Tom Bilyeu
“We only had two manufacturers, and they charged, like, $12 a test, so 10 x higher.”
Gurley suggests a healthcare industrial complex has emerged that prioritizes profit over cost-effective preventative care.
“People talk about the military industrial complex. We may have created a health care industrial complex that really can't stop maximizing profitability and not focus necessarily on the lowest cost, best, most preventative process.”
Gurley cites claim that over 90% of NIH grants fund monetizable products versus preventative behavioral interventions.
“over 90% of NIH grants go towards things that are potentially monetizable, so either a product or a drug, and that the NIH is less interested in funding things that might be just preventative behavior, like behavioral things, like what you eat or your diet or things that don't lead to monetization.”
Gurley argues U.S. may have created healthcare industrial complex focused on profit maximization over prevention.
“And we may have created a people talk about the military industrial complex, we may have created a healthcare industrial complex that really can't stop maximizing profitability and different ways of making money not focus necessarily on the lowest cost, best, most preventative process.”
Gurley says healthcare startups trying to monetize end up reinforcing bad system dynamics instead of changing them
“And then and then some of them end up in a place where they're actually reinforcing the bad stuff, you know, and making it worse.”
Gurley describes $38 billion program paying doctors $44,000 each to buy electronic health record software.
“They came up with a brilliant idea. I have to assume she helped encourage this. Doctors would receive $44,000 each if they bought software. $38,000,000,000.”
All-In Podcast
“I have to assume she helped encourage this. Doctors would receive $44,000 each if they bought software. $38,000,000,000. This is true. You can look it up.”
Gurley says Obama's stimulus included $38 billion paying doctors $44,000 each to buy EHR software.
“Doctors would receive $44,000 each if they bought software. $38,000,000,000. This is true. You can look it up. I'm not making it up. $44,000, give it to a doctor, implement some software.”
Gurley says Germany validated 96 COVID test vendors, resulting in prices of 75 cents per test.
“Here they are on the right, 96 different vendors that they ok'd. And as a result, in the German market, you could buy five tests for $3.75 or €75 cents a test.”
Gurley cites $44 billion spent paying doctors to implement EHR systems as regulatory capture example.
“of my favorite examples, the Obama administration came up with this program where they spent $44,000,000,000 paying doctors to implement EHR systems.”
Gurley calls healthcare marketplaces extremely dangerous with forces in five directions and misaligned incentives.
“It's extremely dangerous because the the laws of most, marketplaces doesn't exist. You know, there's not a simple gravity. There's forces in five different directions.”
Gurley argues the most regulated US industries like finance, telecom, and healthcare become the least capitalistic.
“what happens is capitalism and democracy evolve over time, especially in The US federal system. The most regulated industries become the ones that are least capitalistic. And so finance, telecom, healthcare are completely,”
Gurley says the government paid doctors $44,000 to implement electronic health records in 2009.
“So in 2009, when the government passed the Reinvestment Act to try and get America going or whatever it was called, they put in place a program where a doctor is paid, believe this or not, paid $44,000 to implement EHR, electronic health records.”
Gurley says the government paid doctors $44,000 to implement electronic health records under the 2009 Reinvestment Act.
“So, it'd basically be like telling a construction company if you put in NetSuite, you get paid $50.”
Gurley reports the government has paid $29 billion total for doctors to implement electronic health record software.
“So, the payments for these incentive programs, because I just looked it up to get the recent update, dollars 29,000,000,000. So, our government has paid $29,000,000,000 for doctors to implement software”
Gurley reports the government has paid $29 billion for doctors to implement EHR software.
“So, the payments for these incentive programs, because I just looked it up to get the recent update, dollars 29,000,000,000.”
Gurley reports the government has paid $29 billion total for doctors to implement electronic health record software.
“So, our government has paid $29,000,000,000 for doctors to implement software that they weren't naturally implementing on their own.”
Gurley contrasts U.S. healthcare spending at 17% of GDP with Singapore's 1.7%, a 10x difference.
“The U. S. Spends 17% of GDP on healthcare and Singapore spends 1.7. So, it's a 10x delta and they have relatively reputable healthcare system.”
Gurley notes US healthcare costs 17% of GDP versus Singapore's 1.7%, a 10x difference explained by making everyone a payer.
“Spends 17% of GDP on healthcare and Singapore spends 1.7. So, it's a 10x delta and they have relatively reputable healthcare system. And the key thing they do is they make everyone a payer.”
Gurley warns consolidation of independent practitioners into large medical groups is bad for healthcare innovation.
“the large medical groups have been building out these huge platforms of MRI centers and labs and x-ray, and they're increasingly inviting general practitioners to live under their umbrella, and as that happens, the number of independent general practitioners is dropping as a percentage of all doctors, and that's really bad for innovation.”