The regulation that this article tries to pretend is the problem is actually what protects so many people. Uber drivers are not harmed because the government doesn't recognise them as independent contractors, they are harmed because they aren't recognised as employees. Independent contractors should hold the power in the relationship not the other way around. As it currently stands independent contractors are just a way for companies like Uber to avoid paying taxes, sick pay and any other number of hard fought rights.
I agree a company like Uber and their workers' incentives do end up misaligned in certain ways, and when that happens the contractors often end up losing. But that is all because of this system that we continue to perpetuate, for really no good reason imo. As I heard it phrased by an economist once, why do we look to the government to create jobs and look to private corporations to protect workers? Surely the incentives & competencies would be better aligned the other way around.
If all of the basic, expected workers' rights that we've come to expect were decoupled from full-time employment, surely removing that friction from both workers and companies would be beneficial to the economy.
A couple years ago I left a full-time job to work on a new startup and the overhead was surprisingly stressful - making sure to set up COBRA correctly because it's all but impossible to find good health insurance as 3-person company, and if you do the process wrong you just won't have health insurance for the year. Your 401k was tied to your job so you can't keep contributing without setting up some other system. And this was just transitioning to a new, funded company, I imagine quitting to become a freelancer or independent contractor would be even more confusing.
I suppose it's in companies' best interests to keep this stuff convoluted and keep themselves in the position of power by having built up the knowledge of understanding this stuff. But if we passed laws to change these expectations (Obamacare is at least a step in this direction) so that companies just paid cash and it was reasonable to set up these things yourself, it would make workers' lives so much simpler. And our society wouldn't have to keep having this argument, plus all the lawsuits that stem from it, about whether or not Uber or anyone else should be covering more of these "benefits" for their employees.
> But if we passed laws to change these expectations (Obamacare is at least a step in this direction) so that companies just paid cash and it was reasonable to set up these things yourself, it would make workers' lives so much simpler
You can go one step ahead and make it completely automatic: you get health insurance the moment you are born. You retire the moment you need to. You are automatically insured against unemployment and other mishaps. You get free schooling for as long as you need. It can all be funded by taxes, personal and corporate.
"Surely the incentives & competencies would be better aligned the other way around."
Or, make it easier for Uber drivers to form a union or do other forms of collective bargaining. If there is a more equal balance of power, it should reduce the need of the government to be involved in setting the rules.
I agree with your point that health and retirement benefits should not be coupled to the job.
I don't disagree with you that those are problems, but isn't the low friction to "hiring" an Uber driver, or renting your room on AirBnB, or picking up odd jobs via Postmate, part of what allows them to function?
Some of these are a bit more like real independent contractor relationships than others, so I don't think entirely the same questions are implicated. For example, someone renting rooms on AirBnB can set their own rates, house rules, minimum/maximum stays accepted, etc., which makes them much more like an independent contractor merely using AirBnB as a storefront/marketplace, than like an AirBnB employee.
Signing up for a job as an independent contractor agreed upon by both the contractor and the company...and then after the fact being told that they are actually employees isn't protecting either party involved in the initial agreement. It's using the government to protect OUTSIDE parties by by crippling the business with additional expenses.
Before the overreaching government stepped in and got in the way, parents had the freedom to get gainful employment for their idle children.
Some parents even took it upon themselves to increase their productivity by having the kids do piecework at home. For example, 6 year olds were able to roll cigars at home.
What is the premise of your argument here? That bad things happened in the past so there's now no such thing as too much regulation?
Because child labor existed we should now consider independent contractors employees...?
Care to actually provide a somewhat coherent response instead of baselessly denigrating the parents ideology and implying it represents forced child labor.
I find this kind of cheap, tangentially related strawman so intellectually lazy it's actually offensive.
Your argument for why Uber's workers should be able to sign themselves up as independent contractors can be used to show that children should be able to work in mines, fast food workers should be able to work for minimum wage, and generally that employees should be able to sign off on giving up any and all employment rights.
The point is that either you need a new argument, or you actually believe all of those things.
Keep in mind that I have not actually taken sides on the issue at hand; I'm just claiming that your particular argument is a bit flawed.
My argument is that as a legal adult you should have the ability to make your own decisions. Children in mines do not apply. Kids working for McDonald's at 16 do not apply.
Grown adults should ABSOLUTELY be able to sign off on giving up any and all employment rights if they so choose, as long as they are free from duress when making that decision.
If you can agree to volunteer at a company you should be able to agree to any level of compensation above "volunteer". It is simply, your choice. Nobody is forcing you to do it.
It wasn't my arguement. Care to clarify which argument you're attributing to me?
>The point is that either you need a new argument, or you actually believe all of those things.
No. I can't find one arguement in the thread above that requires 'believing all these things'
-children being able to work in mines(appeal to emotion) is tangentially related we aren't even discussing child labor here.
-fast food workers should absolutely be able to work for minimum wage, I did. Should it be raised? I think so, but again this is a tangentially related appeal to emotion.(seriously what did you mean with this one other than 'feel bad for poor people'? How is minimum wage relevant in this context?)
-Employees should be able to sign off on all employment rights?
Look a relevant point, and generally I agree they shouldn't be able to.
Can you please clarify exactly how this arguement of mine can be used to show the three things you've outlined?
Edit:
The funny thing is I don't even disagree with you or the grandparent on the underlying issue here, I just find this constant strawman bullshit so grating.
Apologies for confusing you with brightball; I didn't notice that you jumped in after the back-and-forth.
The entire argument put forth was that the government can't annul a contract agreed upon by both parties (even if it is illegal under current law). Which is how pretty much all labor laws. It is a completely generic argument. Once we admit that there are exceptions (oh, but children can't form a contract!), the generic argument has been thrown away.
Society reached consensus a long time ago about what an employee is and isn't. Companies have been nipping at the edges of this for years to push more risks on "independent" contractors, which in reality means pushing business risk to society at large.
...Which I think would be fine - employment liquidity seems good just like monetary liquidity - except that we do a shit job of providing benefits (like health insurance, and maternity/paternity leave) via the government.
Making them employees of Uber isn't an answer. Making a Union isn't an answer (I don't think; again, too much overhead, and the point isn't negotiating power anyway). Government probably isn't an answer (regardless of "should", look at effeciveness). Maybe needs a rethink from first principles?
> employment liquidity seems good just like monetary liquidity
Right, but such liquidity is formed either on the basis that individuals don't have to work to survive, or on the basis that employees are so scare and desirable that mobility becomes a non-issue.
I don't disagree that we could address some of these problems by starting over from first principles, but that kind of change takes lifetimes to implement -- we still have to do something about the current people.
Of all those you mentioned, this is the only one that applies:
* When 'this task' classifies you as an employee of the payer and the compensation is under the minimum wage.
