Hacker News Reader

Comment by fotta | Hacker News Reader

Custom fit lightweight wheelchairs are expensive. My Ti-Lite (one of the most popular lightweight chair brands) Aero Z starts at $3k and goes up quickly with wheels and backrest and casters and various other options that I need for sitting 16 hours a day without creating more problems. Insurance covers this for me every 5 years, but of course that's not a luxury every one has. Most plans don't cover DME 100%.

What Zack and Cambry are doing is great.

(edit) I’d like to add that I think part of being able to drive costs down is that they’re not offering these via insurance so they sidestep the need for FDA approval to market it as a medical device (hence the company name), CMS approval and HCPCS coding and all the regulatory costs that come with that.

Now don't get me started on power wheelchair cost...

View on HN

I just want to add some context here because i feel like there is a large gap in understanding of what a wheelchair actually is. Please click through these and get an understanding of the level of detail required to be properly fitted for a wheelchair.

https://permobilwebcdn.azureedge.net/media/hylifiyf/creative... - note the clinical rationale and notes sections on each of these options.

https://permobilwebcdn.azureedge.net/media/4ozh2ary/tilite-s... - seating cushions and backrests

https://permobilwebcdn.azureedge.net/media/npxlfuoh/tr-tra-o... - current ti lite order form.

https://permobilwebcdn.azureedge.net/media/hjvhuqlw/tilite-p... - component list / prices. There are almost 11,000 individual parts that are available for purchase for years after the chair is sold so it can be supported through the expected life of 5 - 7 years usually.

And through all of this you are working with professional therapists that are trained to properly size all these measurements, because an ill fitting chair can cause more harm than good.

This is a bit like saying that an ill-fitting bicycle can cause more harm than good: technically true but missing the point. Sometimes it's valuable to have a cheap bicycle that you can expose to the elements without worrying about messing up the high-end components on your more expensive bike.

These seem to be mainly intended as secondary chairs or for part-time wheelchair users, rather than as primary chairs. My wife has three wheelchairs and I can see a case for buying one of these as her fourth.

Mind you, the situation with electric wheelchairs is very different. Many electric wheelchair users are at elevated risk of pressure sores, may not be able to get in and out or reposition themselves independently, etc. The profit margins on these chairs are still inexcusable, but the amount of custom fitting and memory foam everything is warranted because the user may well be in this chair, in that position all day every day. The cupholder and the umbrella mount are must-have accessories.

A manual wheelchair is less complex than a bicycle, and I can get a decent bicycle for a few hundred bucks. The fact that basic wheelchairs are crazy expensive has little to do with the chairs and a lot to do with insane bureaucracy.

Well, bicycles have more demand and volume (presumably), so that would play in to it. But yes, bicycles are a good point of reference.

Why? The comfort level and ergonomics demands are completely different. Bicycles are for a few hours of weekly use. Wheelchairs are for 16 hours of daily use.

Bicycles built for long duration use - people do ride for 16-24 hours straight more than you'd think do exist.

How many of them do that every day?

And of those people that do, how much do you think they spend on their bikes?

And, when people do use cheap bikes that don't really fit them out of necessity long-term, what's the toll on their body? It's probably not zero!

The parent comment is so bizarre

No one who uses a wheelchair does it because they like doing it

Everyone who rides a bike for 16 hours a day does it because they like doing it, and/or they’re an athlete

When you’re done riding your bike for 16 hours a day - likely one week in a year - you can go to the gym, stretch out

The wheelchair guy has to drag himself everywhere

I don't think many people do that, and if so, how many of them do it on one that cost "couple of hundreds"?

Sure, but those bicycles don’t cost 100 bucks they probably cost 5000+. The last bicycle I bought was $7000 and that was midmarket (my recreational cyclist standards).

I was recently in Rwanda where seemingly half the goods of this very hilly country are transported by bicycle, and those are single speed old english style bikes with steel frame reinforced with rebar. (they carry hundred of kgs on the racks). The bike are run 8 hours a day for years and cost $100.

