Everyone wants healthcare expenses to go down but the biggest healthcare expense is the salaries of providers. So, hard to give the masses what they want without making a smaller group of people who benefit from the status quo angry.
Much like home prices. Everybody says they want homes to be more affordable, but all actions are designed to keep them high and if they did actually fall it would be treated as an emergency.
to be a bit pedantic, that says they account for only 15% of the excess healthcare spending, relative to other countries. It's not surprising given doctors in the united states have a higher level of training compared with many peer countries, and _all_ salaries are much higher in the united states compared with almost any country.
The 15% extra administrative cost of insurance and 15% extra administrative burden of applying care are the big culprits, in addition to extra costs on medicine and machinery. But it's interesting. Why is it that a comparatively deregulated and privatized system has so much extra pricing cost from bureaucracy?
Physician salary is only 9% of total healthcare cost. The rest of the labor pool is administrative - clerks, management, etc.
Physicians also make 2-3x more than physicians in other countries. Why? Their education cost is also 2-3x higher than in other countries.
Hospitals and procedures are expensive, in part because of insurance. Insurance is high because our society is too litigious. It's also expensive because of consolidated private healthcare systems that can control and mark up prices due to lack of competition.
Other countries spend half what we do on healthcare. And their people are often healthier.
In Sweden we had this in the news: https://www.svt.se/nyheter/lokalt/uppsala/hon-pendlar-860-mi...
A US nurse moved to Sweden and preferred to fly to San Fransisco to work ten days at a time, then fly back to be off for six weeks, rather than taking a job as a nurse in Sweden. The salaries are very different.
Most hospitals (both for-profit and non-profit) are terribly inefficient. They burn up clinician time on administrative tasks that could be automated or performed by cheaper office staff or not done at all. And employees often waste a lot of time just waiting around because no one has optimized workflows to shorten queues or eliminate bottlenecks. The incentives are structured in a such a way that there's often little reason to improve.
The exact profit margins of hospitals as a whole doesn't matter. Hospitals are where health care happens but financially, they are simply a platform for a multitude of other private entities which make profits on top of the simple hospital fees - the "Uber For Nurses" thing is just one of many ways this happens, you have everything from data management companies to separately own MRI machines adding to the patient's bill and having a voice in the management of the hospital.
> A companion Roosevelt Institute brief found that some platforms "use data-brokers to determine nurse debt levels and offer lower wages to those with highest debt loads."
When something sounds too bad to be true, I think it's fair that we should ask for some kind of evidence to be produced. They cite a Roosevelt Institute article that says
"Gig nursing apps MAY [my caps] determine pay by what the firm knows about how much a nurse was willing to accept for a previous assignment, how often they bid for shifts, or how much credit card or other kinds of debt they might hold."
That kind of sounds like they are overselling a hypothetical. Even just an "insiders familiar with the matter have told us that it IS happening", would make me believe it more.
Nurses already deserve higher wages than what they already get, but introducing "dynamic pricing" and competition to under-bid each other is just disgusting.
Nurses form the backbone of healthcare. Treat them as such.
Edit: To those downvoting me, talk to a real nurse and I bet you wouldn't take twice the pay to do half the work they have to deal with.
There's no concept of "deserving higher wages". It's a popular online meme but what on Earth does it even capture? If you value the work higher, then pay them more and you'll win the market for that labour.
There's a good argument to say that sufficiently aggregated marketplaces can launder price collusion, and if we were in such an aggregated marketplace then you could make that argument. But we're not in that situation right now.
The 'Edit:' is even more confusing. If I talk to someone in a profession and I wouldn't take twice the pay they receive to do half the work they do then they deserve higher wages? But that list is huge. Congressmen, Senators, many CEOs, Wagner-group mercenaries, ICE officers, drone pilots. In fact, almost every profession has this 4x effective slippage you're talking about.
Thanks for leaving a comment rather than just drive by downvoting.
One movie that made me change my perspective on nursing as a field was the Swiss movie Late Shift. It really opened my eyes to what nurses have to deal with. Yes the US might be different in having lower patient to nurse ratios but at the end of the day I think it's still applicable.
There's no way for me to tell you that I am well aware of this without it sounding like some braggadocious detailing of events of my life, so perhaps it will suffice to say that my parents are surgeons and we lived in rural and urban India at various points in our lives.
I still think their monetary compensation should be provided by market valuation of the utility of the work they do.
