As private equity dominates wheelchair market, users wait months for repairs
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Louis Rossmann interviewed the founder of the project here: https://www.youtube.com/watch?v=eaAj59025Kk
They definitely won't be once this open source effort shows any sign of success. You can't solve political problems with technical solutions. At best, you may be able to displace them, but even that is rare.
Yes, that's what I've been thinking too. Tom Quiter even mentions in the interview that there already have been companies which tried to offer cheap wheelchairs, but the quasi-monopolists had the FDA alter the regulations in a way with which the newbies couldn't comply.
However, since the MIF already attracted suppliers, I hope they can gain some leverage.
I suppose the FDA's reasoning is that they're better off having no mobility than having a device that doesn't work properly.
The FDA is not comparing no mobility and simply an inoperable device, the FDA is comparing no mobility vs the possible outcomes of an malfunctioning device. Like perhaps what happens if the throttle gets stuck on forward.
I don’t think the FDA is in a position to asses whether those risks versus the benefits of mobility are an appropriate trade off for any individual.
The FDA is deciding that some people should have no mobility so that others have… what, exactly?
The people who bought $65,000 chairs still could — and they’d be equally reliable. But because one person needs to use it in Alaska, all people need to pay a premium… even if they live somewhere that cold rating is completely irrelevant and adding a needless $5000-10000 to the price.
While there’s a reason to regulate for truth in advertising and basic safety, eg, not catching fire on its own, the actual regulations extend far beyond that into adjudicating personal risk management without clear benefit.
I’m not a fan of technocracy — I think people themselves know what’s best for them.
Why wouldn't the FDA, which employs experts for that exact task, assess risks? Who is in a better position?
> I think people themselves know what’s best for them.
How can anyone but an expert evaluate the safety of a powered wheelchair?
You might say we could come close with advanced 3D printing and some kind of nanotech,but no such technology will ever be so cheap or ubiquitous as to render politics obsolete. History is replete with advancements and inventions which were supposed to usher in utopia, and all they have ever done is further the means by which the powerful enslave and control us. Technology cannot solve human nature.
Though I agree we probably won't be using it to replicate a cup of Earl Grey for a very long time.
humans are more sovereign than ever before in most calculable metrics.
But unless you hunt and grow your own food, own your own land and aren't subject to laws or government that owns your identity and tells you where you can go and what you can do, you aren't sovereign. If you have to spend the majority of your useful life trading your labor to a corporation, you aren't sovereign even if the market gives you the option of which feudal lord to serve as vassal to. If you require modern technological society, the infrastructure of agriculture and healthcare, for your survival, you aren't sovereign. There is a reason that word is synonymous with "ruler" or "king," it's a status that very few people, particularly in modern society, can claim.
That's what free labor is.
If you believe you're entitled to the fruits of the labor of others, then you've enslaved them, and that's not the moral high ground.
That's because we haven't figured out how to harness it.
For example, 99.9999% of the sun's energy just disappears off into space.
We sit on a hot planet, all that's needed to drive our energy needs is to drill a hole through the mantle. But nobody has figured out how to do that yet.
Car buyers have leverage.
Normally this exorbitant price would incentivize competition in a healthy market, but the private equity players presumably make that difficult. There might also be barriers to entry in the market.
This is also true for most drugs. If we removed private insurance companies, Medicare and Medicaid in their totality from the equation, the market rate for drugs and medical equipment would drop into the abyss compared to where they’re at now.
With something less egregious like "giving a the students a bad education", we still have some level of accountability based on standardized testing and school funding. Standardized testing is far from perfect, and it can be an example of Goodhart's Law, but it's still accountability.
Another signal is the firing of teachers for incompetence is practically non-existent.
A third signal is anytime someone from the school talks about solving issues, they always always always put it down to lack of funding, and the credulous journalists repeat that unquestioningly and the schools get their tax increase.
A fourth signal is repeatedly lowering the requirements for a diploma.
A fifth signal is getting rid of "high stakes testing".
A sixth is getting rid of the gifted tracks.
How much of that can be attributed to selection bias though? Private schools are pretty pricey, meaning you generally have to come from a fairly rich family to go to one. Rich families can afford extra tutoring that a poor family might not be able to.
A better statistic might be to compare public schools to charter schools, and that's a much less clear cut distinction. I can point you to dozens of cases where charter schools are a joke, and a bunch of cases where they're great, it's not a clearly defined "better" just because there's a profit incentive.
> A third signal is anytime someone from the school talks about solving issues, they always always always put it down to lack of funding, and the credulous journalists repeat that unquestioningly and the schools get their tax increase.
Yeah, so that's just not true. If you go to a poorly funded public school, the calls for funding are immediately obvious. There are holes in the ceiling, often there's no chalk/markers to write on the board, the computers will be from the late 90's and half of them just don't boot up.
You could argue that this is due to simply poor allocation, and there's probably some truth to that, but implying that they're not poorly funded is flatly wrong. Have you even seen a high school in a poor neighborhood in the last forty years?
> Another signal is the firing of teachers for incompetence is practically non-existent.
Fair, but you've worked for private corporations haven't you? Surely you've seen employees that do literally nothing manage to hang around the company for years. I had a friend that jokingly told me when he retires he's going to get a job at Bank of America because he can just show up and do nothing at his desk while still taking home a paycheck. I don't know that that's an issue with "accountability" so much as it's an issue with "large organizations are bad at finding outliers".
> A fourth signal is repeatedly lowering the requirements for a diploma.
The GED has been around for since the 40's. I've never taken it since I did high school the normal way, but I know several people of different age demographics that claimed it's much easier than normal high school, so I don't think this is new.
> A fifth signal is getting rid of "high stakes testing".
I guess I just fundamentally disagree with this being a bad thing. Understanding a subject isn't a binary yes/no like a test implies. Testing can be a good way to gauge the level of understanding a student has on a subject, but "high stakes" implies that the student will be punished in some way unless they pass, and I guess I disagree with the utility of that. Again, it becomes a Goodhart's Law situation.
> A sixth is getting rid of the gifted tracks.
Has this actually happend? My younger sister graduated from high school four years ago, she had exclusively AP classes. I'm a good chunk older than her and graduated high school in 2009, but I skipped two grades in math. Where has this happened? A quick search had a few articles calling for the removal of gifted tracks but I didn't see any indication that it actually happened.
