Cities With Uber Have Lower Rates Of Ambulance Usage (npr.org)

An anonymous reader shares a report: Many potential emergency room patients are too sick to drive themselves to a hospital. But an ambulance can cost hundreds or thousands of dollars without insurance. This where a popular ride-sharing app can step in, while also freeing up the ambulances for those who need them most. With demand for ambulances decreased by available Uber drivers, emergency personnel have been able reach critical patients faster while also applying necessary treatment on the way to the hospital, according to a new economic study from the University of Kansas: "Given that even a reduction of a few minutes can drastically improve survival rates for serious conditions, this could be associated with a substantial welfare improvement." The study investigated ambulance rates in 766 U.S. cities from 43 different states. Taking into account the timelines of when Uber entered each city, the researchers found that the app reduced per capita ambulance usage rates by around 7 percent.

Comments

Interesting.

[Anonymous Coward]

I wonder how much the mortality rate has crept up from people who should have used ambulances calling an Uber instead, and arriving at the hospital later and in worse condition than they otherwise would have? Who is going to do that study?

Re:Interesting.

[jellomizer]

A lot of Emergency Visits that someone would ask for Uber would be a problem that isn't life or death, but can't be put off for the next day, and such conditions may make it unsafe for someone to drive themselves.
Extreme Pain, If they are on Meds that makes it unsafe for them to drive, or physically unable to drive. The ambulance is often overkill transpiration for a lot of cases. And with people taking uber to get to the hospital, can make sure the ambulances that are on standby can be closer by to handle a real emergency.

Re:Interesting.

[jedidiah]

...anyone that wants to push for socialized medicine. Although on the flip side, you see complaints in the UK press of ambulances being abused by patients and treated like Taxis.

An obvious question is "why Uber". Compared to the cost of an ambulance, a Taxi is still dirt cheap.

I'm also not sure I see the point in using an ambulance if you aren't actually dying before you make the call to 911. The last time I needed to go to the ER, I didn't really need a mobile ICU for the short trip there. My previous hospital stay before that also didn't require a mobile ICU while in transit.

You're also assuming that everyone who goes to the ER actually belongs there rather than "some geek with a back spasm" who should have gone to a chiropractor or his GP.

Re:Interesting.

[geoskd]

An obvious question is "why Uber". Compared to the cost of an ambulance, a Taxi is still dirt cheap.

Because most places you can expect a good hour wait for a taxi. Taxi service has always been piss-poor, much of that being due to the medallion system. It is one of the few real examples of bad regulation. As much as Uber consists of a bunch of criminals and scumbags (The executives, not the drivers), the industry they are disrupting is far worse.

Re:Interesting.

[jellomizer]

We have Socialized medicine in the United States, We buy insurance. where we pay for everyone on that companies healthcare.
We have Multi-Payer system. Which (loosely) gives us the choice of what features we are willing to pay by ourselves, and what the payer will pay for. A single payer system which we pay via our taxes, isn't that much different, however we do not have a choice to determine if you are willing to say I am willing to pay for these services out of pocket, so I don't need pay as much taxes.
But in terms of using Ambulances for Taxis it isn't the Single Payer, but the rules and policies around such usage. If the single payer system states that you need to be in a particular condition to use the Ambulance, otherwise you will need to pay back the cost, it still in the realm of single payer.

Re:Interesting.

[ShanghaiBill]

An obvious question is "why Uber".

Uber/Lyft is more responsive than a taxi, and since they are depending on a good review, they are more likely to be helpful and patient.

Most Uber/Lyft customers are not former taxi customers. People see "ride-sharing" as something new and different, not as a drop-in replacement for taxis.

I use Lyft mostly when I travel on business, whereas 5 years ago, I would rent a car at the airport.

Re:Interesting.

[Anonymous Coward]

Precious few cities have medallion systems (5? 10?), yet this study looked at over 700 cities. I'd have to imagine that the real problem with taxis in most cities is a lack of demand.

In cities where driving a car is prohibitive (like NYC, Boston, Chicago, SF), many people will take taxis instead, and it is easy to make a living driving a cab full-time. In fact, it's so easy that everyone wants to do it so they use medallions to limit the number of drivers.

In most cities, though, you only take a taxi in rare circumstances like a ride to/from the airport, to/from a bar, or maybe to/from an auto mechanic. This limits the number of people who can make a living driving a cab, such that there isn't likely to be one around when you need one.

With Uber you don't have to make a living driving full-time because you can just drive whenever you have an hour or two to kill. This significantly increases the pool of available drivers to the point where there's some random driver several minutes from your house rather than an hour from your house.

Additionally, the availability of drivers makes it easier to do to a regular doctor's appointment, lessening the need for an ambulance ride in the first place.

dom

Re:Interesting.

[PsychoSlashDot]

We have Socialized medicine in the United States, We buy insurance. where we pay for everyone on that companies healthcare.

You don't, really.

See, with socialized health care, there isn't a company involved. There's a government-run health organization which exists to serve people, not to make a profit. How you pay for it isn't key. How the services are delivered is.

I know there's a hypothetical where it's asked, "well, what if I want to pay more for service which is even better" and it's not a horrible question, but it presupposes that the baseline health-care is sub-par, which is - in most cases - not the case. Yes, here in Canada we've had periods where emergency-room wait times have been excessive, but with triage, true emergencies are handled immediately while "I've got a cough" is back-burnered. As it should be. And yes, there are occasions where some specific procedures are back-logged, and patients are even sometimes shuttled to our nearby American neighbors because they needed to be. But by and large, the vast, vast, majority of us are cared-for properly, promptly, efficiently, and... with disregard for the depth of our pockets.

Re:Interesting.

[AvitarX]

And it's not like wait times are never high in the US.

Trying to get a diagnosis and a procedure from a specialist can be a months long quest (it took my ex wife over six months of bear constant kidney infections before she got curative treatment, I've waited over six hours with a broken arm before an X-ray (that was a fluke though, and not typical, there was a kid that got hit by a car while in a go cart and a dirt bike race earlier that day).

People that I've seen complain about the waits in Canada (as a boogyman) tend to be young, and have never really needed medical care.

Re:Interesting.

[Applehu Akbar]

Add to these the people who have just had a medical procedure that they have been instructed not to drive themselves home from. If you have no second driver in the family and you live in a place where taxi service is sparse and expensive, you will tend to fudge on the instructions and drive anyway. Ridesharing can improve public safety here too.

Re:Interesting.

[Goldsmith]

I'm pretty sure the doctors, nurses, medical equipment manufacturers, drug manufacturers, disposable sterile supply manufacturers, various supply distributors, etc. are all part of some sort of organization (even as small as a family) that expects to turn a profit.

The healthcare system in the US is not cost effective, private (about 2/3 of our healthcare costs are paid by the government), nor particularly "better" than any other reasonable alternative. The US government pays more per-person for healthcare than the Canadian government. If we switched to the Canadian system right now, at the same billing rates, our government spend on healthcare would go down.

The US healthcare system is a very sizable chunk of the economy. Telling all the US doctors, manufacturers, distributors, medical lawyers, etc that they will only get paid what people in, say Canada or Germany, make in the equivalent jobs would unfortunately create a sizable drop in our overall economy. At root, this is why we're not able to actually fix things.

Re:Interesting.

[fluffernutter]

The people who wait in emergency rooms are the ones who can wait. If they can wait, often they shouldn't be there. My wife has received great treatment for two serious medical issues and it hit our pocketbook but it didn't bankrupt us. I will happily wait in an emergency room, it won't kill me.

Re:Interesting.

[fluffernutter]

What you said to a certain extent is very true. However, someone still has to make the products that the socialist healthcare system uses. These aren't all crown corporations. In fact, many of these may be American companies in the case of Canada.

Re:Interesting.

[Luckyo]

From finnish point of view, where ambulance costs something like 20-30 Euro (rest paid by the government), you get not only the unit but trained personnel. These people can quickly assess the nature of your medical emergency and treat it on site when possible. Many smaller traumas or sudden bouts of illness benefit significantly from quick identification and application of correct treatment.

As a result, here you call an ambulance, and they'll often arrive, diagnose and treat the problem and leave you treated, because there's not even a need to visit the ER in the first place. The "mobile ICU" can handle the problem on site and leave patient in acceptable condition for him to be able to remain at home. At the same time if problem is actually serious, they can bypass the queue at the ER because they already performed medical triage and can provide ER doctors with relevant information about specifics of the problem.

Which is results in savings for the entire system as it becomes more efficient overall. People with problems that don't need a visit to ER do not use ER resources. People who need to be treated ASAP before they condition worsens, and costs a lot more money to treat get to go past the queue of "I am drunk, tripped and fell and I need a few stitches" people. Something very important in country with fully socialized medical system, where efficiency of medical treatment of everyone is a key factor to the entire system continuing to exist.

Re:Interesting.

[HornWumpus]

In practice, the improved outcome from ambulances is usually lost as you can often be in the ER well BEFORE the ambulance even gets to you.

Ambulances are for times when the injury is so bad, you can't move the victim. If the victim is mobile, get moving. Consider having an ambulance meet you on the way, if it's that bad. Do get on the phone so the ER knows you're coming, but if the choice is drive or call, drive.

Uber drivers should be safe from liability in these cases, unless they're medically trained. Perversely: If trained, they're risking their net worth by helping (some states protect them, but not most).

Gotta wonder how much Uber would help if your car became a biohazard.

Re:Interesting.

[Anonymous Coward]

People who drive themselves or have someone else drive them to the hospital have lower mortality rates because they get there faster. Based on the data, the critical factor is not how quickly you receive stabilizing care (ambulance), but how quickly you get to the hospital. With Uber it would really depend on how close the driver was. If you had to wait the same amount of time you would likely be worse off because of your inability to avoid traffic, stop lights, etc... compared to an ambulance, but if Uber arrived more quickly then it would be a benefit.

Re:Interesting.

[Anonymous Coward]

I have a friend who is an EMT. Too often he says they are just a glorified taxi service for people who need their pain medication and know they won't have to pay for the ride.

Re:Interesting.

