
Watsi launches universal health coverage, funded by YC Research - chaseadam17
http://blog.watsi.org/watsi-coverage/
======
lkbm
When I first read this article, I thought I'd missed something. Watsi isn't
funding the coverage--they primarily provided a way to efficiently administer
it. That seems a lot more sustainable than what I initially assumed.

Cost savings and scalability seem to come from:

* Easy to ensure treatment guidelines are being followed (so it's catch and eliminate non-administrative waste).

* Avoiding more expensive interventions by providing cheaper, early intervention.

* Easy to track who's enrolled (which also kills the free-rider problem).

* Overall less time (=money) spent on administration in general.

I'm curious if these can be teased apart. What percentage of savings is from
early intervention vs. unnecessary treatments?

I'm also curious why 98% of people signed up. Was it good outreach/marketing,
increased trust that the system would be beneficial to them (as opposed to
bureaucratic delays), or free-riders no longer getting a free ride? Did it get
cheaper? More reliable? Why didn't the other 2% sign up?

I'm sure these variables will all be fairly different when they go on to the
next community, but they'd be interesting to look at.

I'm also eager to see what this does for the medical infrastructure (and
economic growth) down the line. This should make it easier for places offering
medical care to get their funding efficiently and quickly, so I would expect
them to scale as need grows better than they would otherwise. I hope this
means also much more stable school attendance and economic stability for
families and communities. Is this more cost-effective and sustainable than
just buying people bed nets? Track this and find out. A lot of funding will
flow to whatever can be demonstrated to be maximally effective, and it's
important for us to find those interventions.

------
sgpl
This is awesome!

Is there something in the works that would make it possible for 'donors' to
cover the annual enrollment costs for others? Or would that defeat the
purpose?

And this is off-topic but that's brilliant photography - kudos to the
photographer(s)!

~~~
chaseadam17
There's not a way to donate online to cover enrollment costs at the moment.
The best way to support us is to sign up to fund a surgery for a patient every
month: [https://watsi.org/universal-fund](https://watsi.org/universal-fund)

If you'd rather help cover enrollment costs for Watsi Coverage, please email
connect@watsi.org and we'll respond right away. Thank you!

~~~
ketralnis
I just wanted to echo that I'd be interested in an automatic recurring
donation system. I'm sure you guys have thought about this way more than I
have, but my understanding is that those kinds of donations are a significant
portion of funding for other non-profits like NPR

By the way, the link to "learn more" on the FAQ for "can I donate monthly?"
links to [http://wwww.https//watsi.org/universal-
fund](http://wwww.https//watsi.org/universal-fund) which confuses my browser
so I get a connection error

~~~
_asummers
My understanding is that having recurring payments gives a sense of "stable
income" for the non profits, and while having massive donation campaigns is
obviously helpful, it's much harder to forecast.

~~~
toomuchtodo
I'd like Watsi to have an investment account where donations can be received
but they operate off of the investment returns (similar to how Standford,
Yale, etc operate financially).

This would mean a gift provides for operating returns perpetually (or as long
as the financial markets continue to exist).

For example, a one time donation of $300 (invested) would provide for a health
insurance member (at 78 cents/month) in perpetuity.

~~~
byronium
The perpetuity aspect is a good point, but the fundamental pitch of Watsi is
"100% of your donation goes to a specific patient in need", not "100% of your
donation goes into an investment account that will be invested in anything
from oil to cryptocurrency (and things you might not necessarily agree with)
whose returns will then go to a patient in need". The vast majority of donors
donate to Watsi for precisely this pitch. Also if Watsi made this change, who
would manage the investments? Wouldn't it fundamentally change the company
from a small, lean, product-driven global health nonprofit to a socially
responsible investment (SRI) company (which there already are many of)?

~~~
toomuchtodo
Vanguard has a non-profit foundational division that manages this for an org:
[https://institutional.vanguard.com/VGApp/iip/site/institutio...](https://institutional.vanguard.com/VGApp/iip/site/institutional/clientsolutions/endowmentfoundation)
There is no need for Watsi to handle the management of these
investments/funds.

> Wouldn't it fundamentally change the company from a small, lean, product-
> driven global health nonprofit to a socially responsible investment (SRI)
> company (which there already are many of)?

Nothing would change except Watsi having more consistent funding and the
ability to have a longer term strategy.

------
nicpottier
It feels like there aren't a lot of people in this thread that have spent any
time in this space, specifically health care in East Africa or the wild wild
world of NGOs / aid there.

