Cities with Uber Have Lower Rates of Ambulance Usage
npr.org
npr.org
I called an Uber.
I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I can tell, insurance companies throw a dart to decide whether you're covered or not, and then the healthcare provider makes up some insane number if you aren't.
The Uber got me to the hospital faster than an ambulance would have, for less than $10, and I knew it would cost less than $10.
The injury, though extremely gruesome and painful, only warranted an x-ray, some tylenol, and an ace bandage.
I'm insured. They sent me a bill for over $900. For taking a picture, and giving me tylenol and an ace bandage.
I view insurance as a tax my employers pay to the American healthcare system to be compliant. When I have my end-of-life event, whatever that is, I fully expect a choice between death, and living a little longer in bankruptcy. I'll probably get treated outside the US or choose death.
The system works if your net worth is somewhere above $5 million. For everyone else it's just the mechanism that sends everything you earned back to rich people right before you die.
Or maybe I'm wrong! I hope I'm wrong. The stack of papers is 4 inches high so I'll never know, but I sure hope so.
It really seems like the middle class gets the raw end of the deal.
My hairdresser figured she has to spend $5,000 before she can get any benefit from "health insurance". She & her husband decided it'd be better to pay the penalties, spend that first $5000 on herself, and "hope" that she won't need more.
She's from Cuba, originally - left in 1987, iirc.
The dental care was also terrible: 2 places only in my city that accept it. Neither would give an appointment for a cleaning and a checkup at the same time, and I never was admitted less than 20 minutes after my appointment time.
From your perspective that's great, but it's still another sign of the system being broken. As soon as you involve cash flowing between multiple entities, it just becomes a massive cash grab. The physician seemingly knew they could take advantage of your cover in that instance. That in itself seems problematic.
Note: I'm not from the US, so there's probably an aspect of Medicaid that I don't understand. We have a more sane healthcare system :)
Extremely poor people may not pay for care, but be assured that in America, they get no where near the same level of care.
And if you're poor and have cancer? Most other western countries will give you a chance.
There is a much deeper problem relating directly to this topic. Transportation. Access to real transpiration is THE BIGGEST FACTOR in escaping poverty.
Uber isn't public transportation. A train is about $2 ~ $3 in most cities. In an Uber that would be a $10 ~ $20 ride. Multiply that by 7 days a week to and from work, and there simply is no comparison. Many cities have discounted fare cards for the poor as well. The structure of American cities hurts the poor.
Cancer is probably the worst example you could pick to prove your point. It turns out that the US system is highly-optimized for specialized care (which happens to include cancer), as opposed to routine care. That's one of the reasons it ends up being more expensive.
In fact, even when including poor and uninsured people in the mix, the US has dramatically better outcomes when it comes to cancer treatment than the UK, Canada, Denmark, France, the Netherlands, etc.
No, even factoring that in, the US has dramatically better outcomes for cancer than the other countries listed.
You're missing the point, which is that the number of people who die from cancer that would otherwise have been treatable except for their ability to afford it is actually quite low. And the US does much, much better at treating cancer overall. Which is why the overall cancer survival rates in the US are drastically higher, even though a small number of people may not be able to afford treatment..
(You're also assuming that people are able to receive cancer treatment in countries like the UK, which is actually not a foregone conclusion. Assuming it's even diagnosed properly - the UK in particular is really notorious for cancer misdiagnoses - they may actually not be eligible for having their treatment covered under the NHS, even though their cancer may otherwise medically be treatable, either in other countries or if they can self-fund it in the UK).
I feel like the best solution would be to change the arrangement from consumer<-->insurance<-->provider to insurance<-->consumer<-->provider<-->insurance. Have providers charge consumers directly (so prices are more transparent), consumers buy actual "health insurance", and providers buy non-payment insurance. If the government needs to subsidize non-payment insurance rates for certain providers, it can do so without as much risk for inflating prices and screwing over people who can pay the bills.
American healthcare could be a lot better if we just allowed more breathing room for competition
I'm currently on holiday in New Zealand and had to take my infant daughter to the urgent care. The total cost was $21 USD (including the prescription).
Back in the US it's $330 for a 15 minute appointment with her GP.
There is no way it costs $1,300/hour to run a GP clinic. Between my employer and I, the cost of family insurance is > $20,000/year and we pay the first $6,000 in expenses. That's similar to the TOTAL income tax of a median household in New Zealand - how are they providing all of the functions of government plus universal health care for the cost of just health insurance?!?
It really makes me wonder about the ROI on taxes in America.
The problem is that if you don't have insurance, you are charged these total fantasy prices - which is part of why being uninsured in the US is about so much more than just being on the hook for catastrophic costs.
Of course the clinic knows I have insurance so only offers the "insured rate".
It's insane.
IIRC it's $82 or something like that in Vancouver BC Canada.
In the US, with insurance, they're typically like $300.
After being discharged I gave them my passport and the hospital bill was $0 while the ambulance bill was around $950 Aud.
When I moved to singapore to live I got appendicitis. I called a taxi and paid $9 to go to the hospital. Too scared to get ambulance now even if it’s covered by insurance.
There is a big private health care industry in Australia (for better or worse) that's not employer based (you see adverts on TV), so I'm guessing a lot of Kiwis just get private care in the AU.
But I'm wondering how much it costs an actual Australian resident/citizen with medicare. I know as a non-resident, a doctor cost around $70 ~ $80 (went once in Melbourne and once in Sydney) and I saw a real doctor. That's a far cry from America where you pay $200+ to see a Nurse Practitioner (yes, pretty advanced, but still not an MD).
Doctor + Prescription in Australia is expensive! Would cost me like ~200 give or take.
In Singapore, consultation is like $15 and the medicine is prescribed by the clinic so no need to go to a pharmacy, total is like $50.
So I don't even bother seeing my insurance doctor where it costs me like ~$5 total, I just go see my normal doctor cos I trust him. (been to same doctor for 6 years)
Here's the costs for St John's Ambulance. It's $949 for a life-threatening or urgent call, $510 for non urgent. It mentions that Medicare doesn't cover the cost, and that the costs will always be incurred by the patient. (I actually thought it was covered by my private health insurance, but apparently not.)
http://www.stjohnambulance.com.au/ambulance-and-health-servi...
Some doctors in Australia bulk-bill, so it's free for me to go to see a doctor whenever I want. Though for a short period when the government changed the billing rules, he started charging $25 per visit, but he's gone back to bulk-billing again.
I live in Western Australia and it's all done by St John's Ambulance. My partner has needed two non-urgent ambulance call-outs (transfer to a public hospital), which were both charged at ~$500. She's on my private 'extras'* insurance policy, and my insurer fully covers an unlimited amount of ambulance transfers ($50 co-pay for non-urgent). I believe this to be a common thing for this type of insurance policy - I'm not on any fancy tier of coverage.
HOWEVER:
A couple of years ago my significant other had an accident in a public area where she unable to move or call an ambulance. A nearby resident heard her yelling and called the police / ambulance. The paramedics seemingly had the authority to take her away from the police officers who were questioning her. She was taken to the nearest public hospital and was discharged from the ED shortly thereafter. She never received a bill. She's only young and the accident (very apparently) occurred as a result of drug use, so I think that the paramedics operating the ambulance are allowed discretion when deciding whether or not somebody should be charged.