Uber checked the first few digits of your debit card to filter out police officer credit unions to evade taxi regulation enforcement. They use your phone’s battery level as one factor to estimate your elasticity of demand. They have teams of economists to adjust personalized prices to as high as you can bear and pay for drivers as low as possible.
It was only a matter of time and I said (half) jokingly at the time that Uber is breaking the dam for everyone else to follow. Any regulated system will have its day in front of "disruptions" where the disruption is simply ignoring the regulation with some flimsy excuse, supported only by the money and lack of morals of VCs and startup combinators.
Uber took an axe to taxi drivers which weren't a popular group to begin with so that was easy. With the "disruption" perfected, next up are doctors, nurses, lawyers, electricians, cooks, engineers, the sky is the limit.
It has been my observation that the companies all had plans to "disrupt"...but it seems they never had a solid "profitable" plan past when the VC money ran out.
Aside from turning employees into contractors...most of which have not done the math on how much they are losing through having to use your own car with no employee benefits. Doordash/Uber start looking a lot less attractive if you figure in the $.65/mile costs (fuel, repairs, insurance, car purchase price) that you would be paid by most govt or "real" companies.
Almost everyone I know who does Doordash makes about $20/hr (which isn't good anyways) and they are not figuring in the costs of the vehicle.
Lots of people in the US need to own a car already and the vehicle still depreciates sitting in their driveway. The correct calculation there is the marginal cost (faster depreciation rate, gas) versus the income from a ride-sharing app. But yes buying a vehicle specifically to do delivery or ride-sharing is a bad decision.
Depreciation of the vehicle due to time is only a very small part of the costs. Mileage is way, way more important. (Of course Uber requires a certain age of car so that is a restriction).
Maintenance and fuel are a much larger part of the total costs. It is very easy to math out if you break down by the "recommended service intervals" which are largely based on mileage (fluids do require changing with time intervals but normal driving usually matches up with the mileage).
The myth that a car sitting still is losing money has been sold by the insurance companies. It is only cheaper to buy a new car vs fixing one if you account for the loss if someone runs into you and totals the car. My car which I have maintained and is 14 years old is worth way more to me than the amount that is placed on it by people who have it in their interest to say it is worthless due to age.
Sidenote: I tracked all my miles, costs and income while delivering pizzas many years ago. These costs vary greatly depending on the car. The 89 subaru justy I purchased to deliver was $.25/mile whereas my 93 mazda 626 was closer to $.60 (2004 pricing). My current car is ~$.60/mile also.
Currently, the IRS mileage rates for business is $.70/mile, do any of the gig economies pay this? [1]
You can go online and see what people are actually willing to pay for older, low-mileage cars. It's not much of a premium over similar cars with typical mileage. You can't really blame insurance companies when the valuations are determined by what people are actually paying for used vehicles. Sure, you might do an impeccable job of maintaining your car, but a future buyer has to go off of a mechanic's assessment, plus they won't have a manufacturer warranty to fall back on. There's also the issue that newer models generally have better fuel economy, more safety features, etc. Cars have actually gotten cheaper over time after accounting for new features and reliability improvements, which puts additional downwards pressure on the price of used vehicles.
> Currently, the IRS mileage rates for business is $.70/mile, do any of the gig economies pay this? [1]
I used to get paid that rate at my old job and it was an amazing deal, it was way over my actual costs for the vehicle. With a small fuel-efficient car I was covering my gas, insurance, and depreciation with a few trips each year. It was effectively my work paying for a free car I'd get to use the rest of the time.
That's the issue with using one number as a very rough estimate, it has to account for everything from contractors driving work trucks to someone commuting in a Model 3.
TBF it’s also an engine to push for regulations review. Awful lot of regulations are written for an age that no longer exists and just as many are to make management easier therefore startups pushing the boundaries actually are a correcting mechanism.
Unfortunately some harm can be inflicted bur IMHO it’s better than the alternative.
Not only were taxi drivers not popular but it also wasn't and isn't obvious to most people exactly how or why they were regulated. Especially to people outside of major urban areas.
Taxi drivers were not more "regulated" in any meaningful way, in fact oversight of them was significantly worse than the community-driven Uber rating system (not that that doesn't also have flaws).
Some regulation is bad, some regulation is good. There's basically nothing at all that's good about guild systems and I will celebrate each of them facing open market competition.
> Taxi drivers were not more "regulated" in any meaningful way, in fact oversight of them was significantly worse than the community-driven Uber rating system (not that that doesn't also have flaws).