This has the same breathless and "six weeks of hacking to save babies" feel to
it that every other project starts out with. What exactly is different? There
are a zillion mini-EMRs operating in East Africa, especially Uganda, what most
lack is real integration and cooperation with the government to make them
sustainable and scale. What is the story there for Watsi? Why will Watsi avoid
the complexity of a real EMR like OpenMRS? Are you integrating with them?

There's a slide somewhere that I think UNICEF put together of all the NGO (as
in non-UG-government, not just non profit) health projects active in Uganda.
It is this hilarious demonstration of the crazy amounts of bootstrapped
projects exactly like this and just how much they overlap.

To the founders, have you read The White Man's Burden? If not, please bump it
to the top of your list.

Source: I lived in neighboring Rwanda for 5 years and work in this space,
including projects in Uganda. It is a fascinating space with lots of
opportunity for good, but also one that requires real introspection on why you
are pursuing particular strategies and whether that is being driven by ego or
truly because you think it is the best for the people. Almost always the
answer is that no, a new thing isn't required, but rather you should be
pitching in with someone else or building upon an imperfect system to better
it, because that system is government owned and managed and thus will be
sustainable and gives the country and people agency. This is why aid is hard
work, because most good organizations have moved past the "hey, look what we
built you stage" to instead trying to build capacity and institutionalize
changes. That is so much more difficult but much better tack, though my
beliefs are still more in the camp of direct cash transfers these days.

~~~
chaseadam17
Thanks for your thoughts. I've worked in the nonprofit space for a long time
and agree that there are way too many fragmented projects. We did the pilot in
Uganda because we were invited by the community. They wanted to implement a
community health insurance system (similar to the mutuelle system in Rwanda)
but they didn't have the capacity to administer it. The community and the
Uganda Catholic Medical Bureau designed the insurance system and are currently
running it with our technology.

The government (both the Ministry of Health and the district health office)
were involved in the project and even drove out to speak at the launch. They
are interested in national health insurance, and we've been invited to
participate in their technical working group to share our learnings. At
request of the government, our system will integrate with DHIS2 and EMR's like
OpenMRS, however, we've found that very few providers actually have an EMR in
use. Our system isn't an EMR - it's health insurance administration
(enrollment, claims, etc.) which is very different and we haven't found
anything like it for LMI countries, beyond CarePay which is mostly focused on
payments.

Another government in East Africa has already approached us about using our
software to administer their public health insurance system, but the Rwandan
government would be an ideal next partner. I'd love to talk more if you're
interested and we're always open to feedback, especially from people like you
with lots of experience in the space. Please reach out at connect@watsi.org if
you have a few minutes. Thanks again.

~~~
nicpottier
Sent you a note, thanks for the reply.

------
moonka
Incredible work. So many times you hear people working on this that will
"Change the world", but these guys are actually doing it!

~~~
jacquesm
It helps that Watsi is not a traditional start-up in the sense that their
investors expect a return so they are much more free to actually do stuff that
matters.

Way too many start-ups believe their own BS when it comes to sentences like
'changing the world' when in fact all they want to do is make their own stash
of FY money. Most of these are a net negative when it comes to the change they
impart on the world.

If you really want to change the world in a positive way a non-profit is a
much better structure. Unless you plan on using your FY money to change the
world afterwards, Bill Gates style.

~~~
brucephillips
So which is it, they believe their own BS, or all they want to do is make FY
money?

~~~
beaconstudios
Yes.

------
dalbasal
A feel like I'm hearing the middle of a conversatoin

The language used to describe this program seems to land it in the US' medical
system debate. EG _enrolling in health coverage._ A lot of the comments here
are focusing on that debate.

I imagine the situation is different enough (industry, patients, funding,
etc.) to make the comparison something of an analogy.

In any case, I'd like to hear a bit more about watsi's role and goals. Is this
a medical insurance/bureaucracy infrastructure governments can adopt? An
alternative way to raise/use donor aid, funding insurance instead of clinics?
Are "crowdfunding" and "coverage" separate initiatives?

------
Fej
Wow.

With my admittedly limited knowledge, it appears to me that this is one of the
best efforts in our industry, changing the world for the better and directly
making a dramatic difference in the lives of the most vulnerable.

Watsi, and the people behind it, give me hope for our species, despite the
state of politics (both in where I live, the US, and in the world in general)
or whatever other cynical reason one could come up with.

When we come together, we really can do great things... don't give up hope.

Of course, many thanks to the Watsi team. I hope that I will have the
opportunity to join you someday.

~~~
jdiaz5513
Yeah, agreed. I'm sending them my resume.

My last company (RIP) had a similar idea: ruthlessly cut costs typical for the
industry (banking) and pass the savings along to create a product that works
for the disadvantaged.