This is the definitely the standard we should strive for when considering the needs of our wheelchair bound friend and family. If they want anything more than a 130lb wheelchair made out of old rebar they're just being selfish really.

The recreational market does spend a lot of money on bikes. Much of it is of questionable gain already, and in the context of Rwanda negative since the recreational bike generally compromises comfort for speed - a fine compromise for recreation but bad one for most Rwanda uses.

However some of what they are spending money on would make those bikes in Rwanda much better. Better/more comfortable seats can greatly ease the toll on your body. Disk brakes would stop the load much better and so make them safer. A couple gears would be nice (assuming it doesn't compromise drive train strength too much). Modern cargo bikes likely have a better cargo position as well.

In India millions of women are walking miles to fetch few gallons of water everyday. I don't get why people in California are screaming water shortage. Should be possible for Americans to live on a gallon of water if hundred of millions live like that in India.

It’s very hard to change your standard of living, and the standard of living in California is very different. We live off of tens of gallons of water a day or more. When you have to cut back, it’s difficult for your human animal to accept it. Population wide, it’s nearly impossible.

Yeah. This is why I’m so pessimistic about long-term prospects for the human race.

Living minimally is a skill that society has essentially turned into a negative trait. Our planet can only support so much, and individual humans are very selfish. There are 8 Billion now.

Possible? Sure, and a lot oft of hippie/environmentalist types in America do live that way, both in cities and in rural areas.

Is it desirable? Not necessarily. The goal is to be more efficient with water sourcing, distribution, and usage so people have more water to use, not less.

Third party payment markets tend to have prices spin out of control. Usually the end user demand is fairly inelastic, and the third party is not driven by cost efficiencies in the negotiation. Getting into those markets as a new supplier is very hard as typically a select few incumbents have longstanding relations/deals with the third party.

Economies of scale and lack of competition.

When you have all the components for a cheap bike made in 100s of thousands by ie Shimano, the price goes down dramatically. Wheelchairs? Unless there is 1 dominant manufacturer its not going to happen to smaller shops, and monopoly has its own issues.

When you have regulatory tape which require some steep price hikes to cover some specific aspect (which may not be that important), combined with above you get what you get.

I was recently wheelchair-bound for a month due to my recent paragliding accident (crutches now for at least 1 month more, overall an interesting experience of various limits lying everywhere you don't even realize until you are there), and can appreciate even basic wheelchair and its various functionalities. Its simpler than bike for sure, but its also foldable (at least mine) and relatively easy to pack into trunk of any decent car in a minute (not for me of course but accompanying person).

Is there any hope for more affordable options becoming available in the future..?

And also economy of scale, there are 1 billion bikes in the world VS 65 million wheelchairs.

Interesting, only 1 billion bicycles? I would have expected more than that. In most of the places I lived (Europe, Asia) there seems to be more than one beater bike per person lying around somewhere (and some nice bikes, too, but much fewer).

I'm actually surprised it's 1 billion, when you remove children, elderly, people simply out of shape for a bike, people unable to afford a bike no matter how cheap, people with disabilities incompatible with bikes, that billion is like 75%+ coverage of TAM.

Is that 1 billion adult bikes in particular? Because in the US, anywhere outside of big cities or college towns, children are ALMOST the only people who ride bikes regularly.

Lots of people have bikes who don’t use them regularly. It’s the kind of thing you have in your garage and bring out on a nice day sometimes.

Or at least you mean to, but perhaps never get around to it.

I poke fun at my neighbors for having decorative kayaks in their garage.

fair enough!

Some good points.

Many (most?) children have bikes, and lots of elderly people have some bikes somewhere in a shed back from when they used to be able to ride.

Almost everyone can afford a beater bike. That's why they are so common in the third world.