That part right there is the problem and is why the entire issue is ridiculous. Every contract programmer should be an employee of the company that they are contracting for. Staffing firms should virtually be out of business. The only thing that minimum wage laws do for society is widen the divide between "Volunteer" and "Paid" because everything in the middle is deemed illegal for reasons that provide no discernible benefit to society while decreasing available jobs and encouraging companies to simply go to countries where they don't have to deal with:
"Well, I can afford to pay you $10 / hour for this job and I realize that you want to take this job for $10 / hour because would be very beneficial to you right now but unfortunately the state says that's not enough so I'm going to have to hire somebody in China for $10 / hour instead. Hopefully the welfare or unemployment office can help you out. As you are aware, the state knows what's best for two people to decide is agreeable."
It has always been illegal if an employer tells you you're an independent contractor but without meeting the requirements of an independent contractor relationship.
Last time someone ignored that, it cost them $240 million. I'm interested to see how much it costs Uber.
Taxis and public transportation systems SUCK. At least within the Los Angeles area.
It's obscene to pay regular taxi fares. You can take the bus but good luck getting anywhere within a reasonable time and with the risk of some stupid random event that slows the process down. Not to mention the cognitive taxation of being around strangers of varying quality. It's not something you think about until you're in the bus and you're standing up and the guy behind you smells and the bus is stuck in godamn traffic and you have 30 more godamn stops to go...
Uber and Lyft and the other ride-sharing apps are positively godamn humanitarian in comparison to having to use the other options.
I have strong feelings because discussions that focus on the needs and wants of bus drivers and taxi drivers ignores the heavy taxation laid onto the customer for the crime of not having a car (at least in LA). I would rather a hundred thousand more rides accomplishing the personal goals of a hundred thousand people than a thousand pensions for a thousand bus drivers.
As a fellow Angeleno, this mirrors my experience. Public transit is getting better, but it's still not there, and the taxis pretty much suck in all the ways it's possible to suck. Worse vehicles, worse drivers, worse prices, more hassle.
(I think the next hurdle for LA Public Transit is express busses / trains, that DON'T stop everywhere.)
Except if ride sharing services are hobbled, a great public good is hit in the knees in favor of ideological adherence.
I don't think the same standard of employee protection applies to something like being a driver. I don't think you could apply the heavy hand of regulation without fucking over more people than you think. The moment you get the modern state on in, you get professional rentiers sniffing out any holes they can put roots in.
This isn't children being abused by clothing factories. These are an entirely new class of people and provider who are enabled by the fact that the regulatory appartus doesn't choke them before they even make their first step.
The problem is competitive market forces, uber does not increase the number of people who want rides enough to offset downward wage pressure. Supose you work 30 hours a week for minimum wage, uber unlike most jobs lets you back fill even sub minimum wages after costs. So now those workers displace people unwilling to work random shifts as needed and taxi drivers who can work below minimum wage creating an ever growing downward spiral.
In the end when one player gets to ignore the rules they will do so making things worse workers industry wide.
Do you realize that these companies would never have existed in the first place if they had to do those things?
It's objectively better to have Uber and not regulate it than to regulate it and not have it. And make no mistake, that is the choice that is being made here.
> It's objectively better to have Uber and not regulate it than to regulate it and not have it
How is that "objectively better"? What's the limit on regulations that, in your opinion, should be removed if they threat Uber capacity to make money? Or there is no limit?
I think it's pretty reasonable to let two consenting adult parties enter into a short term agreement to provide a ride in exchange for a fee. An Uber driver doesn't have to show up to work in the morning - they can look at the rate on offer at the moment and decide whether or not they feel like driving. You could be an Uber driver for 1 hour a month if you wanted to. It is about as independent as a contracting relationship could possibly be, and I see no reason for the government to interfere in that extraordinarily simple, non-coercive relationship.
If you don't like Uber's terms, just don't drive for them. If you only feel like it's worthwhile to do so when the fares are high enough - wait until they are, if enough people agree with you, then the fares will rise on a permanent basis.
> It is about as independent as a contracting relationship could possibly be
I completely agree that is really independent. And that is what leaves one of the sides completely unprotected. At one side you have Uber that has a big business (that can mean a lot of investors around the glove), lots of money and lots of drivers. It can decide unilaterally to increase/reduce prices as it is better for them. At the other side you have a lot of drivers competing for a small part of the pie. They cannot change anything else than stop working for Uber, and that has a negligible impact on the big company. The only way to compensate for that is for drivers to create an alliance that allows them to actually be able to have negotiation power. And THAT is what the government does with regulations and taxes. They are representing the citizens that want a better quality service, they are representing the citizens that want to drive for Uber and have a fair pay.
Isn't reasonable to let consenting adult citizens to enter into a long term agreement to provide companies, employees and consumers with fair negotiated norms? Why is Uber allowed to bring capital from as many investors as they want while the drivers should not be allowed to organize themselves?
Ya, I agree they are in a much weaker bargaining position. But I guess the way I see it is that at each particular moment, these drivers are making the conscious choice to continue driving.
If at any moment they feel like stopping and looking for other work, they're totally free to do that. So on the one hand, Uber does set the prices and has lots of leverage because of that - but on the other hand, they are pretty beholden to the drivers, because if they set the prices too low, they won't drive. And that might sound a little hollow, until you remember that in most places they aren't even profitable - even though of course they could be if they were willing to lower rates enough. But they must not feel like they have the leverage to do that. Which, IMO, is pretty strong evidence that they don't have undue power if they can't even get themselves a decent margin yet.
I guess from my perspective, when a relationship between two entities is, to this degree, transient, transparent, and independent, it's really hard for me to feel like one of the parties is being exploited to a degree that requires government intervention. If people didn't feel like being an Uber driver was benefiting them, they simply wouldn't do it, or they'd only do it when there were large surge pricing premiums available.
> It's objectively better to have Uber and not regulate it than to regulate it and not have it.
That's a really big assumption and non-obvious.
Uber is currently subsidizing ride costs with VC money. Uber can succeed in driving a lot of taxis/ride services out of business before the VC money shuts off and it implodes leaving people without ride services.
Airbnb can improve the efficiency by moving more people through unused housing. However, that can take away from long term rentals, and also brings problems with it like vermin (bedbugs, etc.) and transient crime.
Whose responsibility is it to clean these problems up? How do we clean those up? Or, do we regulate sufficiently up front that when damage is being done we have some limit to it?
I don't consider it an assumption. Uber reduces transactions costs, increases competition, and improves the user experience of hailing a taxi. They are eliminating deadweight loss.
It is a quantifiable fact that the harm done to taxi drivers is outweighed by the jobs given to Uber drivers (quantifiable in the sense of dollars paid out - Uber has increased the size of the market).
> Uber is currently subsidizing ride costs with VC money. Uber can succeed in driving a lot of taxis/ride services out of business before the VC money shuts off and it implodes leaving people without ride services.
They are actually profitable in the US. However, this is true in many other markets, though I don't really see how its relevant.
> Airbnb can improve the efficiency by moving more people through unused housing. However, that can take away from long term rentals, and also brings problems with it like vermin (bedbugs, etc.) and transient crime.