Taxis have standardized rates set by the municipality and use standardized meters that are periodically inspected. Ride sharing apps have dynamic pricing and no transparency.
Except when the "meter is broken" or they take the scenic route. My grandmother with dementia routinely got charged double or triple the expected rate for trips to medical appointments, until we figured out what was going on and started booking her rideshares.
Just curious what happens if there is a major event going on in the proximity of one of the doctors appointments?
It could turn out to be 2-3x the "normal" cost due to surge pricing. This often happens to people who go out drinking and think "I'll just grab an Uber later".
Recently heard someone complaining about the $45 cost to go 3 miles.
*Sidenote: people with dementia should probably have someone in the car with them to be sure they get to the appointments. That solves the issue of shady people taking advantage of them for the most part.
> Taxi drivers were not more "regulated" in any meaningful way, in fact oversight of them was significantly worse than the community-driven Uber rating system (not that that doesn't also have flaws).
You are defaulting to the US here (and I doubt Taxi regulation in the US is that homologous either tbh given the complexity of 50 states and then cities on top of that).
Taking the country I'm most familiar with (the UK), Taxis fall into two categories (only one of which is technically a taxi by law if not convention - Hackney and private hire vehicles) bothare licensed in different but similar ways by the licensing authorities (usually the local council but not always), some of those laws go back centuries.
Also worth noting, in the UK Uber does operate under the Private Hire Vehicle laws and does have to comply with applicable licensing same as any other "taxi" (private hire vehicle).
They actually lost thrice - in 2017 TFL pulled their PHV licence because Uber London Limited wasn't considered to be a 'fit and proper person', Uber thought they could brazen it out only to find that TFL is beholden only to the Mayor and they ended up having to come back on bended knee, and then it was further refused in 2019 but returned on appeal - https://www.judiciary.uk/wp-content/uploads/2020/09/Uber-v-T...), which lists significant failings by Uber that they had since remedied.
The third outing with the Supreme Court was about employment rights - were the drivers workers, or genuine independent contractors for whom Uber are merely acting as a booking agent (which the Uber model relies almost entirely on).
The Employment Tribunal, The Employment Appeal Tribunal, The Court of Appeal and finally the Supreme Court all said "nah fam, you ain't fooling nobody" and the original ET was especially scathing:
> It seems to us that the Respondents' general case and the written terms on which they rely do not correspond with the practical reality. The notion that Uber in London is a mosaic of 30,000 small businesses linked by a common 'platform' is to our minds faintly ridiculous. In each case the 'business' consists of a man with a car seeking to make a living by driving it.
Uber "deregulating" everything, means Uber taxing everything... because everything will go through it... and you know the EEE thingy right? better prices until you kill industry, then rise prices...
The good thing is that we will not be fooled this time while checking the dead bird thing...
This trend was started in health care by private equity with no inspiration from Uber. Check your local dentists, eye doctors, veterinarians, urgent cares, maybe even hospitals. You'll find very few that are not owned by some large private equity firm these days, who run everything at the highest margins possible. And once you eliminate any higher quality / higher paying positions in an area, moving to pricing on demand and getting rid of full time positions entirely comes next.
Being long degeneracy ( https://oldcoinbad.com/p/long-degeneracy ) really seems to be the correct market position. Turns out laws really are optional, if you're brazen enough.
There was an “Uber for X” wave that didn’t really amount to anything. Stuff like home repairs was a big one. My take was that driving (and delivery) is a rare service that above some basic competence (and I’d say below another) is a pure commodity. For most things, quality is a differentiator, and anyone good would never give up a percentage to an app, so only the worst providers would sign up. My intuition is that nursing would work this way.
I think your intuition about quality and who signs up is correct, but doesn't insulate as much as you're assuming. For one thing, corporations have a nearly unlimited appetite for converting employees to contractors. For another, the economy has produced a large number of desperate people willing to do pure commodity work.
One reason "Uber for X" appears not to have materialized is that the platforms themselves are commoditized, not just the labor. Retailers like Lowe's and Wayfair have built assembly/installation services behind a checkout upsell. They run portals distributing work to their "network of local contractors" .
I got a window into this world through an acquaintance. He has a truck and light trade skills, but mental and reputational legacies of past addiction lock him out of the "anyone good" market. He's on a half dozen platforms, trying to stitch a living doing sink or toilet installs for Lowe's and building bookcases for Wayfair. A negative review gets you demoted from the choice gigs, or even kicked from the platform entirely. It's bleak.
