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Cities with Uber Have Lower Rates of Ambulance Usage

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Re: Cities with Uber Have Lower Rates of Ambulance Usage

#81

Post by kelnos »

throwaway0255 wrote: post #73
FussyZeus wrote: post #63

Earlier quoted context omitted.

This is all coming from a hardcore capitalist, so know that going in: Health Insurance, as a concept, is disgusting. You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put u…

I completely agree, but I don't think it's a winnable fight. I think it's so big and so entangled with everything that the only thing that could ever pry it loose is some kind of fundamentally transformative event that results in the complete dissolution of our entire economy and/or nation. Trying to make any progress through typical political avenues is hopeless. You're casting your vote into an ocean of voters that…

I think this is something where individual US states need to blaze a trail. California passed a (light-on-details) single-payer healthcare bill through the state Senate, though unfortunately the matter has been tabled for now by the Assembly, and funding it would require creative use of Medicare dollars that a) would require federal approval, and b) may not even exist much longer if the GOP gets its way.

I agree that major health care reform at a US national level is pretty unlikely at this point, even if Democrats manage to gain a supermajority in both houses of Congress and win back the presidency. I'm not even sure trying out something novel at a national level is a good idea, since it carries a lot of risk. I think doing something new at the state level, if they can get around federal interference, has a decent chance of getting somewhere.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#82

Post by blhack »

throwaway0255 wrote: post #48

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I…

There is pretty much nothing that infuriates me more than the health insurance system. Here is just one example (other than your ambulance example, which is like some trolley-car problem come real):

We use "insurance" for routine medical examinations which are supposedly to be done regardless of health. We use "insurance" for YEARLY checkups.

The absurdity of this is on par with insuring yourself against getting hungry, or buying gasoline insurance to fill up your car.

Gas in $8000/gallon. But pay $900/month and we will cover the cost!

It is absolutely embarrassing that this is the system we have allowed to exist. I consider myself a pretty staunch capitalist in most regards. Health insurance is definitely not one of them.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#83

Post by barrkel »

FussyZeus wrote: post #63
throwaway0255 wrote: post #48

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I…

This is all coming from a hardcore capitalist, so know that going in: Health Insurance, as a concept, is disgusting. You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put u…

The reason you must get car insurance isn't to cover the cost of the car, it's to cover the very high variance in potential payouts to third parties should you cause an accident.

Health insurance in principle works on a similar basis: it's a cost smoothing mechanism for unexpected large costs that not everyone is expected to incur.

It breaks down if everyone incurs the big costs (old age) or not everyone insures (only at risk people insure, which increases costs, which pushes out people who aren't as risky, which pushes up the price further, in a cycle.) It also doesn't make much sense for regular care that doesn't directly prevent major payouts.

So it seems to me that health insurance is only workable if it is mandatory, old age spending is rationed, and checkups that find things that can become very expensive are covered, but other bits and bobs aren't. Obviously gold plated coverage could cover more, but that's all the mandatory insurance should cover.

It's all far too politically charged for any kind of rationality to prevail though. I think single payer state care can work, but it has high overhead and suits high tax countries better, not the US, where there is less acceptance of the social contract of taxation.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#84

Post by kelnos »

thaumasiotes wrote: post #47
donatj wrote: post #37

Earlier quoted context omitted.

Six years ago I had something similar to a stoke. I had a relative drive me from work to the ER in outer suburbs because: a) I would literally rather die than pay for an ambulance. I put my money where my mouth was on that. b) I knew from previous experience their ER was far cheaper, cleaner and quicker than the one in the cities. Maybe I am just particularly frugal but I had the presence of mind to consider costs wh…

> I would literally rather die than pay for an ambulance. I wish more people realized this was an option. You can't even imagine how common it is to see the claim "medical care is a special market, because if someone is dying, they will pay ANY AMOUNT for care no matter how high". Sure, if that person is dying and rates their own health infinitely higher than the welfare of their family, maybe. That's not many people…

> Sure, if that person is dying and rates their own health infinitely higher than the welfare of their family, maybe. That's not many people.

I don't think that's true. I think that's actually the vast majority of people. Nearly all of them, even. The human survival instinct overrides so much of a human's rational thought processes or even their higher-order emotional processes. You may be one of the rare few for which that's not the case, but, well... you're of a vanishingly rare breed.

And it's not even exactly that. When you're in a life-threatening situation, it's likely that you're either a) unconscious, or b) completely unable to have even a remote grasp of what the cost will be to "fix" you. As in, not even a ballpark figure. Given the potential urgency, you may not have the time to get a second opinion or shop around for a cheaper fix. Just the cost of stabilizing you to the point where you can sit back and make an informed decision could bankrupt you.

Also, just a side note on:

> ... the welfare of their family

There's also a cost to their welfare if you die, too. It's hard to put a number on that while you're healthy, let alone in the midst of an emergency or life-threatening illness.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#85

Post by smallnamespace »

adamnemecek wrote: post #80
FussyZeus wrote: post #63

Earlier quoted context omitted.

This is all coming from a hardcore capitalist, so know that going in: Health Insurance, as a concept, is disgusting. You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put u…

How does your solution solve the problem?

It adds one crucial feature every healthy, functioning market needs: honest feedback.

