
As for food and water I'll say that the case for vegetarian and veganism is often overstated. Out here in upstate New York we have plenty of water and plenty of hillsides that are good for grazing and not for tilling. In other places the situation is different, but in some places animal agriculture is part of the solution and not the problem.
I think both the single payer and pension arguments miss the fact that the US is at a hub of a system. Inflated drug prices in the US finance drug development and cheaper drug prices in the ROW. Similarly, what a government run pension fund can attain in another country is unrelated to what one can attain in the US.
I agree with the part about stagnant real incomes, which meshes with the rising cost of health insurance, housing and college, but I don't think professional pension fund managers do that much better than individuals in the long term. They may avoid stupid mistakes like selling all of your shares in the winter of 2008-2009, but the real advantage pensions have is that they can borrow from peter to pay paul, at least in the short term.
Agreed, I'm a Canadian living in the bay area, and I recently broke my collar bone in Canada. I went the the emergency room in Canada and again, when I touched down in the USA.
The room in Canada was paid out of pocket (because I'm not a resident) and cost $600 for 1 x-ray a consultation with 2 doctors and a room for the night, and another $30 for the pain meds (morphine)
The 60 minute consultation I had in the US was $150 co pay, which if I had no insurance would have been $2000 Which got me an x-ray and 15 minutes with a doctor and another $10 for "prescription" acetaminophen. (aka overpriced over the counter Tylenol)
Doctors aren't the problem, it's the insurance companies. I don't see how it's a technology problem as much as a political will (and maybe stubbornness in believing America is always the best even when it's not). The best we can hope for is technology can help by gathering political will.
Water will be a serious problem, if I remember correctly Jordan has to import potable water. I'm sure they would be interested in any ycombinator ideas, and the government of California.
Where I live there is an abundance of crystal clear drinking water being wasted by fracking to sell LNG at bargain basement prices.
> That's because we dedicate most of our water and land resources to feeding cattle that we then eat.
As a farmer, I'm struggling to picture how we could change that land utilization in a significant way without technology to enable it. It's not quite as simple as consumer desires, although you are right that changing consumer habits changes the flow of money and where it is invested which would also spur on the necessary technology, presumably.
From someone who is not a farmer and doesn't know so much about this, for example could we grow vegetables and feed them to humans directly, rather than feeding grains to cattle?
That's probably a good idea, but it's worth noting that about 30% of the Earth's land surface is too dry for crops, but works fine for pasturing cattle.
I don't really think the issue with with grazing cattle on land that's suitable for it. I think the issue is that we're raising cattle in places that _arent_ suitable for it.
Take for instance the factory farms which have to constantly ship food in to feed the cattle. Another example is deforestation to create fields for cattle to graze.
I think the OP is right, we need to convince more people that beef is not a sustainable food with the rate at which we consume it today.
> Healthcare in the United States is badly broken. We are getting close to spending 20% of our GDP on healthcare; this is unsustainable.
That's mostly a policy problem, not a technology problem. Countries with single-payer healthcare spend massively less on it per % of GDP than the United States with its pro-profit healthcare system, and American doctors and healthcare corporations end up being fabulously more rich than in those countries. (And they still have private healthcare, like in Sweden, which competes with public healthcare organizations.) The other reason healthcare costs are getting higher is that people are getting older and thus more sick. That's a generational bump, there's very little we can do about that. Not that I'm opposing the types of ideas YC is after in this sector (preventative medicine and better sensing/monitoring), just that the premise is wrong that it's a technological problem.
> At some point, we are going to have problems with food and water availability.
That's because we dedicate most of our water and land resources to feeding cattle that we then eat. Innovations that will have the most impact in that sector will involve weaning people from animal products. Stuff like Beyond Eggs and lab-grown meat.
> It’s not a secret that saving money is hard, and that people tend to be bad at doing it. The personal savings rate has largely been falling since the early 80s.
Sure, some super-low-cost index funds would help, but the main problem here is two-fold: 1) real incomes are stagnant, due to government policies favouring corporations and 2) government/pension funds are much better at providing good ROI on investment than individuals can. Once again policy change is much more likely to have a massive impact than trying to improve the individual worker's investment returns. Collect retirement contributions at the source, and have the best investors in the country manage them. Without taking a profit for themselves. It's done elsewhere.