* Physio, psychology, dental.etc. (all non-emergency). These services are not (fully) covered by our public health system, so many people opt for private cover. These policies work heavily on annual limits, so it's a bit unfair to call them insurance.
I've had to take an ambulance to hospital a number of times. Cost to me: eu0.
I've also had to stay in hospital a couple of times, had a couple operations. Cost to me: eu0.
Of course, I pay regularly into the Austrian health system with portions of my pay check every month. But there is no suffering beyond that, if I have to have any medical procedures or take the ambulance for an accident.
A sane system would look at the incentives structure to devise cartel rules to encourage the individual behaviors that lead to the best group outcome.
The injured party desires swift and effective treatment for their injury. They also desire such treatment to be affordable, preferably at no additional out-of-pocket cost.
Onlookers may wish to help in the moment, but they do not want to incur any future obligations by doing so.
Medical providers want the customer brought to their facility, first to assist with the injury, and then also to be rewarded for producing better outcomes due to their care and expertise.
The move that makes sense is for injured parties and onlookers (they cannot know in advance who would be the unlucky one to get injured) to cartelize, and each pay an amount in advance so that the statistically predictable annual number of ambulance rides are all (theoretically) already paid for. And since it could damage the patient to delay care by attempting to verify cartel participation, it really has to include everyone, or ignore free riders. So the cartel becomes a branch of government, and it pays for ambulance rides with some form of tax. Then to prevent gaming the system by private ambulance companies, the cartel can either announce limits on what it will pay for during one ambulance ride, or it can run its own ambulance service.
And to further control costs, if they haven't already determined that it is an emergency with major traumatic injuries, the dispatcher can even just ask the caller if an ambulance is not needed. Most people can at least recognize if someone else does not need an ambulance, and maybe just needs an ordinary ride to the hospital without all the equipment and paramedics. The dispatcher can summon a cab, or Lyft, or Uber, or a bicycle rickshaw, or church bus, or shuttle van, or any other type of local transportation service, and pay their prevailing rate for a prompt, on-demand ride to some form of medical care facility. Since the patient would have to be conscious in order to get a not-ambulance ride, they could either wave it off, or tell the driver to go to their pick of clinic or hospital and have the ride paid for by their ambulance tax.
Other moves create perverse incentives to ignore injuries or hinder the care of an injured person.
Similar analysis indicates that hospital treatment for life-threatening injuries and other health emergencies should also be paid for out of taxes. The rest of the medical system could possibly operate under a different model, but I think most people would rather not be forced to choose between death and bankruptcy--for themselves or anyone else--when there's a dearth of time to think about it.
Health Insurance, as a concept, is disgusting.
You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put up against the security of said property and the odds of loss occurring.
For cars, this presents as the value of the car, factoring in where you live and work (the two places the car is most likely to be), the costs to repair or replace the car, the security devices the cars have, and obviously your driving record.
To insure a life, you need to first establish the value of a human life, specifically your life. Your life (probably) is infinitely valuable to you. The cost to repair you in our current system could also be infinite, given the numerous and terrible things that can happen to a person with literally no fault of their own. By the same token, the odds of you needing that payout are also damn near incalculable; every place you go, every activity you engage in from skydiving to eating turtle soup in Mexico all have a probability of killing you. By the same token you can trip and crack your skull open in Harlem, NY or in the center of the Pentagon, it makes no difference.
Therefore, you have an asset with incalculable worth, incalculable cost to repair or replace, that is exposed to hundreds of things per day that could result in a full-policy payout, with barely a hint of predictability.
Even if the industry behind it weren't legendarily corrupt and full of fraud and nonsense from every player in it, this would be completely insane to attempt. The solution (the first part anyway) is to outlaw health insurance, completely, full stop. Then hospitals must be instructed to destroy their chargemasters and go back to charging for services at reasonable rates. After that, everything else should more or less be solved.
Trying to make any progress through typical political avenues is hopeless. You're casting your vote into an ocean of voters that don't even see health insurance as a financial product, they see it as healthcare itself.
I agree that major health care reform at a US national level is pretty unlikely at this point, even if Democrats manage to gain a supermajority in both houses of Congress and win back the presidency. I'm not even sure trying out something novel at a national level is a good idea, since it carries a lot of risk. I think doing something new at the state level, if they can get around federal interference, has a decent chance of getting somewhere.
Has the GOP actually suggested eliminating Medicare? That doesn’t seem to be accurate at all.
https://khow.iheart.com/featured/ross-kaminsky/content/2017-...
The thing that pisses me off is that the GOP wants to slash funding for a ton of public services, but not materially lower taxes for people. So if states want to bring back those public services, they need to raise taxes, which overall causes a person's tax rate to be higher.
I'd be fine with the federal gov't even entirely killing Medicare if that would cause my effective federal tax rate to drop by several percentage points, points that I'd be happy to turn around and give to CA for them to implement something like single-payer.
(The downside, of course, is that residents of less progressive states get screwed, which is why I'd rather the federal gov't leave things alone, but give states like CA more latitude in how they use those dollars.)
That's similar to insurance in some ways, but isn't in one crucial way: you generally don't know the "repair" cost up-front; the repair is done, and then you get the bill. If you insure your car against damage up to $50k, you get an estimate when it gets damaged, and ask the insurance company for approval for that amount before the work is done. If the insurance company disagrees on cost, you can find another auto shop that agrees with the insurance company's cost, choose to bear the difference in cost yourself, or decide to forego the repair entirely. You can't do any of that when it comes to healthcare.
> The cost to repair you in our current system could also be infinite, given the numerous and terrible things that can happen to a person with literally no fault of their own. By the same token, the odds of you needing that payout are also damn near incalculable; every place you go, every activity you engage in from skydiving to eating turtle soup in Mexico all have a probability of killing you.
This isn't entirely true though, or, rather, it doesn't matter. Health "insurance" companies have a ton of data that allows them to predict pretty well how much it will cost to fix people when they break, in the ways that they usually break. They collect premiums based on that data and are doing a pretty decent job of not going bankrupt while actually fixing people, even outliers who fall outside of the "usually break" range. (Yes, I know, that's certainly debatable; they're dicks and deny coverage for things they should absolutely cover, and that helps with their bottom line; in principle, however they can afford to cover everything that medical science can perform and still stay afloat.)
> Then hospitals must be instructed to destroy their chargemasters and go back to charging for services at reasonable rates. After that, everything else should more or less be solved.
The problem here is that "reasonable" means different things to different people, and for some procedures, even if the price were dropped down to "at cost" (if that's even a calculable thing), you'd still have people who couldn't afford it. Health care itself isn't free. It costs money to develop medicines. It costs money to train doctors. Those doctors, once trained, need to make a living. It costs money to run hospitals and private practices. Someone needs to bear this cost.
So you still have the same problem of inherently deciding that the life of a rich person is worth more than the life of a poor person; in some cases the rich person can afford to get healed, while the poor person can't and dies (or lives, but goes into crippling debt or bankruptcy to do so). I agree that healthcare costs in the US are out of control, but even if you fix that problem, you still need some system in place to ensure everyone gets the care they need, regardless of their financial situation. (That is, of course, if you believe health care should be a basic right. If you don't, then we're not going to have a productive discussion.)