Why is it a problem if it takes away from long term rentals? And i'm not sure how it would increase vermin, bedbugs, or transient crime, though i'd be curious why you think that might happen.
> Whose responsibility is it to clean these problems up? How do we clean those up? Or, do we regulate sufficiently up front that when damage is being done we have some limit to it?
If there are indeed negative, uncaptured externalities from these things, I think it's fair to price them in accordingly, through some sort of tax or similar system. But i'd like to see better evidence that these externalities are real.
Uber, in its most profitable market, currently makes an average of $.19 per ride[1]. These regulations would substantially more than destroy that margin.
And that isn't even addressing the fact that driver liquidity would be worse because it'd be harder for people to start/stop ubering at will. Which would create inefficiencies whereby they'd have to probably maintain an oversupply of drivers just to meet demand, further compounding their profitability problem.
> These regulations would substantially more than destroy that margin.
Why is that bad, though? The customers (or at least some of them) would go back to taxis, and then either taxi drivers/companies or customers would capture the $.19 that Uber was previously taking. It isn't immediately obvious why that would be worse.
Well, because every single person on earth would be slightly worse off. The size of the ride-hailing market would contract to pre-Uber levels, for one. This means fewer jobs for drivers and fewer dollars paid out overall. The liquidity of the ride-hailing market would go back to taxi-levels. You'd have to carry cash, and the rides would be slightly more expensive.
These might seem like relatively inconsequential details, but the sum of them over an entire economy adds up to billions of dollars of deadweight loss. And in an era of slowing growth, we really shouldn't be throwing these things away because it makes some people uncomfortable.
And yet you are dodging the argument again -- the argument is that allowing Uber to dodge all regulations is bad for Uber employees (while it is of course better for customers). And Uber is not the only company capable of writing a simple mobile app for taxi services. Taxi services certainly can do it (it is not hard) and will.
If it were the case that allowing certain companies to use slave labor were good for the economy (it is) then should we allow that as well? It would make every single person on earth better off. Well, so long as I don't include the slaves that's the case, but as you've chosen not to include the Uber drivers in your characterization I think that's fair.
> And yet you are dodging the argument again -- the argument is that allowing Uber to dodge all regulations is bad for Uber employees (while it is of course better for customers). And Uber is not the only company capable of writing a simple mobile app for taxi services. Taxi services certainly can do it (it is not hard) and will.
I disagree that it is bad for Uber employees. Yes, if you regulate Uber, the employees that remain will be better off. However, there will undoubtedly be fewer of them, and they will have a much less flexible relationship with their employer. Those are real costs that you can't simply ignore.
> If it were the case that allowing certain companies to use slave labor were good for the economy (it is) then should we allow that as well? It would make every single person on earth better off. Well, so long as I don't include the slaves that's the case, but as you've chosen not to include the Uber drivers in your characterization I think that's fair.
It is, at best, arguable whether slavery is good for the economy [1]. However, that doesn't really matter, because slavery violates basic human rights. Two consenting, informed adults entering into a voluntary, temporary agreement to exchange a ride for a fee violates nobody's rights.
>Uber, in its most profitable market, currently makes an average of $.19 per ride[1].
If Uber can't pay real wages and benefits to their employees because they make a margin of $0.19/ride, their business model is pathetic and deserves to be replaced by something more productive and efficient.
Uber already produces enormous amounts of consumer surplus. Two examples would be making it possible to get a ride while black and making it possible to get a ride while in San Francisco. If you feel they should go out of business unless they can live up to your standards cool but taxi regulators will be just as effective at protecting consumers after Uber goes out of business as before it existed.
Most of the problems with taxi drivers (and taxis) is that they are independent contractors. If you think you can offer a better service by controlling what your employees can and can’t do then that is fine, but don’t pretend that they are not employees just to get out of paying taxes and benefits.
The specific group of people is the voting populace of the United States which has clearly defined the minimum wage that is allowed to be paid to an employee and also legally required benefit structure.
They get to decide because they are us and we vote to prevent brutal gilded-age era exploitation and abuse by companies, who are unbelievably powerful and can essentially decide on any terms in the employment contract which workers must accept, unless we vote to make them illegal.
I think Uber drivers should be able to decide what "real wages and benefits" means, and they should have the right to make that decision collectively if they so choose.
I think they get to decide it because they are the ones most directly affected.
The other option is Uber, but I think there's too much of a conflict of interest. Uber's primary interest is to maximize profits for Uber, not to maximize the profits of its subcontractors.
Believe or not, there are people who like to have such relationship. The last thing I would like to see is the end of the freedom of choice how you want to be employed. There is a lot of advantages of not being recognised as employee - like minimal exposure to internal politics, zero red tape, tax efficiency, ownership of your time outside of contract and so on.
The biggest problem with Uber & Co to me is that drivers don't get to set their own rates. That makes it not a marketplace at all. They're so valuable because they get to run a command driving economy, but without any obligations to their workers. Not to mention that they're buying market share with subsidized prices. Basically dumping. That's a lot different than AirBnB to me.
Exactly. I do think the independent contractor model (taxis) does not work well in provide a high quality transport option. There is room in the market for a employee-based model (such as what Uber is running in practice), but they should not get to don’t pretend that their employees are independent contractors just because they don’t like paying taxes and benefits.
Uber is basically a heist of taxi medallions. Uber works best where regulation allow the owners of medallion to extract a large economic rent from their customers. Undercutting taxis in these markets is easy because the drivers don’t have to pay the medallion owners their cut. Uber has proven far less successful in markets (like Japan) where there is no economic rent to be extracted.
It's not just independent contractors that need recognition.
Self employed individuals who rely on near monopolies for their businesses also need protection - at least in the form of better due process.
PayPal
eBay
Etsy
Apple
Google
All these and more have banned people from their marketplaces without any serious form of due process. This might be fine if there are competing alternatives in place, but there are not.
> And worst of all, extraneous lawsuits targeting companies attempting to share helpful information with workers regarding taxes, insurance, and retirement accounts, are punishing the very individuals these groups falsely espouse.
David Loeper's book has a few citations of surveys about how "helpful" the information about 401k plans actually is: https://www.amazon.com/Stop-401-Rip-Off-Eliminate-Improve/dp... tl;dr - 401k plans are a Reagan-era privatization scam; almost no one understands what to choose, which makes it easier for plan management companies and funds to charge ridiculous fees.
David Belk lectures on medical insurance plans (https://www.youtube.com/user/davidbelk46/videos I recommend starting at https://www.youtube.com/watch?v=jkAY15p2DN4). Same deal - deductible, copays, caps, lifetime caps, what to choose? A lot of these plan details deliberately obfuscate the fact that you would spend less paying for medication and procedures directly than the insurance co-pay!
I think you are completely wrong about medical insurance being cheaper to pay out of pocket than get the insurance. Perhaps this is true for some horrible 100$/month insurance. But my bills all come with:
list price, plan discount (usually 30-60% off), next what the ins comp. covers = usually 80% of discounted price, then what I pay, that is a small amount, 20% * 60% * original price. I recently had a drug that wasn't covered by my insurance, they wanted me to use the generic. The non-generic was $288/month out of pocket, the generic cost nothing after the insurance paid their part.
on 401ks, i think you might have more of an argument about costs, but since we don't have an alternative, it would lead to many people having no retirement. there's no law that makes people use 401ks instead of private retirement.