Well, at least on case of taxi drivers "the flimsy excuse" phrasing applies more to existing regulation than not following it.
Not sure about the nurses, but my grandmothers were able to afford live-in caretakers in old age, without any government help or having much money, because these are completely unregulated (outside the US; or the regulation is not enforced)... We found good ones thru word of mouth, exactly the approach apps can scale
They aren’t attacking regulation but full time employment. They spent a tremendous amount of money in CA to pass a law that’s nearly unable to be repealed to avoid having their gig folks count as employees. That’s the attack - everyone being a 1099. Not regulated industries.
The entire 'gig economy' model is exploitation. It only works because of income inequality. It requires a large pool of workers who don't make enough money to support themselves (due to insane healthcare and housing costs, and low wages and benefits) and thus will take any money they can get, despite the poor pay, long hours, and lack of benefits. It's taking a person slowly dying of thirst and offering them a thimble of water in exchange for knitting a sock.
Unfortunately it wouldn't fix anything. It would kill gig work because the model isn't sustainable with regular taxes and minimum wage (if it were, businesses would've already been doing that instead of independent contracting). It also wouldn't fix the income inequality that created gig work. People would be back to dying of thirst, without a thimble of water.
The real fix is to make it so their main job is hydrating enough, or the thing half the country hates the idea of (public fountains). IRS can't do either. Independent contracting is still a valuable mode of work, when the contractors are paid enough. So rather than ban forms of gig work, we need to provide good paying jobs and social services, and get the rich to pay their fair share.
To what degree is this just another symptom of the US healthcare system being flawed and in need of rework? To what degree would anyone use such a service if the costs remained high?
I used Zocdoc in the past to find a doctor and ended up with a doctor who just charged out-of-pocket instead of insurance, and it worked great. Would an app that shows up-front pricing be better for the consumer?
Every serious analysis of the US healthcare system I've ever seen comes away with the takeaway "Americans consume a lot of healthcare services and the expensive part of that is the providers' salaries"
It’s pretty well known that vertical integration has been the issue with driving up costs. Salaries for physicians aren’t all that big of a cost, compared to all the administrative BS that hospitals and insurance companies drive up, and conveniently have agreements to heavily discount.
For example, on a roughly 400k surgery, maybe 4-5k of that goes to the providers (anesthesia and the surgeon), dependent one on the codes billed for the procedure.
There are private groups that purposely do not take insurance and bill purely out of pocket with a one time fee including all follow up’s and subsequent care, related to that procedure, and it is significantly lower (like 90%+ less) than what an average hospital is charging.
> There are private groups that purposely do not take insurance and bill purely out of pocket with a one time fee including all follow up’s and subsequent care, related to that procedure, and it is significantly lower (like 90%+ less) than what an average hospital is charging.
I would bet a LOT of money that it is 90% lower for a "typical" patient but not 90% lower (and very likely pretty comparable) on average.
To state it more plainly: every time you pay for medical care in the US, you are subsidizing a half dozen people who consume 5x the services you do and do not pay.
That's why "fee only" medical (which always conveniently has no emergency services, you'll notice) can offer such low rates.
Could I use this app to hire a nurse and get a diagnosis from home? If we can start getting even meagre medical treatment to skip insurance / other middle men, I could see this having a great impact on healthcare prices, especially since AI is such a good information extractor, which is 90% of the role doctors play anyway.
Generally speaking nurses in the united states cannot provide a diagnosis, at least without jeopardizing their license. You can already find a doctor using a service like Zocdoc who may cut out middlemen, though regulatory capture has made it close to impossible to meaningfully reduce costs in this way. I would not recommend using AI to diagnose or treat yourself (https://www.nytimes.com/2026/10/27/well/ai-chatgpt-medicatio..., for instance) without the help of somebody highly trained to interpret this information and make good decisions.
Nurses don't really do diagnosis, but follow the ones doctors give.
(Except for trivial things)
Otherwise I unfortunately know plenty of doctors that could easily be replaced by an LLM, but for now I prefer a diagnosis from a real doctor (who may use AI as a tool).
If you really believe that information extraction is 90% of what doctors do then you're deeply ignorant about how healthcare actually works and not qualified to even have an opinion on this subject.
There are many types of nurses, for example Nurse Practitioners have masters or doctorates of nursing can do much or all of what a doctor could within their specific scopes.