I'm not sure how out of shape you need to be not to be able to ride a bike? In any case, I wasn't wondering about how many people actively ride bikes. I was wondering how many bikes there are.

Don't forget Dutch people. I own and use four bicycles. My wife owns three.

I don’t think most bicycles are designed for 16 hours of daily use…

That being said, the significant price gap still seems disproportionate

How much does a quality ergonomic chair cost vs a pair of walking shoes?

In nations where bicycles are the norm, I would not be surprised if many of them get used 12+ per day.

NYC is awash in bicycle couriers, and they probably ride all the time.

Some of these comments are so bizarre that they could only be made by AI

Do people here really not grasp the difference between a disabled person being forced to use a wheelchair - which they can’t get out of casually and stretch about - vs a fit person willingly using a bicycle?

What is the malfunction?

> I don’t think most bicycles are designed for 16 hours of daily use…

Was stated. The answer directly to the statement was:

> In nations where bicycles are the norm, I would not be surprised if many of them get used 12+ per day. NYC is awash in bicycle couriers, and they probably ride all the time.

No AI needed.

Looks like it might be necessary for interpretation, though. That's not something I have any control over.

BTW: I am quite familiar with Serving disabled folks. That's pretty much my job, at home.

I’ve noticed that the most racist, ableist, you name it, individuals are the people who most claim to defend the group in question.

I guess this might be because strong opinions are best formed from a surface level understanding of a subject, while intricate and complex opinions require deeper understanding.

You cannot get a custom designed bicycle for your body for a few hundred bucks, particularly from a US manufacturer

How many wheelchairs are actually truely customized? I hear a lot of complaints from wheelchair manufacturers that this isn't really customized

Part of the problem is the cost. Very few daily wheelchair users can afford to pay a 5-digit price for one.

If you look on ebay there are loads of wheelchairs for sale from about $100-$200 (£80-150 if british). They are mostly made in China and I think work ok - I bought one for £80 to use with my dad and it was fine. But that was for occasional use. I guess if you were to use it all the time you might want something fancier.

That raises a whole host of other issues. They're $200, because they don't have to pay their employees or provide a safe environment, the Government is subsidizing the manufacture or other unsavoury reasons. You can make things really cheap if you don't care about your staff.

Complete speculation, you’ve downed too much propaganda.

Manufacturing is cheaper in cheaper countries because of less taxes, inflation, bureaucracy, and a dozen other factors that aren’t negative socialist bullshit. Their workers get by just fine with the wages they’re paid.

The Chinese government subsidising the manufacture of wheelchairs doesn't sound as nefarious as you're making out. I would be proud if my government did the same thing.

You probably don’t want to sit on that cheap bicycle for 16 hours a day. Almost guaranteed it won’t fit property and at best will give you saddle, sores and worse cause back knee issues.

Yeah, but can you climb chairs with a bicycle? There are wheelchairs that can do that.

Presuming that you mean "stairs", these exist and impress Hacker News users who think any problem can be solved with enough overengineering, but nobody really uses them because they're so much worse at everything else. I've used one to board an airplane embarking from the tarmac, that's about all they're good for.

I was curious so looked at a few power wheelchairs...It's wild how expensive they are, especially considering the advancements in electric mobility tech elsewhere. You'd think they'd share some components with e-scooters, e-bikes, or even electric cars – motors, batteries, controllers.

Are the powertrains and control systems in power wheelchairs really that specialised? Or is it another case of the medical device markup and regulatory hurdles driving up costs?

I'm a guy who has disassembled and reverse engineered a standard Jazzy power chair, and what I noticed was the attention to detail regarding failures. The chair is thoroughly designed to shut down at the slightest bit of trouble. There's some redundancy in things like the controller, where it used redundant hall effect sensors that were identical to the others, but ran in an inverted power profile, to detect any weirdness in the sensor outputs.

