US cities pay too much for buses • Hacker News Board

Re: US cities pay too much for buses

#531

Post by qgin » Sat, Sep 27, 2025, 5:49 PM UTC

kortilla wrote: post #438

qgin wrote: post #398

Earlier quoted context omitted.

I have a $6500 deductible. I definitely care what things cost because my insurance almost never actually helps pay for anything unless I have an unbelievably bad year. The problem is that literally nobody can tell me how much anything is going to cost until I get the bill in a month. Not even because they don't want to tell me. Nobody at the desk even knows what my price is going to be because it's all numberwang.

You care about small costs but not the large ones. Even with a relatively large deductible it’s irrelevant to you if your hospital charges $50k or $90k for a surgery. $6500 is nothing once surgery, radiation, and/or anesthesiology enters the picture.

Absolutely, there is room for price shopping for a subset of medical treatments. https://surgerycenterok.com is a well-known cash-pay surgery center. If you look through the procedure list, you can see the types of things that lend themselves to this model: lots of orthopedic surgeries, things that are fixes for chronic issues that don't really need to be dealt with on any specific timeframe.

But when you get into the really big, serious, time-sensitive things. Cancer treatment, heart disease, anything that starts with an ER visit... you don't really have an ability or time to "shop around". The demand is inelastic.

Re: US cities pay too much for buses

#532

Post by dml2135 » Sat, Sep 27, 2025, 5:49 PM UTC

moduspol wrote: post #408

qgin wrote: post #398

Earlier quoted context omitted.

I have a $6500 deductible. I definitely care what things cost because my insurance almost never actually helps pay for anything unless I have an unbelievably bad year. The problem is that literally nobody can tell me how much anything is going to cost until I get the bill in a month. Not even because they don't want to tell me. Nobody at the desk even knows what my price is going to be because it's all numberwang.

Not defending insurance but theoretically you do also get a better rate than the uninsured rate just by having it go through the health insurance. I say “theoretically” because I’ve also heard they’re often willing to cut some pretty good deals if you don’t have insurance and pay cash. And I mean “good” relative to the initially billed amount, not “good” relative to what it should actually cost.

Every time I’ve gotten a large bill that hit my deductible, going back to the provider and asking to pay cash without insurance has resulted in a lower bill.

Re: US cities pay too much for buses

#533

Post by Uvix » Sat, Sep 27, 2025, 6:01 PM UTC

BobbyTables2 wrote: post #519

qgin wrote: post #398

Earlier quoted context omitted.

I have a $6500 deductible. I definitely care what things cost because my insurance almost never actually helps pay for anything unless I have an unbelievably bad year. The problem is that literally nobody can tell me how much anything is going to cost until I get the bill in a month. Not even because they don't want to tell me. Nobody at the desk even knows what my price is going to be because it's all numberwang.

The funny thing is there are only a few insurance companies (BCBS, Aetna, United, …) and types of plans (PPO, HMO, EPO). I could be misinformed but I feel like there are only a few possible combinations of one’s actual coverage. A simple spreadsheet could easily track everything. The providers even know how much they get from each company, so they know the allowed in-network cost for a patient. It’s just utter lazine…

Different plans from the same company, even of the same type, don't always cover the same things at the same rates. This is especially true of self-insured plans for large employers - there's certain mandatory things they legally have to cover, but anything beyond that is all up to the individual employers' discretion (since they're paying all the claims directly, as opposed to paying a monthly per-participant fee).

Re: US cities pay too much for buses

#534

Post by circuit10 » Sat, Sep 27, 2025, 6:01 PM UTC

crote wrote: post #491

Symbiote wrote: post #450

Earlier quoted context omitted.

Buses in places like Ireland, Scotland, much of Scandinavia, etc will never need air conditioning. Places a little warmer (England, Denmark, Netherlands, northern Germany) might be warm enough for a few days per year, but the cost of purchase and maintenance of A/C might not be worthwhile.

How many of those places have you been to? They might not need year-round A/C like some other countries, but the increasingly-common heat waves definitely require them. The buses are almost intolerable with air conditioning, there's no way in hell they'd ever purchase them without it. The additional purchase cost is a rounding error, and you're far worse off if cooking people alive during the summer means losing cust…

I live in the UK and most of our buses in my city don’t have air conditioning as far as I can tell since they usually have open windows, except some the very newest ones

Re: US cities pay too much for buses

#535

Post by apical_dendrite » Sat, Sep 27, 2025, 6:02 PM UTC

BobbyTables2 wrote: post #519

qgin wrote: post #398

Earlier quoted context omitted.

I have a $6500 deductible. I definitely care what things cost because my insurance almost never actually helps pay for anything unless I have an unbelievably bad year. The problem is that literally nobody can tell me how much anything is going to cost until I get the bill in a month. Not even because they don't want to tell me. Nobody at the desk even knows what my price is going to be because it's all numberwang.

The funny thing is there are only a few insurance companies (BCBS, Aetna, United, …) and types of plans (PPO, HMO, EPO). I could be misinformed but I feel like there are only a few possible combinations of one’s actual coverage. A simple spreadsheet could easily track everything. The providers even know how much they get from each company, so they know the allowed in-network cost for a patient. It’s just utter lazine…

My understanding is that this is only really true for straightforward things like, say, a therapist. If they only have a couple of codes that they bill and they accept a limited number of insurance providers, then they can probably tell you what you'll pay (although I believe there are still a lot of edge cases).