I think the concept of a pooled health plan is fine; just payments into it need to be dependent on means, and payments of $0 don't disqualify you from coverage. The person who can't afford to pay into it gets the same treatment that everyone else gets. I don't care how we achieve that, whether it's government-single-payer, or something similar to what we have now, just with price controls and government subsidies/credits for those who are unable to pay.
Absolutely agree that the current corrupt health "insurance" industry needs to go, though.
Right now nobody, and I mean literally nobody, makes rational economic decisions for medicine in the US.
Neither the hospital, doctor, administrator, insurance company, or patient really has any real idea 1) the cost of the health care being provided 2) the amounts being charged or 3) the dollar amount of benefit gained by the patient. The actors above who do have some pieces of the data largely aren't the ones making the decisions.
If you abolish insurance and state prices up front, at least you force hospitals to charge something closer to the true cost for services, and you force patients to evaluate whether they would rather have care or dollars in their pockets. Over time, they would figure out what's good value for their health and what isn't.
Of course one could argue that the government should be making all these decisions because it has access to more information, and that's probably true; but that's not what's happening in our Frankenstein ('s monster) of a system.
Health insurance in principle works on a similar basis: it's a cost smoothing mechanism for unexpected large costs that not everyone is expected to incur.
It breaks down if everyone incurs the big costs (old age) or not everyone insures (only at risk people insure, which increases costs, which pushes out people who aren't as risky, which pushes up the price further, in a cycle.) It also doesn't make much sense for regular care that doesn't directly prevent major payouts.
So it seems to me that health insurance is only workable if it is mandatory, old age spending is rationed, and checkups that find things that can become very expensive are covered, but other bits and bobs aren't. Obviously gold plated coverage could cover more, but that's all the mandatory insurance should cover.
It's all far too politically charged for any kind of rationality to prevail though. I think single payer state care can work, but it has high overhead and suits high tax countries better, not the US, where there is less acceptance of the social contract of taxation.
Those are separable concepts. If your rear-view mirror is broken off by a punk with a baseball bat while parked on a Chicago street, that is property damage to your car that would be covered by your car insurance. If you t-bone another car, the damage to their vehicle is covered by your driver insurance, while the damage to your own vehicle might be covered by your car insurance, if that possibility is listed in the policy. Generally speaking, if your car insurance doesn't pay for damages incurred by the owner while driving, you-as-car-owner can't file a claim against you-as-car-driver under the driver insurance policy, and end up getting any money out of it.
When the policies are offered by the same insurance company, the actuaries for each can share information, such that the risk of owner-caused damages can be assessed for the car policy, and can therefore be rolled into its premiums. This is why those policies are often combined.
Where states mandate insurance, the mandate is always for driver insurance. So the car insurance then becomes an upsell option for those who already have to buy something from an insurance company.
With health insurance, there is the one big problem that you just can't get around. Everybody dies, eventually. You can sort of predict when and how in a large enough population, but everyone has a very high, statistically predictable likelihood of needing medical care at some time during their lifespan. There is also another big problem. Most people incur their highest medical costs in the year before their death. Obviously, after you die, you can't work off your medical debts.
That's not a good looking model for healthcare providers, and a tough one for healthcare insurance actuaries to squeeze profitable premiums out of. There is a perverse incentive to drop a client or raise their premiums right after a claim is paid, on the presumption that any uptick in medical payments might be a harbinger of greater future medical expenses. There is also perverse incentive to drop customers immediately after the first payment related to chronic disease is made. We paid for an office visit to an oncology specialist and for biopsy lab tests, so our model says that we should drop you right now before your lab results come back. We hope you don't have cancer, so you can prove it before coming back to us as a customer, but otherwise, good luck with your treatment bills....
Health costs are borne by the community in A&E if people don't pay for it themselves. That's why a mandate is fair from a social contract perspective. Some people might prefer a state that leaves poor people to die on the side of the road after an accident, but not the majority.
(FWIW, in the UK, driver insurance is attached to the car (or possibly multiple cars) and is described as car insurance colloquially. Car insurance may or may not include property insurance, at two levels: damage you're not responsible for (fire and theft), or damage that you are (an accident you caused).)
Actuaries, national health providers, governments -- generally they all have hard cash valuations for human life.
We use "insurance" for routine medical examinations which are supposedly to be done regardless of health. We use "insurance" for YEARLY checkups.
The absurdity of this is on par with insuring yourself against getting hungry, or buying gasoline insurance to fill up your car.
Gas in $8000/gallon. But pay $900/month and we will cover the cost!
It is absolutely embarrassing that this is the system we have allowed to exist. I consider myself a pretty staunch capitalist in most regards. Health insurance is definitely not one of them.
An insurer should provide incentive to bring a building up to code to avoid a costly fire. The option to simply raise prices accounting for the fire leaves out the business of those who cannot afford it: the people leaving in a building that's not up to code.
This is only true in a well-designed system. In a system in which insurance policies are for a one-year term and can be declined or premium-hiked as necessary after that term is up, encouraging preventive checkups can be counterproductive if the risk of being on the hook for problems discovered in the checkups is higher than the preventive benefit during the duration of the policy.
Insurance is for those events where you don't expect a gruesome injury and need to insure, or hedge, against those one-offs. Preventative care isn't the same idea because you expect to get older and things to fail slowly. But barring any conditions or disorders, this isn't insurance against external sources of damage but just an action taken against inevitable consequences of having an organic body that tries to keep itself in a delicate and easily-broken balance for 50+ years.
Highly recommend it. It’s got some great ideas.
Car insurance doesn’t pay for tires or oil while it could be argued that bad tires increase the risk of accident. However tires and oil are an inextricable requirements to owning a car.
This idea that health care should be paid for by someone else has always puzzled me. It’s the equivalent of food being “free.”
For the legitimately poor, there is definitely a role for government just as governments don’t let people starve to death, but for everyone else — its just wacky that the government ought to be involved at all beyond safety regulation. We went wrong when some groups started claiming health care as a right — nobody has a “right” to the labor of other people. In other words — I don’t have a right to make you produce something for me.
Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education.
No, they have spiralled out of control because health care is something where no real market can exists, so you need good regulation (which the USA doesn't have). If you have an urgent and life-threatening health problem you can't shop around for a cheaper hospital or decide to go to none at all if the alternative is death. So they can charge whatever they want if there is no regulation.
You also can't live without food but there is a market for that. Even when you don't have time to cook and need food on short notice, there are plenty of fast food and delivery options available.
There is nothing impossible about a situation where a hospital has a reputation for being cheap but having long wait times while another hospital is more expensive but has shorter wait times. Then in an urgency you wouldn't need to shop around, you would decide based on each hospital's reputation.
Unfortunately hospitals don't publish their median wait times, patient outcomes or even their prices. If they were forced to publish those things, maybe a market would emerge.
At the moment the only thing I can think of that are expensive services are also luxury services. Most people consider health care to be a basic service that should be open to those who need it, regardless of wealth.
Why exactly can't I know ahead of time how much will each hospital in my area charge if I have a heart attack and have to go to their ER? Why can't I know which hospital has better survival rates, or the shortest wait times?
