It’s shameful for YC to invest in this and blast it onto the front page of HN. Unethical and gross. I wish this site was community driven and not used as an avenue for YC to promote their awful investments.

Here's a counter argument: "a company making money off of folks with ____" describes the entirety of the Biomed industry. Every medical device is sold with the intention of helping people with medical issues, but they can't be free. The cost of development and production has to be covered by somebody (be that by the government, medical insurance, or private party). If it wasn't, the company making the device wouldn't have developed it in the first place.

That industry is also regulated and monitored to ensure that the interventions coming out of it are generally safe and effective. Is the same true here?

> Every medical device is sold with the intention of helping people with medical issues, but they can't be free.

Close, but a slight correction here:

Every medical device is sold with the intention of maximising profit, but they can't do nothing or people wouldn't buy them.

That more accurately portrays the priority.

So true.

I don't see anything wrong with it. Surely a lot of people with ADHD would be happy to pay for an app that helps them overcome their problem, and the monetary price most likely exceeds the benefit (assuming the method used by this app works as advertised). In fact the price is much cheaper than a regular visit to a therapist. The problem I see here is the current subscription model. If people are happy with the trial, and see results, they would be happy to subscribe for a monthly fee along with their Netflixes and Spotifys.

If it actually works, an app like this could be worth 10x the price.

Getting rid of all the time waste, all the stress of AD is worth a lot.

Sure, but then isn't this just a "disability tax"? (I'm aware that the word disability is antiquated and not perfect here, but for the sake of being concise, this is what I wrote).

The need for this app is a problem. Insurance should cover the cost of treatment (and insurance should be affordable and available; for transparency: I'm pro medicare for all, here in the US).

Start ups have a bad habit of taking a systemic problem and trying to monetize a solution to it. In reality, the effort being put into this should be put, instead, toward making systemic changes that would make this app unneccessary.

Most of the folks on this thread seem to be objecting to the opt-out nature of their subscription service. I agree with them.

On the other hand, you seem to be objecting to the very nature of money being charged for this app or any other healthcare service?

It's gross, and I do not love this aspect of capitalism. I agree with you to that extent.

But -- again, without ditching capitalism entirely -- what's the alternative? These folks are providing a service and that costs money. Aside from ditching capitalism entirely, what alternative is there to "charging $X to fix Y?" Literally anything amounts to a chronic or acute disability tax. The cost of asprin is a headache tax. And so on.

The best capitalism has been able to do is roll these sorts of healthcare costs into insurance premiums, so we can share the cost collectively to an extent. Unfortunately I doubt an app like this is covered by any plan.

The only other solution (within capitalism) I can imagine is if the creators of this app ran their company as a non-profit org. I have considered that in the past for a venture or two. But, the money would still need to come from somewhere.

You're right, I take a more aggressive stance on this sort of thing than others might. I'm also known to say "if you can't afford to pay your workers a living wage you can't afford to do business" of many retail/service environments.

"But I need to make money, too" isn't an excuse. It wants to be, but it is not. I would agree that the biggest offender is the predatory model, but I would say that the way to do this _correctly_ is to do it free/OSS with a patreon. Let folks who use it pay what they think it's worth.

The problem is that the incentive systems don't align. Someone elsewhere mentioned that this seemed to build dependency in its users (an anti-pattern in therapeutics (and elsewhere, but let's be specific to therapeutics for now)). With something like Patreon, the incentives are much closer aligned: the app _has_ to do good in order to well, because otherwise nobody will pay for it.

Again, they (the developers) could also put their time & energy into enacting systemic change.

   "But I need to make money, too" isn't an excuse. It 
   wants to be, but it is not. 

There's another way to phrase that.

   "But I would like to buy food, clothing, and pay my rent" 
   isn't an excuse. It wants to be, but it is not. 

People need food and places to live. The vast majority of people on Earth aren't fortunate enough to have a year or two worth of savings to tide them over while they work on some dream project that

I would say your incentives don't align. By effectively restricting the privilege of app/product creation to those people that have a strong economic cushion, you're effectively excluding most of the people on Earth, particularly those that not already wealthy and particularly those with people besides themselves to care for.

    "if you can't afford to pay your workers a living wage 
    you can't afford to do business" of many retail/service 
    environments.

But app creators should just do it for free? Until the money maaaaybe rolls in? Most business/apps/etc fail.

> People need food and places to live.

Yeah, and under capitalism, these are linked to some capitalist idea of productivity.

We're getting a little far from the original point of this thread, but I'd argue that food & shelter & healthcare shouldn't be linked to "productivity".

I think the way that this is applicable here is that when the private sector gets involved in an issue, it can be a lot harder for the issue to be addressed by the public sector. That's a really big topic, I'd suggest reading Winners Take All[0] for a more in-depth look at this.

I'll leave this at: some things shouldn't be monetized (and this is one of them).

> I would say your incentives don't align.

I'm not sure what you mean. What are my incentives here?

> But app creators should just do it for free?

There are plenty of consumer spaces where I don't complain (publicly) about app-creators getting involved. This, being a "mental health" app, is an area where the public sector getting involved could be detrimental (see my comment elsewhere where I ask if this could be harmful in the long run).

[0] https://www.penguinrandomhouse.com/books/539747/winners-take...

    I'm also known to say "if you can't afford to pay 
    your workers a living wage you can't afford to 
    do business" of many retail/service environments.

Also, how the heck do you reconcile this with your stance that people shouldn't try and make money from their apps?

I would say, "if you can't afford to pay your developers and other employees a living wage, then you can't afford to make an app or launch a product"

I don't think you've thought any of this through, man. You have some excellent ideals and I agree with them but you need to think through the practical ramifications.