------
Strom
Fingerprint based system seems like an interesting choice. Don't these people
do a lot of manual labor that scratches fingers? I sometimes have identifying
trouble myself due to finger damage and I sit in an office.

~~~
chaseadam17
We're testing a few identification methods in addition to fingerprints,
including cards with QR codes, name lookup, and family lookup. For
fingerprints, we're using an algorithm created by Simprints out of Cambridge
that's specifically for low-income settings where there's a lot of manual
labor. Glancing at our data, it seems like so far we're getting good reads on
more than 75% of scans. Hopefully we can improve that with some optimization.
Another challenge with fingerprints is they don't work for kids under six, so
regardless you need a backup identification method like a card.

~~~
Tade0
Why not iris identification then? It's non-invasive and has considerably more
entropy than fingerprints.

------
gault8121
Congratulations Chase and the team, it's incredible to see such a complex
product built in such a quick time period. How many folks from the dev team
were in Uganda? And is this tool open source?

------
cheeze
My universal fund donation is the best money I spend every month. I love
Watsi!

~~~
RobertoG
Same feeling here. I like the personalize touch. I think this model could make
a lot of good in the future.

I want to take this chance to encourage people here to give Watsi a try. For
the price of two or three beers you can help somebody every month.

------
aheilbut
What exactly can be provided for $0.78 per month?

~~~
chaseadam17
A comprehensive package of primary care benefits that includes all outpatient
care at the clinic (e.g. preventive care, malaria treatment, etc.), limited
in-patient care (but no surgeries), and deliveries.

~~~
repiret
Does the coverage premium fully pay for the cost of care, or are there
additional subsidies?

~~~
chaseadam17
There are some additional subsidies in the form of in-kind donations that help
cover immunizations, HIV/AIDS, malaria, and antenatal care.

------
sriram_sun
FTA:"193 of the world's governments share a goal to achieve universal health
coverage by 2030." What does this mean? Aren't governments always paying lip
service to some form of "universal coverage"? Isn't that one of the goals of
any good government?

~~~
stevenwoo
It has never been the stated goal of the USA government and is not the goal of
the party in power now, in the Obamacare repeal process they have repeatedly
argued that letting people choose how much or how much not to pay (either no
insurance or emergency only type healthplans that are not available in most
healthcare markets now) and to whom to pay for healthcare is more important,
if one is not wealthy enough to pay, their argument is one needs to get more
money. The GOP was in favor of Obamacare when Mitt Romney implemented it as
governor and when it was initially proposed by a conservative thinktank.

~~~
ams6110
> if one is not wealthy enough to pay, their argument is one needs to get more
> money

Please cite the proposal introduced by any conservative senator or congressman
that contains this argument.

~~~
stevenwoo
The most famous example from memory is the congressman who said people need to
stop buying iphones so they can buy insurance instead. As if one - two months
of insurance is more than a temporary salve.

[http://www.cnn.com/videos/politics/2017/03/07/jason-
chaffetz...](http://www.cnn.com/videos/politics/2017/03/07/jason-chaffetz-
invest-in-healthcare-instead-of-phones-sot-newday.cnn)

The other famous quote is people will choose to not buy insurance because it's
not important enough.

[https://www.yahoo.com/news/gops-cornyn-defends-americans-
fre...](https://www.yahoo.com/news/gops-cornyn-defends-americans-freedom-skip-
health-insurance-165433159.html)

If I had time to watch CSPAN I could probably come up with an example from
every GOP congressman/White House spokesman/conservative think tank to match
these with video, since they all use the same talking points they use in
public for the Obamacare repeal.

I guess you could interpret what they are saying to not mean what I think they
mean.

------
fillskills
Wow thats cheap! That's awesome work Watsi team! What are some scaling issues
you think you will face over the next few years?

~~~
chaseadam17
There are a lot - limited internet, different languages, technical literacy,
and eventually government adoption. It feels like a lot of what we're doing is
on the cusp of what's currently possible, but so far it's working, in large
part because of the amazing work our team has done.

~~~
fillskills
Those are some very big challenges. But bigger the challenges, the more fun it
is to solve them. And more of a headstart you get over competition. Best
wishes with the challenges. Your mission is amazing to say the least

------
rsingla92
Watsi has been doing tremendous work in this area. Congratulations!

------
AndrewCHM
[https://watsi.org/faq#how-does-watsi-handle-patient-
privacy](https://watsi.org/faq#how-does-watsi-handle-patient-privacy)

"how do you handle privacy?" "yes"

~~~
aptwebapps
Here's what it says right now,

"We take patient privacy very seriously. It’s important to us that every
patient posted on Watsi understands what Watsi is and how it works. Our
medical partners are responsible for ensuring that every patient understands
Watsi and explicitly wishes to participate in the program. If a Watsi
Crowdfunding patient doesn’t wish to be featured on the website, we give them
the option to have their healthcare funded via our General Fund without ever
appearing on the website."

