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As private equity dominates wheelchair market, users wait months for repairs

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Re: As private equity dominates wheelchair market, users wait months for repairs

#131

Post by fakedang »

nickff wrote: post #10

Private equity discovered that regulations, compliance requirements, & other similar barriers to entry are the most effective 'moats' which allow businesses to raise prices and have little impact on demand; they are now exploiting this 'hack' ruthlessly.

The brevity of this statement belies the prescience of it. Back in my former life in PE, businesses with industry moats were actively hunted down and targeted, regardless of location. That obviously led to the three basic necessities of man - healthcare, education and housing - being the most affected sectors.

Re: As private equity dominates wheelchair market, users wait months for repairs

#132

Post by Terr_ »

Gormo wrote: post #92
wolverine876 wrote: post #73

Earlier quoted context omitted.

How do think we should address security around AI, and the public's control over a major impact on their lives, welfare, freedom, prosperity, etc.

The first step is to stop thinking of "the public" as a monolithic entity whose interests are pursued by the government, and instead recognize that control over things that have a major impact on the lives, welfare, freedom, and prosperity need to be things they can effectively control or opt-out of as individuals . Regulatory intervention makes it harder, not easier, for individuals to take charge of these matters f…

> Regulatory intervention makes it harder, not easier, for individuals to take charge of these matters for themselves.

That strongly depends on the details. In particular, regulation that compel clear disclosure of information to individuals.

Imagine how impossible it would be to "take charge for yourself" if none of the food in the grocery store had any ingredient/nutrition/allergen information, and bottles of pills didn't tell you the active ingredients and amounts.

Re: As private equity dominates wheelchair market, users wait months for repairs

#133

Post by Der_Einzige »

readyman wrote: post #99
renewiltord wrote: post #86

Earlier quoted context omitted.

This is a great project. I didn't realize that FDA Class I regulations were this easy to comply with.

> I didn't realize that FDA Class I regulations were this easy to comply with. 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.

When replicators are invented, most political problems will disappear. Star Trek got it right.

Re: As private equity dominates wheelchair market, users wait months for repairs

#134

Post by charrondev »

cogman10 wrote: post #104
MichaelZuo wrote: post #80

Earlier quoted context omitted.

The regulations don't just disappear to allow for such imports as in your example ...?

Well, that's the interesting thing. You likely can import and use these wheelchairs, but they can't be sold as medical devices and, subsequently, won't be covered by your insurance. The dumb thing is these super cheap wheelchairs would likely cost the end users more money than the expensive ones as they will buy them out of pocket vs having their insurance/medicare cover most/all of the cost. The reason these compani…

I mean they could market similar to Not a Wheelchair I guess? https://notawheelchair.com/products/the-rig

Re: As private equity dominates wheelchair market, users wait months for repairs

#136

Post by johngladtj »

wolverine876 wrote: post #77
vrc wrote: post #38

Earlier quoted context omitted.

It’s interesting. The regulation ostensibly protects vulnerable classes from exploitation and lets them use reimbursement structures to defray cost. At the same time it causes costs to go up and allows people to buy their way across the moat. I wonder if regulation that stipulated that a change of ownership of some percentage would require recertification of the entity would stem this a bit. Or restrictions on buying…

Not all regulation causes costs to go up. Some causes costs to go down, for example, by correcting inefficiencies created by raw game-theory market competition. Some reduce costs by creating a safer environment for investment, reducing risk. Regulation serves market participants too.

Regulation always increases costs, it's just that not all costs are easily visible

Re: As private equity dominates wheelchair market, users wait months for repairs

#137

Post by somethoughts »

minusLik wrote: post #67

What the article does not seem to mention is that an usual electric wheelchair costs about $65,000 (and is intended to be replaced every six years or so). This and the non-availability of replacement parts is why some wheelchair users started a project to open-source a wheelchair from standard parts: https://themif.org/ Louis Rossmann interviewed the founder of the project here: https://www.youtube.com/watch?v=eaAj59…

To be honest - it actually seems like a risky Private Equity play as I bet the $65000 sticker price is due to the fact that Medicare is footing the bill. Medicare is likely what is requiring a regulation grade wheel chair, not the users themselves.

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.

Re: As private equity dominates wheelchair market, users wait months for repairs

#138

Post by Uehreka »

xcdzvyn wrote: post #75
cyberax wrote: post #32

Earlier quoted context omitted.

In free market it's also OK to cut costs as much as possible, making chair that explode and kill the user one day after the warranty expires. That's why we have regulation: to establish the minimum standards. Simple medical devices like wheelchairs (Class I or Class II) are also not super over-regulated, you don't need to do clinical trials to certify them. All-in-all it'll cost you around $10m, which is not at all a…

Why would I buy something that kills me the day after the warranty expires?

Because you don’t know that it will. If it’s been out for less than a year perhaps no one has been harmed by it yet.

Re: As private equity dominates wheelchair market, users wait months for repairs

#139

Post by HillRat »

renewiltord wrote: post #110
readyman wrote: post #99

Earlier quoted context omitted.

> I didn't realize that FDA Class I regulations were this easy to comply with. 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.

I only just noticed that the wheelchair https://libertymemesfoundation.org/donations/endurance-the-o... is actually a Class 2 device. That sounds really hard to get past the FDA. I think it's pretty cool still because folks with the knowhow could make their own, but the disabled are probably SOL because you can't really make these for sale without that. I suppose the FDA's reasoning is that they're better off having…

Without commenting on the specific standards and regulations, the parade of horribles that could go wrong with a powered wheelchair is pretty extensive, when realizing that when a wheelchair goes wrong the user cannot move away from it. Consider the risks of a battery fire you can't escape, a drivetrain that could grab loose clothing around a pair of immobile legs, or a user whose wheelchair dies on an empty street at night at -10°F because it couldn't handle the cold for long enough. This doesn't mean the incumbents aren't fixing the regulations to ensure they've got a manufacturing moat -- this being healthcare, I assume that's exactly what they're doing -- but the FDA definitely has reasons to make sure these are regulated.

Re: As private equity dominates wheelchair market, users wait months for repairs

#140

Post by wesselbindt »

pdonis wrote: post #49
kazinator wrote: post #26

Earlier quoted context omitted.

Capitalism refers to the system of individuals pooling money together (capital) to start a venture that they couldn't if they acted separately. The idea of a company being a person-like legal entity with its own assets and liabilities is capitalistic. In a free marked that is absent of regulatory hurdles, it is far from guaranteed that costs would be affordable. Freedom from regulation about how wheelchairs have to b…

> Capitalism refers to the system of individuals pooling money together (capital) to start a venture that they couldn't if they acted separately. That's one aspect of capitalism, yes. But in capitalism as it is currently practiced, most of the people who are accumulating capital aren't people that are trying to start new ventures. They are people that are already rich but think they aren't rich enough, who are unable…

> Historically, virtually all monopolies have been the result of government interference

I'm with you on this. In general, the state (by definition) functions to protect the interests of the politically dominant class, which, under capitalism, is the owning class. From the haymarket massacre to Biden's strike breaking shenanigans, this is absolutely beyond dispute. The state will always facilitate monopolies. The only way to get rid of monopolies is for the workers to organize and overthrow the dictatorship of the owning class. Until that happens, it's all Disney, Amazon, and pseudo democracy.

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