> Also, how the heck do you reconcile this with your stance that people shouldn't try and make money from their apps?

I think I addressed this in my other reply, but I'll reiterate: given the economic system we exist in, I'm not against people making money from their apps, I'm against certain areas better suited to public works being entered by the private sector (especially in a predatory way).

> I would say, "if you can't afford to pay your developers and other employees a living wage, then you can't afford to make an app or launch a product"

I totally agree with this.

> I don't think you've thought any of this through, man.

I try really hard to be internally consistent, but I'm imperfect. I'd be interested in hearing what I'm not thinking through, because I feel like this is an area where I have.

The respond to the quote at the top of your comment: I've been reading & hearing about a lot of restaurant owners complaining that they can't afford to pay their workers a living wage for $REASONS (this happens a lot in restaurants, specifically). My response is exactly what you quoted (and I'll type it again): If you can't afford to pay your workers a living wage, then you can't afford to do business. Asking anyone to work for a sub-living wage is essentially asking for them to subsidize your business, and, in an area that differs dramatically from start-ups, these restaurant workers generally aren't given equity as compensation (which would tie their wage to the success of the restaurant).

I'll admit that my thoughts in this area are complicated, because we live in a capitalist community (at least here in the US) so there are some concessions that I have to make. Do I think capitalism is viable in the long run? No. But I also think it is a fool's errand to wait for a revolution, so I think my thoughts get a little more nuanced when it comes to working ethically within an inherently unethical system (and I'm being very liberal with what I consider ethical work, by necessity).

I'd love to keep this conversation going. I know I have a lot to learn & that there's a lot that I don't know that I don't know. Conversations like this, that challenge my ideas, can only lead to a better understanding of my concerns and thoughts.

I appreciate you taking the time to respond to my comments.

    Do I think capitalism is viable in the long run? No. But 
    I also think it is a fool's errand to wait for a 
    revolution,

Amen! Honestly, I might wait for or work towards a revolution, but I suspect that whatever replaces capitalism is likely to be a lot worse. Power coalesces, even in well-intentioned and theoretically more egalitarian systems. Their historical track record is not great.

    I think my thoughts get a little more nuanced when 
    it comes to working ethically within an inherently
    unethical system 

Amen to that as well. Ethics are never easy and they always require extra gymnastics and compromise when trying to do the ethical thing in an inherently unethical system.

    > I don't think you've thought any of this through, man.

    I try really hard to be internally consistent, but 
    I'm imperfect.

I'm sorry I phrased it that way. It was glib and rude of me to type that. Clearly you've thought about this a lot.

But, I'm not sure I understand your practical alternative here.

Let's assume that Inflow is (a) actually effective and (b) they drop the questionable opt-out subscription model. Both big assumptions. I have not used the app and am skeptical to say the least. But lets assume it delivers legitimate value/relief/etc.

(Something I'd gladly pay for, and something the world genuinely needs. Doing CBT with a therapist is financially out of reach for many/most)

So, how should this app have been created? How would its creators be paid prior to the app earning money?

I have bootstrapped a product to market, and it really sucked. I went without health insurance for two years, living in the spare bedroom of a family member. And I was extremely privileged to even be able to do that: I was young and healthy and had a family I could rely on, and no dependents relying upon me. Even if I were living in a country where there was some kind of humane public healthcare system that would have been rough.

I'm not complaining. Ultimately it was an awesome experience. But that is just not a viable path to creating stuff for most people.

Obviously a lot of open source projects get created under less-dire situations, but of course there is also a lot of corporate sponsorship there.

You bring up a lot of valid questions and points, and I really appreciate the conversation!

> Let's assume that Inflow is (a) actually effective and (b) they drop the questionable opt-out subscription model. Both big assumptions. I have not used the app and am skeptical to say the least. But lets assume it delivers legitimate value/relief/etc.

These are big ifs, particularly because the incentive systems are misaligned. The incentive of the creators are profitability and growth while the incentive of the user is to manage their ADHD.

Ethics, especially concerning survival in the throes of capitalism, are complicated. I question private sector solutions for public sector problems largely because money speaks in politics and I think having money established in an area makes it _harder_ for the public sector to get involved in that area.

> So, how should this app have been created? How would its creators be paid prior to the app earning money?

Putting aside the fact that this app can't diagnose someone, can't provide alternative therapies (pharmaceutical, non-CBT if CBT isn't working, etc.), growth and profitability are not "helping users". I said this elsewhere: if this _is_ going to exist, it should be funded through something like Patreon, where payment is optional and generally is more tied to the app being functional and beneficial (users who love the service are more likely to pay, while those who do not, lose nothing but their time).

> And I was extremely privileged to even be able to do that...

You raise a really good point that I've been wrestling with a lot lately. The ability to not-charge up front is a position of privilege that locks out a lot of folks (e.g. if one is living paycheck-to-paycheck working 2 jobs, they might not be able to afford to take the time to create the next unicorn app that could put food on their plate forever). I'm sorry, but I'm not sure I have answers. I have a friend asking how to ethically be a landlord, and I can't answer her either.

(as an aside: I'd love to spend some of my time just making apps for folks without my privilege, sort of 'pass on' my privilege to those who might need it, but I'm honestly not sure how that would realistically work or how to get started.)

One of my friends likes to remind me that there's no ethical consumption under capitalism, in response to which I wonder: how feasible is ethical production under a system with no ethical consumption?

This is a solution to the main problem, which is healthcare being a steaming puddle of diarrhea and medication being gatekept by the industry and the government... for your own safety, of course.

A poor solution imo (at least for any serious cases), but at least someone is trying something.