The Seattle Public Schools have recently seen a large outflow of parents because of their wretched performance. The performance difference has to be pretty bad for parents to be willing to pony up $20,000 for private tuition.
> so that's just not true
I read the paper. Every single article about the schools has the schools saying they need more revenue, for my entire life. The Seattle Public Schools get $24,000 per student, and they're claiming they need more revenue.
> private corporations
Sure, I have. They all regularly laid off the non-performers, except for the union members.
> GED
I wasn't talking about the GED. I'm talking about the public schools.
> high stakes testing
No, there is no punishment for failing the tests. But the public schools decry those tests because it shows what a bad job the schools do. They also claim that students can master a subject while being unable to answer questions about it. I'm not buying it. Would you get on an airplane with a pilot who flunked his certification tests? Would you take his word that he really was a good pilot? Washington State just lowered the requirements for becoming a lawyer - passing the Bar exam is no longer a requirement. Would you hire such a lawyer? Not me. Next time I need a lawyer, I'll ask if he passed the Bar. I'd move on if he hadn't.
> has this actually happened?
Yes, at the Seattle Public Schools.
That was orthogonal to my statement and didn’t actually say anything.
> I wasn't talking about the GED. I'm talking about the public schools.
I know. I am saying that for both of our entire lives there’s been an easy way to get a high school diploma, so even if I agree with the assertion that schools are getting easier, it was never a guarantee that the person got a great education.
> I read the paper. Every single article about the schools has the schools saying they need more revenue, for my entire life. The Seattle Public Schools get $24,000 per student, and they're claiming they need more revenue.
You’re saying that number as if it is somehow too big. How much do you think it should cost to teach a student? Public schools have a lot more responsibilities than a private school; if nothing else they’re required to bus students from any distance in.
> Sure, I have. They all regularly laid off the non-performers, except for the union members.
Bullshit. I am sorry but you’re either misremembering or not being honest, or the word “regularly” is doing a ton of work.
I was at Apple for two years, I met people who, I think, did literally nothing the entire time I was there. I suppose it’s possible that they were fired after I left, but they did nothing for at least two years.
> No, there is no punishment for failing the tests. But the public schools decry those tests because it shows what a bad job the schools do.
That’s an assertion and you do not have any way of knowing if that’s true, and borders on conspiratorial.
> They also claim that students can master a subject while being unable to answer questions about it.
Who claims this? I certainly didn’t.
Doing an exam to gauge how much someone knows is one thing, but the school system, public and private, doesn’t do that. It creates a bizarre gamified system of GPAs and also will create situations where no matter how hard you work it is mathematically impossible to bring up your GPA.
I don’t know the solution but it’s absurd to think that what we have had before is perfect.
But I am having some trouble finding anything but opinion pieces on this, do you have any kind of school board ruling or statute you can point to?
> Yes, at the Seattle Public Schools.
Again, I cannot find anything but opinion pieces on this and assertions on Reddit. Opinion pieces are not news, the NY Post is a joke. Do you have any link to the source of these claims?
Even reading through the Reason.com article, which is where I assume you heard this, it doesn’t appear that they’re really getting rid of gifted programs so much as this is just a reallocation and increased integration. That’s not the same thing.
I'm done here.
Due to a WA state Supreme Court ruling, more property tax money will be re-divided to districts that lost the least number of kids (or actually grew). So every kid the SPS loses, it actually loses most of that $24k. And yes, it’s usually the non-special ed kids who are cheaper to teach that move away or to private schools, so that hurts the district even more. I actually like it like this, as it forces the SPS to be more attentive to all its students.
It's both.
The US lacks serious competition in _most_ of it's industries right now.
There's no reason to think this is true. Unless the barrier to market entry is access to huge amounts of capital, it should be no different than if the entire space owned by mom and pop shops.
This puts the Bluey episode "Granny Mobile" in context, where the grouchy granny wants to buy the used wheelchair for a mere $100. $1,200 is still an incredible deal.
I bet a huge segment of the user base could easily self purchase a mobility scooter and achieve the same quality of life if the price point was such that they could out of pocket the purchase and there was decent quality/repairability/safety.
There do seem to be a fair number that are approaching "geez I might as well just buy an over the counter version" (i.e. sub-$2000) instead of going through the paperwork hassle of getting a free Medicare "prescription" for one.
My daughter literally just got approved for a talking device that would otherwise cost us $4000. It’s a Samsung tablet with $300 software and an attached speaker and comes with some sort of repair agreement. I can buy and break 20 iPads for that price…and we did end up buying one with the software on its own.
If you want to know who’s causing waste, look to the ones who stand to benefit from it.
If the customer is government with endless budget, inflate costs, and use regulatory capture to maintain the cash flow.
Right now we basically end up going to Mexico if we can help it, where there's basically no real oversight or regulation to raise cost so long as the doc/pharmacy pays off the cartels.
I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.
Eg the FDA ought be to dissolved, and replaced with state level agencies. The state level agencies are, of course, free to cooperate and coordinate. Comparable to how the traffic signs work already in the US.
It's good for Hawaii and New York to have the same road signs, but they can agree on that voluntarily. No need to have a central party force them. Similarly, it's good for both states to have the same or similar rules on drugs, but no need to force them.
See also how the recent wave of cannabis legalisation has been driven by the states. I want to see more of that innovation and experimentation.
> I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.
In what I suggest each state would most likely still have mandatory regulation, but it's a lot easier to move between states to find a place that suits you best, instead of moving between entire countries.
I have lots of sympathy for your position, and I would hope that at least some states would take a more laissez faire approach. But the policies you get will ultimately still be decided by what's popular with voters, and they can be a fickle bunch.
I can't wait for drugs having to be certified safe in 50 different jurisdictions, instead of one, with 50 different agencies, each with a different set of politicians putting their thumbs on the scale having their own rules for them.
That'll really bring down medical costs, and will not at all destroy the incredible economies of scale that a single 350 million person national market creates.
I also can't wait for the cross-state litigation when an upstream state's equivalent of the EPA will be paid off to allow a firm to dump toxic waste into a river, that will be poisoning the people downstream.