[plopez]

That's where Urgent care is supposed to come in. Something really an emergency but unable to wait for a dr. appt.

Re:Interesting.

[plopez]

Don't forget the impact of decentralization

Re:Interesting.

[Anonymous Coward]

Don't forget us drunks!

I once used an Uber-like service (can't even recall the name) to take a pet to an 24-hour emergency animal hospital because I was in no condition to drive.

I've injured myself a couple times while drunk and considered using a taxi to get to the ER but just did first aid on myself instead. Those were minor injuries although I'm guessing a lot of people would have gone.

Some injuries are obvious that emergency care is required but minor injuries can be difficult to tell.

Re:Interesting.

[plopez]

It depends. Providing med. care w/o compensation is usually covered. With or with out training. These are know as "Good Samaritan Laws". Even if a trained doctor provides assistance the Doc. is usually covered if the Doc. does *not* bill for the service.

Re: Interesting.

[nitehawk214]

But what if you can't drive? I recently had kidney stones and live alone. I had to take an ambulance.

Actually I probably would have not gone Uber as I was pretty sure I was dying. Kidney stones are way worse than gall stones.

Re: Interesting.

[nitehawk214]

Yeah I always wonder about that. Wait times at hosptials in the USA are huge if it is not life threatening.

Re:Interesting.

[Anonymous Coward]

An "Emergency Visit" that can be put off to the next day ISN'T an "Emergency Visit." It's a visit that should go to an Urgent Care or Primary Care facility.

An "Emergency Visit" IS a situation where chronic injury or illness that has life-threatening potential.

So no, Uber should *never* be taking people to the Emergency Room. If it isn't bad enough for an Ambulance, they should be going elsewhere. And that includes things like simple broken bones and stitches - they can be done at Urgent Care.

Re:Interesting.

[arth1]

Uber drivers should be safe from liability in these cases, unless they're medically trained. Perversely: If trained, they're risking their net worth by helping (some states protect them, but not most).

It depends on where you are. Where I am, only people with current emergency/first aid training credentials are covered by good samaritan laws. Untrained people or those who haven't paid the troll to renew are not. Unsurprisingly, those who provide emergency services for profit are also those who have lobbied those laws through.

Where I originally came from, it was a duty to provide first aid, regardless of skills. Not attempting to provide assistance to someone in dire need was a felony

Re:Interesting.

[arth1]

The problem I see with this reasoning is that taxis provide the same service, so a shift from Taxi to Uber shold not make any change here.
If anything, depending on location, taxis often have first aid kits and basic first aid training for all the drivers. Or (again depending on locality) laws preventing them from turning down a fare because a person is leaking.

I am very suspicious of the conclusion drawn that Uber causes lower ambulance usage. I would suggest looking at whether something else could be causing Uber usage to go up and/or ambulance usage to go down. Like, for example, fewer people going to the ER with the vastly increased co-pay prices and shift from full coverage to percentage coverage plans. Or fewer traffic accidents due to more traffic jams. There can be many factors, some right and some wrong, but jumping to the conclusion that Uber is the cause and less ambulance usage is the result seems premature.

Re:Interesting.

[Anonymous Coward]

America has yet to discover properly functioning public transport and independence from driving. In any Japanese or European town or city you can hop on a bus or a tram and get yourself to a hospital without needing to drive. Functioning public transport gives a lot of freedom.

Re:Interesting.

[arth1]

A lot of the medical procedures, equipment and medicine Americans now rely on were developed in non-profit universities and research centres in countries with socialized medicine. I'm fairly certain that American medicine depends more on the rest of the world than the other way around.

What's special about the US system is that you pay not only the medical staff, but lawyers, insurance companies, more lawyers, patent holders, more lawyers, stock holders, and a few lawyers too. The $50 hospital aspirin is $50 mostly because of all the lawyers who have to be paid, in case something goes wrong and there's a million dollar lawsuit.
"Cover your ass" comes way before "help the patient". But the patient has to pay for the ass coverage.

Re:Interesting.

[Xenx]

Not immediately killing you, and not life threatening are two completely different things. It doesn't sound like you are qualified to make that distinction. There are plenty of conditions that have much better survival and/or quality of life odds if addressed sooner. Each person has to judge how critical their situation is for themselves, and aren't trained to do so. While it is wasteful to go to the ER when unnecessary, if you like living it's better to err on the side of caution.

As to your claim about broken bones and stitches being urgent care. You might be right, you might be wrong. I've looked through a handful of recommendation lists. Some don't list broken bones at all. One listed it under both. Another two listed them under ER. And these are lists from insurance companies and hospitals.

Re:Interesting.

[sg_oneill]

Yeah. I found myself in hospital recently due to Anemia via an ambulance and ended up in fairly serious debt as a result. Since I know the anemia thing isnt immediately life threatening (Its something Ive had a long time and I know once the fainting starts I do have a bit of time before it becomes truly dangerous) I would genuinely refuse to do the ambulance again. Ubers are perfect (Cabs too. but ubers half the price, assuming its not surge fee oclock)

Re: Interesting.

[Anonymous Coward]

I was a Paramedic for 1 year and in my country in Western Europe it was basically impossible to not bring someone into the hospital after arriving at the scene. Even if the patient refused to go it would require a doctor to come to the scene and the patient would be hit with a big bill from the insurance company, because the argument goes that the ambulance wasn't necessary in the first place.

The reason for all that: You guessed it, cover your ass. There was a lot of fear that even if something unrelated happened to the patient after leaving him at home that we'll be on the hook for it.

Re:Interesting.

[Anonymous Coward]

To compare the US healthcare system with other countries you have to combine both government and private payments together. Then you'll find the US pays twice as much as the next-highest country for the same level of service. Most of that is unregulated prices, and perverse incentives that encourage every value-added step to pad the bill, and labs overbuying expensive state-of-the-art machines and then marketing to convince people to overuse the machines to amortize the cost of the machines.

There's also a wide discrepancy between cities: similar or adjacent cities have widely different health-service costs for reasons that aren't fully clear, but it has to do with whether they have influential patient-centric providers (The Mayo Clinic, Cleveland Clinic, Virginia Mason, etc) or just money-grubbing providers, and what the competition profile is (especially whether there are too many expensive machines for the population size).

Re:Interesting.

[MrL0G1C]

But an ambulance can cost hundreds or thousands of dollars without insurance

So glad I live in the UK, ambulances are free for everyone and anyone, no one has to think about cost when calling an ambulance for themselves or for complete strangers.

I was unconscious, came around concussed with (very) temporary memory loss when a couple of people called an ambulance for me, would I also have had to pay for an ambulance in the US if I didn't have insurance?

Re: Interesting.

[Luckyo]

It is in fact fairly common around here. Here in the Northern Europe, common sense still rules supreme over "cover my ass, always" attitude.

It's one of the main reasons why we can offer as wide of a social security net as we do in comparison to most of Western Europe.

Re:Interesting.

[thsths]

I am not sure what it is like in your place, but have you tried to order a regular licensed taxi recently? I managed to do it, but it is much more difficult and takes much longer than just hailing an uber. And if you want to go to the emergency room, I guess you have a feel of urgency, that most taxi companies just do not cater for. ("We have one driver free tomorrow at 10am, is that ok"?)

Re:Interesting.

[Anonymous Coward]

I think Uber tends to respond quicker and is easier to book.

Re: Interesting.

[volmtech]

While this was true in my area 40 years ago today hospitals pride themselves on short wait times. In Orlando one hospital has a large billboard by I-4 with a wait time clock displayed, usually it is 15 minutes or less. A Jacksonville hospital advertises wait time on the radio, again usually less then 15 minutes. The last three times I have taken my wife to our small town hospital emergency room she was the only patient.

Florida is in a building boom with much of it fueled by retirees who bring their Medicare money with them. States with declining populations are the ones that have long wait times.

Re:Interesting.

[Anonymous Coward]

OP AC here. You make good points. But I am plenty qualified to make that decision; I have a license that says I am and I'm studying for a yet higher level. Being AC just lets me speak more bluntly and less tactfully than I should.

An Emergency Room should be used for life threatening conditions. "Survival and quality of life if addressed sooner," care are what urgent care centers are for, or primary care doctors and the non-emergent conditions. And urgent/prompt cares came about for this reason: Lots of care that an emergency room DOESN'T want to treat, because it takes away resources from the care that IS needed for treatment of people who will die without immediate attention (and may die, even then.) And there's plenty of business in that department.

You're right that there is variation. Different regions, different standards; urban vs. rural and economic base of state and lots of things. (I mention that in a later post below....) So yeah, there may still be an area where you ought to go to the ER when you need a decision if you need stitches. It's also true that the Nurse Practitioner at Walgreens or CVS may not be prepared to give you an X-Ray and put a cast on you until you can PCP, where the Physicians Assistant at that stand alone Urgent Care is just waiting to reduce and set that fracture. But, generally, the trend is movement away from the ER for anything not truly Emergent, including non-emergent acute conditions.

I'm not saying people won't judge their criticality or that it's not better to err on the side of caution. And yes, it is better to take an Uber to an emergency room for a heart attack then not take anything at all and die. (Though best still to call the ambulance, no?)

But once you start working in an ER you see the "frequent flyers" who come in for the most frivolous of reasons. And the ER does still assess, evaluate, and treat any acute condition (along with counseling about what ER's are and do.) They can't just send those frequent flyers (who are almost always state assistance and completely broke but won't use the Community Health Center system) away. And maybe there are conditions where ride-sharing or taxi services might help as conveyors to appropriate care. But I'm absolutely positive that the vast majority of Uber rides for medical care should NOT be going to the ER but instead other providers. And they won't.

(Oh, and if you mess up and show up to an Urgent Care center and you really shoulda gone to the ER - they'll tell you that as well as offering to call the ambulance for you. And then it is still your choice where to go.)

So my recommendation is: If it ain't bad enough that you're thinking about an ambulance, go to the Urgent Care. If you have the slightest question about that, go to the ER by any method. By all means, get the care how you can. Just don't die because you shoulda called the ambulance and your heartburn turns into a cardiac arrest on some poor Uber driver who doesn't know CPR, let alone be able to MONA you.