Go ahead and downvote me for this, but the medical field in the US especially when it comes to RNs needs a shake up. This is going to sound very crass, but the only skill that your average person on the street doesn’t have that nurses have is to stick a needle in a vein and that’s something that can be taught to a lay person over a week. Pretty much everything else are skills that any person off the street possesses and we would do well to have a lower bar for entry for it.
Nurses change dressings. Insert catheters. Move heavy patients without hurting themselves. Prepare equipment for surgery. Ensure the sterile field is maintained. Operate specialized equipment. Triage medical emergencies.
And about a million other things that the average person doesn't know how to do.
Yeah, I was relying on anecdotal experience so I went and looked it up and they do an incredible amount. Well, it’s too late though I can’t modify or delete my comment anymore.
While I do understand the importance of training, degrees and experience I see that people in the medical field beyond Doctors seem to have a very holier than thou attitude probably because they have 10 edge cases of how MRI can go wrong drilled into them (MRI technicians), not everyone is comfortable with needles and human body (nurses) and because it seems that only Pharmacists can sort and provide us the right medicines when in fact it can be easily done by some robots.
In before someone says that your reasoning is flawed because that is very incorrect perception of the field. All I see is that regulatory capture has worked very well here and is simply stopping totally novel and practical ideas which work on tradeoffs from even taking off
This sounds like pure insecurity with a sprinkle of Dunning Kruger. Unless I'm missing the joke somewhere? Nurses don't mind needles is the only difference? I must be missing the joke.
On the one hand, a good nurse is invaluable. They do the hard work that doctors won’t/don’t do, and can be so kind and generous during your time of need.
On the other ones, there are so many who mail it in and are just milking the system
Healthcare is so expensive - some nurses are making 500k a year - their union contracts base vary from 200k to 300k for something like 32-36 hours per week
On top of that, they can pretty much work unlimited overtime with zero restrictions. They can work enough overtime hours such that they can nearly double their salary. And that’s how you come up with the 500k figure I posted
Granted, that’s at the top of the range, I’m talking about somewhere like the Bay Area, and does require a ton of overtime, but those extra 100s of thousands add up. These hours can’t be spread around to minimize the amount of time and a half or double pay paid out, per contract they go in order of seniority
This is just nurses and I imagine it’s something similar but with higher rates for specialists like anesthesiologists and still beyond that doctors and surgeons
I don’t begrudge anyone’s salaries, but it’s a zero sum game. There’s a reason why, aside from typical corporate profit maximization, you wind up with a 30k bill for a short visit. Even if you account for the lower rates insurance companies pay, it’s still in the thousands of dollars for treatment where you were seen for less than 30 minutes
Like I said, to be clear, I don’t begrudge anyone’s salaries - this is just an under discussed point when we talk about healthcare costs
Labor is generally reported as 60% of the costs of hospitals - so if you’d ever want to talk about making healthcare affordable you’d have to address this which I feel like is a bit of a taboo subject. Many nurses are in a union which makes it an even more difficult conversation
All that is to say, I can see the motivation behind stuff like this, even if I don’t agree with it
> Like I said, to be clear, I don’t begrudge anyone’s salaries - this is just an under discussed point when we talk about healthcare costs
You are begrudging someone’s salary. Nurses make 500k by working overtime. You know why they work overtime? Because it’s cheaper for the hospital than to hire 2 nurses. The problem isn’t the nursing salaries. It is the administrative costs that make your healthcare too expensive. Why do you think single payer reduces healthcare costs?
PS: median nursing salaries are still under a $100k. The numbers you pointed to are not the norm.
Not really, I just said they can’t spread out over time across staff because you have to move up the seniority ladder - so in this particular case, what any manager would do and does in other industries, is spread hours to limit the amount of the really expensive overtime. Instead of one person working and getting double time or more, you can have two people working regular overtime, but this isn’t always possible
I also said this was for the Bay Area - it’s not the norm but it’s not infrequent either
Labor costs are 60% or hospital expenses, I didn’t make that number up and you just glossed over.
And again, I said it was just an issue to be discussed. If discussion leads to it’s not worth discussing, that’s great and a great outcome
You did the thing where you just sort of read what you wanted to read in my comment vs addressing what it said
I am all for it, and hopefully seen in Canada soon too, the smug nurses are literally doing janitorial works and get paid 90k and above, always complaining, very bad attitudes, make it feels like they are doing all the work for free too.. hopefully doctors follow too, the healthcare mafia and their bureaucracy must end, these abysmal waiting times aren’t because of low resources or whatever BS excuses, it’s intentional from doctors/healthcare staff supply all the way to the actual process you get to deal with while being treated or going to ER, it is designed that way.
