@sethbannon There are many of us in YC that want to build a successful company and are also mission driven (🙋♀️)! We might also tend to be the companies that are less loud online (🤷♀️).
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Louise Tanski
14 posts
Louise Tanski
@LouiseTanski
replacing COBOL era health insurance infrastructure | YC F25
San Francisco, CA Katılım Ekim 2025
59 Takip Edilen26 Takipçiler
This is my single biggest disagreement with YC.
Starting a startup to get famous, or to do better than those around you, or for vanity, or yes even just to get rich, is worse for society and worse for founders. It's what leads to the rise of gambling apps and slop apps and get rich quick schemes.
Society is better served by founders who have a vision for how the world should look that they care deeply about and work tirelessly to build it. It's also better for founders! Those that have made the biggest impact throughout history and those that have been the most fulfilled are people with deep meaning in their lives. Meaning does not come from chasing fame or riches or titles. It comes from doing something greater than yourself. It comes from serving others.
Ironically, having a mission that's bigger than yourself is also more likely to lead to outsize financial success than simply chasing money. Can you imagine if Steve Jobs was driven by fame? Or to get rich? Jensen? Page and Brin? All were driven by a vision they had for the world first and foremost.
If we encourage founders to start startups to get famous, we're in for a bad time. If the highest aspiration founders have is to get rich, the future will be worse off.
We can do so much better. Let's make something civilization needs.
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“How can you sell security if you’re insecure yourself?”
- @deepkkapur overheard at a YC dinner
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@SenBillCassidy One place to start is making sure insurance companies count cash pay spend towards deductibles for eligible expenses. Some states have these laws (ex. Texas) but not all.
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Mark, thanks for engaging.
On your first point, absolutely AGREE! I want to work on legislation to fix how Americans with high-deductible health plans get stuck paying the full sticker price instead of the real discounted price.
Mark Cuban@mcuban
If you want some bandaids that help patients 1. Make all deductible phase brand drug purchases be priced at net, after rebate and fees. Not just for ACA, for everyone in every plan. This will save patients 10s of billions 2. Require inter company transfers from owned providers be at Medicare rates. Ends gaming MLRs 3. Rather than giving money to everyone for their HSA, work with providers to guarantee payments for all deductibles, if they charge Medicare rates for ACA plans. This reduces provider bad debt, ends medical debt for patients under the ACA , and makes ACA plans pay more because patients don’t avoid care because of they can’t afford deductibles. If the numbers work , expand this for all care provided to the uninsured. Means test repayments with a reinsurance cap This changes the game for insurance 4. Mandate Nationally, that any cash purchases have to be applied to deductibles. This allows for competitive price shopping. 5. Create a national rebate GPO that all states participate in by default that negotiates rebates for brand and specialty drugs. These aren’t perfect and are generalized. But you get the direction it can go
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@JahangirAsgha10 More self-funded employers need to consider adding cash pay plans. To some extent we will always need some government intervention to support the disabled and elderly.
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Here’s the deal.
I don’t think government can manage healthcare appropriately. Even if we built the perfect social program—the perfect Medicare-for-All system that somehow kept everyone happy—it would still deteriorate quickly.
It would accumulate regulations, attract intermediaries, and get captured by the same grifters who are already driving Medicare and the broader healthcare system into decline.
That’s the pattern, and it repeats every time. Models that actually empower the individual and keep decisions between the patient and the physician—without layers of intermediaries—are the only ones with a real chance of surviving the inevitable corporate–government manipulation.
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Agreed. I explored building a cash-pay network but faced a key challenge: physicians are reluctant to publish their cash rates because insurers will lower contracted reimbursements to match these published prices. Additionally, cash-only and direct primary care physicians lack sufficient geographic density in most areas. Hospitals are in a better position to do this because they have more leverage but the CFOs and ops teams have to get onboard.