Re: Interesting.

[Anonymous Coward]

In the United States, generally, a patient who refuses transport may do so as long as it is clear they have the decision making capacity to do so. Even if they die. My instructor told me of a call he ran where they showed up and it was a clear heart attack in progress. Patient allowed an EKG that showed the STEMI. But patient refused both transport and any further care. Crew got the ER on the horn and had the ER doc talk to the patient, who still denied it. They told his sobbing wife that they could do nothing further for him as long as he refused consent, and that they'd be waiting in the ambulance outside. 20 minutes later the wife comes out - he'd slipped into unconsciousness. At that point (in the absence of legally executed written advanced directives) implied consent takes over. So they started resuscitation, which failed. He died on scene. The crew did their job properly according to the letter and spirit of the law.

Forgive the morbid illustration, but things are different here and the legal system 100% backs doing so. (The patient may also accept or refuse any level of care but refuse transport, or may request transport and refuse any intermediate measures including vital signs though that is pretty dumb.) That said, in many types of call (as above) a refusal requires the crew to contact their medical control (the ER) to document the refusal.

Re: Interesting.

[Agripa]

Kidney stones are way worse than gall stones.

Do they treat kidney stones by removing an organ? They sure do with gall stones.

Women who are in a position to compare the pain between kidney stones, gall stones, and childbirth say that gall stones are the worst. I can only personally compare gall stones to being shot or having a hand mangled and gall stones were by far much more debilitatingly painful.

Re:Interesting.

[Agripa]

Taxi service has always been piss-poor, much of that being due to the medallion system. It is one of the few real examples of bad regulation.

It is one of the many examples of good regulation ... for the industry being regulated once it captures the regulators.

Re:Interesting.

[Agripa]

In practice, the improved outcome from ambulances is usually lost as you can often be in the ER well BEFORE the ambulance even gets to you.

The improved outcome for either is lost if you have to wait in the ER for hours.

Re:Interesting.

[Anonymous Coward]

People go to emergency rooms for stupid things like a common cold or flu because they want prescription meds and don't want to wait a few weeks/months to see their physician when all they really had to due was go to their local drug store for some off the shelf remedies and stay home a few days. This is why antibiotics such as Amoxicilin should be sold in a controlled/metered fashion by drug store pharmacists rather than require a doctor's prescription.

Re:Interesting.

[Not-a-Neg]

I was just T-boned yesterday while driving through an intersection, called 911 and in less than 2 minutes the first responder on the scene was an ambulance. 30 seconds later a fire truck arrived, then a minute after that 2 police cars arrived. 3 and a half minutes for all the needed emergency services to be on scene. Far greater service than you will get in any other country. Later that day I scheduled a ride with an Uber to take me to a car rental place. Estimates for Uber drivers in my area started at 8 minutes and only went up from there.

Re: Interesting.

[nitehawk214]

My guess is those wait times are only for triage. 15 minutes for triage is pretty terrible. Once admitted to the ER your wait depends on how urgent your condition is.

Re: Interesting.

[nitehawk214]

Interesting, the gall stones were not like being stabbed for me (though I have never been shot or stabbed (or gave birth) to compare. I bet it depends on the shape and size of the stones, so either one could be worse.

My mom did tell me that gallstones were worse than childbirth. Coincidentally when I had them, I was the exact age she was when she had them.

Fortunately modern laparoscopic surgery got rid of the gall bladder with very little pain and only a few days of recovery.

Not "Uber"

[Anonymous Coward]

The consumers do this, not some magical app. Presented with a transportation option previously depressed by the city overlords, consumers are now able to seek out the most efficient means that meet their transportation needs.

Re:Not "Uber"

[jellomizer]

In many suburban and rural areas, Taxi service is unavailable or prohibitively expensive. A Taxi company cannot profitably operate in such areas, however a lone Uber or Lift driver can. With the big name of Uber and Lift to back them up so they don't need to advertise and sell themselves. They can just drive.

Not Magic, but franchising.

Re:Not "Uber"

[iamgnat]

Presented with a transportation option previously depressed by the city overlords

So these cities refused to allow taxis to operate prior to Uber? I doubt it. Even though they may be more expensive than Uber, they would still be far cheaper than an ambulance ride. So is Uber truly the savior of humanity this study wants us to believe, or are there maybe other factors that they missed/ignored in their effort to show Uber in a good light?

Re:Not "Uber"

[Anonymous Coward]

I call Bullshit. Name some example areas. The rural areas I know have local taxi companies but no Uber.

Re:Not "Uber"

[jellomizer]

Upstate NY.

Re:Not "Uber"

[ShanghaiBill]

So these cities refused to allow taxis to operate prior to Uber?

The cities set the price and restrict entry to the market. The obvious response from taxi drivers is to focus on the core urban area where they can get the most fares and ignore suburbs and outlying areas. If you need a taxi from a suburban area, you may have to wait for an hour or more for a taxi doing a dropoff from the city or airport, and looking for a return fare.

Uber provides a solution to this problem: Prices based on supply and demand.

If you are interested in reading more about this concept, try googling for "Why communism doesn't work".

Re:Not "Uber"

[jedidiah]

That leaves you with somewhat of a split though. You have cities where Taxi service is useful and those where it is not. Even for something that is not immediately life threatening, even a 45 minute wait for a Taxi may be perfectly acceptable.

It all depends on the nature of the "emergency".

For the use case where Uber or a Taxi works, the 45 minute wait is probably not a problem.

I would't expect the "Uber effect" to be as great in places like New York City or London. Also in some of those places, the Taxis have started to adapt and steal some of Uber's tricks.

Re:Not "Uber"

[iamgnat]

I've only used Uber twice for work, though I've tried to use it more. Getting an Uber home from a major international airport takes about 5 minutes (so longer than walking right up to a cab) and costs within a few dollars of what a taxi costs for the same trip. I use Uber because my company has some connection to them so the rides feed our expense system. The local cabs don't take our corp Amex (also directly feeding our expense system), so that it's less hassle for me doing my expenses is the only reason I have opted for them so far.

Trying to get from home to the airport, on the other hand, can vary from 30 minutes to an 1.5 hours while the same cab company that can bring me home from the airport is 45 minutes and SuperShuttle (much cheaper than either) gives me a time I can count on for planning. It's not like I'm out in the sticks either. I'm in the middle of a bunch of heavily populated suburb developments and happen to be 2.5 miles (as the crow flies) from the end of said airport's runways. This area (and the county that I and the airport fall in) are one of the country's biggest Tech sectors (outside of SV) too which was an early adopter of Uber.

The point being that while taxis have problems, they are far more predictable outside of the major city areas. Uber is far from the panacea the "True Believer" want us to believe.

Not sure why you are trying to bring Communism into this since nothing about the subject or my comments has anything to do with Communism (or any particular form of government).

Re:Not "Uber"

[plopez]

If you can wait for 45 min. you can go to urgent care instead of an ER. Urgent care can then triage you.

Re: Not "Uber"

[nitehawk214]

Your comment about "nature of the emergency" made me think that the self driving Ubers in Pittsburgh can say "please state the nature of the emergency".

Re:Not "Uber"

[smooth wombat]

You've never been to the central part of the U.S., have you? How about a place such as Wall, South Dakota, population 500 (or so).

The nearest city is an hour drive. Tell me how a cab company could operate in such a place.

And that is not an outlier. There are tons of towns all over this country where there is no possible way for a cab company to operate. I'm not sure even the Uber or Lyft cab companies could operate in such places.

Re:Not "Uber"

[stephanruby]

Taxis have the ability to stop to pick up someone, when they're already on the way to pick up someone else. Hence, they're unreliable (even if they're not supposed to do that, they still do it). In the most populated American cities, their total numbers were/are artificially limited, which means they were almost impossible to hail during peak hours (unless you're waiting for one at a very nice hotel, where the doorman has some leverage with taxi drivers because he can blacklist them if they do not show up).

Uber has an elastic workforce, elastic pricing, elastic capacity (if you know about UberPool), which adapts itself well to the peaks and valleys of market demand. The taxi industry, on the other hand, has a static workforce that doesn't adapt itself very well the ebbs and flows of the market.

Also, if you're having an emergency, you might as well order an Uber, a taxi, and a Lyft, all at the same time, and only get into the first one that arrives, but you'll find that if you cancel on the taxi, the taxi dispatcher will most likely blacklist your phone number for cancelling on them.

I can give you more reasons if you want.

In any case, you're correct that Uber is an awful company, for the workers, for the drivers, and for the investors, and I can give you a dozen reasons of why that is so, but from the perspective of the customer, the system works pretty well.

If you don't believe me, talk to any veteran policeman, or talk to any veteran bartender, where Uber (or Lyft) is strong, and they'll tell you that Uber/Lyft has saved thousands of people from getting DUIs in their city.

The problem is scheduled Doctor visits.

[jellomizer]

The problem with people going to the ED, is the fact that they are not going for a real emergency, but an urgent visit or just see a doctor without a schedule. The fact that Uber is cutting down ambulances is proof of this. Because if it is life or death, you wouldn't want Uber. However if it is just and issue of pain, or some issue preventing you from driving, but not life or death. Then the Uber drivers should be trained to ask them to go to the Urgent Centers, which may be closer by, and cheaper. As they are Doctors offices without an appointment. Who can treat most issues.

What health care really needs though is the return of home visiting doctors. Vs having ill people deal with the stress of transport.

Re:The problem is scheduled Doctor visits.

[Mashiki]

Then the Uber drivers should be trained to ask them to go to the Urgent Centers, which may be closer by, and cheaper. As they are Doctors offices without an appointment. Who can treat most issues.

Here in Canada, taxi drivers are required to have first aid (Class A or C) before they can drive for a company. Class A is CPR+emerg first aid+AED training on individuals aged 8+, Class C is the above + infant CPR. While taxis don't carry AED's, almost all municipal buildings have an AED that anyone can get to in an emergency.

Uber pushes that it's not a taxi company, it pushes that it doesn't have to follow the rules that taxi drivers are required to have. They don't want to play by the same rules that the other taxi companies have to deal with, and that's one of the reasons they're continually being hit by regulators. Until that changes and they finally get in line that they are indeed a taxi company, and their drivers actually have to follow the same rules they can piss right off.

