Louis Rossmann interviewed the founder of the project here: https://www.youtube.com/watch?v=eaAj59025Kk
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.
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.
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
One issue is a big disconnect between user and payer. Government is especially prone to that, but any big organisation can have this problem.
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.
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.
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.
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.
What is that based on? Do you have experience or know anyone who does? A news article or research?
$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.
Probably even a higher quality of life, because the manufacturer can make arbitrary changes to the unregulated scooter in response to market demands.
The crackdown on scooters was going after blatant and obvious fraud.
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.
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 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.
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.
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.
It's both.
The US lacks serious competition in _most_ of it's industries right now.
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.
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.
$24,000.
So if Medicare is paying $65k, something is seriously wrong.
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.
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.
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?
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.
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.
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.
Though I agree we probably won't be using it to replicate a cup of Earl Grey for a very long time.
A usual one?!?
The MSRP of a 2024 Tesla Model S is $72,990.
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EDIT: Do you have a source?
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
"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.
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?
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-...
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.