Is that different from when you looked at it?

~~~
pgodzin
I think his point is that this only addresses patient consent and website
publicity, and nothing about what they do to actually keep patient data secure
and private.

~~~
microcolonel
I think prettymuch anything they could do would be better than paper files
sitting in unsecured rooms protected only by people's sense of individual
decency; or worse, no files at all.

~~~
tehlike
No. I argue paper files are more secure, at least they wouldnt be target of
digital breach where millions' data could be "hacked"

------
EternalData
A true step to equality, in a truly global sense.

------
spike021
This is awesome to hear! First saw/heard about you guys at the ELEO conference
in San Jose a few years back.

Great work!

------
plumeria
What's the brand and model of the fingerprint reader featured in the Watsi
animated gif?

------
pchristensen
This makes my heart happy to hear!

------
knivets
Does anyone know what is the model of the fingerprint scanner used in the
article?

~~~
brepl
Looks like [https://www.simprints.com/](https://www.simprints.com/)

------
danreed07
This is an incredible accomplishment. Congratz guys.

------
wslh
Where do you apply to be funded by YC Research?

------
jnardiello
State-sponsored universal coverage: "that's for commies! Not acceptable!"

Silicon Valley VC-based universal coverage sponsored with crowdfunding:
"wooooho that's super great! I love technology"

I would laugh if It wasn't for the milions not being able to afford basic
healthcare.

~~~
brucephillips
I don't agree with it, be the counter-argument would be that state-sponsored
coverage involves taking money from people without their consent (taxes),
whereas charity doesn't. You should always address the strongest version of
the argument you're refuting.

~~~
simonh
All laws are coercive. Why are you picking out specific ones, what are the
criteria?

For example public parks have bipartisan support and are funded by taxes. So
why will the US tax people to care for wildlife, but not its own citizens?

At one time the US instituted a military draft, requiring citizens to carry
out military service. Citizens are required to obey the law, pay taxes and
serve the interests of society, as determined by the government. I believe
that this places a responsibility on that government to care for and protect
citizens. It must offer them the protection of the law, defend them in times
of war and, I believe, provide basic health care. It should do so not just for
the benefit of the individual, but for the benefit of society.

There's no point drafting people into the military if the health of the
population isnt up to it. This was a major issue for the UK in WWI and a key
factor in getting cross-party support for a national health service, because a
shocking number of young men were unfit for duty. Currently not being in a
time of war doesn't change the relationship though. The duties and
responsibilities are still there.

~~~
bduerst
>All laws are coercive

Locke would disagree with your premise. You're an individual with the freedom
to move to any society that you agree with the most. Unless your freedom has
been alienated, you are tacitly consenting to a government's laws by remaining
where you are.

~~~
soVeryTired
So why does the typical American live within 18 miles of home? [0]

Do they just happen to agree with the society they're born into, or is it
possible there are stronger forces than political preference that constrain
their movement?

[0]
[https://www.nytimes.com/interactive/2015/12/24/upshot/24up-f...](https://www.nytimes.com/interactive/2015/12/24/upshot/24up-
family.html)

~~~
bduerst
Choosing to live close to family isn't alienation of freedom. Those are
economic choices, not coercive constraints.

~~~
soVeryTired
Sure, but I don't think that amounts to a tacit agreement with a government's
laws. Sometimes people are just stuck where they are.

~~~
bduerst
That's definitively what tacit agreement is, especially when someone claims
that all laws are coercive.

------
kbart
What I don't get about USA mentality is that Americans collectively pay
>600B/year to fund military[0], trillions worth of pointless wars[1] via taxes
and are happy about that, but when it comes to paying some extra to fund their
_own_ and fellow citizens healthcare (which costs nearly _twice less_ than
military spending[2]), suddenly it's somehow against free market and "American
spirit". Is it a paramount of government brainwashing, lobbying or something
else?

0\. [https://www.cnbc.com/2017/05/02/how-us-defense-spending-
stac...](https://www.cnbc.com/2017/05/02/how-us-defense-spending-stacks-up-
against-the-rest-of-the-world.html)

1\. [https://www.reuters.com/article/us-iraq-usa-funding/u-s-
cbo-...](https://www.reuters.com/article/us-iraq-usa-funding/u-s-cbo-
estimates-2-4-trillion-long-term-war-costs-idUSN2450753720071024)

2\.
[https://en.wikipedia.org/wiki/Health_care_in_the_United_Stat...](https://en.wikipedia.org/wiki/Health_care_in_the_United_States)