I ended up adding a long range remote control to it. A remote control power chair is fun to drive around. People do get a little concerned when they see a chair rolling around without a driver

My mum recently had a curbside crash while she was riding an e-bike. This resulted in her breaking bones in both her hands, which resulted in a surgery in her left hand and various problems (tcl fracture related) with her right hand.

This makes me actually appreciate reliability in e-vehicles motor cutoffs etc. I keep thinking if this could have been avoided with a better quality e-bike or if actually it would be even worst with a cheaper one.

Which makes one think, how often a wheelchair with cheap e-scooter parts would crash people into staris, cars etc

I know public use devices have their own problems with reliability, but I did almost cause a traffic accident a couple times over the years. Every time, the scooter's accelerator lever got "sticky" due to repetitive (mis)use, and would sometimes not go all the way to 0 when released. Stuck at ~10%, the scooter would brake normally and remain at halt under my weight, but the moment I stepped off it, it would suddenly launch itself at the cross traffic.

It's these little things that get you. The scooters all have some kind of debounce logic, disabling the accelerator until you're moving sufficiently fast - but the logic doesn't kick in when you stop without releasing the lever. A little bit of redundancy would've helped here.

A friend has an e-unicycle (I think the category devices has some other name as well..) and he wanted to try out how it behaves in a track.

He sort of knew, but didn't expect it, that when the roll of the device exceeds a certain threshold, the device will shutdown. Even if you're on a curve going with some speed. Broke his wrist. Since then he's also wearing wrist protectors that keep the hand straight.

Actually it was a bit unexpected that it would have known to do that; it must have used its complete IMU data to even know it was rolled, as plain accelerometer would have been pointing "down" as usual.

> Actually it was a bit unexpected that it would have known to do that; it must have used its complete IMU data to even know it was rolled, as plain accelerometer would have been pointing "down" as usual.

That actually feels like overengineering based on well-intentioned, but wrong specs. You probably want to just use sideways acceleration for "falling over" detection, instead of roll.

I'm an embedded software engineer with past experience developing robotics and motor control drivers.

Those e-unicycles terrify me. No way I'd trust my life to one. Once you're at speed, every failure mode results in instant passenger ejection. I see people flying through traffic on those things - they're just one sensor glitch or integer overflow away from serious injury.

The safety with ebikes does vary a bit although I'm not sure it's down to price. My one is quite a cheap one but has quite a lot of safety features - will only go if you pedal it, motor cut if you touch the breaks, 14 mph speed limiter etc. But I guess you can come off any two wheeled vehicle.

> People do get a little concerned when they see a chair rolling around without a driver

Add a hat and a scarf on a wire and you've got a Halloween prop.

Assistive technology costs are high because consumers barely have an alternative. I am blind. In Europe, a 40-cell braille display starts a 6k. 6k, just for a monitor which displays 40 characters. Prices are largely unchanged since 20 years. Technological advancements are irrelevant. Resellers will squeeze the cow, thats plain capitalism man.

Just from googling -- an orbit reader 40-cell appears to cost $1,700 USD, is there a reason this doesn't actually solve the same problem as the 6,000 euro display, or are these not available in your market for that cost? Sorry if my question is off the mark, I don't know a lot about this and your comment piqued my curiosity.

Orbit reader is the most low-quality device you can find on the market. This is like suggesting a bicycle to someone complaining about car prices.

I’m sure the commenter meant well. You said “In Europe, a 40-cell braille display starts a 6k.” Which to me means that the most low quality, cheapest device starts at 6k.

Now i learn from you that that low quality device is so bad that you consider it a separate product class in itself. Can you tell us more what does it lack? In other words what features are you looking for when you are looking for a 40-cell brail display? (What is the minimum quality for it to be a “car” in your analogy?)

This is a fascinating potential wedge for an open-source initiative. Could you please elaborate as to what makes a device highly usable and of good quality, vs cheap and unpleasant to use?

I’ve long thought that open source would make a lot of sense for assistive devices, and that it has the potential to change incentives within the cartel of assistive device manufacturing.