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What is needed is a national network of providers that will offer cash pay pricing around a single standardized contract to employers and a simple to understand price list for patients. Each can charge what they choose, as they do now.
Employers will save money. Providers reduce admin costs significantly. Insurance companies will have to meet market prices for services. The game changes.
Who puts this network together ? If the hospitals are smart , they will work together to create it. Otherwise they will be looking down the barrel of fighting single payer or universal healthcare, sooner rather than later.
And if you wanna replace the ACA ? That’s also the first step.
It answers the “how much does it cost “ question.
The only 2 remaining questions are “how do you pay for the care “, and who takes the risk when patients can’t afford the cash prices.
That’s a conversation for another post
All suggestions welcome!
Wall Street Apes@WallStreetApes
American Health Insurance is legalized racketeering. It’s a scam American doctor calls the hospital to get self pay pricing for a patient for pregnancy care Hospital response: “If they're self-pay, they give them a package price which would include the delivery and all of the services that they might need during the nine-month period” Doctor “If you could give me the package price?” Hospital “$5,730.37 and this is for a routine vaginal delivery with pre and post care in the hospital.” Doctor “Okay, so does that cover like the hospital facility fee or is that just the OBGYN group fee?” Hospital “It is both. It includes all of it” Insurance pricing would be 2-3x+ this cost
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Louise Tanski retweetledi
🚀 Amera launched! Automating health insurance claims processing Web Task
“Eliminate manual claims processing workflows"
🌐 fondo.ai/47SeB8I
Congrats @deepkkapur & @LouiseTanski!!
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@realdocspeaks @FrederikNeckar Adding Green Imaging to this list!
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For drugs, go to: CostPlusdrugs.com
For labs, go to: laboratoryassist.com
For imaging use: Radiologyassist.com
Avoid hospital-employed physicians, outpatient centers, urgent cares, labs, and imaging if the tests are routine and scheduled.
Always ask for the cash price for everything!
Joe K@joekkea5
@realdocspeaks So how does the average American patient compare and negotiate cash pricing that’s affordable?
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Louise Tanski retweetledi
Wanna help offset the loss of ACA premiums?
1. Require patients pay net price for medications during the deductible phase.
2. Require intercompany expenses of ACA carriers be set to Medicare rates so they can't game the ACA medical loss ratios
3. Require all cash pay medical or pharma expenses be applied to deductibles so patients can spend less out of pocket.
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@yanatweets @ycombinator I’m in YC now! Happy to help review apps esp for those building in healthcare/health insurance
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I’ve referred almost 200 female founders to @ycombinator
And I will refer more! Ping me if you’re considering applying.
We need more female founders shaping the future!
Otherwise, we end up with healthcare that ignores women’s symptoms, seatbelts that don’t protect pregnant bellies, voice recognition that doesn’t understand female voices, and much more!
The deadline is in one week.
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I want to help 100 founders raise their rounds before the end of the year.
We just unlocked a version of @boardyai that we didn’t think was possible.
Boardy raised his own $8M seed round earlier this year. Since then, he's introduced thousands of founders to investors who have raised millions.
We’ve been testing an overpowered version internally, and the results have been wild - founders are meeting stronger investors and closing rounds in weeks instead of months.
He’s not ready for public release yet (the token costs are insane), but it’s time to start introducing him to the world.
I’m personally working with 100 founders who are actively raising to help them close before the end of the year. You’ll work directly with me and the Boardy team and get early access before this version rolls out next year.
Comment “Boardy” below, and I’ll message you the link to apply.
If you know someone who’s raising, tag them below.
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Perplexity just quietly dropped a 42-page internal guide on how they actually use AI at work.
What I found most useful:
→ How they automate the small stuff. Email, meeting prep, research (all done by AI)
→ Using AI to amplify your curiosity, not replace it.
→ Their prompting playbook is simple, practical, and genuinely good.
Comment “AI” and I’ll send it to you for free.
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