That information is all that is needed to have a healthcare market. It should not be impossible.
How many people on HN have done the reading to know when a fecal occult blood test can and can't be substituted for a colonoscopy? And those are generally tests that don't have urgency. When you're in the hospital because you've been vomiting for 6 hours and are passing out, are you going to say yes to the abdominal CT? This recently came up with a friend, who called me for advice. I was with a doctor in the moment, who said that he didn't see why it was indicated (for a host of reasons). The doc got on the phone with friend who handed the phone to the physician's assistant who was going to bring him to the CT, and argued the guy out of the CT. This took knowledge, effort, and persuasion. Who here is going to be able to self-diagnose and say, "Skip the CT -- I'll have it if X has not improved in 24 hours and Y continues to decline."
For many reasons, in the US there is a lot of "defensive medicine" practiced. The doc would rather order the CT than defend against a lawsuit, and for him/her it takes less time to order the CT when the patient rolls in than wait 24 hours while observing the patient in the hospital. But it's not actually in the patient's best interest. Our incentives are not aligned, and patients do not have the time or baseline knowledge to evaluate individual treatments.
Cosmetic surgeons disagree.
They are all medical procedures that are not covered by insurance. As the number of providers increases and the technology advances, prices drop and quality increases.
Lets engage in an intellectual exercise. 10MM USD (today) and for 1 person cancer is gone. Should we include coverage for cancer into all policies?
350 million people. 50% chance of cancer. 175m will get it. Payment to make it go away is 10MM USD. Should it be covered?
10MM USD today payment => cancer cured.
Patient's lifetime earning => 2MM USD
Should the patient expect cancer to be cured by his or hers insurance payment?
P.S. I love the downvotes. Downvotes is like a child stomping his foot in a toy store "Mom, but I want that toy!"
What happens if it was your brother or sister dying? Not paying for them! Nice chap.
Healthcare costs are high because of lack of regulation and the ability for private enterprises to set costs. Profitability is not ethical when it comes to doing no harm. I’m sorry I can’t treat you, you can’t afford that option.
The US is the worst situation: expensive government provision, that doesn't prevent the harm caused by lack of access, but which also causes harm with too much access for the wealthy.
> It’s the equivalent of food being “free.”
Even the US provides free food to the poor.
This is a pattern we have seen time and again. Describing this as "about as far away as you can get from capitalism" is the no true Scotsman fallacy. Perhaps it doesn't match how you believe capitalism should work or you have a very different definition of capitalism to the more regular meaning of the term.
Cartels are only a problem if no new suppliers can enter the market.
> lobby for regulation
This is a problem of any representative system. Convince them and you're set. No capitalism involved.
> crush competition
Just a consequence of the abovementioned.
Summary: step 2 is the crucial problem, it's usually corruption or idiocy and a governance problem - not a capitalist problem.
If capitalism is only capitalism when there is no conglomerated power structure then capitalism is impossible.
Often enough today its the left who are defenders of capitalism (ie., of disentangling power structures from coporate control) whereas the right seems possessed by the idea that whatever a company does is by definition captailism.
Capitalism was all about recognizing that business interests are anti-capitalist.
I grew up in a communist country and guess what: politicians co-opted local power structures for their personal benefit. They drove the good cars, had the nice houses at the lakes and hard (= Western) currency. This is the case for (AFAIK) every single "socialist" state.
The only difference was that in socialism, corruption was not done for the benefit of a company but for an individual.
Do you really think that once the economic system changes, they (= we) are all suddenly better people?
It's the power itself that is corrupted and it doesn't matter how or by whom or in what system, the end result is the same.
What I was saying was a defence of the fundamental economic model of capitalism, not a criticism of it.
> we are all suddenly better people?
Yes. People are largely ethical products of situations they find themselves in. Reduce the number of opportunities for bad behaviour and you get Good People.
unaccountable systems of power are the recurring situations causing bad-behaviour here.
A healthy democratic capitalism aligns the interests of those power with the people. So that capital owners do not seize control.
"Capital" is not capitalist. It is anti-capitalist, wanting to monopolize and dictate.
It seems pretty obvious that, if your aim is to accumulate capital, regulatory capture is a pretty damn efficient strategy as compared to marketing or product development. It's also efficient for the government official, who gets to sell access to regulation processes (an otherwise difficult-to-sell service!) at market rates.
(Not that libertarian-style "OK, let's get rid of governments!" approaches are a good solution here. In that case, the optimal strategy becomes force, which in effect establishes a government of sorts.)
Going the other direction you can have a big government with extensive powers that tries to force fair play through extensive regulation, as ours does. But this has been tried over and over again, and it invariably trends towards corruption. I think that particularly in a democracy, this outcome is going to be quite difficult to avoid. It seems that these basic facts should be the starting point of discussion, as opposed to the point where people have long since splintered off and polarized themselves towards opposite extremes.
But it ain't "free enterprise" whenever regulation limits consumer choice and market entry by competitive participants.
Let's ask a simple question to determine which is which in the US: because attending your annual checkups reduces your risk of needing expensive treatment, somebody who attends their annual checkups are cheaper to insure. Are there any American insurance plans that effectively pay patients for attending their checkups? Are there any American insurance plans which say, well, your premiums are $1000/month, but if you go to your annual checkup, not only will your checkup be completely covered with no co-pay, but we'll reduce your next 12 monthly premiums to $950/month each?
After all, if it reduces costs for the insurer, then the insurer is motivated to incentivize patients to go, right?
Btw, there's no evidence of this.
Zero...zip...zilch...none.
diabetes usually shows itself, hypertension is a silent killer though.
i'm not arguing against check ups, but I could imagine why they are not as effective as you might think.
i myself do not get checkups, i have insurance, but going to the doctors is a miserable experience.
First is trying to schedule a visit. Usually the earliest they can see me is 3-6 weeks away. when I have free time to see a doctor, thats when I need to do it. I dont know whats going to happen in my schedule a month from now?!
next, if I actually get the appointment, I am punctual and show up 15 - 30 minutes before the appointment. However, I dont get seen for 30-45 minutes after the scheduled appointment. This isn't just one time, this is E[X]. thats 45 minutes waiting with people who are coughing , sneezing, etc. after I see a nurse for 2 minutes and get sent to a room, usually thats another 5-10 minutes waiting in an empty room.
when I finally see a doctor, I am only allowed to talk about one thing. if its multiple things, I have to schedule another appointment. usually the doctor cant help with any of my ailments, I need to schedule an appointment with a specialist. usually another facility. unfortunately, I am not allowed to schedule an appointment with a specialist directly, I have to see my primary care first.
> diabetes usually shows itself, hypertension is a silent killer though.
Diabetes does not always or often show itself until a major issue has come up.
> i'm not arguing against check ups, but I could imagine why they are not as effective as you might think.
I have this sense that medicine is in some kind of "PTSD" from ...something...? right now. I don't feel like I can mention things to a doctor without them feeling like they absolutely need to do something about it. For instance, there is this one doctor at my child's pediatrician who will prescribe things (for instance she prescribed a nausea medicine when my kid had a stomach bug) that my wife and I are like really; it doesn't help that she doesn't communicate anything about the meds. (Yes, we've mentioned her to the other doctors at the practice.) But that's an extreme case, but little things in the same vein do annoy me.