> I also can't wait for the cross-state litigation when an upstream state's equivalent of the EPA will be paid off to allow a firm to dump toxic waste into a river, that will be poisoning the people downstream.
How much is that happening between eg Canada and the US at the moment?
Is that really what you want? It sounds absolutely mad to me. Your ideology is driving you to ask for a monkey's paw.
And yes, voluntarily following an example is better than being forced to follow an example. Duh.
Other states get the choice between not having cars, and following California's rules, despite having no input into them. Because it's uneconomical for manufacturers to produce custom, per-state models.
You're still forced to follow the rules, except that in the case of federal rules, you have democratic input into them, because you elect both the federal legislature and the executive.
In the case of non-federal rules, the largest state will set the rules for you, and you won't have any say in it (at least, if you want to have things like cars and drugs). That's not a choice.
Or, you could always take a look at how abortion rights are currently handled. Texas is suing people who get abortions in Colorado. Truly magical stuff. I'm sure the people in Colorado 'volunteered' for that.
The only way this works is if the government subsidizes the regulated market such that it is accessible (and sustainable) to an appropriate market. It also generally puts some populations at severe disadvantages, and usually those populations are disadvantaged to begin with.
This may seem good to you but, unless your fellow man is equally wealthy, it is problem detrimental to your fellow man.
If you play the idea out (I’ve thought about this for years, perhaps you have fully considered it).
I think this works for people of all economic backgrounds.
There would be multiple competing standards for lower cost businesses, will the low standards business exist if people get sick, or will a slightly higher priced but much safer low cost standard excel in the market?
I think many of the issues you bring up already exist in the current market.
Is that a good idea for an industry that seems filled with completely immoral bastards that'll screw over everyone ("they'd sell their own grandmother!") to make an extra cent, or save themselves a cent?
I could see it might be a good thing where an industry has a good reputation for fair dealing. US health care doesn't seem to fit that description though.
One issue is a big disconnect between user and payer. Government is especially prone to that, but any big organisation can have this problem.
Asking because there's a bit of a different between standard consumer grade stuff, and specialist high performance things designed for a specific exotic environment.
Presumably there for political protection as much as anything else: "Bushinggate topples Senator after it's revealed a Russian company supplied the titanium" or "Scandal of the aircraft parts Anerica has forgotten how to make".
That being said, as far as I know the FAA standards aren't really military standards.
Doing some quick searching shows this which seems relevant:
https://aviation.stackexchange.com/questions/12401/how-much-...
So just because something meets a particular level of FAA compliance doesn't really speak to whether they'd work properly on the example "fighter jet" (potentially needing much higher performance).
Sounds like the guy was trying to do a populist pulpit style smoke-and-mirrors kind of thing?
Though if you can follow up and get the details of what type of fighter jet, and what type of bushings he meant (good luck with that! ;>) maybe that guy will turn out to be the first politician in history that's not completely full of crap. :D
In defense procurement the costs are frequently inflated greatly by the procurement process overhead and the government imposing last minute changes of scope, requirements, or delivery dates. The government customer is also often slow or delayed on their contracted deliverables, so they can end up spending a lot of money to essentially keep idle capacity warm on the vendor side while they sort out delivery of their part. And then there are the budget rug-pulls at the 11th after the vendor has already committed significant internal resources, which are often a pure loss to the vendor. All of this is endemic to the process. The government knows they are a difficult and expensive customer to work with, and they do try to compensate vendors for the overhead costs this imposes.
People like to talk about $2000 hammers etc but if you actually look at the audits, more often than not the cost was justified. Not because a hammer should cost that much but because that is how much it ends up costing after you account for the government procurement process overhead and the way in which the government executed the contract.
What is that based on? Do you have experience or know anyone who does? A news article or research?
The crackdown on scooters was going after blatant and obvious fraud.
Probably even a higher quality of life, because the manufacturer can make arbitrary changes to the unregulated scooter in response to market demands.
$65k is an obvious rip-off.
> Medicare is likely what is requiring a regulation grade wheel chair, not the users themselves.
It's a shame Medicare can't just give the users cash and allow them to choose their own wheelchair; both Medicare and the users would win.
1)The chair has to be comfortable enough to be in almost constantly - for someone whose body may not be shaped the same as most other people's. It may need to be designed in a way that makes it easier for the user to get in and out of, unassisted. That means a substantial part of it is customized to each user, probably in consultation with medical professionals. It may need to carry medical devices/equipment.
2)The chair has to be navigable in indoor spaces with a fine degree of control, by someone who may have lower motor skills and range of motion than others. So it may need customizable response time, input smoothing, and acceleration.
3)The chair cannot, under any circumstances, make an un-commanded motion - which could easily kill the occupant (ie going into traffic, or down a steep hill, or off into water.) That has implications for the physical controls, the electronic controls, and mechanical drives (I'm guessing many chairs have electrical locking, and can use the motors for braking.) Similarly, the chair has to be very reliable, or that could kill the occupant (say, a fire or other emergency where they are) or otherwise be a major inconvenience. If you're unable to move much from your chair and, say, your cell phone is in another room - you're varying levels of screwed.
4)It has to be designed such that fire would be a very low risk.
Are they probably more expensive than they need to be? Yeah. But I'm sure it's nowhere near an order of magnitude, and your comment is pretty ignorant.
Can you go into what that statement means? I'm having a hard time parsing "an usual". Seems like there are some electric wheelchairs for ~$2,000:
https://www.forbes.com/health/accessibility/best-electric-wh...
...maybe some specialized wheelchairs cost considerably more?
Or, for people with very limited mobility, they need very special cushioning to avoid bedsore type problems.
Just 2 examples, there are many more. Though $65k still strikes me as unusual.
Here's an example of a real full-time use electric chair. [0] It's front wheel drive, has standard attachment points for medical devices, a standardized controller interface that can be adapted to just about anyone, false bogey-arm suspension for stability sake, and all the certs.
It starts around 8k-ish out of pocket. I don't use electric chairs myself, so i'm unfamiliar with what insurance/medicare costs would be.
I pay ~2-4k out of pocket for a manual wheelchairs 20% co-pay through medicare, to give an example of the costs of things. Electric full-time use chairs are astronomically more expensive.
