As private equity dominates wheelchair market, users wait months for repairs • Hacker News Board

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

#241

Post by eru » Sat, May 04, 2024, 1:38 AM UTC

underlipton wrote: post #224

newsclues wrote: post #177

Earlier quoted context omitted.

It’s similar to defence procurement. If the customer is government with endless budget, inflate costs, and use regulatory capture to maintain the cash flow.

Regulatory capture is likely the most important component. People complain about government spending, but those close to progressive issues can tell you that it's just as likely, if not more likely, to be remarkably stingy when it wants to be. The issue isn't government, it's who's using government; access to capital on top of that government influence gets you a lot closer to that bottomless wallet.

> The issue isn't government, it's who's using government; access to capital on top of that government influence gets you a lot closer to that bottomless wallet.

One issue is a big disconnect between user and payer. Government is especially prone to that, but any big organisation can have this problem.

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

#242

Post by harimau777 » Sat, May 04, 2024, 1:38 AM UTC

zmgsabst wrote: post #163

HillRat wrote: post #139

Earlier quoted context omitted.

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…

Do they? I don’t think the FDA is in a position to asses whether those risks versus the benefits of mobility are an appropriate trade off for any individual. The FDA is deciding that some people should have no mobility so that others have… what, exactly? The people who bought $65,000 chairs still could — and they’d be equally reliable. But because one person needs to use it in Alaska, all people need to pay a premium…

Under that model, what about the people who can't afford a more reliable wheelchair because insurance is no longer obligated to cover it?

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

#243

Post by silisili » Sat, May 04, 2024, 1:38 AM UTC

digger495 wrote: post #195

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…

They do not. I just was fitted for one. I asked "how much is this retail, out the door, cash?" $24,000. So if Medicare is paying $65k, something is seriously wrong.

With all due respect, that figure is still absolutely insane.

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

#244

Post by Spivak » Sat, May 04, 2024, 1:39 AM UTC

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…

> they can't be sold as medical devices and, subsequently, won't be covered by your insurance.

This is something I've never really understood. Wouldn't the insurance company be ever grateful to you if you accepted a non-medical wheelchair because it's 1/10th the cost. Hell, have 5! Is there any reason insurance can't pay for them?

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

#245

Post by heyoni » Sat, May 04, 2024, 1:40 AM UTC

nullindividual wrote: post #202

heyoni wrote: post #151

Earlier quoted context omitted.

In my experience, the chairs and how they’re built aren’t what adds to the price tag; the fact that an insurance company is paying is what is. My daughter literally just got approved for a talking device that would otherwise cost us $4000. It’s a Samsung tablet with $300 software and an attached speaker and comes with some sort of repair agreement. I can buy and break 20 iPads for that price…and we did end up buying…

That tablet and software cost a large sum to be validated. Those CFRs get extremely expensive.

You can buy the same exact app on the app store for $300.

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

#246

Post by Spivak » Sat, May 04, 2024, 1:41 AM UTC

yumraj wrote: post #122

MichaelZuo wrote: post #80

Earlier quoted context omitted.

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

The price difference seems to be enough for a person to fly to India and bring one with them. Can the FDA stop a person from using one by coming to their home and confiscating it?

No and you needn't bother with the medical tourism. You're allowed to use whatever assistive device you'd like, it's only when you wade into getting insurance or the govt to pay for it that the regulations start to matter.

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

#247

Post by jordanb » Sat, May 04, 2024, 1:43 AM UTC

Our whole economy is feeling increasingly Soviet. Somehow our business leaders have decided that the best business is one that does not serve its customers, and that providing a good or service efficiently and effectively is poor management because it is "leaking value" to counterparties.

I guess the next phase is going to be you need to know people if you want your medical device delivered, your car repaired, or for your internet to quit dropping.

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

#248

Post by jandrewrogers » Sat, May 04, 2024, 1:44 AM UTC

newsclues wrote: post #177

heyoni wrote: post #151

Earlier quoted context omitted.

In my experience, the chairs and how they’re built aren’t what adds to the price tag; the fact that an insurance company is paying is what is. My daughter literally just got approved for a talking device that would otherwise cost us $4000. It’s a Samsung tablet with $300 software and an attached speaker and comes with some sort of repair agreement. I can buy and break 20 iPads for that price…and we did end up buying…

It’s similar to defence procurement. If the customer is government with endless budget, inflate costs, and use regulatory capture to maintain the cash flow.

I used to work at an org that audits defense programs. A surprising amount of the unreasonable cost is self-inflicted, which is a valid cost to the vendor. If it wasn’t, the auditors have the power to clawback the excess cost.

In defense procurement the costs are frequently inflated greatly by the procurement process overhead and the government imposing last minute changes of scope, requirements, or delivery dates. The government customer is also often slow or delayed on their contracted deliverables, so they can end up spending a lot of money to essentially keep idle capacity warm on the vendor side while they sort out delivery of their part. And then there are the budget rug-pulls at the 11th after the vendor has already committed significant internal resources, which are often a pure loss to the vendor. All of this is endemic to the process. The government knows they are a difficult and expensive customer to work with, and they do try to compensate vendors for the overhead costs this imposes.

People like to talk about $2000 hammers etc but if you actually look at the audits, more often than not the cost was justified. Not because a hammer should cost that much but because that is how much it ends up costing after you account for the government procurement process overhead and the way in which the government executed the contract.

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

#249

Post by harimau777 » Sat, May 04, 2024, 1:44 AM UTC

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…

How does that work for things that can only be effectively controlled or opted out of collectively? There's not really a way for an individual to opt out of a corporation using AI in a way that negatively effects them.

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

#250

Post by eru » Sat, May 04, 2024, 1:44 AM UTC

newsclues wrote: post #237

beaeglebeachh wrote: post #235

Earlier quoted context omitted.

This is why I'm for total deregulation of healthcare. Government fucks it up so bad hamstringing access that some hack work with 15 minutes of YouTube training plus whatever pills drop out the dark web is often better than not being able to access it at all. Right now we basically end up going to Mexico if we can help it, where there's basically no real oversight or regulation to raise cost so long as the doc/pharmac…

Regulations should be voluntary and exist in a market with options. I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.

That's why I am in favour of more city states like Singapore, or at the very least towards pushing more responsibilities from the federal level to the state level. (The Catholics and EU call that concept 'subsidiarity', handle everything as locally as possible and have the higher levels only there to help when the lower levels can't handle it.)

Eg the FDA ought be to dissolved, and replaced with state level agencies. The state level agencies are, of course, free to cooperate and coordinate. Comparable to how the traffic signs work already in the US.

It's good for Hawaii and New York to have the same road signs, but they can agree on that voluntarily. No need to have a central party force them. Similarly, it's good for both states to have the same or similar rules on drugs, but no need to force them.

See also how the recent wave of cannabis legalisation has been driven by the states. I want to see more of that innovation and experimentation.

> I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.

In what I suggest each state would most likely still have mandatory regulation, but it's a lot easier to move between states to find a place that suits you best, instead of moving between entire countries.

I have lots of sympathy for your position, and I would hope that at least some states would take a more laissez faire approach. But the policies you get will ultimately still be decided by what's popular with voters, and they can be a fickle bunch.