Re:The problem is scheduled Doctor visits.

[iamgnat]

The problem with people going to the ED, is the fact that they are not going for a real emergency, but an urgent visit or just see a doctor without a schedule.

Obviously you are a learned doctor that knows all the the possible health conditions and how they should be managed and treated. Please enlighten us more...

There are plenty of issues that are not life threatening which can not be treated by urgent care. There are also plenty of conditions that complicate less severe issues which make having access to a full hospital's resources the better choice. There are also plenty of areas where urgent care facilities don't exist (or are run by a specific group that do not accept non-members).

There are plenty of people that waste the ER's time for things like non-critical flu/cold symptoms and the like, but to argue the patient being able to drive themselves or not is ludicrously naive.

Re:The problem is scheduled Doctor visits.

[ShanghaiBill]

What health care really needs though is the return of home visiting doctors.

Actually, home visiting nurses would make more sense. 90% of health problems are totally routine, and we do not need an expensive MD to treat every sniffle or cough. We only use doctors for everything because of legal concerns, and this is a major inflator of medical costs in America.

In other countries, with far lower medical costs than America, when you "go to the doctor" you are much more likely to actually be seeing a nurse or PA.

Re:The problem is scheduled Doctor visits.

[jellomizer]

I am not a doctor, but I see their data, and I am involved in the policies and procedures.
Normally unless the person is showing signs of trauma, hear attack or stroke in the ED, they will be placed in a lower priority queue. And the doctor will not see them often for about an hour, while they treat the real emergency cases. Where these people will be treated by the Mid-Levels. At the urgent care facilities. The doctor will normally see you right away. Urgent care often have X-Ray and access and authorities to fix most issues. If found to be something that really needs to go to the ED, Then you will get transferred there. In the mean time you are under supervision of trained staff. Over all this is much better in terms of care, while it might be inconvenient to those who will need to be transferred, however it normally it isn't life threatening, but annoying.

We as a culture cannot afford the one size healthcare for all problems.

Re:The problem is scheduled Doctor visits.

[ShanghaiBill]

Here in Canada, taxi drivers are required to have first aid

That seems like a silly requirement. How often is this skill actually used in a way that makes a difference?

Sure, it is possible that a taxi driver could use first aid skills, but you could make the same argument for requiring that plumbers or barbers or accountants learn first aid.

Disclaimer: When I was a cub scout, I earned the 1st aid merit badge.

Re:The problem is scheduled Doctor visits.

[AvitarX]

I'm not sure I buy your argument.

Something like a broken arm is an emergency room visit, but really doesn't need an ambulance at all.

Re:The problem is scheduled Doctor visits.

[Mashiki]

That seems like a silly requirement. How often is this skill actually used in a way that makes a difference?

Considering it only costs $150(or less) and 6hrs of your time to get the training? Recerts every 3-5 years run about $75. Ask yourself the question, for a person who's on the road nearly all the time how is it not worthwhile to have people with that training everywhere. The belief is that it's better for people to have the ability to treat those in need, then not having those in need not being treated.

Sure, it is possible that a taxi driver could use first aid skills, but you could make the same argument for requiring that plumbers or barbers or accountants learn first aid.

Those plumbers, barbers, or accountants aren't traveling on the roads and carrying people in their vehicles now are they. The taxi drivers on the other hand are. This is the same reason why bus drivers(both public and private) have to have first aid certification.

Re:The problem is scheduled Doctor visits.

[Cigaes]

In other countries, with far lower medical costs than America, when you "go to the doctor" you are much more likely to actually be seeing a nurse or PA.

I am pretty sure you are quite mistaken. For France, I know you are.

In France, the official fee is 25€, minus 16.50€ reimbursed by the Sécurité sociale. I do not find on the web stastics on how many doctors follow the official fee (“conventionnés secteur 1”), but partial statistics seems to indicate they are the huge majority of general practitioners. At least I can say that I had no trouble finding several of them in my neighborhood.

And they are actual medical doctors, not nurses or anything else. And most of those I visited spend time with their patients, they do not expedite them to make a living.

I think you need browse some more to know why the medical costs are so high in the United States of America. You can probably start with the “Adam Ruins the Hospital” episode of “Adam Ruins Everything”, I remember it covered that topic.

And by the way, the nameless country between Canada and Mexico is not the whole of America. ;-

Re: The problem is scheduled Doctor visits.

[c6gunner]

He's right; it's a stupid requirement. The fact that the course is cheap, or that the training is useful, does not change the fact that it's a stupid requirement.

It's also not an "in Canada" thing since regulation is done primarily by cities and provinces, so some places require first aid and some do not. Toronto used to require it, but no longer does. St. Johns doesn't require it but wants to make it a requirement, and is trying to get the province to do it for them.

The people trying to bring in first aid training as a requirement in Newfoundland also want to make "sensitivity training" mandatory, too. Both of them seem like equally absurd requirement to me.

Re:The problem is scheduled Doctor visits.

[plopez]

Emergencies don't always happen in a vehicle. Though driving is still a risky enterprise.

Re:The problem is scheduled Doctor visits.

[plopez]

Too risky. See the great influenza epidemic as an example. Can you say "disease vector"?

Re:The problem is scheduled Doctor visits.

[iamgnat]

We as a culture cannot afford the one size healthcare for all problems.

You'll get no argument there from me just as you'll get no argument that ERs get overcrowded with those that have no business there. Your original assertion, however, was that someone's ability to drive to the ER and their decision to call an Ambulance was the deciding factor of if they are a valid ER patient. That is demonstrably not true.

One of the factors that this study doesn't seem to take into account is Obamacare. That, I think, has had far more impact in overuse of the ER than Uber. Many ERs were used in place of doctors by people that had no insurance and/or couldn't pay since most public hospitals reduced costs or simply didn't bother to chase down those who couldn't pay. In my area within a few months of OC getting in gear ER wait times dropped significantly while getting an appoint with GPs became harder (e.g. outside Urgent Care level stuff, same day appointments are just about gone). OC has a lot of problems, but it's impact to ER usage definitely seems to be a big pro for it.

Re:The problem is scheduled Doctor visits.

[ShanghaiBill]

Considering it only costs $150(or less) and 6hrs of your time to get the training?

It also costs only $150 for waitresses and mechanics. So that is not a good argument for singling out a particular group.

is it not worthwhile to have people with that training everywhere.

They are already everywhere. They are called "ex-cub-scouts". There are millions of us.

Those plumbers, barbers, or accountants aren't traveling on the roads and carrying people in their vehicles now are they.

Most injuries occur at home or at work, not while sitting in the backseat of a vehicle. Unless you can show evidence to the contrary, I would say that a driver is about the least likely to need 1st aid skills. Most likely may be a cook using knives and hot liquids.

Re: The problem is scheduled Doctor visits.

[nitehawk214]

It's the other way around. Pre-Obamacare people would go to the ER for non emergencies since they have to treat them, and walk out on the bill.

Granted the implementation is so fucked up this probably happens anyhow and nothing has changed.

Re:The problem is scheduled Doctor visits.

[Rockoon]

I am not a doctor, but I see their data, and I am involved in the policies and procedures.

So you are completely unbiased... oh wait... you are actually being a self-absorbed pretentious fuck right now? ..and your opinion on this is probably completely entirely selfish because you are a lefty? yeah...

Re:The problem is scheduled Doctor visits.

[Anonymous Coward]

I'm not sure I buy your argument.

Something like a broken arm is an emergency room visit, but really doesn't need an ambulance at all.

I would agree that a broken arm should be seen in an ER, or perhaps "urgent care" if they are qualified. I have never been to an "urgent care" so I don't know.

The need for an ambulance to transport a patient with a broken arm should be carefully considered.

If someone else was around when the accident happened, and they had basic first aid training & a willingness to help, and they had some materials to splint the arm so it was immobile during transport in a civilian vehicle (car, truck, Uber, whatever), then an ambulance is not necessary, just a safe ride to an "urgent care" or ER since a GP is unlikely to be prepared to handle this; it should be X-rayed before it's set.

If the accident happened and nobody knows how to splint that arm to immobilze it, then calling an ambulance is probably a good idea. Most if not all ambulance personnel can perform basic first aid. Some ambulance personnel are trained & certified EMTs that can perform advanced care. Perhaps some ambulance personnel are even more qualified than that; laws, trining, and certification requirements can vary by location and country. So I think ambulance personnel have the training and materials to properly splint the arm so it's immobile during transport in the event a bystander cannot render assistance (first aid & splinting).

The last thing you want with a broken arm is to have the thing moving around while you are moving. The ends of broken bones might get chipped by rubbing together, or broken limbs could puncture the skin maing it a "compound fracture". If a broken limb is left unsplinted during transport, the break could be made worse by jarring movements during transport and require surgery to properly set the bone(s) and maybe insert reinforcing plates.

If you are alone and you break a limb, you probably should call an ambulance and not an Uber for the reasons I mention above. You would likely get a "code 1" (no lights and no siren) or "code 2" (lights only) trip to the ER, depending upon the severity of the break and first aid needed to stabilize things before transport along with any other medical complications that might arise as part of the accident.

Re:The problem is scheduled Doctor visits.

[ImdatS]

Here in Germany, if you want to get your driving license, you have to have a 1st-Aid training first. Without a 1st-Aid-training you can't get a driving license. I don't know how it is in other countries, though. Maybe it is the same in all of European Union.

Third World?

[Anonymous Coward]

Erm, in which third world nation are people needing to take a taxi (an Uber? It's an unlicensed taxi, but that's another rant) for hospital emergencies?

Re:Third World?

[jellomizer]

In a country where not all Emergency visits are life threatening, but the patient cannot drive. We don't need a Semi truck to move a single chair. We don't need an ambulance to move every person who needs to go to the ED.

It is about efficiency. And saving resources for those who need it.

Free advertising for Uber! They must be rejoycing.

[bogaboga]

Uber must be rejoicing over this "free advertising."

You see, when it comes to "ride sharing" all media talk about is "Uber," "Uber" and more "Uber."