[0]: https://rehab.invacare.com/Power-Mobility/Invacare-AVIVA-FX-...
"Electric wheelchairs usually cost a lot of money."
vs.
"A usual electric wheelchair costs a lot of money."
The second form begs the question, what is it that comprises a "usual" electric wheelchair? What would make an electric wheelchair seem "unusual"? A custom muffler? The statement creates more questions than it provides answers.
The first form however is simple and clear. What about these wheelchairs can be considered "usual"? The cost. They cost about the same. What would make a wheelchair expressed in this context unusual? The cost. It's either cheaper or more expensive. No additional unanswered questions have been created by expressing the statement in this form.
A usual one?!?
The MSRP of a 2024 Tesla Model S is $72,990.
---
EDIT: Do you have a source?
The article does mention this bit to sort of justify the cost:
> To get such a chair, a person needs a prescription, authorization from their insurance company, and a custom fitting from an assistive technology professional. Like a tailor crafting an exquisite suit, these technicians meticulously measure a client’s body to ensure the device’s specifications will match.
In many cases, yeah the wheelchair is specialized and has features that each individual needs. My friend with muscular dystrophy had one of those. But the drivetrain and the lead acid batteries seemed generic enough though possibly a higher quality, but it was definitely not something that should cost $65k.
$24,000.
So if Medicare is paying $65k, something is seriously wrong.
Can you point to any project site that has released anything along this line? Blueprints, bills of material, code? There's nothing on the site you linked having any such resources. The closest thing is a block diagram including an RS-485 motor controller, which doesn't really seem like an alternative to standard parts at first glance.
https://www.aliexpress.us/w/wholesale-Electric-wheelchair.ht...
No idea if it makes more sense to buy those, design from scratch, use those for inspiration, or buy one, tear it down, and rip off the bill of materials.
It’d be fun to take advancements in electric mobility devices to wheelchairs.
This one from Youtuber Jerry Rig Everything https://notawheelchair.com/products/the-rig
He usually reviews mobile phone durability etc, there are videos on his channel about the chair, this started as project for his wife who was paralyzed in riding accident very young.
Akin to the flamethrower that Musk was selling a while back as long you don’t call it a medical device there isn’t much regulations (hard to differentiate say a Walmart scooter style device from a actual wheelchair)
Of course if it’s not a medical device it won’t qualify for insurance or Medicare , but you can still sell it for reasonable prices
It seems to be blatantly obviously regulation in this case. There are electric wheelchairs in other countries. What's stopping them from being imported are the regulations.
There would still be regulations that would allow public equity wheelchair makers to jack prices.
I'd start importing them for less than $500 from India [1]. (Versus $1,500 to $6,000 for these jalopies.)
[1] https://www.amazon.in/electric-wheelchair/s?k=electric+wheel...
My point is the regulations are leading to the duopoly, which is the source of the problem. The last private-equity owner seems to have been fine. And the market was competitive before the CMS rules in 2005. I’m not suggesting scrapping the rules. But the rules are clearly well past safety.
> how would it fix things then if it wasn't private equity dominating that market?
The visible answer is clearly contingent on some future regulatory landscape coming into existence, otherwise it makes no sense, so I was wondering how does it answer the original question?
The dumb thing is these super cheap wheelchairs would likely cost the end users more money than the expensive ones as they will buy them out of pocket vs having their insurance/medicare cover most/all of the cost.
The reason these companies don't sell these wheelchairs in the US is likely because the marketing would run afowl of regulations about selling medical devices. You probably could sell these as bicycles and hobby chairs though.
This is something I've never really understood. Wouldn't the insurance company be ever grateful to you if you accepted a non-medical wheelchair because it's 1/10th the cost. Hell, have 5! Is there any reason insurance can't pay for them?
Also, medical insurance is supposed to cover bona fide medical treatments and supplies. So this likely bumps up against regulation again. If something goes wrong with the out-of-regulation device that insurance paid of as if it were a medical wheelchair (e.g. safety incident leading to injury), they could be liable.
It's the same as why dental insurance won't pay for your next door neighbor handyman to pull out your tooth with a pair of pliers.
Can the FDA stop a person from using one by coming to their home and confiscating it?
Let's say in this scenario you do import an electric wheelchair. You fork out a few thousand dollars on the expensive costs of said purchases. It breaks. No one in America can repair it. Or if they can repair it, you have to go through the PE-owned wheelchair market, whom charge a premium. Your options are fork out the money for repairs, import another wheelchair, or send it abroad for repairs.
Assuming that instead you create a company designed around importing said wheelchairs, PE buys you out and then sells imported wheelchairs at monopolistic prices.
Vested interests sell regulation to the public as a "consumer protection" mechanism, then use regulatory capture as a tool to erect barriers to entry and impose complex rules that supersede common-law jurisdiction while giving them a range of tools to evade liability. The threat of competition is restrained, and a de facto collusive oligopoly can squeeze the market dry.
In a free market, "moats" like regulatory capture would not exist. In a market like this, where the customers--wheelchair users--are generally pretty savvy about what they need, a free market would have no trouble providing products that met customer needs at an affordable cost, because customers would have meaningful choices about who to buy from and who not to buy from, and customers would see the full cost of the products so they could make meaningful cost-benefit calculations.
In capitalism such as we currently have, none of that is happening. The government aids and abets rich people who want to siphon off even more wealth than they already have by putting regulatory barriers in place that stifle competition, and it removes visibility into actual costs by forcing all medical products and services to be provided through health insurance, even when, as in this case, there is no insurable risk involved--it's an ongoing medical need that is already known (not a risk) and which is predictable (so insurance makes no sense anyway). The result, of course, is that the customers get shafted while rich people get richer.
In a free marked that is absent of regulatory hurdles, it is far from guaranteed that costs would be affordable.
Freedom from regulation about how wheelchairs have to be constructed would go hand-in-hand with freedom from regulation against monopolistic practices!!!
In a completely free market, devoid of regulation, wheelchair makers can get together and fix prices. Or buy each other.
It independently evolved in Rome and India to provide legal personhood to cities, guilds, public works and later, in the former, the Catholic Church.