On the whole medical insurance is more expensive than paying out of pocket, otherwise the insurance companies would be losing money and wouldn't exist.
Insurance companies have a built-in asymmetry of information and bargaining power compare to you, and most areas have a monopoly or near monopoly of health care services, such that it is possible to pay more out of pocket than if you had insurance, even if you had the float.
Consider two populations: insurance companies which can negotiate effectively because they know the true cost, and uninsured people who do not know the true cost.
Let's suppose the true cost is $10, but the hospital charges $30. The insurance companies negotiate beforehand to only pay $11, allowing 10% profit. The hospital likes this. The insurance company takes in enough to cover those costs, so it's also happy.
Think also of the person with insurance, who gets the "bill" for $30 and the note that it's been paid by the insurance company. Looks great, yes?
But now think of the person without insurance, who gets a bill for $30. Do they accept the price, or negotiate to lower it? Some will just pay. Others might negotiate it down to, say, $25 - a 33% savings! But to the hospital, that's $10 in profit.
And if the bill uses medical codes and abbreviations that you don't know, then that's more wasted time trying to get up to speed to understand what it is you are negotiating. While the insurance company has an economy of scale.
"Float, or available reserve, is the amount of money on hand at any given moment that an insurer has collected in insurance premiums but has not paid out in claims. Insurers start investing insurance premiums as soon as they are collected and continue to earn interest or other income on them until claims are paid out."
https://en.wikipedia.org/wiki/Insurance
Pardon if I misunderstood, or misinterpreted your post, but you seemed to be saying that premiums must be more than the claims or they wouldn't/couldn't be in business. That is not true.
Even if an insurance company has claims greater than its premiums it could exist, and even be profitable, because of its ability to earn additional revenue through investing its float. You seemed to omit this consideration, which is significant because investment returns on billions of dollars can be significant.
This argument hinges on counting the time value of money for insurers but not their customers. The investment money made on float would instead have been made by the customers if they didn't buy insurance.
I think you're correct in a very specific technical sense (measuring in nominal dollars, that is), but not in the sense that matters in the real world.
Not really. Each individual customer requires much higher liquidity than the insurance company does - it's fairly likely that you'll have to spend your entire medical fund unexpectedly, but incredibly unlikely that every single insurance customer will need to claim at once. Also, investing is a lot more inefficient at small scales.
Well, at that point they're basically turning over a loan again and again. I'd thought they could walk away and keep the money, but I now see that if the insurance truly was unprofitable, they'd be left with nothing by the time the last day covered by their insurance ended.
I have insurance strictly for the emergency room. year over year my deductible and monthly rate have gone up.
I'm more bothered by doctors refusing to charge without insurance. My pcp used to charge 120 a visit, then they went through my insurance. Because I hadn't met my deductible the payment was now 650. I've seen pretty much every facet of medical care go up.
I'm not the healthiest, several neurological issues. But I'm primarily treated by eastern medicine. None of which is covered by my insurance. The budget I allocated for my treatment is now allocated to an insurance I use.
I was in a bike crash a couple of months ago without health insurance. The total was ~$4500 for urgent care on a Sunday, or about 10 months of ACA coverage.
The whole point of medical insurance is to hedge against the risk of medical expenses.
If you're a relatively healthy person, of course insurance is expensive. If you're someone who needs monthly prescriptions, multiple operations, or frequent emergency room trips, it would be absurdly expensive for you not to have insurance.
Long-term insurance business is losing money. It only exists as small insurance companies can re-insure with bigger ones and the biggest get state support.
Also consider that paying out of pocket has transactionall cost and it could be that on average it is cheaper to pay through insurance company.
> list price, plan discount (usually 30-60% off), next what the ins comp. covers = usually 80% of discounted price, then what I pay, that is a small amount, 20% * 60% * original price. I recently had a drug that wasn't covered by my insurance, they wanted me to use the generic.
Can you please read/watch linked sources before commenting? The videos go into detail about "plan discounts." tl;dr - it is basically the same trick as the "50% off sale!" in retail.
I actually tried to pay 100% out of pocket instead of using insurance.
Some procedures may cost comparably if you immediately pay 100% in cash, but these are few (of what I asked).
Some medicines may cost comparably, but prescription medications usually cost so much higher it's not even funny, e.g. $100 co-pay vs $550 out of pocket.
That all great if your only visiting quick care places for minor issues. Wait until your getting a CT scan or a stay in the hospital and let's see how that cash payment works out. Insurance is a gamble regardless, but medical costs are out of control and getting worse.
I'm not sure you can make a good case that regulation opposed to the interests of AirBnB/Uber/etc. is a bad thing for the economy from the point of view of the workers. From that angle, it's zero-sum: the more people who use AirBnB, the fewer stay in hotels; the more who use Uber/Lyft, the fewer take taxis.
Rather, it's from the point of view of the customers that you can make this case: people have transportation and travel options they didn't have before. That effect doesn't necessarily show up in GDP, but it does mean that life is a little bit better on the whole.
> I'm not sure you can make a good case that regulation opposed to the interests of AirBnB/Uber/etc. is a bad thing for the economy from the point of view of the workers.
Sure you can. If I'm a part-time Uber driver, forcing me to be classified as an employee might very well remove a side income stream from me.
It's even more farcical for AirBnB: people renting out their spare bedroom would not otherwise be working in hotels.
> From that angle, it's zero-sum: the more people who use AirBnB, the fewer stay in hotels
Actually, I'm not sure this is true. If AirBnB reduces the cost of temporary accommodation, you might very well see increased travel overall without hurting hotels. In fact, I strongly believe this is true: look at things like the digital nomad movement, which heavily uses AirBnB and would be much less common without modern technology. Right now I'm staying in an AirBnB—if this option weren't available, I wouldn't have stayed in a hotel.
The observation about AirBNB that it increases possibilities for travelling without hurting hotels significantly is spot on.
Personally I know students who would not go to some conferences without AirBNB. Staying in a hotel is just above their travel allowance. Less anecdotal is reports from hotel industry in Norway about record levels of occupancy despite growth in AirBNB and similar services.
Unless the you're one of the 80% of drivers having another job not because you want one, but because being a driver doesn't pay enough. Part time work is allowed, why would reclassification take away the other income stream?
Or if you're one of the many delivery drivers who are only self-employed because the organisation insists. It gives the organisation a means to evade employee regulations and pay despite a 40 hour week, but nothing to the worker.
Yeah, neither Uber nor AirBnB area a zero sum game, esp. ABnB.
There is some 'growing the pie' at the margins, but I'd suggest that Uber Corp. grabs more than what is created, and that drivers et. al. are holding the losing end of the stick.
