I'm all for removing the broken system we have today, but a single payer system doesn't remove the challenge that the entrepreneur faces - it just changes it. Under single payer, you are now trying to sell to a large government organization, with all the pain and red tape that comes with that.

Not necessarily. Doctors can still have individual discretion over their choice of IT service provision (etc) under single payer.

The only thing single payer does is eliminate insurance company opportunism. It doesn't suddenly convert the entire healthcare system into a dystopian concrete monolith.

Although if it did it would make OP's job far easier, because if you could prove there were cost and health outcome benefits on a national scale you would be able to convert the idea into a viable business with a single corporate sales pitch, instead of trying to sell to every doctor individually.

In fact the real resistance would come from pharma. Single payer or not, evidence-based prescribing of empirically proven best-in-class drugs would undermine pharma's entire business model.

> because if you could prove there were cost and health outcome benefits on a national scale you would be able to convert the idea into a viable business with a single corporate sales pitch, instead of trying to sell to every doctor individually.

As someone who ran a healthcare business in Canada, I can tell you that this is absolutely not the case. Single payers are outrageously conservative buyers... sure, you may convince them in 5-10 years, but no startup can spend 5-10 years burning cash without making revenue. Particularly since, unlike with drug discovery, there's no guarantee that you'll be the only one selling this if the single payer eventually approves it.

What actually happens is that the single payer orients itself to big, slow companies that more closely resemble it, thus devastating small businesses and rewarding large, established players. It is damn near impossible to create a startup that sells to a single payer healthcare system.

That's a shame, in the UK we've seen some medical companies do very well by selling to GP surgeries and Primary Care Services (e.g. Egton who provide the online prescription and appointment booking service PatientAccess).

Providers are still basically private businesses (at least in primary care), so it is possible to sell to them. The problem is that each province runs its own system, unlike the UK where the NHS is universal across the country. So your addressable market is limited unless you can tailor your product to fit all 10 provinces. In practice it's very difficult, which is why almost all of the electronic health record software is owned by one of 3 large companies.

> As someone who ran a healthcare business in Canada, I can tell you that this is absolutely not the case.

Correct me if I'm wrong, but doesn't Canada have publicly funded providers? I'm all for single payer, but with a completely privatized provider network. Make the free market compete for the government's dollars. Technology should theoretically reduce costs because it more automation generally means higher profits.

provider != payer

You are wrong. The single payer in Canada is each province's respective health insurance plan. Anything listed on their "schedule of benefits" can only be paid for by the province.

Providers are actually in many cases like contractors... most family doctors, for example, bill for services rendered and are otherwise free agents (unlike in the UK).

Presumably the government will be incentivized to try to save lives in a way that simply doesn't exist for doctors and insurance companies trying to make a profit.

What happens in reality in systems like that is that doctors are lectured to avoid prescribing expensive exams, things like MRI or PET scans, even sometimes not telling patients they should do them if they could afford to pay them on their own.

And the same goes for drug prescriptions.

Thanks for refocusing the conversation back on the people that really matter.