That's one aspect of capitalism, yes. But in capitalism as it is currently practiced, most of the people who are accumulating capital aren't people that are trying to start new ventures. They are people that are already rich but think they aren't rich enough, who are unable to start new ventures themselves because they have no actual skills at providing valuable products or services, so instead they find some existing venture and siphon off all its wealth. (This pattern is not new, btw; it's the same way the "robber barons" in the late 19th century operated.)
> In a free marked that is absent of regulatory hurdles, it is far from guaranteed that costs would be affordable.
Nothing is ever "guaranteed". But the article under discussion makes it obvious that with regulations in place, not only are costs not affordable, but even the very existence of products meeting customer needs is not happening. A free market couldn't possibly do any worse.
> In a completely free market, devoid of regulation, wheelchair makers can get together and fix prices. Or buy each other.
This would only happen if it were economically more efficient for wheelchairs to be made by a monopoly. I strongly doubt that is the case. It's not the case for the vast majority of products and services. If it's not economically efficient, the monopoly (or price-fixing cartel) will simply be out-competed in a free market, because it will have no way of keeping other companies from producing at a lower cost.
Historically, virtually all monopolies have been the result of government interference. (The original meaning of the word "monopoly" was a royal grant of the exclusive privilege to sell a particular product or service.) Most large corporations today are not the size they are because that is the most economically efficient way to deliver their products or services, but because it's the best way to buy government favors.
I'm with you on this. In general, the state (by definition) functions to protect the interests of the politically dominant class, which, under capitalism, is the owning class. From the haymarket massacre to Biden's strike breaking shenanigans, this is absolutely beyond dispute. The state will always facilitate monopolies. The only way to get rid of monopolies is for the workers to organize and overthrow the dictatorship of the owning class. Until that happens, it's all Disney, Amazon, and pseudo democracy.
It worked very well in Tsarist Russia, but that could have been a fluke.
It could get chummy with them and fix prices. It could buy them.
Which were put in place in response to other rich people lobbying the government for regulations that favored them and their companies. Perhaps there haven't been many recent ones put in place specifically in response to lobbying by private equity companies (though I'm not sure that's true). But that doesn't change the main point.
That's why we have regulation: to establish the minimum standards.
Simple medical devices like wheelchairs (Class I or Class II) are also not super over-regulated, you don't need to do clinical trials to certify them. All-in-all it'll cost you around $10m, which is not at all a moat.
Only if a wronged party has the resources (time, money, political capital) to pursue it.
Which is but one reason why it is deeply silly to rely on it to make a society go.
In a free market, if there is a market need for more efficient achievement of redress for wronged parties, the market will produce it.
> Which is but one reason why it is deeply silly to rely on it to make a society go.
But of course relying on governments to achieve redress for wronged parties works just great. Not.
In our current market, many companies have worked around redress of wronged parties by mandating arbitration in various contracts.
> the market will produce it.
Only if it's profitable. Feeding poor people, caring for the indigent, etc. isn't profitable.
Are you confusing markets with business?
To profit means that you accepted a debt instead of getting something in return for your efforts. Business seeks profit because the expectation is that it will pass the debt on to the stakeholders who will then call the debt and get something in return for their efforts.
But it is people who participate in the market. If they demand profit continually, therefore not getting anything in return, that just means they're working for free. People won't feed the poor unless they can do it for free? Methinks that's not what you meant.
Regulation is by nature slow and highly susceptible to corruption or stagnation. Whereas the courts, as onerous as they may be, essentially achieve the same thing through liability but it is more dynamic, more responsive, and more likely to error correct than the former.
Likewise regulation is limited to preventing foreseeable issues, and is often only implemented after somebody suffers damages.
The difference is that regulations are imposed by a third party whose interests may not be aligned with those who are actually involved in the matter. This is good in circumstances where there are externalities, for example just because I'm okay with entering an agreement with a company to use my backyard to store toxic waste doesn't mean my neighbors would be very happy. But when people are making decisions that will only affect themselves, such as what wheelchair to purchase, liability really is the more sensible consumer protection.
No, it isn't, because nobody will buy chairs from a company that does that. In a free market, no company can use the get out of jail free card of "but I was following all the regulations". Businesses have to actually meet customer needs.
And in a free market, customers can't delude themselves that Big Brother is looking out for them (even though Big Brother is not actually doing that); they know that they have to enforce quality if that's what they want. That means customers know that it's on them to be savvy enough to be able to evaluate the quality of products and services.
> That's why we have regulation: to establish the minimum standards.
That's what regulators claim, but all history shows that claim to be wrong. The end result of regulations is to reduce the quality and availability of products, not increase them. The wheelchair market described in the article is a classic example: it's regulated up one side and down the other, yet customers can't get simple things like proper footrests.
> Simple medical devices like wheelchairs (Class I or Class II) are also not super over-regulated, you don't need to do clinical trials to certify them.
Doesn't this contradict your claim that regulation is the only way to avoid exploding chairs? If you don't do clinical trials, how do you know the chairs won't explode one day after the warranty expires?
Of course the answer to this is that the regulators just, you know, look at the design of the chairs to evaluate them for certification. But customers could do the same thing for themselves, at less cost (what, you think those government regulators work for free?). So the regulations are actually adding zero value. But they're certainly not adding zero cost.
> All-in-all it'll cost you around $10m, which is not at all a moat.
So you'll be going into the wheelchair business then? Looks like there's plenty of opportunity to out-compete the current incumbents.
> regulators just, you know, look at the design of the chairs to evaluate them for certification. But customers could do the same thing for themselves, at less cost (what, you think those government regulators work for free?). So the regulations are actually adding zero value. But they're certainly not adding zero cost.
I have little idea how to evaluate the safety of an electric wheelchair, and don't have the time to acquire the expertise to learn how to do that with everything I buy. But we all can chip in and pay someone, who has the expertise, to do it once rather than than millions of people doing it redundantly.
Also, I don't want to live in world of frauds and scams and other crimes, trying to navigate it, for obvious reasons. It's also an economic disaster.
You're doing an awful lot of work to empower already powerful people by removing democratic power over our society.
Yes, what if it does? Unfortunately getting FDA approval isn't going to do anything to prevent that. I fully acknowledge that regulatory bodies are good for dealing with externalities, but consumer protections do not fall under that category.