Right now nobody, and I mean literally nobody, makes rational economic decisions for medicine in the US.

Neither the hospital, doctor, administrator, insurance company, or patient really has any real idea 1) the cost of the health care being provided 2) the amounts being charged or 3) the dollar amount of benefit gained by the patient. The actors above who do have some pieces of the data largely aren't the ones making the decisions.

If you abolish insurance and state prices up front, at least you force hospitals to charge something closer to the true cost for services, and you force patients to evaluate whether they would rather have care or dollars in their pockets. Over time, they would figure out what's good value for their health and what isn't.

Of course one could argue that the government should be making all these decisions because it has access to more information, and that's probably true; but that's not what's happening in our Frankenstein ('s monster) of a system.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#86

Post by ComputerGuru »

jMyles wrote: post #66
joshvm wrote: post #41

Coming from a country where ambulance usage is free for citizens, it would be interesting to see the stats in Uber cities. The only reason not to call an ambulance here is if you feel it would be unethical (e.g. if you broke your arm and your partner could drive you). EDIT: That is, I imagine you might be able to see whether Uber provides a better alternative than the local cabs. This still holds in US cities though,…

> The only reason not to call an ambulance here is if you feel it would be unethical I dunno, maybe you just want to avoid the psychological feeling of urgency and gravity that comes with an ambulance. I think there's something to be said for staying calm and keeping self-control and dignity when facing an emergency situation. If you're bleeding profusely or are in-and-out of consciousness or have a deadly virus, obv…

There’s also the question of control. No matter how badly injured, if I’m driving myself or taking a cab, I am still “the boss.” But as soon as EMTs and doctors become involved, that control is lost.

In an increasingly authoritarian country/world, where we are expected to give up all rights upon first interaction with persons in a position of power or authority, be it the policeman that graduated yesterday but has the full might of “the boys in blue,” the TSA agent at the check in line, the EMT responding to the call, or the nurse checking you in, it is easy to understand why some people have an aversion to willfully surrendering themselves and their free will so long as an alternative is present.

I prefer to not cede what little control I have until I have to. If I want the driver to take the highway and not the local roads, it’s my call. If I want to text while I’m being driven through traffic, it’s my call. If I change my mind and want to go back home to die, well, it’s my call.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#87

Post by kelnos »

chiefalchemist wrote: post #22
Spooky23 wrote: post #10

I’d be more interested to see the reduction in medicab or medivan usage. My father had the misfortune of having a stroke, and transporting him via van is outrageous — you’re talking >$250 for a 15 mile drive, in what amounts to a cargo van with zero service beyond driving. It’s one of those weird markets where the pricing is driven by the Medicaid reimbursement, which is a price floor.

Same situation for me, and I've seen the same with regards to price. That said, I also suspect the med transport niche is heavily regulated (a la taxi service). Special training for drivers, insurance, etc. I don't think that covers the full $250; just saying they're not identical to a Uber.

Right. If the Uber driver fails to get you to the hospital in time to save your life for any reason, they have no liability or consequences whatsoever, because they're not intended to be a life-saving or emergency service.

If the ambulance driver screws up in some way, they're in for a world of trouble and legal liability.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#88

Post by pritambarhate »

gonyea wrote: post #58
eugeniub wrote: post #51

Earlier quoted context omitted.

"taking a picture" is not the same thing as "an x-ray"

It’s incredibly old tech and costs you maybe $5 in most countries.

In India in Tier 1 City at a reasonably good private hospital, it takes around Rs. 500 ($8) to Rs. 750 ($12) to get an X-Ray done.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#89

Post by caresource_ta »

FussyZeus wrote: post #63
throwaway0255 wrote: post #48

I injured myself and needed to go to the ER. The injury wasn't life threatening, but I definitely needed to go to the hospital immediately. I called an Uber. I don't have the time or expertise to do the months of legalese and calculus it would take me to understand my insurance policy, so I have no idea how much an ambulance ride would have cost me. $0? $400? $15000? None of those numbers would surprise me. As best I…

This is all coming from a hardcore capitalist, so know that going in: Health Insurance, as a concept, is disgusting. You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put u…

Insurance does not replace value, insurance is fundamentally and always a value transfer vehicle. Although in some implementations insurance can act as a value replacement mechanism this is the result of the implementation and not a fundamental property of insurance. You seem to base your understanding of insurance on some common implementations that do replace value but these are not the rule for all insurance.

Re: Cities with Uber Have Lower Rates of Ambulance Usage

#90

Post by yeowMeng »

adamnemecek wrote: post #80
FussyZeus wrote: post #63

Earlier quoted context omitted.

This is all coming from a hardcore capitalist, so know that going in: Health Insurance, as a concept, is disgusting. You "Insure" property. You "Insure" specifically against loss of that property, and the cost of insurance is determined (forgetting an awful lot of math, but the basics are) by: The value of the property in question, the amount of payout required to replace said property in the case of full loss, put u…

How does your solution solve the problem?

Speculation to follow: Health care as an industry is significantly more profitable than the proactive/preventative healh programs. Eliminating insurance removes a volatility dimension. Preventing problems (if possible) saves infinite suffering but costs someone profit.
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