There was a HackadayPrize 2023 competitor that worked on this [0]. He had to rethink the way those devices are built to bring the cost down.

That would be interesting to know if his solution could match the 4k$ in term of usability or if there is some issue like refreshing rate that make the piezo based system necessary for a good user experience.

[0] https://www.youtube.com/watch?v=BXi1tG78AW4

That looks like a great project. I share your curiousity regarding the user experience of this vs the piezo units. Looking at it, it should be in the 50-100mS range for refresh times, maybe that is too slow? It seems like it would be plenty fast? I wonder if there are other haptic factors with the piezo, like vibration?

This is specifically like someone that has never seen or used a car or bicycle asking about why a bicycle wouldn't work for someone complaining about car prices, which I think is a pretty reasonable question!

If that is the case, then there seems to be a place in the market for someone else who can sell these devices for cheaper.

However, as you have pointed out, since it is also a market where people have few choices, there is no incentive for any new player to significantly lower the prices. Even if they easily could. Because they know that they will get the customers anyway.

That seems to be the root cause of the excessive price problem. An existing oligopoly of rent-seeking companies. Or a cartel, if you like.

I think that one of the ways to disturb this market and bring the prices down is for some honest company to join it and price their products fairly.

Once there is one such company, I assume that everyone else will lower their prices as well. Because otherwise they will run out of business.

The problem is if you spend 100 million dollars to make one (which is about 30 engineers, 50 testers, and 20 other for a year) and sell 10,000 units (remember there is competition who will get come sales) you need $1000 each just to pay engineering costs. Lack of scale is what makes many products expensive.

If you don't mind educating a curious person — why are Braille displays still worth making when text-to-speech is free, everywhere, and communicates information much more quickly than Braille? I can understand that there might be special situations where you really need a device to be silent, but it's hard for me to see how the cost-benefit tradeoff would weigh in favour of a Braille display except in the rarest of circumstances.

I suspect a major difference is that those e-scooters, bikes, cars, etc are produced and sold by the millions, whereas wheelchairs are small volume by comparison. Another commenter mentioned the legal requirements, which complicates things.

That said, a quick google says there's 65-132 million wheelchair users worldwide so it's not a small market either.

...but the production and distribution of wheelchairs

Most of them are probably in countries where 1000 is a years wages.

It's impressive and a little sad how cheap you can get them second hand.

I think a significant portion of the cost is related to the "medical device" label.

I'm a big fan of his channel, but when I saw the price tag, it got me thinking for a moment. Wheelchairs are a great example of why niche products are expensive.

I think you're spot on with certifications.

I was stupid a few times and needed orthopedic equipment. Each time, the price flabbergasted me. But it didn't matter since the health insurance fully refunded it.

In a regulated market, if you can influence the cap, the item will cost exactly that, no less. And if the market is small enough to not allow any disruption, then it will stay that way forever.

I need to talk to my girlfriend who's a physiotherapist about it. But for now I'm hoping his YouTube fame would start a snowball effect.

Thinking he could do with the wheelchairs what Elon is pretending to do with EVs is truly exciting.

It’s not that small of a market if you consider how many wheelchairs the European public sector buys. Take your average Danish hospital and they’ll have at least 10 wheelchairs placed at every major entrance. They’re basically like shopping carts in a lot of public healthcare places. These are semi-regularity replaced because of wear and tear. If you could supply them with a cheap, solid be easily repairable version you could disrupt that market.

Of course you’re not going to have a very easy time entering the market. But even though they buy these things on regulated supply deals, they’re not cheap. If you could get a certified electric one on top of a (I’m not sure if it’s called regular), then you would be posed for disrupting the market.

$1000 is not cheap for an off the shelf wheelchair such as hospitals make available for patients (in the UK, at least). That was my first thought on reading the article - "$1000 for a wheelchair, really?" - and a quick Google shows that you can buy what looks like reasonable quality wheelchairs for less than that. But the ones on the article are custom-made for each buyer, which is clearly a vastly more expensive option.

