> this field here is ripe for disruption

meaning what? that a VC funded startup should come in and start offering health insurance? what are you suggesting? what does disruption even mean in this context?

let's get away from those corner cases where it's even thinkable to fly to Dubai for surgery. that's a high cost intervention for specific (wealthy) individuals. that isn't solving the problem of providing health care for 300 million people. how do you propose we do that?

Nothing to do with insurance or VC. Think of a consumer service at Walmart or Home Depot, helping people get very competitive services at prices to fit people's need.

Yes, travel is not a total solution for all 300 million people, but think along the lines of many packaged tour companies in cities who cater for international travellers and can arrange such facilities very efficiently. (I once had dental work done in India, and people don't realize how easy it is, the same kind of thing that you get here.)

Walmart already provides a handful of services of the kind you're mentioning. They have low cost clinic services (at some locations) for flu-shots, eye exams, and prescription drugs. Expanding those services would require having MDs on staff and on location.

There are plenty of businesses trying to offer more accessible medical services also. Urgent Care clinics are becoming popular in New York City, where I live.

None of this is doing much about cost though. The Walmart style sells things cheaply that are allowed to be sold cheaply. They don't sell what they are prevented from selling due to regulations or due to non-viability of offering the service due to staffing limitations. The Urgent Care style is going through the private health insurance system like just about every other medical care provider.

So I suggested an insurance "startup" because the space that seems to lack innovation is the payment side of the health care industry.

You are just changing the problem, not solving it: the American health care would downgrade (less money to spend) and the people from that countries would complain that their access to health care got worse because of Americans.

This is a good point. If we could avoid massive expansion of arbitrary and innovation-killing biotech regulations, then the market will eventually correct the current shortcomings and will catch up and work within the current framework. This will lower costs and drive up quality of care. Silicon Valley potentially has an important role to play here.