
SimplyInsured (YC W13) raises $750K to simplify health insurance - vivekajayshah
http://venturebeat.com/2013/10/02/simplyinsured-aims-to-put-health-insurance-into-terms-anyone-can-understand/
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daguar
The key question here is how much additional value-add does SimplyInsured
provide over the online marketplaces being set up under the Affordable Care
Act.

A significant part of the broker's value is the high-touch relationship and
trust.

The market fit question to me is: if a state marketplace has a decent web
portal (like California's [http://www.coveredca.com](http://www.coveredca.com)
), what additional value does a private portal offer that NEITHER the official
portal NOR an offline broker can offer?

(Don't mean this as polemical by any means; lots of states are _not_ going to
have great portals. Just interested in hearing opinions on this.)

[Edit: making CA link a real URL]

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nhashem
I'd argue the ACA will enhance the market for SimplyInsured. Yes, for an
individual who wants a basic policy, Covered CA will probably be sufficient
and they won't need more help than that. But there are dozens if not hundreds
of edge cases.

Some examples off the top of my head:

\- A healthy 24 year old software engineer is making $75,000. This means he
doesn't qualify for any of the tax subsidies by buying insurance on the
exchange. He wants to avoid the $2,500 penalty for being uninsured, but every
plan on the Covered CA will cost more than that over 12 months. Perhaps his
best option is to buy an individual policy for catastrophic coverage only.

\- A small business isn't sure whether it's optimal to insure their employees,
or just give them a cash "bonus" and tell them to buy their own policy on
Covered CA (similar to what Trader Joe's announced they're going to do with
their part-time employees).

\- Purchasing insurance on Covered CA is limited only to certain enrollment
periods (this is perhaps the biggest misunderstanding, as I've seen various
media personalities ask "why wouldn't healthy people just wait until their
sick, and then get insurance?" countless times). However, there are exceptions
for a life-changing event. Thus, a person who is laid off (thus counting as
one of those life-changing events) would like information on whether their
best option is to pay for COBRA or buy a policy on Covered CA.

Basically the ACA is complex, but it does turn health insurance into a much
more structured and transparent market, which lends itself well to
applications like SimplyInsured. Otherwise, what could any sort of system do
for my third scenario, for example? All anyone could advise to have them stay
on COBRA because they'd probably get screwed by letting it lapse and then
trying to get an individual policy.

~~~
mjn
I agree on the last point: ACA probably actually helps them by making this
kind of analysis possible to automate, since it gets the plan data into some
kind of commensurable, analyzable form, and simplifies the answers to all
kinds of eligibility questions. Once you have a standard format for health-
insurance offerings, one analogy could be with air travel, where people build
sites like Kayak and Hipmunk on top of ITA's systems. That isn't possible to
do adequately if every health plan has its own custom set of terms written in
English/legalese.

~~~
vivekajayshah
Exactly! Unfortunately - the ACA "format" is still legalese... like this
(government mandated form)
[http://www.seechangehealth.com/SitePages/PDFLoader.aspx?Titl...](http://www.seechangehealth.com/SitePages/PDFLoader.aspx?Title=SG%20Classic%203500%202013)

We've built software to normalize despite that - check us out!

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rdl
It would be nice to know if I should get a Bronze HSA or a Gold PPO based on
1) my medical billing history for the past 1-3 years 2) my past and projected
income 3) potentially, my current medical status and good projections about
that.

The weird thing about ACA is it essentially turns this into a relatively low
range problem; I'm going to be spending $200/mo to $400/mo in premiums, and
I'm never going to be out of pocket more than $6350 on top of that. So even if
I do exceptionally well, it's maybe a $200x12 - $3300x0.35 (tax savings on
HSA) cost vs. a $400x12 plus epsilon cost vs. ($200x12 + $6350). Which isn't
enough to _really_ care that much, since most likely it's within $1-2k/yr
regardless of which plan I pick. And I doubt your picking would be that much
more accurate than a general WAG based on "do I often go to the doctor?"

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toomuchtodo
How is SimplyInsured going to deal with the long-term move of health insurance
towards single payer?

~~~
bifrost
Hopefully they figure out how to stop it. Single payer is a horrible idea and
generally lowers the standard of care for everyone.

~~~
toomuchtodo
....which would explain why every first world country uses it except the US?

I'd much prefer we don't devolve into a political argument. My question, I
thought, was relevant due to ACA kicking in, which is the first step towards
universal healthcare/single payer in the US (which would eliminate the
business model in question).

In closing, here is healthcare spending as a percentage of GDP by country
(almost all first world countries):
[http://upload.wikimedia.org/wikipedia/commons/a/a1/Internati...](http://upload.wikimedia.org/wikipedia/commons/a/a1/International_Comparison_-
_Healthcare_spending_as_%25_GDP.png) The US leads in spending, and only
spending.

~~~
kenrikm
I would like to point out we're also significantly more overweight, have
higher rates of heart disease, have a quickly aging population of baby boomers
etc.. Your argument is not logical as there are plenty of other reasons we
have higher healthcare costs other then that we're not single payer.

~~~
dragonwriter
> I would like to point out we're also significantly more overweight, have
> higher rates of heart disease, have a quickly aging population of baby
> boomers etc..

Those are all, arguably, _consequences_ of the poor access to health care in
this country and the short-term incentives in this country to delay care. IOW,
they are products of the system that we pay more for (per capita or even per
GDP -- or even either way _only considering public expenditures_ and excluding
the private costs) than first world countries that provide universal coverage
through government single-payer systems.

~~~
ams6110
I see this argument a lot: people go without care, or delay early treatments
that would be cheaper, because they can't afford to go to the doctor. I'm sure
this is true to a degree, but making terrible diet choices, being sedentary,
and being 100 lbs overweight is not a consequence of not having health
insurance.

And I really don't see the avoidance of primary care being primarily financial
either. A yearly routine physical is not very expensive, and is often free at
many public health clinics. Likewise common preventive care like flu shots,
pap smears, and prostate exams.

A big reason a lot of people don't go to the doctor is that they _don 't like
going to the doctor._ I'm in that group. Having insurance doesn't change that.

~~~
zanny
There is a huge cultural difference between almost every single payer nation
and the US. For example, I haven't seen a regular doctor in 3 years for any
kind of check up, because I'm uninsured. Meanwhile, I have friends in Canada
that get quarterly or even monthly checkups. It isn't even a cost thing, they
say it is cultural - their parents and peers expect them to regularly see a
doctor to make sure nothing is wrong with them, and if they sneeze wrong they
see the doctor.

I dislocated my knee this spring and reset it and just stayed in bed for 2
weeks. Never saw a medical professional, because they would want to x-ray (it
might have broke, it was much more painful than a normal dislocation to me,
and swelled huge for a while) and I'd be stuck with a $3 - 5k bill minimum
just for that, combined with any treatment, and I'd laugh if they'd want me in
physical therapy for it.

So it isn't just about not haivng a doctor to say 3 bic macs a day is bad for
you, it is that in most other places people _do_ see their doctors, regularly,
and for most issues, beucase it doesn't bankrupt them. That adds up over a
lifetime.

~~~
ams6110
I haven't been to see a doctor in at least 5 years, and I have insurance.

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Splendor
This appears to only be value to businesses who aren't interested in self-
funded policies.