> Also, I don't want to live in world of frauds and scams and other crimes, trying to navigate it, for obvious reasons
Then, as I said, just stick with the FDA approved products. Government standards would still exist, you'd just have the option to purchase things that didn't meet those standards. The freedom to color outside the lines includes the freedom to color within them. You're not harmed by other people choosing differently.
> It's also an economic disaster.
Citation needed. Typically heavily regulated economies fare worse than those where competition is permitted.
> You're doing an awful lot of work to empower already powerful people by removing democratic power over our society.
We clearly have very different ideas about who holds power in our society.
Meeting customer needs is optional, what businesses might decide to do instead is change their name once a week on amazon/ebay, hire teams of robots to fake reviews, and then deceive customers into buying doll house furniture at full size prices.
It seems unlikely you are unaware of this type of behavior, so I guess you have an explanation for how an unregulated market in a modern context is supposed to deal with bad actors?
Ok, I know we’re assuming electric wheel chairs, we don’t want fires or stuck accelerators, but really? This is still fairly close to literally reinventing the wheel, or adding complexity, a RC car.
It’s pretty sad to think this level of almost Stone Age technology only needs a 10 million dollar investment to bootstrap.
It's really not. If your chair overturns and traps a disabled user, it can be a death sentence for them. If your battery starts burning, your user _might_ _not_ _be_ _able_ to escape the flame.
I don't think people give Meta enough credit for their roll in that. Microsoft/OpenAI got cozy and thought they had a huge moat made of $100K hardware to protect their $10B investment. Then Meta shadow drops Llama and within weeks regular folks were running GPT3 level LLMs on consumer hardware. That was such a huge win for opensource and consumers.
The same way we address security around cars: we don't ban individuals from working on project cars, or driving them on public roads - instead, we have standards for OEMs and individuals, and prosecute negligence.
AI safely is similar to GM lobbying for laws making it illegal to tweak your own car or changing your own brake fluid for "public safety".
I'm not quite sure what you mean, or what in AI safety you see as analogous.
For other technology, certainly building and using certain things is illegal - you can't make hand grenades, lots of chemicals; I'm pretty sure you can't own certain instruments of crime, counterfeit money, etc. Many things you can do; it's not all or nothing.
IMO, for the general public, current AI models are much closer to cars than they are to anti-personnel weapons, when plotted on risk/benefit axes. FWIW, vehicle regulations are not an all-or-nothing affair either - there are things that remain verboten.
Those who claim AIs are too dangerous to be in the hands of the public have ulterior motives, and/or are far more optimistic than I am on the speed and ease the chasm between LLM and general intelligence will be bridged - if it at all.
Regulatory intervention makes it harder, not easier, for individuals to take charge of these matters for themselves. You can bet that the first casualty of a regulatory regime for AI would be to suppress development of FOSS solutions that would eventually give people the maximal control and benefit from AI, and force them into dependence on third-party solutions offered by organizations that have influence over the regulatory regime itself.
If AI takes over the world, or others pump lots of GHG into the air and cause climate change, or someone sets off explosives and burns down my neighborhood, or my frozen chicken contains poisonous bacteria, or my bathroom sanitizer doesn't really sanitize - how do I opt out?
Plenty of regulations coexists with FOSS, obviously.
The arguments against all regulation are transparently weak, and the apparent dogmatism discredits everything else. Why be so dogmatically anti-regulation? Dogmatism isn't about finding truth but about serving someone's political interests. If I understand correctly what's happening, whose interests are you serving and why?
This is a potential concern, but no currently-existing computer system (that I'm aware of) is any kind of risk for that. Certainly, nothing OpenAI has produced is.
I'd say the currently-real unaligned-agent behaviour of our institutions is a bigger risk than currently-fictional computer-instantiated unaligned superintelligence. And we do have regulation in place to constrain the behaviour of many institutions: governments, corporations, utility operators, and so on.
The unaligned agent problem was not discovered by the AI safety people. They merely named it.
In other disciplines, this is known as the "principal-agent problem" [1] or "fiduciary risk" [2].
Like you, I'm far more worried about the behavior of human institutions controlled by third parties with their own agendas than I am about the behavior of software that implements stochastic algorithms.
The risk in both cases comes from people surrendering their own agency and autonomy to external parties, and we already live in a word where too many people put blind faith in dysfunctional institutions which are demonstrably "unaligned" with the actual values and interests of those they pretend to act on behalf of. Turning to those very institutions to stop people from relying on "unaligned" software seems absolutely insane.
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[1]: https://en.wikipedia.org/wiki/Principal%E2%80%93agent_proble...
That strongly depends on the details. In particular, regulation that compel clear disclosure of information to individuals.
Imagine how impossible it would be to "take charge for yourself" if none of the food in the grocery store had any ingredient/nutrition/allergen information, and bottles of pills didn't tell you the active ingredients and amounts.
I can't think of many such things. Do you have any examples?
> There's not really a way for an individual to opt out of a corporation using AI in a way that negatively effects them.
Refrain from doing business with that corporation? If they are transgressing against your person or property, that's where the law comes into play.
I wonder if regulation that stipulated that a change of ownership of some percentage would require recertification of the entity would stem this a bit. Or restrictions on buying HIPAA covered businesses with patient data. Might pose a problem to folks in the business today, but could slow down the massive acquire-and-merge train in these industries.
PE is responsible for PE's actions. If these services and goods decline under PE, with the same regulations as before, then the cause is clear.
My eye doctor office got bought out. They pay the doctors as little as possible and maximize the number of appointments per day.
At smaller places, sometimes the owner sells to PE and stays on - they just don't want to deal with the business side of things anymore.
Quitting your job to start your own thing is never an easy step.
But even more frustrating than that? NSM continued sending me phony bills for parts that I did not order. I just trashed them until it went to collections. (Fortunately, the collection agency they use is even more incompetent than they are, and I've been able to put them off with standard anti-collections form letters.)
I figured I'd go with Numotion when insurance is ready to re-up me for a new chair, but reading this article, it doesn't seem that would be any better.