However, if it's something like a surgery at a major health system, then it's way more complicated. The health system can't be as selective about what insurance they take, so they're dealing with medicare, medicaid, plans sold on the individual/small business market, and employer-sponsored plans. So way more than a few providers and a few types of plans. I checked the stats for my state and just the individual/small business market is 12 providers and 250+ plans. Medicare Advantage is at least 14 providers. A major hospital system probably accepts thousands, if not tens of thousands of different types of plans. Then you have to consider that the anesthesiologist, the surgeon, and the facility are all separate providers who may not all take the same insurance.

Re: US cities pay too much for buses

#536

Post by kjkjadksj » Sat, Sep 27, 2025, 6:04 PM UTC

DudeOpotomus wrote: post #530

In many municipalities, it would be cheaper to run on demand van service for people than run busses. Not only would it get people to and from their actual homes and work, vans are cheap and readily available. Paying more drivers is cheaper than buying and maintaining multi million dollar busses that are empty a lot of the time. In most of CA, most homes are far from bus lines. Making their use prohibitive for all but…

Metro micro doesn’t scale at all. It is still limited to pilot study areas. Cost per trip is absurd compared to traditional bussing. One of the stated goals of the next gen bus plan in LA was to get a bus stop in a 10 min walk of 85% of the workers in LA county and this was achieved.

The real trouble with transit is people choose where they live based on car convenience rather than transit convenience. So they open an app and go “gee I can drive to work in 30 mins but I have to take two or three busses and three times the time on transit.” And write it off forever, rather than considering that they could have optimized their housing for a 30 min single bus transit commute when seeking housing convenient to work. The way LA county is developed is that there are apartments basically in every neighborhood anyhow without very strong neighborhood specific effects on pricing. Housing a little more neighborhood specific but that changes as townhomes and other sort of not-detached-sfh buying opportunities come to bear generally in neighborhoods with demand for a song compared to detached housing.

Re: US cities pay too much for buses

#537

Post by cowpig » Sat, Sep 27, 2025, 6:10 PM UTC

reliabilityguy wrote: post #522

avar wrote: post #325

Earlier quoted context omitted.

> The second you detach the consumer from the > price of something, even through an > intermediary such as health insurance, that > is when they stop caring about how much > something costs, and so the price jumps. In reality, this claim doesn't survive a cursory glance at the OECD's numbers for health expenditure per capita[1]. You'll find that (even ignoring the outlier that is the US health care system) that in so…

These reports tend to ignore how fast you can get a specific service or test done. There is plenty of anecdotal data out there that in US you can get CT or MeI the next day, while in many countries in the EU you have to wait months. I think looking only on the spending per capita tells us nothing about accessibility of service, and its quality. Once you start to consider those things, imo, the whole thing is not as a…

Wouldn't that be a latent variable in health outcome data?

Re: US cities pay too much for buses

#538

Post by rootusrootus » Sat, Sep 27, 2025, 6:10 PM UTC

kjkjadksj wrote: post #536

DudeOpotomus wrote: post #530

In many municipalities, it would be cheaper to run on demand van service for people than run busses. Not only would it get people to and from their actual homes and work, vans are cheap and readily available. Paying more drivers is cheaper than buying and maintaining multi million dollar busses that are empty a lot of the time. In most of CA, most homes are far from bus lines. Making their use prohibitive for all but…

Metro micro doesn’t scale at all. It is still limited to pilot study areas. Cost per trip is absurd compared to traditional bussing. One of the stated goals of the next gen bus plan in LA was to get a bus stop in a 10 min walk of 85% of the workers in LA county and this was achieved. The real trouble with transit is people choose where they live based on car convenience rather than transit convenience. So they open a…

> rather than considering that they could have optimized their housing for a 30 min single bus transit commute when seeking housing convenient to work

In many places I've lived, this optimization would need to be re-done every job change and you would probably need to move, because it's as much about where the job is as where your house is.

The thing about optimizing for a good commute in a car is that you're way more likely to be at least average or better even if your job location changes.

Re: US cities pay too much for buses

#539

Post by rsynnott » Sat, Sep 27, 2025, 6:14 PM UTC

ainiriand wrote: post #470

rsynnott wrote: post #452

> Two US transit agencies, RTD and SORTA, bought similar 40-foot, diesel-powered buses from the same manufacturer in 2023, but RTD's 10 buses cost $432,028 each, while SORTA's 17 cost $939,388 each. Huh. TFI, the Irish transport authority, currently has a deal to pay 400 million euro for 800 electric buses, mostly double deckers (so a lot bigger than these ones). Diesel double deckers cost them significantly less (ab…

But each State and County wants their say on what vehicles they want, and for sure a lot of them do not want those woke electric buses...

So give them a choice of two or three.

Re: US cities pay too much for buses

#540

Post by kjkjadksj » Sat, Sep 27, 2025, 6:24 PM UTC

rootusrootus wrote: post #538

kjkjadksj wrote: post #536

Earlier quoted context omitted.

Metro micro doesn’t scale at all. It is still limited to pilot study areas. Cost per trip is absurd compared to traditional bussing. One of the stated goals of the next gen bus plan in LA was to get a bus stop in a 10 min walk of 85% of the workers in LA county and this was achieved. The real trouble with transit is people choose where they live based on car convenience rather than transit convenience. So they open a…

> rather than considering that they could have optimized their housing for a 30 min single bus transit commute when seeking housing convenient to work In many places I've lived, this optimization would need to be re-done every job change and you would probably need to move, because it's as much about where the job is as where your house is. The thing about optimizing for a good commute in a car is that you're way mor…

With the way traffic works in LA county that isn’t so much the case. Rush hour speeds are like 15mph or less no matter surface streets or freeways. Really large geographic area too. Other metros where you can move at more or less 60mph even in rush hour I agree.