It's as if the other more than 10 ride sharing companies/services just do not exist!

You have to pay for using an ambulance?

[Anonymous Coward]

Sounds like a third world country.

Re:You have to pay for using an ambulance?

[jedidiah]

Why? Because you aren't using a mobile ICU for something that's not an immediate matter of life and death? Resources like that should be reserved for people that actually need them.

This goes equally well for "civilized" countries with socialized medicine.

Just because something is free, it doesn't mean it's an open excuse for abuse.

Re:You have to pay for using an ambulance?

[thegarbz]

Not having to pay for an ambulance doesn't elevate you from 3rd world to 1st world. It just puts you at the top of the 3rd world. First world countries have along with covered ambulances for emergencies, house doctors, or emergency doctors who can go treat people who don't need an ambulance but who are otherwise unable to get themselves to care.

Why is everything so black and white with Americans?

Re:You have to pay for using an ambulance?

[thegarbz]

Apologies to the Canadians, I mean to say: People who live in the United States.

Re:You have to pay for using an ambulance?

[HornWumpus]

We're not the one making up a private definition of 'first world' to make things seem simple.

Re:You have to pay for using an ambulance?

[Anonymous Coward]

You used the correct word. Americans.

You could I suppose refer to Canadians as North Americans, but that sounds wordy, so you'd probably just use the word Canadians.

Re:You have to pay for using an ambulance?

[Anonymous Coward]

Why? Because you aren't using a mobile ICU for something that's not an immediate matter of life and death? Resources like that should be reserved for people that actually need them.

This goes equally well for "civilized" countries with socialized medicine.

Just because something is free, it doesn't mean it's an open excuse for abuse.

Most parts of the US are served by private companies that run the ambulance service. If you use their service, regardless of your medical issue, you get a bill. Paying your bill pays for the costs of running that private company to provide that ambulance service.

In bigger cities in the US you might find the ambulance service run by the local fire service, or (and this one is much less common) run by the local police or health department, or maybe a county agency; there is no consistency in this across the USA. Maybe these cities & counties don't send a bill because the ambulance service is paid for out of taxes, but then again I could be wrong.

In "small town" USA you might find the ambulance run by the local volunteer fire department (or not). The staff might be all or mostly volunteer, but the equipment and facilities are paid for by tax money, perhaps some donations, and some equipment (trucks, hoses, ladders, etc.) could be "previously used" and were 'gifts" or "low cost". Again, I do not know if volunteer departments send a bill or not, though I know the volunteer ambulance where I brother worked did not send a bill (they graciously accepted donations of money and equipment).

As always there might be "special case" situations that I am not aware of....YMMV

My point is this: If you pay for it, either out of your own pocket or out of your taxes, then it's NOT FREE.

Most of the so-called "socialized medical systems" ("single payer" if you wish) are funded by tax money. That tax money can be acquired from any number of sources such as: (1) your own pocket (direct taxes on you); (2) sales & VAT taxes (an indirect tax on you); (3) "use" taxes (another form of indirect tax on you); and everyone's favorite, (4) taxes on businesses that you may or may not patronize (yet another form of indirect tax on you).

The distinction between direct and indirect taxes is this: Direct taxes you have to pay or else your property could be sold to pay the taxes or you could be jailed. Indirect taxes are taxes you pay on goods & services that choose to consume or use; there is no legal penalty for not consuming or using them.

One way or another you pay for public services. "There is no such thing as a free lunch."

Re:You have to pay for using an ambulance?

[thsths]

> One way or another you pay for public services. "There is no such thing as a free lunch."

Did anybody claim that public services just happen? No, of course they are paid for, but they are (or can be) free at the point of delivery. That means everybody can afford them, whether rich or poor. It is part and parcel of what most countries consider to be part of "a minimum standard of living". And it seems hard to argue with that, because dying for lack of medical care can hardly be called any standard of living.

Taxis work too.

[Anonymous Coward]

Iâ(TM)ve rushed to the hospital in a taxi and it was fine. Uber makes no diff

Re:Taxis work too.

[jellomizer]

Taxis are not as available in non-urban areas, while Uber and Lift are.

Re:Taxis work too.

[Anonymous Coward]

I'd say it is the other way around.

You some words out

[Anonymous Coward]

"This where"
"been able reach"

You words out.

Kansas?

[Anonymous Coward]

Doubt ANYTHING that comes out of Kansas. That's Trumpverse in a flat, barren landscape.

Re:Kansas?

[Anonymous Coward]

Is it physically painful to be this stupid? I sure hope so.

Re:Kansas?

[Anonymous Coward]

Kansas (the state) is so bad even its named-for city is IN ANOTHER STATE! All Kansas is, is dust in the wind.

People have to pay for abulances?

[Anonymous Coward]

You are kidding right? Really?

Wow.

Wow!

[nospam007]

"But an ambulance can cost hundreds or thousands of dollars without insurance. "

I'm European and I can't believe my eyes.
First, here _everybody_ is insured, even the bums living under a bridge.
Second, an ambulance ride costs around 150$ if some uninsured foreigner ordered one.

I guess you're doing it wrong.

Re:Wow!

[Anonymous Coward]

Welcome to GOPcare

These people need to pull themselves up by their bootstraps and walk to the hospital (uphill) like my grandfather used to do. Lazy injured and ill Americans!

Re:Wow!

[Joe_Dragon]

well you need to pay for the deadbeats that just show up at the ER and don't pay. For some that is there only doctor other then the jail / prison ones that do cover stuff that the ER does not.

Re:Wow!

[Anonymous Coward]

Tell me all about your wonderful socialist health care. My cousin lives over there. Her husband started bleeding from his ass. Made an appointment with "free" national health care doctor. Yup, but unfortunately we are not budgeted this year for more colonoscopies, the first available appointment is in six months. Here's a wad of cotton, shove it up your ass, and see you in six months.

He had to fly to Germany, and get everything fixed up by the capitalist pig doctors.

The basic problem with free health care is that it costs too much.

Re:Wow!

[jedidiah]

> Welcome to GOPcare

This has nothing to do with the GOP. This is how it was when a black democrat was still in the White House and even when he had a democrat house and senate.

This is how it's always been.

This is simply paying for what you use rather than turning it into a (underfunded) government monopoly that looks "free" but really isn't.

Re:Wow!

[Anonymous Coward]

French here.

> First, here _everybody_ is insured, even the bums living under a bridge.

No, they are not insured, they just go to the ER and don't pay. It also means clogging the ER which is why people who actually pay for it avoid it unless absolutely necessary.

> Second, an ambulance ride costs around 150$ if some uninsured foreigner ordered one.

Where the fuck do you live? Also, nice "European" using dollars.

Re:Wow!

[mi]

Some time ago we made it legal for people to not pay. With other businesses, a non-paying customer quickly finds himself barred from the establishment. But Emergency Rooms can not turn anyone away for the dirty reasons like "money" — since 1987. And that's just the Federal Law. Various States, no doubt, have their own feel-good legislation, that allows deadbeats to get free evaluation/treatment and continue to not pay the bill.

Whether these laws were passed out of sheer stupidity or with a hidden plan to get us a step closer to the Collectivists' wet dream of "single payer healthcare" is unclear.

Re:Wow!

[Anonymous Coward]

I think it's Germany's system we're envious of, not whatever country you live in. You're aware that Germany has socialized medicine, right?

Re:Wow!

[Anonymous Coward]

This. In 1987 Congress socialized healthcare. Every plan since then, including Obamacare, has just been trying to pay for that decision.

I remember visiting the hospital long ago and seeing the ER crammed full of poor people who went there for every earache and headache because they wouldn't be turned away and wouldn't have to pay. I remember also seeing healthcare costs inflate far faster than the rate of inflation for other goods and services: the ten dollar aspirins, the absurd cost of a hospital room, all going to pay for the poor who abused the free ER. That was wealth redistribution plain and simple, taking from those who could pay to give to those who could not and clogged up the system with trivial complaints. Obamacare was an attempt to get that clog out of the ER and into primary care physicians' clinics, but it imposed other problems like breaking the financial back of the middle class, especially the vast numbers of young men who never see a doctor and who therefore were essential to the risk pools because they had the most to lose financially.

Healthcare is already socialized. Fixing it will mean repealing the free ER coverage and, hopefully, removing the parasitic middleman of the health care insurer. When transactions are between a doctor and patient and nobody else, costs will go down.

Re:Wow!

[squiggleslash]

Some time ago we made it legal for people to not pay.

Nope. Never happened. Been GOP mantra for a while, "Oh, healthcare is already free! Everyone has the right to go to the ER and not pay!" they claim.

And it's not true.

If you go to the ER, you have the right to be treated regardless of whether you can pay the bill. That's it. That's not the same thing. All it means is that the hospital can't insist you have insurance, or run a credit check on you, before treatment.

If you don't have the money on you, they have the right to send you a bill. And you absolutely will owe the money on that bill. If you try to avoid paying, you will spend the rest of your life being hounded by debt collectors, you'll be subject to liens and wage garnishments. Your credit rating will be ruined.

Are hospitals having problems because of that policy? Why, yes! It costs money to go after people who can't pay, and obviously there are classes of people who'll never be able to pay, from the occasional illegal immigrant or other underclass member to, well, to name the obvious class of people who turn up at an ER and then can't pay, dead people.

The fix for that, BTW, is universal healthcare. Real universal healthcare. Make sure everyone who turns up at the ER has paid, through taxes or premiums, for the full costs of treatment ahead of time.

But here's a question: in the current world, what's the alternative?

If you turn up at the ER, and don't have documentation with you that can be linked to either a bank account or a valid insurance policy, should you be kicked out of the hospital? Should they leave you to die? Should they delay administering any treatment until you're able to identify yourself and your intended form of payment?

Because for all your huffing and puffing about deadbeats and "sheer stupidity", that's what this boils down to. Love the status quo as much as you like, but what you're proposing is death by bureaucrat.

Re:Wow!

[HornWumpus]

In Germany, everybody is required to carry health insurance. Most insurance companies are run by states, but private ones exist.

It is a much better system than England's.

Re:Wow!