I don't think yearly checkups are a cure all, but there are chronic diseases that our socity lends itself too. Changing social patterns (e.g. what we eat, how we get around, &c) would probably do more than any amount of medicine could.
One insures for what one cannot covers himself or herself. Regular risk (maintenance) one simply absorbs. That's why the mandatory health insurance especially as defined by ACA is a total garbage - it forces insurance companies to cover regular risk.
I only want to carry catastrophic insurance. If I could, I would have had a policy that kicked in at $50,000 and covered to some absurd amount.
Then don't call it insurance. Call it what it is: a subscription to a medical service provider.
It's pretty darn common across a lot of industries.
You can always rip out the HVAC and put in a new, off the shelf unit with roughly the same specs (often better, because progress) at a fixed, known cost, and the customer will even often be happier if they end up doing that instead of repairs. If health care providers could trivially decide to euthanize and replace patients with expensive diseases, health care insurance would be as trivial as HVAC maintenance plans.
All i was saying is that it's pretty common/normal/etc for insurance (in any industry. Literal insurance or things that are insurance in practice but not literally) to offer routine exam/tests/maintenance/checks if it can prevent the worse case scenario $$$ from happening.
Insurance is based on the assumption that only an extremely small number of insured persons will ever make [significant] claims against the policy; insurance is for expensive potentialities that are very unlikely. The entire industry and regulatory framework is structured around that assumption because that is what the word "insurance" means in all contexts outside of health care.
The problem is that pretty much everyone is going to need significant medical care at some point in their life, certainly as they age into their senior years if not earlier.
Would you buy a "health maintenance plan" under the stipulations of health insurance policies, which are basically "Pay us a lot of money, and we'll make some farcically big numbers look smaller for you, but you'll still probably owe a lot of money; we won't know how much until you already owe it"? Of course not.
The racket we call the American health system can only exist by masquerading as "insurance".
It was probably the more socially responsible option all things considered. I didn't require urgent medical care, so taking Uber helped ensure those resources where free to those whom might have (though this thought didn't cross my mind at the time).
Must be above my net worth! Sure I can afford to pay out of pocket for everyday medical expenses, but cancer or a heart attack would probably destroy my finances.
Funny thing, though, the ambulance bill was the only thing NOT covered 100% initially. The hospital and surgeons bill your insurance, and we didn't pay a dime (other than a comical $200k+ explanation of benefits telling us our claim was denied when they initially submitted to the wrong insurance). The ambulance company billed us, and I spent ~6 months working it out, and I think it's finally sorted. The upshot is because it was a "car accident", the health insurance doesn't want to pay it; car insurance is primary. In theory the car insurance is the primary on her entire hospital stay, but because the medical payments on our car insurance is only $10k it's basically pointless to involve them. They don't even know there was a hospital visit. So I had to go back and forth a bunch of times to even (re-)open the car insurance claim, get it submitted, send more and more documents, fend off the ambulance company always threatening to send us to collections because I had better things to do than deal with their crap, and so on.
Current status is I've paid maybe $600 on a payment plan, my insurance says they paid in full, the payment wasn't yet reflected on the ambulance co billing site, but in theory once that payment posts they issue me a refund on my payments to date.
We're so incredibly lucky to have insurance; actually she was double-covered at the time of the accident (hence the billing confusion initially), we have money, we have family in the area to help with doctor visits, and there was really only one provider. I can only imagine what a nightmare sorting the bills would have been if we had to manually submit to insurance from multiple providers and stay on top of many many claims. It would be a full time job for sure.
Some credit cards come with automatic travel insurance, but regardless it is well worth researching before you travel. Hospital stays abroad sometimes need to be paid out-of-pocket until you are reimbursed later on.
It all depends on the circumstances, your country of origin and any extra insurance you might have taken out.
I ended up in hospital for a fairly routine operation about a decade ago and had to pay out of pocket, luckily it was in a place where they just charge you for actual cost rather than to try to balance their budget by bankrupting you so it ended up being $1500. The same thing in the US would have been a large multiple.
I mean, I have no idea what would happen if I broke my arm while overseas either. I have insurance (in the US), and assume it would get sorted out somehow, eventually, but I have no idea what my share would be. I just don't anticipate being turned away at the hospital door though.
Actually a better example, might be HKG, where service probably exceeds US, an ambulance ride is HKD990 (~USD127) apparently. It is mentioned elsewhere in this topic that its $82 in Canada for an ambulance.
So the choice is easy: If it's urgent call an ambulance, if it's not urgent and/or there are other ways too get to the hospital quickly and easily use those instead.
I should say though that Eastern European countries do have issues with Islamophobia in general, so if you are muslim I would not recommend those countries.
This ia really common misconception perpetuated by (white) Europeans. It couldn't be more wrong.
Systemic racism is pervasive throughout Europe, and in many ways, it's even more institutionalized in Europe than it is in the US.
Please stop spreading the myth that Europe is free of institutionalized racism, or even that it's somehow better in this regard than the US.
I know that this does not prove everything but it's one way to measure institutional racism which is kinda hard to measure in an objective way.
European soccer games, for example, have had many examples of widespread racist chants and gestures.
Racism is absolutely a problem in Europe.
I should also add that discrimination in European countries is based more along ethnic and nationalistic lines, not race or color the way it's in the US. While in the US people are categorized by their "race" (black, white, asian, middle eastern, etc), in Europe they are categorized by their country or geographical area of origin (Polish, Italian, French, English, Eastern European, Western European, etc). A black English guy is not primarily "black", he is primarily English.
It's also quite interesting how US-centric this website is and how patriotic most of you are.
It's a lot harder to collect data when you expunge all references to race from the law, and also prohibit public institutions from collecting data on race and ethnicity, as five European countries have already done. Heck, you'll be hard-pressed to find reliable statistics for how many black people even live in (e.g.) France. That doesn't mean racism doesn't exist there; it just means it's impossible to separate out the effects of racism in analyses. The racism has become fully integrated.
This is exactly what institutionalization of racism looks like - racism becoming part and parcel of the society, so tightly integrated that it's actually hard to disentangle the racism from the rest of society.
It certainly doesn't eliminate racism from society, no. It just makes it impossible to measure the effects of racism independently. Hence, the racism becomes integrated into the rest of the society.
As far as is it a good place to live, well, it's cold (but very tech-advanced). Check out https://e-estonia.com/
That is awful :(
Imagine someone making minimum wage. 900$ is huge for most people.
Honest question - outside of politics, is there anything a person on the road do to help make this situation better (other than not falling sick)? Any company/org working on solutions?
If you intend to visit the US, you absolutely need to buy traveler's insurance, with medical coverage, before you enter. If you can't afford the premium, cancel your trip, and go spend money in a country with a better paradigm for emergency medicine.
https://www.howmuchisit.org/how-much-does-urgent-care-cost/
Better yet, get direct primary care. It's ideal for tylenol and ace bandage situations.