But, to the point, hospitals don't buy custom wheelchairs.

What about serviceability and spare/replacement parts?

I guy selling mobility scooters told me that most customers never service theirs as it is easier to get the health insurance to pay for a new one every x years. This results in a very limited second hand market.

It doesn't work like this.

Take aircrafts or (to some degree) a racing car. You need a screw. Sure you can get one at your local hardware shop for a penny, but for regulated market you need one with certification and that will cost you something close to $10. I know it's crazy but that's how it works.

Difference being it doesn't fail and if it does you know exactly how it was made and under which process. There will be an investigation to see what went wrong - was it the screws fault or was more force placed on it than it was certified for.

Vs the one from the hardware store could have come from Alibaba and be a plastic core with a thin coating of metal for all you know.

No, you can't buy a reasonable quality wheelchair for less. You can buy what a person who doesn't need a wheelchair consider reasonable. If you had to use those cheap chairs for 16 hours a day, and pushing yourself even just for a mile of well paved roads, not even uphill, you would never consider those reasonable.

This is absolutely the point. You have to live sitting in there. That must be more comfortable than the best thing in your house. No way you can do it for less than 1k.

Not just sitting, pushing yourself. Making a comfy chair is one thing, making one that you can also be mobile in, much harder.

Except the wheelchairs used in hospitals are to push patients short distances across hard flat floors.

The OP isn't about hospital wheelchairs, but daily use wheelchairs. It's just most of the commenters here showing ignorance or ableism by suggesting the two are equivalent.

I'm not saying otherwise - my comment reaffirms this. There are two separate things going on here -

- You can buy a reasonable wheelchair for moving people relatively short distances across flat surfaces for less than $1000. E.g those used in hospitals and for the partially mobile.

- You cannot currently buy a reasonable self propelled wheelchair for full time use for less than $1000 (give or take the manufacturer in the article).

I think it works in this case because Zack has a high profile YouTube channel and a high degree of trust in his workmanship from that. As they say, regulations are written in blood, and I would trust an approved device over a chair from some no name company somewhere because I have more faith that it won’t break on me while I’m out and about. Zack is obviously an exception to that because of his reputation which I think will help him be successful in this endeavor.

Ya, I was expecting to see something not very impressive at that link, but was pleasantly surprised. My chair is about $7k and while this one doesn't look like it would work for me, it is definitely much better than the cheap hospital chairs.

Are the hospital chairs cheap? Genuinely asking...

Amazon appears to offer such chairs for like $200? They're probably crap though.

They're crap. And that's what you find at hospitals and airports.

If you don’t mind sharing, what aspects of it make it seem like it wouldn’t work for you?

What do you recommend for my parent, they are using a crappy Medicare approved Medline wheelchair that’s like $300 on Amazon. They can’t use their right side of their body really due to a stroke paralysis.

The wheelchair is like starting to fall apart. What should I I get them that will last many years? Thanks!

You should really have an ATP evaluate them to determine what they need. Hemiparesis and a bad fitting chair is no joke. Unfortunately this is likely to be expensive (as noted in this entire post). You can try getting a lightweight chair like a TiLite or Quickie online, but the fitting and sizing is the most important part and in my experience a trained professional is the best route your first time around. After that, as you become more familiar with the needs of your parent you can make adjustments in the future.

So about the price of a Herman miller chair. Honestly sounds pretty reasonable to me. Though ideally it was less so price doesn’t limit access

Anything medical becomes a licensing nightmare. With how expensive power wheelchairs get I’m shocked they don’t come with a flight box.

Hey, would you get started on power wheelchair costs? Inquiring minds would like to learn more.

Device so essential to daily life is treated in such a costly, bureaucratic manner

Reply on news.ycombinator.com