[mi]

Are hospitals having problems because of that policy? Why, yes! It costs money to go after people

Ok, so you admit, the problem exists.

[...] who can't pay

"Can not" or "would not"?

Real universal healthcare. Make sure everyone who turns up at the ER has paid, through taxes or premiums

How do you "make sure"? Ah, "through taxes" — yes, collect money at gunpoint to be spent later as the government decides proper and, likely, to treat someone else. The typical Illiberal approach to everything...

should you be kicked out of the hospital?

Not "should". But most certainly "could". No one is obligated to work for free — indeed, we denounce such arrangements as slavery. But hospitals and doctors, in the vision you share with the harebrained lawmakers from 1986, can be compelled to treat people who wouldn't pay — and you jeer at any suggestion, that something may be wrong about it, as "huffing and puffing". Sheer stupidity...

what you're proposing is death by bureaucrat.

That's rich, coming from someone, who wants government to further extend its control over subjects...

Re:Wow!

[Wrath0fb0b]

Second, an ambulance ride costs around 150$ if some uninsured foreigner ordered one.

No. It costs much more than that. There is no way you can pay for for EMTs and equipment for $150 a ride.

I'm not saying this because I oppose the idea that society should pay for healthcare. I am in favor of a strong social safety net. But a strong safety net doesn't magically make ambulance rides cost less by helping to pay for it.

Re:Wow!

[Solandri]

There's a company running commercials here called DealDash which advertises HDTVs for $10, laptops and tablets for $20. I was curious how they got prices that low so I investigated. It functions as an auction, kinda like eBay. Except you pay a transaction cost for every bid you make - roughly 75 cents per bid. So if a $300 TV comes up for auction and sells for $10 after 10 bid cycles, the winner will have paid $10 + 10*$0.75 = $17.50 for it. Sounds great, right?

But if you look at the total cost to society, if 50 people made a grand total of 10 bids each on it trying to win that TV, the total cost to all of them to purchase that TV is actually $10 + 50*10*$0.75 = $385. And the company makes a tidy $85 profit even though the winner only paid $17.50 for a $300 TV.

That's what you have to remember when you socialize costs. The price the individual user pays is only a fraction of the actual cost. The rest is distributed over society, paid for with your taxes. So the cost of your ambulance ride is actually $150 + whatever general tax revenue is needed to fund the system. (The price the uninsured foreigner pays is probably the marginal cost - most of the fixed costs like purchasing the ambulance has already been paid for by your citizens, and the foreigner is only paying for a few minutes of the EMT's time and equipment depreciation, and the gas.)

This is why the cost to operate an ICE vehicle isn't just the gas you buy put into it. It's the cost of the gas + the cost of the pollution caused by the emissions. Likewise, it's why EVs aren't zero emissions. All they do is displace the emissions to the power plant which generates the electricity they use. Which means if your electricity is mostly generated by coal, the overall EV efficiency (after factoring in generation, transmission, and charging losses) is about the same as for a gasoline vehicle.

You have to look at the total cost of something to all of society, not just to the individual user or in an individual instance. You can criticize the U.S. for having 2x the health care costs of the OECD average. But criticizing it on the basis of a single ambulance ride cost to the end-user is naive.

Re:Wow!

[guruevi]

Yeah, but you pay 55% income tax and 21% sales tax. The ambulances still have to run, still cost (more expensive) gas. So basically any foreigner that pays $150 is subsidized by you.

Re: Wow!

[Anonymous Coward]

Ha ha. I really like it when an American looks down on socialised healthier. It's like a knight turning up to a gun fight and laughing at the kevlar armour because it's not shiny enough

Re:Wow!

[Rockoon]

Germany's system is the system we got when ObamaCare was passed. Everyone in America is required to have insurance just like in Germany.

Basically you are labeling all the pros of both socialized and privatized healthcare as "because sicialized" while leabeling on he cons of both socialized and privatized healthcare as "because privatized."

You are another dishonest lefty fuck.

Re:Wow!

[Anonymous Coward]

Indeed, so take a look at the total cost of healthcare (adjusted for PPP, if you like) in the USA versus other developed economies.

It's scary. It actually *does* cost way less to provide socialised healthcare. In fact, for the price paid for healthcare in the US by most people, they could contribute their fair share to something like the NHS budget (in the UK) and *also* take out a strong private policy, too - all for less than the cost of their mandated healthcare in the US.

The US system is incredibly inefficient and filled with profit-seeking and inefficiencies...

Re:Wow!

[Anonymous Coward]

You have to look at the total cost of something to all of society, not just to the individual user or in an individual instance. You can criticize the U.S. for having 2x the health care costs of the OECD average. But criticizing it on the basis of a single ambulance ride cost to the end-user is naive.

No. We'll criticize your lack of health care on evry level. Pricing the cost of an ambulance so its unaffordable to even a large percentage of your working population is not providing healthcare. Its denying it.

Re:Wow!

[Actually, I do RTFA]

Why do I have to look at the total cost? Or, to be more blunt, you're making a case that the ambulance ride is subsidized. To which the answer is... duh . It's subsidized because non-US countries decided that saving lives is the government's job.

Re:Wow!

[Anonymous Coward]

So what's wrong with that in healthcare? Today it's me, tomorrow it's you, the day after tomorrow is my child, the day after that is your father... and so on and so on. In the end the whole society paid for everyone who needed it. No less or no more than what it would have been for everyone to pay individually. Except that you needed an operation that the hospital, the surgeon, the anesthesia guys and so on asked for $10k each, and you don't have $120k (only have $8k in your bank account), the bank won't give you $120k because you may die on the table and won't pay them back, and the hospital does not offer a payment plant (also because they know you may die). So in this model where everyone pays their own, the majority of people can't actually afford to get the care that they need. In a single payer system the total cost for all the people in the county for a year of all medical services they needed is not higher, it is lower, due to lower overhead of administration, yet everyone got the service they needed.

I don't see you protesting that the army is being financed by everybody's taxes. Why don't you personally sponsor a part of the annual expenses of a single soldier, and then when someone invades your country, only that soldier is allowed to render protection to you, and all the other people who sponsored them. Other passing soldiers will ignore you as you do not sponsor them.

Why should healthcare be different than the army? Your argument is idiotic.

Re:Wow!

[Anonymous Coward]

Germany regulates the price and services that all insurers must offer. Obamacare regulates only the minimum services, not the price. Also Germany's private insurers are nonprofits, so their biggest incentive is to treat customers fairly so they'll keep coming back, not to fleece customers to send high dividends to shareholders.

Re:Wow!

[AmiMoJo]

You are comparing a scam where people pay for nothing (a failed bid) to socialised healthcare where all taxes paid into the system result in some benefit for the payee.

We know exactly what it costs, where the money comes from. We have endless debates about it. But the question is always "how much should web pay?", not "should we pay?" because when we need medical care we don't want to be checking our wallets first.

And I'm not sure how you think insurance works, but that's the healthy subsiding the sick too.

Re:Wow!

[AmiMoJo]

I'm totally fine with that. Foreigners represent a tiny proportion of the users, and I'd rather the ambulance crew didn't have to check my ID and tax status before administering care.

More over, I want foreigners to feel safe in my country, and to bring their tourism money here.

Re:Wow!

[DNS-and-BIND]

Just curious, do you or do you not realize that your nice welfare state was built because you don't have to pay for your own defense? Because if you had to pay for an army, you would never ever be able to have free healthcare for everyone. I bet you aren't aware. The really ungrateful part is when you turn around and spit in the face of your benefactor. I mean, wow...just wow. Criticize the fuck out of the Americans for spending their money on your defense instead of providing for their own people. That's a whole new level of ingrate asshole.

Re:Wow!

[Altrag]

And in the US, every dollar your company pays for your corporate health insurance plan is a dollar they can't add to your paycheck.

As with everything in life, you pay for it one way or another.

Re:Wow!

[Altrag]

*Pre-Obamacare I mean, of course.. when your only real option for health insurance was through your workplace.

Re:Wow!

[Anonymous Coward]

A thousand dollars for an ambulance sounds unusual. In my city if there's an accident and the paramedics come, their ambulances don't charge because they're funded by your city fire taxes. But if you use an ambulance outside that (e.g., to transfer between hospitals, or if you're too sick to drive), then you or the insurance will pay a few hundred dollars for that. But once you get to the ER then the big charges start. A few hundred for something little like sewing on a chopped finger-end or checking for concussion, to $2,000 for an MRI scan or $10,000 for a leg cast. It always cost more than making an appointment with a regular doctor Monday-Friday daytime. And if you're admitted to a hospital, that's $250 a day just for the bed, and a typical total bill will be in the $5,000-10,000 range on up.

That's all before insurance of course. The insurance will get you a bulk discount on everything, and will pay most or all the remaining cost depending on the plan, after you've paid your annual deductible (the minimum out-of-pocket cost before insurance pays anything, typically $0-1,500 for good plans or %1,500-5,000 for bad plans).

Of course there's a law that ER's can't turn anybody away even if they can't pay, but some ER's really turn the screws on you to find a bit of money, and make you fill out paperwork to get "charity care", and arbitrarily approve or deny your application after a delay. The net result is that the obviously indigent get free care (with maybe some paperwork and humiliation and delay), but the not obviously indigent get denied and told, "Show us a credit card with $5,000 available or pay a $5,000 deposit, and then we'll take care of you."

Re:Wow!

[Anonymous Coward]

In society a certain number of people get sick per year and the total cost is $X. It costs $Y to employ salaried doctors to handle all these. There are actuarial tables to quantify this based on the age profile and health profile of the population. So the cost is not insurmountable for the government to pay, expecially if the doctors are salaried rather than charging sky-high fees just because they can. Or the government can make the recipients pay part of the cost in some manner. There is no advanced country where individuals pay the full cost: even the US has socialized medicine for veterans, subsidized care for (some of) the poor, government insurance for the elderly, and public health clinics for infectuous-disease vaccinations and some services for the poor.

