VC Bill Gurley on transforming health care

Washington has been gripped of late by the world’s most depressing, least imaginative, debate over health care. The question, as it stands, is whether Obamacare will survive (while being mildly, but persistently, sabotaged by the Trump administration), or whether it will be rolled back and replaced with a system that covers 24 million fewer people in order to fund tax cuts for the richest Americans. Huzzah!But a better conversation awaits. Bill Gurley is a partner at Benchmark Capital, and an early investor in Uber, Grubhub, Opentable, and more. In 2016, TechCrunch named him venture capitalist of the year. And for the last few years, he’s been studying the American health care system, trying to find an opening where technology can make a difference, and build a business. Now he thinks he’s found it.This is a conversation about what kinds of health care systems are, and aren’t, possible in this country. As you’ll hear in this discussion, I’m much more skeptical than Gurley is about both the need and the desirability for reforms that push costs onto consumers, but I agree with him that Obamacare has moved the system farther and faster in that direction than people realize. We talk about that, as well as why it’s been so hard for technology to cut costs in health care, the Singaporean health care system and the lessons American can learn from it, the way regulation protects incumbents, the government’s strangely structured investments in electronic medical records, and whether Silicon Valley’s move-fast-and-break-things culture can work for something as personal as medical care. We also discuss Gurley’s view that democracy and capitalism will, if given enough time, eat each other, and why he’s looking to China for the next great health innovations. This conversation won’t fix the American health care system, but it was, for me, a refreshing reminder that better, more productive discussions are possible. Books:“Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong," by David Goldhill"Startup: A Silicon Valley Adventure," by Jerry Kaplan“Myth or Magic - The Singapore Healthcare System," by Jeremy Lim"Shoe Dog: A Memoir by the Creator of Nike," by Phil Knight