It's happening everywhere. All these apps who try to be endless rent-seekers, injecting themselves in a process where they have very little to add.
I don't need a platform that takes 25% off of the handyman that I call. All that happens is that I pay 25% more. And if the platform becomes large enough it'll set policies that the handyman cannot offer lower prices outside of the platform...
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[ 0.20 ms ] story [ 38.7 ms ] threadhttps://www.commonwealthfund.org/publications/issue-briefs/2...
The 15% extra administrative cost of insurance and 15% extra administrative burden of applying care are the big culprits, in addition to extra costs on medicine and machinery. But it's interesting. Why is it that a comparatively deregulated and privatized system has so much extra pricing cost from bureaucracy?
Physicians also make 2-3x more than physicians in other countries. Why? Their education cost is also 2-3x higher than in other countries.
Hospitals and procedures are expensive, in part because of insurance. Insurance is high because our society is too litigious. It's also expensive because of consolidated private healthcare systems that can control and mark up prices due to lack of competition.
Other countries spend half what we do on healthcare. And their people are often healthier.
[1] https://www.trillianthealth.com/market-research/studies/hosp...
Last I heard the AMA controls how many doctors can be educated.
https://www.kff.org/health-costs/key-facts-about-hospitals/?...
It is also unclear how this is any different than traveling nurses which operate similarly.
What is the solution that doesn’t result in at least some large group of people making less money?
thanks free market
"Gig nursing apps MAY [my caps] determine pay by what the firm knows about how much a nurse was willing to accept for a previous assignment, how often they bid for shifts, or how much credit card or other kinds of debt they might hold."
That kind of sounds like they are overselling a hypothetical. Even just an "insiders familiar with the matter have told us that it IS happening", would make me believe it more.
Nurses form the backbone of healthcare. Treat them as such.
Edit: To those downvoting me, talk to a real nurse and I bet you wouldn't take twice the pay to do half the work they have to deal with.
There's a good argument to say that sufficiently aggregated marketplaces can launder price collusion, and if we were in such an aggregated marketplace then you could make that argument. But we're not in that situation right now.
The 'Edit:' is even more confusing. If I talk to someone in a profession and I wouldn't take twice the pay they receive to do half the work they do then they deserve higher wages? But that list is huge. Congressmen, Senators, many CEOs, Wagner-group mercenaries, ICE officers, drone pilots. In fact, almost every profession has this 4x effective slippage you're talking about.
One movie that made me change my perspective on nursing as a field was the Swiss movie Late Shift. It really opened my eyes to what nurses have to deal with. Yes the US might be different in having lower patient to nurse ratios but at the end of the day I think it's still applicable.
I still think their monetary compensation should be provided by market valuation of the utility of the work they do.
We can assume all gig economy companies do this? Brave new world indeed.
Uber took an axe to taxi drivers which weren't a popular group to begin with so that was easy. With the "disruption" perfected, next up are doctors, nurses, lawyers, electricians, cooks, engineers, the sky is the limit.
Aside from turning employees into contractors...most of which have not done the math on how much they are losing through having to use your own car with no employee benefits. Doordash/Uber start looking a lot less attractive if you figure in the $.65/mile costs (fuel, repairs, insurance, car purchase price) that you would be paid by most govt or "real" companies. Almost everyone I know who does Doordash makes about $20/hr (which isn't good anyways) and they are not figuring in the costs of the vehicle.
Maintenance and fuel are a much larger part of the total costs. It is very easy to math out if you break down by the "recommended service intervals" which are largely based on mileage (fluids do require changing with time intervals but normal driving usually matches up with the mileage).
The myth that a car sitting still is losing money has been sold by the insurance companies. It is only cheaper to buy a new car vs fixing one if you account for the loss if someone runs into you and totals the car. My car which I have maintained and is 14 years old is worth way more to me than the amount that is placed on it by people who have it in their interest to say it is worthless due to age.