~~~
developer2
Bang on. Across the globe, citizens of every other nation cannot fathom why
the US prioritizes military spending above all else. It just doesn't make
sense.

~~~
Noos
because we're subsidizing europe, which is a huge free rider on the US
military. If Putin for whatever reason decided to become an expansionist power
and the US had an european level military, no one could stop him.

Europe in general has been massively subsidized in different ways by the USA
from the end of WW2. They turn around and love to show off their moral
superiority while someone else picks up the bill.

~~~
kbart
I agree with that (though things are slowly getting better in Europe), but
then why average Joe from USA is OK with government subsidizing Europe with
his tax money, but freaks out on the idea of paying for his own healthcare
from the _same tax money_?

~~~
chimeracoder
> why average Joe from USA is OK with government subsidizing Europe with his
> tax money

Where do you get the idea that "average Joe" is okay with that? It's been a
huge talking point for Trump and his supporters for the past two years.

~~~
ZeroGravitas
Also, the majority of American's are actually in favor of having some kind of
sane medical system, like other first world countries. That's well supported
by polling (though interestingly they don't like "Obamacare" but do like all
the policies that make up the Affordable Care Act)

This was also a talking point for Trump and his supporters for the past two
years. ("we're going to have insurance for everyone", "No cuts to medicaid",
"No one will lose coverage", "Nobody will be worse off financially", "I am
going to take care of everybody … Everybody’s going to be taken care of much
better than they’re taken care of now.")

Of course, in that case as well, he took them for the rubes they are and
likely had no plan for delivering on his promises.

------
Noos
This isn't going to work.

It looks like they are just appifying the missionariy/charity elements already
going on in african nations, not providing universal healthcare. To have real
universal health care would involve a lot of infrastructure building and
education which would be way beyond what a small start up could do.

~~~
narrator
Indeed, nothing really about the supply side. If they don't take care of that,
spending more money on health care will just raise prices. Don't tell
Americans that though. They believe, as a matter of ideology, that spending
more money is the only effective solution to all problems

~~~
lkbm
They increased the customer base (by increasing healthcare enrollment to 98%)
and made it quicker and easier to get paid for treatment provided, while also
preventing unnecessary treatments.

What deficiencies do you see in the supply side right now, and why don't you
think this addresses them?

~~~
narrator
Number of available doctors. Drug production. Consumable medical supply
production.

I guess if you can import this stuff from China and India with minimal quality
checking things are good. I am not being sarcastic about the China importing.
In the U.S we have $500 bags of saline that the minimally checked bag from
China would cost $5. Really you don't even need universal health care, just
adequate supply and that means imports, cheaper schooling and deregulation to
solve health care.

~~~
lkbm
We're trying to solve healthcare in Uganda. It does look like supply of
doctors is an issue[0], but it also seems that delayed paychecks are a big
part of that, and this seems like at least a partial solution.

I'm not sure what to do about there being higher salaries for doctors in the
US. Subsidizing education for medical students who promise to stay in Uganda
for several years might be a good option. But it seems silly to complain that
Watsi has only _partially_ fixed healthcare in Uganda. I _certainly_ don't see
any basis for the blanket claim that "This isn't going to work." This is
already working--it's just not a panacea.

[0] [https://www.theguardian.com/global-
development/2015/feb/10/u...](https://www.theguardian.com/global-
development/2015/feb/10/uganda-crippled-medical-brain-drain-doctors)

------
peterwwillis
Healthcare is complicated and expensive. This startup comes out with an app, a
fingerprint scanner, and some compelling images, and now people are willing to
hand over their money to some brand new company claiming they will bring
universal healthcare to the masses.

Rather than develop a long-term set of healthcare provider alternatives,
they're depending on selling a story and getting funding from people sensitive
to heart-warming stories on the internet to "change the world". If any link in
their public relations chain is broken, there goes the project.

I really like the idea. But copying a Sally Struthers late-80s TV commercial
probably isn't going to solve healthcare.

~~~
icelancer
>>brand new company

Watsi has been around since 2011.

>>Healthcare is complicated and expensive

Overall? Yes. Compartmentalized and decentralized, it does not have to be.
That's the whole point of these types of initiatives.

~~~
peterwwillis
> Compartmentalized and decentralized, it does not have to be.

Being compartmentalized and decentralized is what the story claims is
inefficient and expensive.