I am completely convinced that even if you have insurance, you are much better off acting as a self-pay patient. Your options are better, and you have a much better idea of how much things cost. People say you can't shop for a hospital in an emergency, and that's true -- but I already know how much the hospitals around here cost and how good they are because I have to for routine medical care.
Absolutely you still need to get there. Absolutely Uber is a good option when you shouldn't be driving.
Don't take an ambulence unless getting medical care on the way could be lifesaving. Don't go to an ER unless getting medical care in the next couple hours could be lifesaving.
What also happened: You received care at an ER. The time of professionals was used on you and not other patients at that time. You also received a diagnosis and verification that the injury was easily treatable and didnt require much else. What if they came to a different conclusion?
$900 is expensive but you are grossly mischaracterizinf the services you received.
Beyond that, I'd like to see statistics on whether people ride-sharing to emergency rooms / urgent care facilities was freeing up ambulances or causing them to sit idle. I suspect it's the former, which would mean ambulances could be more available for more people with more serious conditions, but I could be wrong.
Reducing BLS calls via uber wouldn’t affect availability of ALS units for serious things, but would probably save money.
a) I would literally rather die than pay for an ambulance. I put my money where my mouth was on that.
b) I knew from previous experience their ER was far cheaper, cleaner and quicker than the one in the cities.
Maybe I am just particularly frugal but I had the presence of mind to consider costs while I could not feel one side of my face.
Another time, I needed surgery and called around to get quotes. The place I ended up was something like a quarter the place my doctor wanted to send me.
This works if and only if you are in control of the situation. That being said, have you considered if when the worst case happened to you, the kind of stress your relative could experience afterward? Perhaps guilts? What about if you are permanently disabled? You probably won’t be able to keep your current job, and then have to re-adjust to a different life style and re-learning whatever physical skills you have lost. Meanwhile, others would have to take up responsibilities for you, and more money draining down the road. Next thing you know, you regret your decision.
I do share you views in general - I would prefer going to a hospital I know that can provide better service per dollar value, but when it is life threatening situation, I won’t choose money over my life. If it was a minor stroke that probably okay, but still, so much uncertainty. Yes, if ambulance is late, you probably should consider going there on your own (keep 911 operator on the phone - never hang up until an officer has arrived). I am too really frustrated with my ambulance bill, and I wish someone can help me understand why the heck an aumblance can cost $1000.
I am sure you know the risks, but I do want to give my two cents.
I wish more people realized this was an option. You can't even imagine how common it is to see the claim "medical care is a special market, because if someone is dying, they will pay ANY AMOUNT for care no matter how high".
Sure, if that person is dying and rates their own health infinitely higher than the welfare of their family, maybe. That's not many people.
Incidentally, the same stupid argument also proves that scamming a life insurance policy by committing suicide is impossible. Life insurance companies, in general, do not agree.
I don't think that's true. I think that's actually the vast majority of people. Nearly all of them, even. The human survival instinct overrides so much of a human's rational thought processes or even their higher-order emotional processes. You may be one of the rare few for which that's not the case, but, well... you're of a vanishingly rare breed.
And it's not even exactly that. When you're in a life-threatening situation, it's likely that you're either a) unconscious, or b) completely unable to have even a remote grasp of what the cost will be to "fix" you. As in, not even a ballpark figure. Given the potential urgency, you may not have the time to get a second opinion or shop around for a cheaper fix. Just the cost of stabilizing you to the point where you can sit back and make an informed decision could bankrupt you.
Also, just a side note on:
> ... the welfare of their family
There's also a cost to their welfare if you die, too. It's hard to put a number on that while you're healthy, let alone in the midst of an emergency or life-threatening illness.
If I'm having a stroke, I'm not going to care about anything except getting to the nearest emergency room as fast as possible. Minutes matter in a stroke. The faster you can get basic drugs and a CT scan, the better your chances for preventing serious damage.
I'm still in my 30s and young. Maybe when my body is older and falling apart I'd have a different opinion, but your statement feels really ludicrous and dangerous advice to me.
Third world health care.
I'd also like to see whether ride-sharing increases the number of people who attend ED.
"I can't justify getting an ambo, so I won't attend" vs "I'm not wasting an ambo, so it's okay if I attend".
EDIT: That is, I imagine you might be able to see whether Uber provides a better alternative than the local cabs. This still holds in US cities though, why is Uber specifically good? Why don't people consider calling their local cab company, which will still be much cheaper than a $250 ride.
I dunno, maybe you just want to avoid the psychological feeling of urgency and gravity that comes with an ambulance. I think there's something to be said for staying calm and keeping self-control and dignity when facing an emergency situation.
If you're bleeding profusely or are in-and-out of consciousness or have a deadly virus, obviously that's different. But what about a broken bone? Or a laceration or burn for which you've already successfully applied first aid?
Might you not prefer to stay out of an ambulance in those situations, even if it's free?
In an increasingly authoritarian country/world, where we are expected to give up all rights upon first interaction with persons in a position of power or authority, be it the policeman that graduated yesterday but has the full might of “the boys in blue,” the TSA agent at the check in line, the EMT responding to the call, or the nurse checking you in, it is easy to understand why some people have an aversion to willfully surrendering themselves and their free will so long as an alternative is present.
I prefer to not cede what little control I have until I have to. If I want the driver to take the highway and not the local roads, it’s my call. If I want to text while I’m being driven through traffic, it’s my call. If I change my mind and want to go back home to die, well, it’s my call.
Ambulance ride here in Finland has a symbolic fee (10 eur if it's deemed necessary), but still, for a non life threatening issue it feels much more sensible to get a taxi. Since the situation is not life threatening you'd be put in a pretty low priority for the ambulance and have to wait for an hour or so. Taking a taxi is even incentivized - taxi to the hospital is going to cost the same 10 euros even if it's from further away, but even without that system I'd probably still use a taxi for broken bones etc.
Imagine you call a taxicab for a medical emergency, and they never show up, or only after an hour.
Uber and Lyft are extremely popular because the apps always tell you if a driver will come, the drivers almost always arrive very quickly, and the price is set in advance.
I'd bet that most people younger than 25 years have never used a traditional taxi, and they never will. They don't even see them as an option.
In the case of taxi dispatch, a car may never show up, and you won't know until you get tired of waiting, and there are no consequences for the taxi company or driver if they do this. Pre-Uber, in SF, the normal quoted wait from a taxi dispatcher was on the order of 20 minutes, which if anything was usually understated. If you're in a lot of pain you probably don't want to wait that long.
I would probably still call an ambulance for something I thought might be life-threatening, but for anything else I'd take a Lyft.
depends on the country and the taxi company. England has a reasonably effective regulatory regime for taxis and cabs.
I imagine, maybe, there are keywords or phrases that result in instant dispatch but the default behaviour seems to be to frustrate you as much as possible to the point where you just hang up and drive yourself to the nearest hospital accident and emergency department.
This is, I suppose, a result of the service being costed and allocated to different departments who are all under pressure to manage their own budgets?
Accident and emergency departments obviously get the brunt of all this because they don't have anyone to pass the buck to.
So, yeah, maybe utilising a service such as Uber is actually going to be a way around this problem?
Resulting in news stories of how some people call of help and don't get any. But these stories are rare, it's seem better than letting poor people die.
This said, we probably should add a tiny ambulance fee ($50), and apply a fine for inappropriate use.
