
Ask HN: Healthcare or energy startup? - myrloc
Yes, both terms are vague, but that&#x27;s kind of the point.<p>Which industry would you choose to start a business in and why?
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PaulHoule
Healthcare still has low hanging fruit, although you have to deal with a lot
of bullshit. In fact, the bullshit is why there is still low hanging fruit.

I do not think there is low hanging fruit in energy. The astonishing story is
just how long it takes for things to develop: i.e. shale gas was known about
in the 1970s, the Molten Salt Reactor was expected to take 30 years to get to
market in the 1970s if it was funded (and I got boos at a Thorium conference a
few years ago when I took their timeline and reset it to the present.) The
first hot dry rock geothermal well was drilled in... the 1970s, and they are
just talking about the second now, etc.

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myrloc
Do you have examples of the low hanging fruit that you're referring to?

From an software engineering perspective, which do you think provides more
interesting challenges?

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PaulHoule
One basic one is that doing the little things right consistently can save a
lot of money.

For instance, if a diabetic has their blood sugar monitored, gets a good
regimen of medication, and does what they can in terms of lifestyle, they can
control their condition.

If they don't control it, then they need expensive interventions such as
amputations.

Another one is inhaled corticosteroids for asthma. The price of a steroid
inhaler is eye-popping ($200 a month) but the cost of a hospital visit for an
asthma exacerabation is upwards of $8000 a month.

Now many of the problems are structural. Under a "fee for service" model, it
is not as profitable to give basic preventative care than it is to do
expensive exacerbation. The "Medicare Advantage" programs are mostly a scam
(you see those ads on TV at the end of the year which look like something you
need to keep grandma away from) but there has been some success where a
medical group gets $X a year to treat a person with a chronic condition which
is a great business if they manage patients well.

In general doctors are not happy with the software they work with, they aren't
happy dealing with insurance companies, getting paid, etc. There is all kinds
of talk about "curing cancer", etc. but very little talk about the primary
care physician who provides front line treatment for everything from blood
pressure to mental health issues.

Go talk to a doc and see what bugs them...