The power imbalance between Uber Corp. and drivers is quite massive. Esp. without employment status.
Uber is designed to suck every last penny of real margin out of the system, and leave drivers with the absolute minimum.
Worse: because many drivers make short term decisions about their costs, and don't calculate wear and tear into their decisions, it's probably that Uber driving is borderline unprofitable.
Imagine if there was one factory in the world where you could work. You got $10 an hour - just enough to stay alive. But - you are going to get sick and die in 10 years from the toxicity. Well, the real 'market price' for such dangerous work might be $20/hour - enough to pay for health insurance and medicine, but because of short term decisions made by workers who are desperate - it's $10/hour i.e. a 'long term money losing venture' to work in the factory.
I generally like Uber as a concept, but we can't ignore these issues.
Remember that Uber replaced a model (taxis) wherein drivers not only where also independent contractors, as they had to pay at the start of each day to rent a medallion, not knowing if they would earn enough to compensate.
Uber's model seems strictly better than what has existed for decades.
You're missing the most important difference: Taxi market is regulated, and numbers are controlled. This keeps some degree of profits backed into the market.
The other difference is that taxi drivers have generally stable work. A guy can drive a cab consistently for years. The pay is not good, but the economics have to work out.
Cab companies and owners have enough wherewithal to make long term decisions, moreover, the 'drivers' - the ones on the end of the chain - if they are not owners - are not responsible for the fixed costs of the cars etc..
Finally, cab companies are by nature, small - and don't have hyper-leverage over drivers. Cab companies have to compete efficiently for talent among their drivers. If you can call it talent.
Uber is a hyper-capitalists dream - you take 105% of the surplus from a market.
You're missing the most important difference: Taxi market is regulated, and numbers are controlled. This keeps some degree of profits backed into the market.
The number of medallions (ie, jobs) is controlled, which means their owners reap those profits, not the drivers, who must compete with each other for access to those medallions. Uber's breaking of the monopoly expanded the market and created more jobs.
The other difference is that taxi drivers have generally stable work. A guy can drive a cab consistently for years. The pay is not good, but the economics have to work out.
There's no stability, the cost for leasing a medallion was constantly increasing, as was the number of people with licenses to drive (competitors).
Cab companies and owners have enough wherewithal to make long term decisions, moreover, the 'drivers' - the ones on the end of the chain - if they are not owners - are not responsible for the fixed costs of the cars etc..
Where do you think the money comes from? Not being responsible just means they don't get to make choices - they're forced to accept whatever the car owner says.
Finally, cab companies are by nature, small - and don't have hyper-leverage over drivers. Cab companies have to compete efficiently for talent among their drivers. If you can call it talent.
Then why was medallion ownership the single best investment in the last 30 years? Compete for talent? Where?
+ That there are market controls ensures the viability of the system, that alone doesn't speak to necessarily how it was distributed. But you've contradicted yourself - and I don't think you grasp my argument: Uber vs. drivers is an infinitely large imbalance than cab-owners vs. drivers.
Putting the 'profits' in local cab owners - all things equal - is still better than putting all the profits in Uber.
+ "Where do you think the money comes from? Not being responsible just means they don't get to make choices - they're forced to accept whatever the car owner says."
Again you contradict yourself: Uber drives are more forcibly required to 'accept what uber says' - then any cab driver is forced to accept what an owner says. But again you missed point point: Cab companies and drives are businesses, and they can make longer term decisions about insurance and capital allocation. Cab owners will not run their business at a loss. Many Uber drivers, probably are running their business at a loss.
"Then why was medallion ownership the single best investment in the last 30 years? Compete for talent? Where?"
+ One, I don't believe you, and two, they compete for talent (i.e. drivers) like any other entity. Drivers can work for another owner, another cab company. There is a massive diversity of Cab owners in any region. This diversity creates competition. Uber is a de-facto monopoly in the service that they provide, given them even more power.
"Uber has crated jobs" - Uber has created a means for people to get around regulatory issues - earn mostly less than minimum wage, by making short term decisions about their work vs. long term investment in capex (i.e. cars) - and reaps 100% of the profits from a system.
Now - if we want to have a discussion about whether or not cab companies regulatory framework are appropriate, that's fine. But make no mistake - almost all of the benefit from Uber goes to Uber, and Uber riders, not the drivers.
I fully admit I may be wrong, though I don't believe I have contradicted myself.
Are Uber drivers running at a loss? Perhaps. At least the analysis I've seen (such as [1]) don't point to that, especially if we assume drivers aren't buying an extra car exclusively for Uber (just wearing it more). The earnings are crap, but then again, the NYT article I linked above mentioned pre-tax income of $19k, which would be around $11/h today. And there more people driving, so the overall effect is positive.
The monopolization effect is worrying, but while it may be naive, I believe it's a short-term concern. Uber has no "moat" - especially as they refuse to actually hire people, hence they can "hop" between apps -, and while some competitors may be in dire straits, others are still popping up (around here, the new one is Cabify).
I don't like Uber; they're dishonest and I'll probably stop using it as soon as new competition arrives. But I think the medium term consequences will be beneficial to both drivers and users, at the expense of middle men.
You're assuming that people who take Uber would take taxis if Uber were not available. That's a big assumption.
I (like most people, I'd imagine) evaluation my options for each trip:
- Drive for myself. Fast, comfortable, fun, probably a trivial amount of gas, but I refuse to search for street parking and depending on destination I may not want to pay $30+ for a garage space.
- Taxis, which will probably run $25-30 each way + tip, for around $70 spent on transportation for the evening.
- Cycling, which is a no-go in Chicago winter, or when I'm going somewhere nice and don't want to arrive sweaty, or when I'm going home late and don't trust the safety of the bike path.
- Public transit, which will be cheap but excruciatingly slow and a revolting experience on hard surfaces in a harsh florescent-lit car smelling urine, listening to ambient rap music from people's shitty phone speakers, and trying to find something to look at other than the people my seat is pointed at.
- UberX, which is fast but a tad expensive for me at ~$15 for a taxi-like experience (except you can actually get one in my neighborhood).
- UberPOOL, which is usually a "just right" balance of comfort (sit in a nice or at least modern car, look out the window, other passengers are rarely if ever an issue), speed (the routing algorithm does do ridiculous things, but rarely), and cost - usually around $7-$10.
- Not go out because I don't want to put up with public transit or spend what it costs for private transit.
Withdrawing Uber won't put me in a taxi, it'll put me in my own car, occasionally public transit, or more likely staying in and ordering delivery.
Same with Airbnb. I take longer vacations, or vacations I wouldn't have in a hotel, because Airbnb is cheaper. I don't have extra money lying to pay hotel prices; if the cost of travel increases I will buy less travel.
> Withdrawing Uber won't put me in a taxi, it'll put me in my own car, occasionally public transit, or more likely staying in and ordering delivery.
This is my experience as well. My wife and I have traveled from our inner suburb into the city for dinner and drinks far more often than we ever did before Uber. Because of convenient and reasonably priced transportation, we've spent more money overall in the local dining economy.
