Comment by rectang | Hacker News Reader

Comment by rectang | Hacker News Reader

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Possibly. I thought the top answer in the Uber-as-ambulance discussion offered a lot of insight as to how the current system is a market failure:

https://news.ycombinator.com/item?id=16007246

>> 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.

It would be interesting to have a conversation about how you deliberately construct a sane ambulance market (liability, dispatch, predictable pricing, proper competition) to handle a wider range of emergencies.

But in the US, I don't expect such a reasonable conversation. I expect to be bludgeoned to death with the word "deregulation", as if the only control we have is a a single dial to turn "regulation" up or down.

You never get to zero "regulation". "Deregulation" is always selective and another form of market interference -- and like any market constraint, selective deregulation will always favor certain players.

So, can we have a conversation about constructing a market? It's the US. I'm not getting my hopes up.

It's the most frustrating thing in today's climate.

Everyone agrees there are good and bad regulations, but everything gets framed such that any regulation is bad, and any deregulation is good!

There's no real conversation about which regulations are which! It's just naive free market vs full socialism debates in every public sphere.

The simple answer is not to construct a market, but just have the government set a reasonable price.

Another option would require localities to use a bidding system for ambulance providers rather than doing it themselves or contracting a gold plated service.

Maybe mandate the ambulance charge the same rate to insurers as they do non-insured people. A huge part of the "list price" for these services are just an attempt to set the negociation with insurers high.

Also, comparing Uber to an ambulance is silly. They aren't comparible services. Ambulences aren't a hospital taxi. They provide some level of first aid and stabilization.

If you don't think you are going to get or potentially die, you should be taking an uber/taxi/friend ride to the ER.

> The simple answer is not to construct a market, but just have the government set a reasonable price.

My point is that all markets are artificially constructed. Having the government set prices is simply constructing a market using a different set of rules.

Your proposal sounds like applying the "all-payer" system to ambulance service.

https://en.wikipedia.org/wiki/All-payer_rate_setting

There probably isn't a more appropriate use case for all-payer than ambulance service!

> Also, comparing Uber to an ambulance is silly. They aren't comparible services.

Au contraire -- it's a brilliant, revealing comparison. It illustrates exactly what is missing from ambulance service today: price transparency.

Even if there were an ambulance market, it's not like I'm going to spend time researching pricing when I need an ambulance. That'd be like if 911 and police services were market-based instead of public utilities. I know police do charge for special events and misuse, but I just mean the average citizen emergency.

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