The whole point of insurance is that everybody pays something so the sick people that year don't pay extraordinary costs, and you might pay for somebody this year and they'll pay for you another year, or even if you never use the service you have continual assurance that it'll be there for you if you need it. So there's no difference macroeconomically between whether the government pays or individuals pay -- except to the extent that bankrupt individuals can't be productive members of society, and may suffer unconscionable stress and misery. The problem is the US has a very inefficient system that skyrockets total costs, and individuals get stuck with these costs and go bankrupt. But the inefficiencies *don't* occur in government-run plans where they can control costs: Medicare has much less administration overhead costs than private plans, because it doesn't have big marketing expenses or shareholder dividends.

Re:Wow!

[Anonymous Coward]

People in countries that pay 55% income tax and 21% sales tax generally say that they get more for their money than Americans get spending their tax savings for similar things. In France for instance you don't have to save your take-home money for certain very-expensive services you might need, so most of your remaining check can go to discretionary spending and maintenance costs (rent, utilities, food).

And in Finland, which is similar, people see a "freedom" in their social programs -- the freedom to not be dependent on your family, spouse, or charity. The freedom to be an entrepreneur without worrying that if it fails you might become homeless, have no healthcare, and no access to education. The freedom to not marry because you don't need your spouse for financial security, so you can remain single or marry purely for love. Americans look at it the opposite: freedom from dependency on government. Finns look at it as freedom from dependency on all these other things that distort relationships and incentives.

Re:Wow!

[ImdatS]

You know, one thing I learned over the last 20-30 years is that one of society's purpose is that those who are better off help those who aren't.

I live in Germany and make a decent living. I don't go to the doctor very often (last time, apart from dental, was about 5 years ago and that because I had a very bad infection after a dental surgery). But I think it ok that I pay 6.5% of my gross income (and my employer another 6.5% of my gross income) into a health care system where everybody participates. This is part of being member of a society for me: solidarity with those who can't afford those things that more wealthy people can. And no, I'm not talking about the rich or super-rich. The rich people won't give a shit about poor people, unless you make it (somehow) legally mandatory.

I've spent a few years working in the US and realized how abstruse the US healthcare system is. A friend of us got sick in a restaurant, we called an ambulance (because she couldn't stand up anymore). When the ambulance arrived, they treated her a bit and asked her to transport her to a hospital (and yes, we were in favor of it). Because (at that time) she didn't have health-insurance, she refused because the cost would've been too high for her.

In Germany, that would never had happened. They wouldn't even ask in a situation like this and instead transport her to the hospital.

The life of a person is worth more than anything that money can buy. And who can say whose life is worth more than someone else's? Is the life of a poor person worth less than the life of a rich, or wealthy or middle-class person?

For me, healthcare is as basic a service as infrastructure, security, and rule-of-law: a society's job is to provide these services to anyone regardless of their income. We have governments because we decided that having such a centralized organization helps providing these services better than if we'd leave it completely to the market economy.

In Germany, everybody has a health insurance. If you can't pay for it, the government will pay - and we all, those that have enough income, participate in this social system. Admitted, it is not perfect and there are loopholes where the rich people can opt to privately insure themselves. But we are currently considering changing that, too. You can always opt to add private insurance on top of your government-mandated health insurance and that will stay. But the government mandated will be enough for about 80-90% of the people.

The great thing about it is that if you are employed, half of the insurance must be paid by the company. It is, after all, in their interest if their employees are not sick too often or get the best treatment if they get sick. And, again after all, the companies are part of the society and they need to do their part as well.

I don't want to live in a society where everybody is "his next" - we don't need societies for that. What we need societies for is that the strong help the weak, that the rich, wealthy or even middle-class people help those that are in need of their help.

Yes, governments are not the most efficient to do so. But markets are even worse. Thus, in Germany, we have an economic model called the "Social Market-Economy". It is quite ingenious and it helps that we have quite a high well-being.

This changed the last 20 years - to the worse - but I'm confident that the backlash will be large enough that it will change back to the better in the next 20 years. Most people, even (and especially) in business realized that the German Social Market-Economy is better than the anglo-saxon capitalism - at least for Germany. And this will bring about the change in the next 20 years.

Re:Wow!

[guruevi]

There has never been a case in the US where ambulances checked your ID and tax status before administering care.

What did happen pre-Obamacare was they would take you to a hospital, treat you and then worry about your insurance/costs. If you had no insurance, then you would have to pay for it, which is why you choose not to pay for insurance after all, although pretty much everywhere you didn't have to if you were poor enough. Also, your medical debts couldn't be collected upon and would just sit there until you died. My wife actually delivered a baby, free of charge because she didn't have insurance and some federal program kicked in.

Post-Obamacare, you will still get treated although now you are forced to pay both for insurance and for the treatment. If you can't pay, your medical debt gets sent to a private debt collector. My wife recently delivered another baby and even though we can't afford the bill out-of-pocket (did I mention, we have a "Gold Obamacare Service Plan", the bill now gets sent with threatening letters and we're forced to enter into a credit agreement, not a big deal, because I can pay it but it's on my credit report, which was previously illegal.

Re:Wow!

[Anonymous Coward]

Just having insurance gives you a bulk discount on all the costs, because the rates have been pre-negotiated between the provider and the insurer. And then the insurer pays part of the cost, which may be all of it or nothing or somewhere in between depending on your specific plan and whether you've paid your annual deductible (the first $X dollars of costs that year). guruvei's comment implies the insurance never pays anything, which is false. And it definitely gives you a price discount even if you have to pay all of it.

For people without insurance, individual providers may give them a 10-20% cash discount to match what they'd get from insurance, especially because the provider gets the money immediately and certainly rather than going through the months-long uncertainty of insurance billing, but this is totally up to the provider's discretion, and most will only do it for a few patients they've had a long-time relationship with.

Re:Wow!

[Agripa]

In Germany, everybody is required to carry health insurance.

Why not just require that nobody get sick or injured?

Ambulances are expensive

[alkurta]

An ambulance ride can cost $1000 even if you have insurance.

Re:Ambulances are expensive

[thegarbz]

Really? An ambulance doesn't cost a cent in most first world countries.

By the way, what's Ambulance insurance? Is that like the volcano insurance the salesman tried to sell Homer Simpson?

Re:Ambulances are expensive

[Anonymous Coward]

Really? An ambulance doesn't cost a cent in most first world countries.

Yes, really. Nearly every News @ 11 (local news) includes a story that ends with someone refusing to be taken to the hospital (presumably because they fear the cost). It's sad.

The US medical system has good points & bad points. The inequality of access (based upon $$$/insurance) is one of the bad points. Obamacare (formerly Romneycare) was an attempt to rectify that bad point without disrupting the existing good points.

For some reason, access to decent healthcare seems to have become a partisan issue.

In other words

[jbmartin6]

Taxi licensing laws are killing children.

Backwards

[holophrastic]

Community services a) are meant to be used; and b) get better, cheaper, and more effective the more we use them.

This 7% signifies three things:

1) that some people were calling for ambulances when they didn't need any medical care en-route to the hospital. Ambulances aren't taxis. These people should have been taking taxis or asking a neighbour to drive them. You don't need to pay a stranger to help you. You live with others.

2) that there are some people calling uber when they should be calling an ambulance. Medical issues can get worse en-route, especially with added delays and random things that can happen -- accidents, weather, traffic, jostling, tripping, indigestion, et cetera. Expert medical professionals are a good idea when there's already something seriously wrong with you (serious enough for a hospital visit) simply to ensure that nothing else happens to you also. Like my doctor says, once you're sick, you can still get another sickness too.

3) your ambulances are far too expensive. Ours cost $45 - Canadian Dollars. Always. That's it. And you won't get the bill for about a month. That's a driver, two paramedics in the back with you, the ambulance itself, and nothin' but green lights all the way. It's cheaper than a taxi -- as it damn well should be! Strangers pull over, delaying their plans, whatever they are, for your medical benefit. It's probably the most beautiful thing in the history of civilization. And I think it's the greatest achievement of mankind.

Re:Backwards

[jedidiah]

Your ambulance doesn't cost $45. That $45 is just your "copay". The price is much more and you are paying for it in some fashion.

You're just charged for it in a manner that makes it easier to kid yourself that it's free. You're the proverbial slowly boiled frog.

Re:Backwards

[Anonymous Coward]

Your ambulance doesn't cost $45. That $45 is just your "copay". The price is much more and you are paying for it in some fashion.

You're just charged for it in a manner that makes it easier to kid yourself that it's free. You're the proverbial slowly boiled frog.

Or perhaps, the additional cost is spread across the population by some weird mechanism, such as insurance or taxation. <Gasp!>

In the US we don't really believe in that, as it'll allow poor people to obtain treatment just likes their betters can. Not the American way at all!

Re:Backwards

[holophrastic]

If I use an ambulance ten times a month, it'll cost me $450. If I use it zero times, it'll cost me $0.

Nothing else is variable. My taxes are lower than yours -- I promise.

Re:Backwards

[holophrastic]

You're very correct. In your country, healthcare isn't a right, it isn't a luxury. It's a status symbol.

That would be all fine, in theory. I can accept the concept that not dying in the streets is a status symbol -- hey, it would certain motivate me to work harder.

The problem is that, in practice, you pay more taxes than we do. You get far less out of those taxes too. And, overall, while you have far more "control" over what you do and don't get, and over what you do and don't deserve, you wind up all getting a whole lot less than we do.

I don't know what else to say. You pay more, you get less, you have more and bigger problems.

Personally, I couldn't imagine a scenario where I get hurt, and my first thought is anything but calling an ambulance. I stub my toe, and 9-1-1 is my first thought. But all healthcare is no-cost or near no-cost here. My family doctor is a ten-minute drive, available at a moment's notice, and free. The drugstore across the hall is peanuts.

I can't imagine worrying about my pain and my pocketbook at the same time.

Re:Backwards

[Agripa]

1) that some people were calling for ambulances when they didn't need any medical care en-route to the hospital. Ambulances aren't taxis. These people should have been taking taxis or asking a neighbour to drive them. You don't need to pay a stranger to help you. You live with others.