This actually touches on something that seems to have changed in the past 10-15 years: in my experience, shops now absolutely refuse to touch wheelchairs that they did not themselves provide. I'm lucky that I can generally do my own maintenance, because even something simple like a deep cleaning is met with worries of voided warranties, etc. etc. I'm not sure when this changed, but throughout the aughts I was able to get service at shops in multiple different cities without any issues.
Electric wheelchairs are built to be very rugged and dirt simple.
There are 2 problems:
The first problem is insurance. People expect their insurance to cover everything. If they need a new set of 35 AH SLA batteries, they will throw their old chair away and ask for a new chair on insurance.
The second problem is that wheelchair users are disabled. As an able-bodied nerd with a socket set and a few wrenches, I can repair an electric wheelchair. A disabled person usually can not do that. They can not even follow the (good) advice to use an external charger instead of the (garbage) charger built into most wheelchairs; they physically can not get to the relevant parts.
Home oxygen companies send people out on short notice to debug, repair, or replace home oxygen equipment. If you want insurance to cover electric wheelchairs, then rent them instead of selling them and include service visits.
The problem with shipping an electric wheelchair back for service is that this thing weighs almost 100 pounds without batteries and is a very odd shape. Before anyone complains, you want it to be heavy so it will not tip over when the human (who is high up) leans over, takes a corner, or drives sideways on a slope.
If you want a less-insurance-intensive solution, pass a right-to-repair law that (1) requires all electric wheelchair parts to be marked with a manufacturer and part number, and (2) requires all electric wheelchair makers to sell parts for a decade or two after they stop selling the chairs. If they use industry-standard parts, and mark the parts as such, they should be relieved of the obligation to carry the parts for 20 years. Here's an example: Include a label on the chair saying that all bolts are either m6x60mm or m4x25mm and that all red and black electrical connectors are PP75 series Anderson Power Poles.
Here is a case that drove me nuts: I was dealing with an electric wheelchair that had some odd version of Anderson PowerPoles connecting the batteries and motors. These connectors had been knock-offs, and the reseller of these (Chinese-made) connectors lost a patent lawsuit to Anderson (before their patent expired.) One connector broke and was impossible to replace. I would gladly pay $100 for a single connector, but they do not exist. Before someone says to replace both ends of the connector, this is a connector mounted in a custom bracket with almost zero clearance as the chair's seat fits right on top of the bracket, connectors, and wires.
On the broken, ruled as patent-infringing part, what do you want to happen that would comply with patent law? If it was compatible with Anderson, you’d just buy that. Since it wasn’t and the original company isn’t allowed to keep making them…
> On the broken, ruled as patent-infringing part, what do you want to happen that would comply with patent law? If it was compatible with Anderson, you’d just buy that. Since it wasn’t and the original company isn’t allowed to keep making them…
That is true of professional mechanics. A disabled guy with a screwdriver who never changed his own oil needs some help.
I did a poor job picking examples. Let's take about the complicated parts.
The joystick controller on most electric wheelchairs uses a very particular connector. If I do not know the brand and model number on that, I am probably screwed.
"Trim" pieces are often required to prevent a disabled person's limp limb from being sucked into a gap near a tire. Trying to order replacements for those is almost impossible.
This is not a solution that would help the wheelchair user, but if you have a set of inexpensive ($10 bought in the US, less from china) 3" digital calipers, you could likely measure the socket and get it 3D printed. I've done it for obsolete electrical connectors in cars and while it takes time and some effort, it's very doable.
Like this: https://upload.wikimedia.org/wikipedia/commons/6/63/Powerpol...
> One connector broke and was impossible to replace. I would gladly pay $100 for a single connector, but they do not exist. Before someone says to replace both ends of the connector, this is a connector mounted in a custom bracket with almost zero clearance as the chair's seat fits right on top of the bracket, connectors, and wires.
So.. which is more prevalent.. users throw away their chairs because they expect to live high on the hog off insurance, or users throw away their chairs because any form of replacement is often met with these arbitrary and senseless complications?
> So.. which is more prevalent.. users throw away their chairs because they expect to live high on the hog off insurance, or users throw away their chairs because any form of replacement is often met with these arbitrary and senseless complications?
Those who can work on chairs themselves do so. Those who can not work on chairs do not.
If you have on idea what kind of connector a 12V 35AH battery would have, and have no way to disassemble your chair to replace the batteries, then you can not realistically replace those batteries. Add in living off $1,400 a month and you see why someone would ask for a free wheelchair instead of paying $250 for an uncertain chance at repairing their wheelchair.
I guess the next phase is going to be you need to know people if you want your medical device delivered, your car repaired, or for your internet to quit dropping.
Almost a new form of feudalism.
Get back to work IT surfs while we continue to extract wealth from your labor.
At this point I feel it really should be illegal.
Globally, the International Standards Organization (ISO) manages the wheelchair standards. ISO and the RESNA standards committee work collaboratively. ISO and RESNA have often been driven by outside sources to expedite their work and to address needs of consumers and other organizations. In the 1990s, the European Community Medical Device Directive provided impetus to make a number of changes to ISO standards and to create new standards in response to stricter regulation. The European Committee for Standardization (CEN) went its own direction for a while and over time, CEN and ISO standards have begun to merge. American National Standards Institute (ANSI)/RESNA was a driving force for a long time and often had different standards than ISO. However, this has dwindled in the past decade. Concomitantly, the wheelchair industry has exploded over the past 10 years, and the standards have simply not kept pace. There is a clear and present need for change in standards development and support in the United States.
Most of the participants in wheelchair standards development are employed by the wheelchair industry, an inherent conflict. Unfortunately, wheelchair users and clinicians have traditionally not had the financial support to participate in sufficient numbers. Interestingly, the same companies that participate in the standards committees develop internal tests not represented by ISO or RESNA as part of their product development programs to protect them against legal liability. Test laboratories do the same thing, creating a number of tests that differ from or improve on ISO or RESNA standards. None of the existing standards (ISO, CEN, or RESNA) is comprehensive enough to cover all areas of wheelchair evaluation."
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1929010/ 2006
This is one of the market failures caused by excessive regulation.
To make a chair you requires so much paperwork that only a small number of business can do it.
I especially like the regulations that make sure only those who need the chair get it, to reduce medical costs, but in the process all the paperwork dramatically drives up the costs.
These aren't off the shelf mobility products. Each one is assembled to specification.