Sidenote: I tracked all my miles, costs and income while delivering pizzas many years ago. These costs vary greatly depending on the car. The 89 subaru justy I purchased to deliver was $.25/mile whereas my 93 mazda 626 was closer to $.60 (2004 pricing). My current car is ~$.60/mile also. Currently, the IRS mileage rates for business is $.70/mile, do any of the gig economies pay this? [1]
[1] https://www.irs.gov/tax-professionals/standard-mileage-rates
> Currently, the IRS mileage rates for business is $.70/mile, do any of the gig economies pay this? [1]
I used to get paid that rate at my old job and it was an amazing deal, it was way over my actual costs for the vehicle. With a small fuel-efficient car I was covering my gas, insurance, and depreciation with a few trips each year. It was effectively my work paying for a free car I'd get to use the rest of the time.
That's the issue with using one number as a very rough estimate, it has to account for everything from contractors driving work trucks to someone commuting in a Model 3.
Unfortunately some harm can be inflicted bur IMHO it’s better than the alternative.
https://hiring.amazon.com/promotions/anytime-shifts
I do not think this will hold with nursing.
Taxi drivers were not more "regulated" in any meaningful way, in fact oversight of them was significantly worse than the community-driven Uber rating system (not that that doesn't also have flaws).
Some regulation is bad, some regulation is good. There's basically nothing at all that's good about guild systems and I will celebrate each of them facing open market competition.
Taxis have standardized rates set by the municipality and use standardized meters that are periodically inspected. Ride sharing apps have dynamic pricing and no transparency.
It could turn out to be 2-3x the "normal" cost due to surge pricing. This often happens to people who go out drinking and think "I'll just grab an Uber later".
Recently heard someone complaining about the $45 cost to go 3 miles.
*Sidenote: people with dementia should probably have someone in the car with them to be sure they get to the appointments. That solves the issue of shady people taking advantage of them for the most part.
You are defaulting to the US here (and I doubt Taxi regulation in the US is that homologous either tbh given the complexity of 50 states and then cities on top of that).
Taking the country I'm most familiar with (the UK), Taxis fall into two categories (only one of which is technically a taxi by law if not convention - Hackney and private hire vehicles) both are licensed in different but similar ways by the licensing authorities (usually the local council but not always), some of those laws go back centuries.
Also worth noting, in the UK Uber does operate under the Private Hire Vehicle laws and does have to comply with applicable licensing same as any other "taxi" (private hire vehicle).
The third outing with the Supreme Court was about employment rights - were the drivers workers, or genuine independent contractors for whom Uber are merely acting as a booking agent (which the Uber model relies almost entirely on).
The Employment Tribunal, The Employment Appeal Tribunal, The Court of Appeal and finally the Supreme Court all said "nah fam, you ain't fooling nobody" and the original ET was especially scathing:
> It seems to us that the Respondents' general case and the written terms on which they rely do not correspond with the practical reality. The notion that Uber in London is a mosaic of 30,000 small businesses linked by a common 'platform' is to our minds faintly ridiculous. In each case the 'business' consists of a man with a car seeking to make a living by driving it.
I can't wait until they disrupt something a cartel or the mafia are in on.
The good thing is that we will not be fooled this time while checking the dead bird thing...
One reason "Uber for X" appears not to have materialized is that the platforms themselves are commoditized, not just the labor. Retailers like Lowe's and Wayfair have built assembly/installation services behind a checkout upsell. They run portals distributing work to their "network of local contractors" .
I got a window into this world through an acquaintance. He has a truck and light trade skills, but mental and reputational legacies of past addiction lock him out of the "anyone good" market. He's on a half dozen platforms, trying to stitch a living doing sink or toilet installs for Lowe's and building bookcases for Wayfair. A negative review gets you demoted from the choice gigs, or even kicked from the platform entirely. It's bleak.
Not sure about the nurses, but my grandmothers were able to afford live-in caretakers in old age, without any government help or having much money, because these are completely unregulated (outside the US; or the regulation is not enforced)... We found good ones thru word of mouth, exactly the approach apps can scale
The real fix is to make it so their main job is hydrating enough, or the thing half the country hates the idea of (public fountains). IRS can't do either. Independent contracting is still a valuable mode of work, when the contractors are paid enough. So rather than ban forms of gig work, we need to provide good paying jobs and social services, and get the rich to pay their fair share.
I used Zocdoc in the past to find a doctor and ended up with a doctor who just charged out-of-pocket instead of insurance, and it worked great. Would an app that shows up-front pricing be better for the consumer?
Every serious analysis of the US healthcare system I've ever seen comes away with the takeaway "Americans consume a lot of healthcare services and the expensive part of that is the providers' salaries"
For example, on a roughly 400k surgery, maybe 4-5k of that goes to the providers (anesthesia and the surgeon), dependent one on the codes billed for the procedure.
