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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

#291

Post by gravescale »

justinclift wrote: post #285
konfusinomicon wrote: post #234

Earlier quoted context omitted.

some senator just held up a bag on bushings for use on fighter jets suring a speech..the cost for a sandwich bag full...$90k

Any idea if they're precision engineered out of something exotic? Maybe machined from single-crystal titanium or something. Asking because there's a bit of a different between standard consumer grade stuff, and specialist high performance things designed for a specific exotic environment.

Also each one probably also has its own fully traceable and auditable supply chain, with a record of every step, including who signed off on it, when and where, from the moment it entered the refinery, and the records are guaranteed to be kept available for decades, along with storage and maintenance of the tooling and capacity to make more at short notice indefinitely. Plus the costs of getting the contract sorted and the part specced and signed off on in the first place, amortised across the relatively small initial batch.

Presumably there for political protection as much as anything else: "Bushinggate topples Senator after it's revealed a Russian company supplied the titanium" or "Scandal of the aircraft parts Anerica has forgotten how to make".

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

#292

Post by api »

discardedrefuse wrote: post #173
api wrote: post #54

Earlier quoted context omitted.

Lots of people see it. It's very clear to me and many others that a lot of the AI safety push is about going straight for regulatory capture and effectively outlawing competition.

Yup. Sam Altman stood before congress and practically begged them for a regulatory moat. Straight up rent-seeking behavior. I don't think people give Meta enough credit for their roll in that. Microsoft/OpenAI got cozy and thought they had a huge moat made of $100K hardware to protect their $10B investment. Then Meta shadow drops Llama and within weeks regular folks were running GPT3 level LLMs on consumer hardware.…

Zuckerberg invented engagement farming social media to ruin the mind of humanity and drive the political discourse to madness, so anything he wants to do to redeem himself is great.

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

#293

Post by sokoloff »

xnyan wrote: post #121
RecycledEle wrote: post #85

I deal with wheelchairs, electric wheelchairs, oxygen systems, CPAPs, spirometry, and more every day. Electric wheelchairs are built to be very rugged and dirt simple. There are 2 problems: The first problem is insurance. People expect their insurance to cover everything. If they need a new set of 35 AH SLA batteries, they will throw their old chair away and ask for a new chair on insurance. The second problem is tha…

> One connector broke and was impossible to replace. This is not a solution that would help the wheelchair user, but if you have a set of inexpensive ($10 bought in the US, less from china) 3" digital calipers, you could likely measure the socket and get it 3D printed. I've done it for obsolete electrical connectors in cars and while it takes time and some effort, it's very doable.

These are high-current (30-50A range) connectors though (for the wheelchair traction batteries). Getting the positioning correct so that the spring tension in the metal terminals creates a reliable/low-resistance/non-sparking connection is a shared contribution from the geometry of the metal terminal and the plastic housing (as opposed to most low current (0-5 Amp) electrical connections, where the connection geometry is most commonly provided by the metal geometry alone and the plastic's contribution is just keeping them "organized and close enough to mate").

Like this: https://upload.wikimedia.org/wikipedia/commons/6/63/Powerpol...

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

#294

Post by [deleted] »

eru wrote: post #250
newsclues wrote: post #237

Earlier quoted context omitted.

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.…

[deleted]

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

#295

Post by newsclues »

xyzzy_plugh wrote: post #260
newsclues wrote: post #237

Earlier quoted context omitted.

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.

This doesn't really work. An unregulated market has every opportunity to undercut a regulated market in almost every dimension. Do you expect that a highly regulated market would become sustainable let alone affordable? You may as well just demand that regulations are removed. The only way this works is if the government subsidizes the regulated market such that it is accessible (and sustainable) to an appropriate ma…

Has the concept ever been really tested?

If you play the idea out (I’ve thought about this for years, perhaps you have fully considered it).

I think this works for people of all economic backgrounds.

There would be multiple competing standards for lower cost businesses, will the low standards business exist if people get sick, or will a slightly higher priced but much safer low cost standard excel in the market?

I think many of the issues you bring up already exist in the current market.

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

#296

Post by tombert »

WalterBright wrote: post #211
SllX wrote: post #159

Earlier quoted context omitted.

It’s more the divorce between the receiver, the seller and the buyer. Sellers are not selling to the people using the wheelchairs, they’re selling to insurance companies and the government. Both types of entities have a proclivity for overpaying. This is also true for most drugs. If we removed private insurance companies, Medicare and Medicaid in their totality from the equation, the market rate for drugs and medical…

Consider the public schools. You have the customer (the students), the buyers (the taxpayers) and the service provider (the teachers), which are accountable to neither.

Define "accountable"? If a teacher does something awful to a student (e.g. sexually harass them), a taxpayer-funded entity (the school board, the police, or the courts depending on the severity and what happend) will reprimand the teacher.

With something less egregious like "giving a the students a bad education", we still have some level of accountability based on standardized testing and school funding. Standardized testing is far from perfect, and it can be an example of Goodhart's Law, but it's still accountability.

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

#297

Post by xp84 »

WalterBright wrote: post #211
SllX wrote: post #159

Earlier quoted context omitted.

It’s more the divorce between the receiver, the seller and the buyer. Sellers are not selling to the people using the wheelchairs, they’re selling to insurance companies and the government. Both types of entities have a proclivity for overpaying. This is also true for most drugs. If we removed private insurance companies, Medicare and Medicaid in their totality from the equation, the market rate for drugs and medical…

Consider the public schools. You have the customer (the students), the buyers (the taxpayers) and the service provider (the teachers), which are accountable to neither.

lol. The teachers have very little say in anything. The service provider is the school board and the administrators, the teachers are just like an instrument they operate as they see fit.

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

#298

Post by azinman2 »

srackey wrote: post #259
tenuousemphasis wrote: post #192

Earlier quoted context omitted.

It doesn't sound like you understand what Private Equity means. Allow me to assist you in your quest for enlightenment. >Private equity describes investment partnerships that buy and manage companies before selling them.

And it sounds like you’re a communist, unless how you can explain how you can ban “investment partnerships buying companies” without doing away with private ownership more broadly? The issue people have isn’t with “private equity”. If it was a publicly traded company doing this people would be equally upset.

Notice my “not sure how”

There is a very negative behavior right now by companies that call themselves private equity to buy up your local vet, doctors office, etc. Then they fire staff, reduce services, and increase costs.

We the people are losing, even if some of our 401ks grow because those funds invested in these PE vehicles.

This practice imho should be banned. How? I don’t know. But the U.S. will become shittier and shittier because of it.

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

#300

Post by vrc »

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.

In this case it’s regulation on who can sell DME paired with how payor negotiations are handled. So even if you had cash to buy many DME, you still need a prescription and sometimes forced to pay the contracted price if you are known to have insurance.
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