I agree although reclaiming this fee from those who abuse the system is likely to prove difficult?
I can remember a time in the UK when ambulance and, IIRC, fire service would bill you after the event for attendance.
Not sure if this was every case or just where they deemed it appropriate? But, I do remember, it was common knowledge there was no penalty or follow-up if you didn't pay.
You assume everybody that abuses free services are broke. We need data to tell whether that's the case. I would assume that a significant portion of the abusers mostly just lack manners.
Anyways, the point isn't to kick the ones who are down (poor). It's only to limit abuse... But first maybe it should be assessed of abuse is a problem.
And maybe, having a deal with taxi company is a better solution...
As you point out above, the decision to dispatch an ambulance is ultimately the emergency operator's. Typically you tell them what's wrong, and they send out what they think is necessary (which might also be police and fire).
My father had the misfortune of having a stroke, and transporting him via van is outrageous — you’re talking >$250 for a 15 mile drive, in what amounts to a cargo van with zero service beyond driving.
It’s one of those weird markets where the pricing is driven by the Medicaid reimbursement, which is a price floor.
That said, I also suspect the med transport niche is heavily regulated (a la taxi service). Special training for drivers, insurance, etc. I don't think that covers the full $250; just saying they're not identical to a Uber.
If the ambulance driver screws up in some way, they're in for a world of trouble and legal liability.
Uber and Lyft can get away with this because they self-insure and amortize over a much larger customer base.
https://i.pinimg.com/originals/5c/ff/1e/5cff1eac4bef3b52f76d...
Because it's free to use, a lot of people call ambulances when they really don't need them. Women in the early stages of an uncomplicated labour. Young people with minor injuries. Elderly people who want a repeat prescription. Discouraging these people from abusing the service without putting off people who are genuinely in need of an ambulance is a complex and delicate task.
The US healthcare system is clearly an unmitigated disaster, but our single-payer utopia has a different set of problems.
People sat similar things as GP about A&E - "the problem is all the people who use it who shouldn't". No. Those people are easily triaged and sent away. The problems with A&E are all the people who need a hospital bed who spend hours on a trolley in a corridor.
That's taking a bit of a shortcut there. You don't know if a labor is uncomplicated until it is done and it can go from 'uncomplicated' to 'life threatening' in the space of a heartbeat.
http://www.londonambulance.nhs.uk/talking_with_us/freedom_of...
Childbirth is not a medical emergency.
I feel like Ambulances/Hospitals charge way too much and using the app/tech at a basic level to connect the ambulances with patients addresses may be a good start for everyone and also the increase in supply may reduce costs.
http://www.nytimes.com/1987/01/31/style/private-ambulances-w... (yes, over 30 years old, but most of it still holds true)
It’s a real mix though... paid fire dapartments, volunteers, and private operators all respond to emergencies.
There's no theoretical reason why Uber couldn't get into the driving side of the business, with human drivers. Their future is in autonomous however, which will never be the ambulance business (it will never be autonomous, ambulance drivers frequently have to break standard driving laws in emergencies, drive at high speeds, drive around vehicles, etc).
You'll still need warm bodies in the back for life support, but I see no reason that the human in the front seat can't be replaced by sufficiently advanced technology.
Hell, in this ideal future where most or all of the rest of traffic is also autonomous, you don't even need to avoid congestion -- you just "phone ahead" along the route to tell any cars in the way to, well, get out of the way. As long as you don't have standstill traffic (which might actually be something you can eliminate as a general rule with a fully-autonomous, networked fleet), you're fine.
And because they have to perform emergency medical treatment, right?!
Are we talking about different things - a mini hospital on wheels staffed by highly trained paramedics, and glorified taxis for the elderly/non-critical?
If it weren't for the need to drive in a "non-standard" manner, you could likely save on costs by having an autonomous vehicle staffed by an EMT. The EMT can't also drive the vehicle, after all.
None of these are reasons for ambulances to not be autonomous. If you accept that most other vehicles will be fully autonomous, ambulances do not require anything further extraordinary to also be autonomous. The vehicles on the road would likely be networked, at least within a nexus of proximity, and move out of the way of the ambulance so it could speed past them.
NB: I’m not saying ambulances will be autonomous. I’m just saying that if everything else is, the ambulances have no significant (technical) obstacle for also being autonomous either. A significant theoretical advantage of fully autonomous vehicles is not simply that the modal vehicle is safer than a human, but that a networked and autonomous fleet is hyper-efficient and hyper-aware as a hive mind.
Shoot, it'd be safer even if the ambulances weren't autonomous - because the cars would be reacting in a predictable manner.
ATM if my father (who had a stroke in early Oct) has to go to the doc there aren't many options - that I've been made aware of - other than me. My mother can't help him enough (without endangering both of them), and anything more traditional would just pull up and wait at the curb.
Long to short, the country - and 1st World - is getting old. It's a big market. The issue is how well technology is a fit, at least for the next couple generations.
p.s. I should know this but does Uber or Lyft deliver groceries? For less than the market?
Just read this thread - the way medical care is paid for in the US is batshit-insane, injured people not wanting to call an ambulance incase they lose their house - and reads like a history book about european medieval history. The solution is not more apps, it's a proper healthcare system like almost every other developed country.
The US would be a better place with that hypothetical startup.
If Obama couldn't successfully reform healthcare long-term (as Trump will repeal it sooner or later), what can regular people do?
Let them make that app.
We cannot propose a solution to the ultimate cause, because that would require the representative democracy to elect more scientists, technicians, engineers, and mathematicians to the legislature in lieu of the usual professional politicians, lawyers, corporations managers, and educators.
So we work on what we can reach.
We cannot create a proper healthcare system from the top down, but we can issue bugfix patches and hope they get adopted upstream. That keeps the system limping along, but never getting quite bad enough for anyone to demand the complete overhaul that it needs.
It only looks crazy because the biggest problem any motivated individual can solve is limited either by the amount of investment capital they can attract with their solution, or by the amount of campaign funding they can attract with their solution. So any proposals that threaten profit margins cannot be considered.
I'm not sure what I would have done without Uber. I guess I could call a cab, but I don't know that I would have wanted my ride to the hospital to be 30 minutes late, to refuse to turn the music down, and to tell me the credit card reader is broken when I get to my destination and then insist on taking me to an ATM. So I might well have called an ambulance.
As much as I'd like to stick it to taxis because of their decades of price gouging due to being granted a monopoly, I have not had many bad experiences riding a taxi. If I had to put a number on it, I'd say that less than 5% of my taxi rides were in any way unpleasant other than for the cost. What city or country are you in if I might ask? Are taxi experiences really that bad for most people?
In Binghamton NY, they all tell you the credit card readers are broken at all times of day and insist on driving you to an ATM so they can get paid in cash. In Washington DC, if they think you're drunk, they overcharge you / don't start the meter and the dispatchers always tell you 15 minutes, but then the cabbies just grab other people and you end up needing to call the dispatcher repeatedly to actually get a cab and it usually takes closer to 45 minutes or an hour. And in Ithaca NY, they tell you the credit card reader doesn't work until you say you don't have any cash, and then it's suddenly working.