Bit, a high end e-bike is $12-$15k. Which also seems ridiculous to me. And I’m a cyclist with several nice bikes (none of which were more than $7k).
"Nine", or did you mean "none"? I'm just checking if it was a typo, or if I should be jealous. :-)
vs. a technician fixing the chair in the house.
But how about something in between? A medium-skill employee who takes the chair from their home to the repair facility? They would need to carefully document what's wrong with it, so they need a little skill but not as much as a full skill repair tech.
What the actual fuck? Power wheelchairs run the spectrum for a few thousand USD to ten thousand plus. And they only last ~5 years, and even then with several major repairs in that period?
That sounds like an absolutely atrocious durability/reliability record.
Not saying it's not a viable possible strategy for the investor, but that it's perhaps a suboptimal strategy if greater net profits were desired long-term.
My guess is, like for hearing aids from costco, you won't get reimbursed by insurance if you buy it yourself.
Seriously, the issue here can most likely be tracked to private equity taking advantage of existing regulations. Not sure why MORE state involvement in the economy would be the solution.
>Private equity describes investment partnerships that buy and manage companies before selling them.
The issue people have isn’t with “private equity”. If it was a publicly traded company doing this people would be equally upset.
There is a very negative behavior right now by companies that call themselves private equity to buy up your local vet, doctors office, etc. Then they fire staff, reduce services, and increase costs.
We the people are losing, even if some of our 401ks grow because those funds invested in these PE vehicles.
This practice imho should be banned. How? I don’t know. But the U.S. will become shittier and shittier because of it.
Any company with more than 25% market share in a category gets broken up. Period. At all levels.
This prevents the "12 companies all buying from the single upstream supplier" problem.
The first is that you say that this kind of thing is good. It's all part of capitalism. The market will work it out. People will say this kind of thing with a straight face.
The second is to say that it is bad. But why is it bad?
The first stage is you believe that there are bad apples. Private equity is simply a few bad actors who may or may not need to be dealth with by way of legislation, regulation and/or prosecution. Lots of people believe this because they still fundamentally believe in our current economic system.
The second stage is you realize that private equity isn't an outlier and isn't a few bad apples. It is exactly what our system is designed to produce: to financialize and rent-seek in every aspect of our lives as a means of extracting wealth from the poor to the already vastly wealthy.
Private equity is taking over every aspect of your life by buying up homes, mobile home parks, vets, medical practices, hospitals, etc. There probably isn't a single aspect of our lives that hasn't been tainted by private equity.
And the playbook is exactly the same:
1. Jack up the prices, usually by cornering a market by either buying up all the competition or through legislatively creating enclosures;
2. Cut costs. Use noncompete agreements and and the like to suppress wages; and
3. Load up the entity with exploding debt and sell it to the market before the debt explodes.
This is capitalism working as intended. No more, no less.
On wheelchairs in particular, it's truly disgusting what we as a society put wheelchair users through. One of the most egeregious examples is how airlines will routinely destroy wheelchairs.
We are steadily marching towrads a future where almost all of us will be a permanent underclass devoid of any kind of security. Every aspect of our lives will be at the mercy of our overlords. Capitalism inevitably leads to neofeudalism.
We sometimes don't even hear the names of the companies, just "private equity".
Do we need to systematically trace and publish which individuals and institutions benefit from the nasty companies?
People will take action faster if they knew Thaddeus Wrappesalot went straight from lacrosse captain to executive chairmen hiking veterinarian costs.
We have a lot of work to get from here to there though, and much of it is the undoing of mass psychological condition.
> from a genuine, sophisticated democratic system
Do you think something more powerful than capitalism is impossible?
"Doomed" I don't know but they seem quite stuck now between a lot of internal problems.
[1] https://en.m.wikipedia.org/wiki/Chinese_property_sector_cris...
We are also told that democracy is the best form of government, and we are also told that our democracy is genuine, and that it must be protected. For some reason, people are unable to wonder if these various stories are true...perhaps because that skill is not innate, and is not taught in school?
Wheelchairs are regulated (barriers to entry), pollution is the nonexistence of property rights, and your take-it-or-leave-it noncompete agreement is a consequence of high transaction costs (job search, legal negotiations).
To expand on this inconsistency, it comes from different people cheer-leading "the free market" with different and conflicting sets of assumptions about what the phrase means.
For example, one economist makes an assumption of "perfect information on prices and transactions", and declares that it's the most efficient thing ever.
But another one assumes actors are free to make secret deals and private transactions, and concludes that the free-market doesn't have a cartel problem, because individual members will secretly defect and undercut so that it falls apart.
Those two assumptions are in direct contradiction, yet somehow the overlap phrase "the free market" still gets touted as having both of the incompatible features.
One reason they may not be able to hire is that they paid a ton to buy out all the competition and now have a bunch of investors wanting to see high rates of return. That requires cutting staff and raising prices. I'm all for a free society that allows private parties to make agreements, but PE is by definition all about breaking markets by creating a monopoly where they have large amounts of market power and where no competition can realistically occur. The end result is consumers getting screwed all over.
Every single non-public business is "Private Equity". How is every single small business in the entire world "a pox on society"?
Perhaps you mean "short term thinking" is a pox on society? Or in, like in this case, a duopoly is the issue? If there were 10 such companies a reputation for slow repair would drive people to other suppliers and things would rapidly get better.
"In the field of finance, private equity (PE) is capital stock in a private company that does not offer stock to the general public. Private equity is offered instead to specialized investment funds and limited partnerships that take an active role in the management and structuring of the companies. In casual usage, "private equity" can refer to these investment firms rather than the companies that they invest in."
On the one hand, I don't think it's right to restrict the rights of the business owner. If they have a company with $20M in revenue and PE offers $60M to buy them out...fair game right? On the other hand, it takes perfectly profitable companies providing value, extracts that wealth from happy consumers of the product to people already wealthy and then leaves the consumer with a crappy, expensive, and barely supported product. If this happens just a few times...it sucks, but no big deal. Once it starts happening all over America, then we start running into systemic problems like not being fleeced every time you want to go to a concert. It's not like a competing firm can just pop up either in a lot of cases as there are huge barriers to entry. There is no recourse other than not ever seeing your favorite artist again.