With increased supply come decreased price and increased usage. Uber and airbnb increase the supply of transportation and hotel places in total, decreasing the price for customers and increasing the total volume used.
Specifically, this is because demand for these things is elastic, in econ terms.
A buddy of mine in the hotel industry says that this seems to be the case. They can't quantify the negative impact of AirBnB on their bottom line. But he's at a high end hotel, I'm sure different parts of the industry see different things.
This is a great idea. We should definitely undo the 40 hour work week and other progressive-era trifles, serfdom was way better. Who wants to own things anyway
His point is that it's not about the quantity of regulation, but the type of regulation. In short he sees two types:
1. Regulation that I can read and now I know what to do and not do.
2. Regulation that requires me to consult an expert and apply to some government agency who then tells me if I am allowed to do something or not.
Obviously the second type is the bad one. You cannot properly plan. There often is no guaranteed time frame, you have no proper recourse and ideally have some kind of fixer. This type of regulation also tends to give large businesses an edge over small ones, creates large overhead for the system as a whole and ultimately hurts innovation.
I think it would help any discussion about regulation to carefully differentiate between these two types of regulation.
Econtalk ( http://www.econtalk.org ) is an amazing resource for understanding economics and the theories and incentives at play within it. The guests have a wide array of perspectives and the host does a good job of letting them talk so they can truly express their opinions during the hour conversation. It's so refreshing compared to the 2 minute soundbite theatrics you'll hear from "experts" on the tv news.
He makes a ton of suggestions on how to simplify regulations. Among other things he wants to do taxing corporations altogether because according to him they eithe avoid them or pass them on anyways.
The problem with not taxing corporations is the rich can use corporations as a tax free saving vehicle.
There is a great need to simplify regulations, but until the political system is reformed it will be hard to prevent the political class conspiring with vested interests to create regulations. Fix the cause not the symptoms.
Yes they do now, but if you stopped taxing corporations then it would be a lot harder.
The system we use in Australia is quite good. Corporations pay income tax, but any tax paid is passed onto the shareholders in the form of a tax credit (franking credits).
This is almost embarrassingly naive. GWB years saw the house, senate, and white house controlled by republicans, yet regulations continued to grow apace.
Furthermore, Republicans have long given up any pretext of wanting to reduce government control. No Child Left Behind, Sarbox, the entire mess that is Homeland Security, Defense of Marriage, "religious freedoms", increasing layers of drug regulation... it's just that Republicans want to regulate how people live their lives, instead of focusing on major corporations.
(Then, this doesn't even begin to get into the fact that many regulations are state level!)
This is correct. This is also a false dichotomy, unfortunately.
Both Democrats and Republicans are for large, strong, overarching government.
Probably a Libertarian president might make a difference and actually try to reduce the powers (and expenditures) of Washington, DC, and lower the burden of regulations. Try voting for Johnson. Unfortunately, chances to elect a candidate from outside the two big parties are about zero; Trump had to basically hijack the Republican party at its all-time weakest to become a real candidate.
A president can't do anything without the support of Congress. Electing a libertarian president would move the needle not a jot. Look at how Obama has been stymied, and he's all for the establishment.
If Trump gets in, he'll be able to do a lot of reputational damage with his rhetoric, but without the support of Congress, he'll be able to do very little in the way of actual legislative change. Mind you, it'll be interesting to see what he does when the debt-limit timebomb comes up again.
A president can do an enormous amount without the support of congress. A president can veto, and many, MANY regulations are executive branch administration rules rather than laws passed by the legislative branch.
I'm not particularly in favor of a president whose goal is to "burn it all down" in the way the Libertarians want to, but executive power is wide reaching and almost unfettered and there is a whole hell of a lot a president can do.
A libertarian may well do that, but in this world we (Americans) live in, it _is_ a dichotomy.
I would say, as an aside, that we give too much credit to the president - you want to cut red tape? Start with the municipal government, and get them to ease off on zoning regulations. Go from there.
When I had a small business in the US, my biggest concern was figuring out medical insurance and retirement. Since I had no clue one what to choose from the myriad of options.
I wanted more government control - single payer health care and decent Social Security coverage. I didn't feel overtaxed either.
I still feel that unions are far more over-regulated than businesses. I think many of the employee laws the article mentions are in place because collective bargaining has been so nerfed that the only remedy to bad but common management abuses (eg, wage theft) is through the legal system.
I think of a single payer system as infrastructure like roads, electrical supply, water... It collectively takes the risk from the individual and provides for everyone. A business no long gets distracted with pension, drug, medical... and focuses on the business of making money. They pay tax and that is it.
>A business no long gets distracted with pension, drug, medical
Unless that business was in the pension, drug, or medical industries.
My point is that it's not super clear where to draw the line between common public services and businesses, and people's perspective is usually determined by the nature of their own business.
For example, provide gov't healthcare and pensions so my smartphone company can focus on making great devices instead of worrying about health care.
Or... provide gov't smartphones so my social media app company can focus on making great apps rather than worrying about what mobile OS to support.
Or... provide gov't social media apps so my independent media company can focus on generating content rather than worrying about distributing it across many social media platforms.
There are still companies involved with "roads, electrical supply, water", even when they are part of the public infrastructure. It's not like there are no drug or medical companies in Switzerland.
The evidence doesn't need to be "super clear." The numbers are pretty solid that universal healthcare is more efficient than the current system the US has. That is, the US government spending alone, on a per capita and GDP basis, is higher than the combined public+private spending in most countries with universal health care. Yet the public+private funding in the US doesn't result in a higher quality of health care, by most measures.
Even sticking to the US, we can get an idea from Medicare and the VA system of the advantages to single payer systems.
Those comparison numbers don't exist for the proposals you mentioned, and there is no reason or experience to suggest they make sense in the current market. (But, consider France's Minitel in the 1980s, when it did make sense.)
Also, the failure costs in health care are much higher than the failure costs in choosing the wrong mobile OS. The worst case for the former is an nation-wide epidemic. The worst case for your company is ... you run out of money and need to get a job.
I live in Quebec, Canada and the healthcare here is among the worst in the civilized world.
Also - it's illegal to pay a doctor to fix you. Canada is the only place in the world where it's illegal to pay someone to cure you of something. It's basically communist.
The American system is untenable, but 'single payer' is not the solution.
Successful countries that do it are tiny. Sweden is smaller than Los Angeles. Swtizerland does it at the cantonal level, which on average is 800 000 citizens. Can you imagine your entire hospital and insurance system being in blocks of 800 000?
Maybe at the state level, subsidies, regulating drug prices etc. etc. - but full-on national level 'single payer' would be a huge disaster, beyond contemplation.
Also in many single payer systems - the guy who snuck across the border illegally gets the exact same healthcare as you, working professional, paid a million in taxes, dutiful citizen etc..
I think there should be coverage for everyone, but single-payer is not the path.
Health care also isn't like writing software. I know how to write software. I don't know how to select health care plans, and I when I had my own US company I was always afraid that I had made the wrong choice.