2) that there are some people calling uber when they should be calling an ambulance. Medical issues can get worse en-route, especially with added delays and random things that can happen -- accidents, weather, traffic, jostling, tripping, indigestion, et cetera. Expert medical professionals are a good idea when there's already something seriously wrong with you (serious enough for a hospital visit) simply to ensure that nothing else happens to you also. Like my doctor says, once you're sick, you can still get another sickness too.

So we should blame the people who lack medical degrees and are not licensed by the state to practice medicine for misdiagnosing their own condition? That makes as much sense as blaming people who rely on the expertise of banks to approve their home loans.

Maybe...maybe not.

[Rick Zeman]

Since when is correlation causation?

Re:Maybe...maybe not.

[Altrag]

Since journalists weren't scientists so.. basically always, assuming you only ever read the newspaper stories and don't care to dig into the actual papers and whatnot for yourself. It probably doesn't help that the major publishing organizations for research papers call themselves "journals," even though they have nothing to do with journalism in the newspaper sense of the word. I'm sure there's some historical reason for that but its certainly a bit weird by today's common usage of the words.

Do Uber drivers want sick people in their car?

[schwit1]

Would you want someone with a communicable disease in your back seat? Do you want to be the next passenger?

Re:Do Uber drivers want sick people in their car?

[jedidiah]

> Would you want someone with a communicable disease in your back seat? Do you want to be the next passenger?

We have Measles outbreaks at Disneyworld and Noro outbreaks on cruise ships. International airports are an international germ exchange. You have annual flu season. If you think you only have to worry about people going to the hospital, you're really kidding yourself.

Re:Do Uber drivers want sick people in their car?

[thegarbz]

Would you want someone with a communicable disease in your back seat?

The vast majority of Ambulance patients do not have communicable diseases. They have things like severe sprains, fractures, maybe blood sugar problems, or any of the most of the other things that people can have affect their health which they are unable to pass on to others.

Re:Free advertising for Uber! They must be rejoyci

[ShanghaiBill]

It's as if the other more than 10 ride sharing companies/services just do not exist!

People use "Uber" as a generic term, sort of like when you google using Bing, people also uber using Lyft.

Free business advice: Don't use a common generic word as your company name. Even if you do something cute with the spelling, it will still sound awkward to say "I am going to lift a ride". If people don't say it, they don't think it, and if they don't think it, they don't use it. This mistake likely cost Lyft more business than their stupid pink mustaches (at least that was fixable).

THINK like a lawyer

[p51d007]

You know this can happen. Call a ride share place, to take you to a hospital. Die before you get there because you are concerned about paying for an ambulance (can't blame ya!). Lawyer sues the ride share company because you died (through no fault of their own). You know it is a possibility.

Re:THINK like a lawyer

[Anonymous Coward]

They'd have no hope in hell of winning that one.

But...

[14erCleaner]

What about Lyft? When Uber is consuming all the oxygen, Lyft might be the only thing to keep some patients alive.

Back in the day

[Holi]

People used to use Taxi's for this same reason. Eventually Taxi's stopped taking fares to emergency rooms due to the liability they were exposed to. When Uber gets sued because someone dies on their way to the hospital expect this to end quickly.

Re:Back in the day

[avandesande]

People who drive uber don't have anything to sue for.

Uber ~= Taxi (or Lyft)

[rsborg]

Uber must be rejoicing over this "free advertising."

You see, when it comes to "ride sharing" all media talk about is "Uber," "Uber" and more "Uber."

It's as if the other more than 10 ride sharing companies/services just do not exist!

Doesn't everyone know that Uber is the "kleenex" or "coke" of their respective market?

meaning, it's a name brand that belies the actual choice made (Uber could mean "taxi" if that happens to be less friction - like ride from the airport).

Lower capability ambulances?

[Wrath0fb0b]

Doesn't this scream out for some kind of service for non-life-threatening conditions that's significantly less capable (and cheaper) than our existing ones?

I mean, I can understand why it's not socially optimal to send two trained EMTs and a ambulance full of cutting edge equipment for a caller that cut his hand while slicing a bagel and needs to go to the ER for stitches. The caller isn't going to die in the next 2 hours (note: if the ER is busy they'll logically wait while more dire cases are handled first), all they need is gauze (or if they already grabbed a t-shirt, it'll be fine).

What's more, sending them in a low-capability ambulance frees up the kitted one with a defibrillator and full set of drugs for someone that really needs it. That is, allocating resources efficiently saves money but it also can save lives.

Sadly, I guess we can't get our shit together here so we ad-hoc a solution with Uber, lmao.

Re:Lower capability ambulances?

[Altrag]

Trouble with that is that it then places the burden on the 911 operators to determine whether you need a "high capability" or "low capability" ambulance, and all they have to go on is whatever you tell them so there's a very high chance that they'll make the wrong call given that some people freak out over a hang nail while others have half a limb chopped off and think it'll be fine and finish whatever they were doing before they even bother calling.

To some degree of course, the same argument could be made against an Uber driver having to take someone to the hospital -- they'd have to decide on the spot whether they'll take the fare or call an actual ambulance (and even more wait time for the patient.) But the hospitals can't control that one so there's not much to be done about it short of Uber blanket refusing to take people to the hospital at all and throwing the onus back on the ambulances.

Re:Lower capability ambulances?

[Wrath0fb0b]

But they already need to know that because they need to know whether to send a high capability ambulance right the fuck away or whether it might have to wait.

The entire emergency medicine system is critically centered around triaging each patient in order to have a clear sense of priorities.

911 / Hospital also don't push ambulance

[rsborg]

I've had to call 911 or Hospital emergency line a few times over the past several years (elder parent who's prone to issues + kid injuries). In most cases, they don't push you to get an ambulance. In one case, the ambulance arrived and said it'd be cheaper if we drove our daughter in (they took a look and determined it wasn't a critical injury), so that's what we did.

Uber/Lyft/Taxi instead of ambulance makes a lot of sense if you've talked with the appropriate folks to make sure there isn't a need for blood/oxygen/IV or EMT during the ride over.

He had a Congress full of Republicans

[rsilvergun]

and for historic reasons some of them had a 'D' next to their names. Also, what does Obama's skin color got to do with any of this?

Google the phrase "Wallet Biopsy". Look up the cost of Single Payer Health Care vs our current system. You've been had (assuming you're not an insurance company shill). No joke, we could pay off the national debt in 10 years with the savings from Single Payer Health Care.

Re:He had a Congress full of Republicans

[Altrag]

what does Obama's skin color got to do with any of this?

Its the Trump era.. blatant racism is the only argument you need in any discussion!

You can't get chemotherapy at the ER

[rsilvergun]

or any other kind of long term care. They just patch you up enough so you don't die then and there and send you on their way. The idea you have healthcare because of the ER is a bold face lie meant to trick you into supporting a for pay insurance company that pockets trillions of dollars while providing less than no service. I say 'less than no' because they actively fight you when you try to use the product _you_paid_for_.

ER worthy isn't necessarily ambulance worthy?

[Anonymous Coward]

Father of 4 here. US east coast. We've taken all kids to the ER multiple times. The first kid more than was warranted, in retrospect. We never considered an ambulance. I'm unsure what our bar would have been for us to call 911 - but cost of ambulance wasn't one of them.

I cannot help but think that Uber is enabling uninsured, to too easily get to the ER.

Ain't nothing to do with Dems or Repubs

[Anonymous Coward]

Anyone who thinks this has anything to do with Democrats or Republicans, think again.

It has everything to do with wanting the following parameters:

1) We want to have ambulance care available.
2) We generally don't want to charge anyone not actually transported (to avoid people NOT calling the ambulance when really needed.) Almost any US jurisdiction, an ambulance can be called for and there will be no charge unless transport happens. At the same time, the crew can and DOES have an obligation to render appropriate patient-desired treatment even if patient refuses transport. Charging for non-transport only happens if the calls are so egregious that there is no medical condition present, usually. But I digress.
3) We generally don't want to tell people there's no ambulance available for them or that they'll have to wait an hour. (This can still happen rurally, but for the most part services align themselves so that there's always a neighboring unit available in less than a certain timeframe.) So a small town might have two or three ambulances, for example.
4) We don't want to make this a generally taxed service. (That is, no charge to the caller and the crew is paid 100% by taxes.) This can avoid people calling the ambulance for a hangnail - sometimes, anyway.
5) We don't want to establish any rules beyond statewide level for emergency care, and even then how care is parsed out is determined at the county level.

So we have the system we have. It ain't a D thing or an R thing particularly.

No, ride share isn't proper for an ER

[Anonymous Coward]

Because most of what comes into the ER isn't proper for an ER, either.

Things do vary, and it wouldn't surprise me to see a rural area for which the ER is the primary point for all acute care. However, for the most part an ER in the US exists to supply immediate acute care for patients with immediately life-threatening conditions. Heart attack, stroke, anaphylactic shock, shootings / stabbings and similar actual EMERGENCIES. Some ERs have an associated minor care facility but that is really separate from the ER legally and usually physically. An Uber should never take someone to the ER, because if it's ER worthy it is likely also ambulance worthy.

The vast majority of what people consider emergencies actually aren't. And the proper venue for these is a primary care provider, an Urgent Care / Prompt Care or similar, or a Community Health Center. You may have to wait until they're open, but if you can you should. THOSE are the kind of patient care situations an Uber can take care of.

The funny thing is... if you show up at an ER with a non-emergency the law says they must offer you an assessment/evaluation and treat any emergent condition. But you'd probably get better care at the proper facility. In fact, an ER can NOT provide you with primary care services - only treat the immediate acute injury and cut you loose and tell you to follow up with a physician, because doing so (using ER resources for nonacute care) is billing fraud.

Amusing because....

[Anonymous Coward]

Of course in civilised countries with decent health care, ambulance transport is free.

That's gogin to be a lot of fucking use.

[RockDoctor]

Uber don't operate within about 150 km of home. The nearest emergency room is about 2.5km away. Thoroughly useless.

Importance of insurance

[AlexPhilton]

Medicine is the main and important element for the health of society! After all, we get sick, sometimes die unknown what.... Therefore, it is important to insure their lives and health. On the website: https://generalinsurance.com/ you will go to the sections: health insurance, life insurance - learn where and what is best for you!