None of my female friends dare get into a Taxi due to, well, harassment, (some have stories of groping, attempted rapes, etc.). Generally, they'd only take a taxi in groups, or walk. Uber seems to be working well in that regard (at least for now).
On the other hand, Uber drivers with a bad score are usually suspended or banned from the app, keeping out the bad apples, and they're usually the car owners themselves, thus having an incentive to drive better and take more rides.
I believe than something similar to Uber scores for taxis with similar effects (removing bad drivers from the service) would create a huge improvement.
Another unfortunate side effect is that there's some segmentation - poorer and older people still take taxis, while more affluent people take Ubers.
The hospitals also had contracts to send their patients home. One pre-obamacare passenger comes to mind: she didn't have a problem that wasn't related to being poor/homeless/childhood abuse, but the E.R. couldn't address her actual problems, and gave her a prescription for "something". She waved the prescription and said, "I can't afford these pills..." The hospital sent her to her sister's apartment. I called twice to check up. She was doing okay the first time. The second time the passenger's sister said she was at the State's psychiatric hospital.
A non-insurance passenger with a non-life-threatening injury asked to go to an emergency room. I suggested going to the full-service emergency room at the heart hospital. They got in & out in a fraction of the time that people usually spent at the big hospitals.
I knew of that emergency room because the Fire Department had a contract with the taxi company too. They sent people who didn't need an ambulance via taxi to the nearest emergency room. That guy was homeless, iirc.
During undergrad in the Midwest, I heard a freshman who was way too drunk fall off his lofted bed around 4 in the morning during the last couple days of the year. I heard his roommates discussing whether or not to call the ambulance because last time this guy got super wasted and hit his head drunk, the ambulance ride was a couple thousand dollars.
It was so messed up to hear them talking. He could have a brain bleed going on and they were discussing how handle the situation. Ultimately they did call 911 and he was fine the next morning.
As long as you have money the US is great.
I guarantee the hospital administration isn't going to pay the upcharges for the fanciest new MRI if they can spend it on themselves.
Doctors, Hospitals, Insurance companies and everyone else are working with what are essentially cost-plus contracts, so the more expensive everything is the more they make.
this speaks more to a failure of the healthcare system than it does to the success of ridesharing
Uber is using venture capital to subsidize rides. Drivers are often providing the services by going underpaid and putting up their own capital without getting the appropriate rent.
This is not a sustainable model. If there is a real need that is currently not met it has to be provided through other means in the long run.
What a shame.
Obviously if it's a service dog they're required to transport it, but from knowing people with service dogs, it's still worth calling because some drivers are allergic and would rather you call another
But Uber is not a cab service; instead, they are trying to evade all the rules.
Why would anyone take this seriously?
The rich?
In fact, any kind of public transportation will result in lower ambulance usage. Because when there are alternatives some %age of ambulance rides will be replaced by some %age of public transportation rides.
If you have a condition that is so serious that you feel you have to keep in contact with a doctor while you're transported to the hospital in case it gets worse, call an ambulance since they can actually treat you in-route.
If you call a taxi service, and they say "15 minutes," it could be 30, 45, or 60. Maybe they're mussing with the truth, maybe they're outright lying. You don't know, and without the map showing the driver, you have no way of knowing.
Also even before Uber/apps, I never had a problem with calling a Taxi and it not showing up within a few min, and I've lived a lot of places.
The first time was in 2012 because Microsoft was paying for it. It was from downtown Bellevue (so not an obscure place). I called them, they estimated 15 minutes, and it took them 40 minutes to show up. I'd never called a taxi before so I didn't realize this was normal; I called them back a few times to ask what was wrong, and they just said "soon!"
The second time was in 2015 in a country that didn't have Uber. They had an app. The app didn't work. They also didn't answer the phone. I tried multiple times, including an hour later after eating lunch. I gave up and spent 50 minutes walking home in ridiculous heat.
The third time was in 2016 because it was in a small town in the US that didn't have Uber. They did have an app. Their "app" displayed a phone number and told me to call it. That was the entire app. I called it, they estimated 30 minutes and showed up in 45 minutes, and they charged me $40 for a ten minute ride. Small town so I can understand the wait, but the price was definitely because they knew I had no other choice.
Meanwhile, I get annoyed when Ubers take longer than 5 minutes to show up because they take wrong turns.
I think it's definitely a matter of luck and location. Some places have horrible taxi services, some places have okay taxi services. Some places only have okay taxi services now because of competition from Uber. Ubers are still nearly always a huge margin better.
You can call an uber (or lyft) for your destination, with a few finger taps.
(*And the driver will know who they are looking for visually, as well.)
I pay directly to the insurance company. It costs me about 145 usd/month and includes health insurance (with urgent care), long term care insurance, life insurance (about 500k usd) and some more.
I could have done it through my employer, but when I leave for another place I'll have to renegotiate the price with the insurance company, and also this option has less good of coverage IMO. It is cheaper by 70% tough.
The paper looks at 700 different cities, each with a different Uber market entry time over a two year period. The researchers also control for some seasonality effects.
Perhaps more covariates could have been considered, but this seems like a pretty decent design to measure a before/after causal effect.
From the article:
_______ With demand for ambulances decreased by available Uber drivers, emergency personnel have been able reach critical patients faster while also applying necessary treatment on the way to the hospital, according to a new economic study from the University of Kansas:
"Given that even a reduction of a few minutes can drastically improve survival rates for serious conditions, this could be associated with a substantial welfare improvement."
The study investigated ambulance rates in 766 U.S. cities from 43 different states. Taking into account the timelines of when Uber entered each city, the researchers found that the app reduced per capita ambulance usage rates by around 7 percent. _______
Okay they claim the study says "emergency personnel have been able reach critical patients faster" but decreased usage does not necessarily equal faster response time. It would have been much more solid if they actually looked at the ambulance response time, not just how many are being used. (My skeptical side leads me to think this is because that data-set didn't match their narrative.)
There is also the question of: Is this actually a good thing? Are those 7% less people using ambulances all not having serious health issues? Especially when something is wrong, you are often not a good judge of your own health.
How many people having chest pain thought it wasn't too bad so they called an Uber instead of an ambulance and died on the way to the hospital? Might not have turned out that way if they just called an ambulance in the first place..
Need more data to decide if this is an Uber propaganda piece.
I honestly question of the numbers are even statically significant, but even if they are, this is seriously fucked up and not something Americans should be proud of at all!
Well, they could ask Uber for all the rides they made to the ER and see if - roughly - the numbers match with the claimed 7% reduction of ambulance calls.
I mean, a lot of people may have - coincidentally in the same period Uber came to the cities - become aware of the high cost of ambulance, or lost their insurance or whatever other reason and used taxis or some other means.
After all the study takes into account what happened over very roughly 3 years 2012-2015, how many people read (say):
http://articles.latimes.com/2013/aug/23/business/la-fi-healt...
http://www.nytimes.com/2013/12/05/health/think-the-er-was-ex...
If there was a "penetration rate" (which is not the same thing as "establishing the service") and a direct correlation with roughly the same number of UberX rides to the ER and of less ambulance calls then it would IMHO sound much more credible.
(It doesn't have to be that way. Other countries have managed to keep ambulance services affordable.)