> "Can you imagine your entire hospital and insurance system being in blocks of 800 000"
I now live in Sweden, so I'm not unfamiliar with how single payer works in a country of 9 million people. Do note that it's not so isolated as you think. If I were to travel to France, and fall ill, I am entitled to any medical treatment that a resident would receive. This includes Switzerland, so your statement isn't quite a match to how the system works.
And let me say that it's a big relief to not worry about those details anymore. With our first kid on the way, I didn't have to wonder if my insurance would cover everything, or if I was feeding into the cost machine that has caused the price of giving birth to triple over the last 20 years in the US.
> "Successful countries that do it are tiny"
icebraining pointed out the 63 million people living in the UK with its NHS.
Even in the US, there are about 9 million people in the VA system and 55 million people in the Medicare system. Is there some fundamental reason which explains why Medicare cannot scale by a factor of 6?
> "the guy who snuck across the border illegally gets the exact same healthcare as you"
First, in the US everyone, no matter their immigration status, has the right to emergency care. See http://www.medscape.com/viewarticle/590328 for how the ethics are clear. So you end up with pregnant women coming to ER to give birth, which is expensive. And you have people coming to ER for things that could have been handled at a clinic more cheaply, and before any complications might have come up.
To make things more complicated, how does this hypothetical border crosser live in the US without a job? Because if he had a job enough to live on, then either the US employer is paying under the table, or he has a falsely acquired SSN and is paying into Medicare, even if he can't use it. The same works for universal healthcare - the money comes from payroll tax/automatic salary deductions, so even if someone snuck across the border, as long as they have a job they are paying for healthcare.
Second, people visiting (say) France from a country outside Europe are not covered under the French system. They are supposed to pay. Indeed, they do pay. Medical tourism is a thing. People will travel to France for treatment, and they pay for the treatment. It is not free to all comers. When my then-girlfriend visited me in Sweden for a couple of weeks, she needed an emergency root canal. She had to pay, and she did, even though she isn't a dutiful Swedish citizen.
But sure, there are people who are in the country but aren't eligible for health care and can't afford to pay or refuse to pay. There are two options 1) treat them, 2) don't treat them and wait until they appear in the ER once the problem gets more serious. (Option 3 is let them die, but I'm not inhumane enough to want that.)
Which is why the following happened in Spain. "Under a reform that came into place in September 2012, foreigners without residency papers lost their national health cards which allowed them free treatment in local public health clinics." Then in 2015, "Spain's conservative government said ... it would restore free healthcare for illegal immigrants, overturning a controversial decision taken three years ago." - https://www.thelocal.es/20150331/spain-to-restore-free-healt...
And they did it to take the load off of expensive ER care, which even the non-single-payer US does.
"Do note that it's not so isolated as you think. If I were to travel to France, and fall ill, I am entitled to any medical treatment that a resident would receive. This includes Switzerland, so your statement isn't quite a match to how the system works."
+ Yes - it is. Your system is absolutely isolated from the French system. The fact you can get coverage is no different from the fact I can get coverage in another province. There is absolutely no operational relationship between French and Swedish healthcare systems.
"Even in the US, there are about 9 million people in the VA system and 55 million people in the Medicare system. Is there some fundamental reason which explains why Medicare cannot scale by a factor of 6?"
Ask yourself the question: would you want a 'EU' level healthcare system - where Greeks, Swedes and Bulgarian were managed by the same entity? Do you grasp why that would not work? Greece is a completely dysfunctional country. How do you think it would fare under the 'same system'? Would Doctors in Greece be granted retirement at age 55, but Swedish Doctors not until 65? Under the same pay? It would never work.
+ It doesn't matter that everyone is entitled to some kind of 'emergency service' - and frankly - I'm not against that. But what if you were to put people who illegally into the country 'last week' - ahead of American citizens who required 'knee surgery' and because of this - American citizens who wanted (and paid for) knee surgery, went from waiting on average 2 weeks, to 18 months. Is this fair, or even moral? It's absurd. If people want to pay for healthcare, they can pay for the service to have it in two weeks.
The question of 'how much medical coverage we give to illegal citizens' is really another question entirely.
You argument is that single payer only works in countries with a small population. How come it manages to work with the British NHS and the US Medicare? Why can't those systems scale up by a factor of 10 to work for the entire US population?
Or, let's agree that it only works for a UK-sized population of 80 million or smaller. That's fine. Even California only has a population of 40 million. Let each state run its own medical system, and some of the smaller states can form a interstate compact to share costs.
I had no idea what you are talking about with knee surgery. I believe that a decade ago the queue for non-emergency knee replacement surgery in the UK could be 18 months, but it's 18 weeks now. https://www.theguardian.com/society/2015/jul/24/nhs-waiting-...
Nor was delay caused by non-UK people getting priority. A non-resident does not somehow have priority over all citizens. It's the same queue. Unless coincidentally every single non-resident needed immediate knee surgery, while the resident need wasn't so critical, what you describe (17 months added to wait time because non-emergency health care is extended to people not in the health system) cannot happen.
FWIW, in the 1980s, "The median waiting time for an initial consultation was two weeks in the United States and four weeks in Ontario ... The median waiting time for knee replacement from the time surgery was planned was three weeks in the United States and eight weeks in Ontario. ... Overall satisfaction with surgery (85.3 percent of U.S. respondents and 83.5 percent of Ontario respondents were “very or somewhat satisfied”) was not associated with the duration of the wait for surgery" - http://www.nejm.org/doi/full/10.1056/NEJM199410203311607#t=a...
Sure, that was the 1980s, but it shows that single payer even in Canada doesn't intrinsically end up with 18 months of wait time for knee replacement surgery.
Those comparison numbers are biased. They only include people who had knee surgery. In the US, the uninsured, or those who switch jobs only to find out that it's a "preexisting condition" under their new plan, may not be able to afford it. (And yes, the fear of losing coverage keeps some people working at otherwise horrible jobs.)
Their years of extra pain aren't included in the average or maximum queue times.
> "If people want to pay for healthcare, they can pay for the service to have it in two weeks."
Sure. But single payer doesn't require that there cannot be private doctors as well. The UK has private health care in addition to single payer universal health care. Here's a price list for private knee replacement surgery in the UK: http://www.privatehealth.co.uk/conditions-and-treatments/kne...
As that BBC article points out, "The move follows a European court ruling which broadens the circumstances under which countries can carry out reciprocal treatment. ... Mr Milburn's statement follows a ruling by the European Court of Justice (ECJ) that patients facing "undue delay" in their home countries could seek treatment in other EU states."
Tell me again how the other medical systems in EU are "absolutely isolated from the French system"?
You can vote me down if you want, but I live in a system where I cannot get a doctor. And it's illegal to pay for one. I' forced by the government, to use local clinics where they don't have my records, I don't have a relationship with the doctor, they can't make longer term prognosis, and frankly, the care is sub-par.