There are private groups that purposely do not take insurance and bill purely out of pocket with a one time fee including all follow up’s and subsequent care, related to that procedure, and it is significantly lower (like 90%+ less) than what an average hospital is charging.
I would bet a LOT of money that it is 90% lower for a "typical" patient but not 90% lower (and very likely pretty comparable) on average.
To state it more plainly: every time you pay for medical care in the US, you are subsidizing a half dozen people who consume 5x the services you do and do not pay.
That's why "fee only" medical (which always conveniently has no emergency services, you'll notice) can offer such low rates.
To see how this is possible, enumerate all the other people getting paid, and then compare to a country with a working health care system.
The most obvious difference is that the US spends an absurd amount of money administering health insurance.
You know the videos of those couriers eating your food and claiming that it was delivered?
see also: https://en.wikipedia.org/wiki/Hippocratic_Oath
100%.
Nobody living in a country with healthcare for all with no out of pocket costs would ever care about such a thing.
I spend as much time thinking about “fixing” my healthcare as I do thinking about fixing the supermarket or the roads around here.
Ie not one second because they work perfectly.
Like nurses are just an expense.
Otherwise I unfortunately know plenty of doctors that could easily be replaced by an LLM, but for now I prefer a diagnosis from a real doctor (who may use AI as a tool).
Ripe for disruption!
Nurses change dressings. Insert catheters. Move heavy patients without hurting themselves. Prepare equipment for surgery. Ensure the sterile field is maintained. Operate specialized equipment. Triage medical emergencies.
And about a million other things that the average person doesn't know how to do.
In before someone says that your reasoning is flawed because that is very incorrect perception of the field. All I see is that regulatory capture has worked very well here and is simply stopping totally novel and practical ideas which work on tradeoffs from even taking off
On the one hand, a good nurse is invaluable. They do the hard work that doctors won’t/don’t do, and can be so kind and generous during your time of need.
On the other ones, there are so many who mail it in and are just milking the system
Healthcare is so expensive - some nurses are making 500k a year - their union contracts base vary from 200k to 300k for something like 32-36 hours per week
On top of that, they can pretty much work unlimited overtime with zero restrictions. They can work enough overtime hours such that they can nearly double their salary. And that’s how you come up with the 500k figure I posted
Granted, that’s at the top of the range, I’m talking about somewhere like the Bay Area, and does require a ton of overtime, but those extra 100s of thousands add up. These hours can’t be spread around to minimize the amount of time and a half or double pay paid out, per contract they go in order of seniority
This is just nurses and I imagine it’s something similar but with higher rates for specialists like anesthesiologists and still beyond that doctors and surgeons
I don’t begrudge anyone’s salaries, but it’s a zero sum game. There’s a reason why, aside from typical corporate profit maximization, you wind up with a 30k bill for a short visit. Even if you account for the lower rates insurance companies pay, it’s still in the thousands of dollars for treatment where you were seen for less than 30 minutes
Like I said, to be clear, I don’t begrudge anyone’s salaries - this is just an under discussed point when we talk about healthcare costs
Labor is generally reported as 60% of the costs of hospitals - so if you’d ever want to talk about making healthcare affordable you’d have to address this which I feel like is a bit of a taboo subject. Many nurses are in a union which makes it an even more difficult conversation
All that is to say, I can see the motivation behind stuff like this, even if I don’t agree with it
You are begrudging someone’s salary. Nurses make 500k by working overtime. You know why they work overtime? Because it’s cheaper for the hospital than to hire 2 nurses. The problem isn’t the nursing salaries. It is the administrative costs that make your healthcare too expensive. Why do you think single payer reduces healthcare costs?
PS: median nursing salaries are still under a $100k. The numbers you pointed to are not the norm.
I also said this was for the Bay Area - it’s not the norm but it’s not infrequent either
Labor costs are 60% or hospital expenses, I didn’t make that number up and you just glossed over.
And again, I said it was just an issue to be discussed. If discussion leads to it’s not worth discussing, that’s great and a great outcome
You did the thing where you just sort of read what you wanted to read in my comment vs addressing what it said
I don't need a platform that takes 25% off of the handyman that I call. All that happens is that I pay 25% more. And if the platform becomes large enough it'll set policies that the handyman cannot offer lower prices outside of the platform...