I once had an ailment that was difficult to diagnose, the doctors at the clinics, used to seeing people for coughs and colds could give a shit. I ended up having to pay a few grand for an American entity operating barely within the bounds of legality in Canada (the Cleveland Clinic). I can assure you that it's a pretty desperate feeling when you are locked out of the system.
Notre Dame Hospital in Montreal is lined with people in beds in the hallways, broken chairs, broken, leaking water fountains in the waiting room, broken / discarded beds in the waiting room - I thought I was in Cuba. The doctor was actually nice but the facilities were crazy. A well run McDonald's has more visible operating efficiency.
BTW, Cuba appears to have a significantly better system than what you describe.
Cuba also trains doctors for other countries, including people from the US. Medical training in the US is so expensive that people who want to be doctors for the poor can't afford the loans. See http://www.pbs.org/newshour/rundown/cuba-offers-poor-med-stu... .
"uba appears to have a significantly better system than what you describe."
Cuba has no money. They pay their doctors roughly $10/week.
Do you think Cuba can afford all of the drugs, diagnostic equipment, software and services that are required to make a highly functional modern Medical system?
Of course not. I made a reference to Cuba out of sarcasm - there is no defending the Cuban system, other than to say that they can provide adequate 'very basic coverage' to it's citizens, which is good.
They pay their doctors literally less than the cost of many common and important therapeutic drugs. It's an economic non-sequitur.
For your "sarcastic" comment, you happened to pick one of the developing countries known for doing well with limited resources, with child mortality and longevity rates comparable to the US.
My father just came back from Cuba. They are encouraged to bring a 20lb bag of tooth-brushes, toothpaste, clothes, toilet paper - and other items because Cubans cannot afford them.
It's a real stretch of the imagination to suppose that Cubans are doing anything, realistically in this area.
'Longevity' is not in any way a measure of the quality of healthcare - and 'infant mortality' is not so much a function of the sophistication of the healthcare system. Any nation with any civic control can achieve relatively low rates of infant mortality with clean water, reasonably informed doctors, antibiotics and some degree of pre-natal care. It does not take cutting edge healthcare system.
Again - the monthly salary of doctors in Cuba is $25. Please don't even begin to talk about anything until you address that point. Can you tell me how many functional CT scanners they have in Cuba? They have one for Fidel & Co. but the economics of it imply the number is de-facto 0. Anything but the most basic medical equipment is out of bounds for Cuban doctors.
Second - when Cubans send doctors abroad for training, and for 'aid' purposes, they do so whilst holding the doctors family members hostage, given the possibility for defection. If aid agencies pay said cuban doctors $1K/month - Fidel & Co. grab 99% of it, and leave the doctor with their $25 a month.
There is absolutely no preponderance of Canadians going to Cuba for medical care.
When Canadians 'really need healthcare' - they go to the US.
This, not including a) plastic surgery and b) middle class types who want otherwise very expensive surgery. But even in those cases, it's very rare.
I'm questioning why you picked Cuba when most other developing countries are worse. I'm not saying it's great. I'm asking why you picked on the standard American boogieman country.
> "'Longevity' is not in any way a measure of the quality of healthcare" ...
Life expectancy and child mortality are two commonly used proxies for the quality of healthcare.
> "Can you tell me how many functional CT scanners they have in Cuba? They have one for Fidel & Co. but the economics of it imply the number is de-facto 0."
> Since 2003 more than three dozen companies, including Philips Electronics of North America Corp., have faced penalties due to violations of the travel embargo, according to the Congressional Research Service. The change could also mean more consistent medical scanning options for research. Direct imports of medical supplies from the U.S. have remained rare, and sometimes Cuba has run up against difficulties even getting spare parts. At one point, CT scanners, angiography and ultrasound equipment from Philips—technologies common in health care facilities around Cuba—were lying idle, leaving patients with few options for three years, according to The Lancet Neurology.
I contrast the SciAm statement that CT scanners are "common in health care facilities around Cuba" with your statement that is is de facto 0, based on purely economic reasons.
I think it's safe to conclude that there is more than 1 scanner in Cuba.
> "There is absolutely no preponderance of Canadians going to Cuba for medical care"
Never said there was. Indeed, I said that many more went to India. One of those links suggested why - there are relatively few English speakers in Cuba.
You'veused your limited canadian experience to say that single payer everywhere is a terrible idea.
You're using some things which are peculiar to the canadian system (particularly the banning of private medicine) to say why single payer can't work anywhere, even though most other places allow private healthcare.
'Single payer wherein you cannot buy private services' is basically unique to Canada, and is fundamentally part of the reason that the quality of care and services in Canada is so bad.
My fellow Canadians are smug and righteous about their system, thinking that it's superior to the American system.
Anti-American bigotry is frankly rampant in Canada.
I lived in the US (and abroad) for many years, while most of my peers have never spent more than a few weeks in the US - and their understanding of the system is nill, and comes from the highly biased and borderline propaganda they get from our 'State Controlled National News' entity - the CBC. I generally like the CBC, but they also support national programs, and most of their staff don't have the relevant experience or competence to make any assessment.
My position on healthcare is a lot more nuanced.
Canadians are almost religious about their healthcare system, they have little grasp of how things work elsewhere, and little awareness of how poorly their system fares against other system.
Yes, thank you for posting this. It's exactly the case that if one were to start a small company, the more govt services that automatically take care of things like ins and retirement, the easier it is to focus on your business.
This seems like a false dilemma. Housing, food, clothing, and most other things are not directly provided by either employers or governments, and yet people are able to acquire them.
I started learning about housing, food, and clothing from my parents, when I was a toddler. They taught the basics, including how to cook, how to buy groceries, how to maintain a house, etc.. I had over a decade of practice under their watchful eyes before doing it on my own.
Then in school we learned more about food during health class. Those who wanted to learn more could take home economics. Also, many people purchased magazines to help understand and select clothing styles, participated in discussions on the topic, and spent a lot of time at stores evaluating the different options (i.e, "hanging out at the mall").
Even for housing, I did it in steps, with college dorm, then shared apartments, to shared houses, to my own apartment, to my own house.
By comparison, when I started my company, I had no corresponding practice or experience in selecting health care or retirement options.
Just like I had no practice in reading NDAs and consulting contracts, or setting up a company. But those are remarkably stable. A NoLo book on consulting and the advice of a friend who started a company a couple of years previous was enough. Then hire a CPA who has a legal obligation to work in my best interests.
An insurance agent does not have the same obligation. I also don't have the experience to judge between the offerings from the different companies, nor experience in the local hospitals or clinics to know who is in which system or what I should be watching out for.
That's straight 'paradox of choice', making it all the more difficult to figure out what to do.
It didn't help that every few months I would get a message that the health insurance rates were increasing, making my wonder if I had made a mistake and was being screwed over by the insurance company, who knows that most small business owners really don't want to deal with re-evaluating the insurance market all the time.
Uber et all are not "Independent contactors" and for those of us that could fall into that status" the tax authorities don't like the idea that non lawyers/doctors (aka greasy engineers) get the advantages of self employment.
