
Cities with Uber Have Lower Rates of Ambulance Usage - lyk
https://www.npr.org/sections/thetwo-way/2017/12/18/571689807/cities-with-uber-have-lower-rates-of-ambulance-usage
======
throwaway0255
I injured myself and needed to go to the ER. The injury wasn't life
threatening, but I definitely needed to go to the hospital immediately.

I called an Uber.

I don't have the time or expertise to do the months of legalese and calculus
it would take me to understand my insurance policy, so I have no idea how much
an ambulance ride would have cost me. $0? $400? $15000? None of those numbers
would surprise me. As best I can tell, insurance companies throw a dart to
decide whether you're covered or not, and then the healthcare provider makes
up some insane number if you aren't.

The Uber got me to the hospital faster than an ambulance would have, for less
than $10, and I knew it would cost less than $10.

The injury, though extremely gruesome and painful, only warranted an x-ray,
some tylenol, and an ace bandage.

I'm insured. They sent me a bill for over $900. For taking a picture, and
giving me tylenol and an ace bandage.

I view insurance as a tax my employers pay to the American healthcare system
to be compliant. When I have my end-of-life event, whatever that is, I fully
expect a choice between death, and living a little longer in bankruptcy. I'll
probably get treated outside the US or choose death.

The system works if your net worth is somewhere above $5 million. For everyone
else it's just the mechanism that sends everything you earned back to rich
people right before you die.

Or maybe I'm wrong! I hope I'm wrong. The stack of papers is 4 inches high so
I'll never know, but I sure hope so.

~~~
blhack
There is pretty much nothing that infuriates me more than the health insurance
system. Here is just one example (other than your ambulance example, which is
like some trolley-car problem come real):

We use "insurance" for _routine_ medical examinations which are supposedly to
be done _regardless_ of health. We use "insurance" for YEARLY checkups.

The absurdity of this is on par with insuring yourself against getting hungry,
or buying gasoline insurance to fill up your car.

Gas in $8000/gallon. But pay $900/month and we will cover the cost!

It is absolutely embarrassing that this is the system we have allowed to
exist. I consider myself a pretty staunch capitalist in most regards. Health
insurance is definitely not one of them.

~~~
briandear
Insurance should be used for what it is — an financial instrument to protect
against unforeseen and catastrophic financial loss.

Car insurance doesn’t pay for tires or oil while it could be argued that bad
tires increase the risk of accident. However tires and oil are an inextricable
requirements to owning a car.

This idea that health care should be paid for by someone else has always
puzzled me. It’s the equivalent of food being “free.”

For the legitimately poor, there is definitely a role for government just as
governments don’t let people starve to death, but for everyone else — its just
wacky that the government ought to be involved at all beyond safety
regulation. We went wrong when some groups started claiming health care as a
right — nobody has a “right” to the labor of other people. In other words — I
don’t have a right to make you produce something for me.

Health care costs have spiraled out of control because of the detachment of
who is paying from who is receiving the service — much like higher education.

~~~
skrause
> _Health care costs have spiraled out of control because of the detachment of
> who is paying from who is receiving the service — much like higher
> education._

No, they have spiralled out of control because health care is something where
no real market can exists, so you need good regulation (which the USA doesn't
have). If you have an urgent and life-threatening health problem you can't
shop around for a cheaper hospital or decide to go to none at all if the
alternative is death. So they can charge whatever they want if there is no
regulation.

~~~
saint_fiasco
Why not?

You also can't live without food but there is a market for that. Even when you
don't have time to cook and need food on short notice, there are plenty of
fast food and delivery options available.

There is nothing impossible about a situation where a hospital has a
reputation for being cheap but having long wait times while another hospital
is more expensive but has shorter wait times. Then in an urgency you wouldn't
need to shop around, you would decide based on each hospital's reputation.

Unfortunately hospitals don't publish their median wait times, patient
outcomes or even their prices. If they were forced to publish those things,
maybe a market would emerge.

~~~
Robotbeat
You can live for weeks without food, it can be stored easily (unlike services
which aren't stored at all), and the barrier to entry is low... Many people
even have their own food gardens. It's also very amenable to nearly complete
automation. Therefore food is super cheap.

~~~
throwawayaway12
>I understand that healthcare is more expensive than food for all those
reasons. What I don't understand is why there can't be a market for it.
Expensive services can have markets too.

At the moment the only thing I can think of that are expensive services are
also luxury services. Most people consider health care to be a basic service
that should be open to those who need it, regardless of wealth.

~~~
saint_fiasco
Back to the food analogy, people who can't afford the food they need to live
are given food stamps. Even so, there is still a market for food. People know
ahead of time what the exact price of the thing they are buying with their
food stamps. Nutritional information is available on the packaging.

Why exactly can't I know ahead of time how much will each hospital in my area
charge if I have a heart attack and have to go to their ER? Why can't I know
which hospital has better survival rates, or the shortest wait times?

That information is all that is needed to have a healthcare market. It should
not be impossible.

------
bmelton
If you don't get bogged down in details of the service, I see this as
generally net good. For many, ambulance rides are prohibitively expensive, and
while I certainly wouldn't be cost-conscious taking an ambulance in the event
of a seizure or heart attack, for something like a broken arm, or non-life-
threatening ailment, an Uber/Lyft/Cab is a good alternative to trying to drive
myself.

Beyond that, I'd like to see statistics on whether people ride-sharing to
emergency rooms / urgent care facilities was freeing up ambulances or causing
them to sit idle. I suspect it's the former, which would mean ambulances could
be more available for more people with more serious conditions, but I could be
wrong.

~~~
donatj
Six years ago I had something similar to a stoke. I had a relative drive me
from work to the ER in outer suburbs because:

a) I would literally rather die than pay for an ambulance. I put my money
where my mouth was on that.

b) I knew from previous experience their ER was far cheaper, cleaner and
quicker than the one in the cities.

Maybe I am just particularly frugal but I had the presence of mind to consider
costs while I could not feel one side of my face.

Another time, I needed surgery and called around to get quotes. The place I
ended up was something like a quarter the place my doctor wanted to send me.

~~~
thaumasiotes
> I would literally rather die than pay for an ambulance.

I wish more people realized this was an option. You can't even imagine how
common it is to see the claim "medical care is a special market, because if
someone is dying, they will pay ANY AMOUNT for care no matter how high".

Sure, if that person is dying and rates their own health _infinitely_ higher
than the welfare of their family, maybe. That's not many people.

Incidentally, the same stupid argument also proves that scamming a life
insurance policy by committing suicide is impossible. Life insurance
companies, in general, do not agree.

~~~
kelnos
> _Sure, if that person is dying and rates their own health infinitely higher
> than the welfare of their family, maybe. That 's not many people._

I don't think that's true. I think that's actually the vast majority of
people. Nearly all of them, even. The human survival instinct overrides so
much of a human's rational thought processes or even their higher-order
emotional processes. You may be one of the rare few for which that's not the
case, but, well... you're of a vanishingly rare breed.

And it's not even exactly that. When you're in a life-threatening situation,
it's likely that you're either a) unconscious, or b) completely unable to have
even a remote grasp of what the cost will be to "fix" you. As in, not even a
ballpark figure. Given the potential urgency, you may not have the time to get
a second opinion or shop around for a cheaper fix. Just the cost of
stabilizing you to the point where you can sit back and make an informed
decision could bankrupt you.

Also, just a side note on:

> _... the welfare of their family_

There's also a cost to their welfare if you die, too. It's hard to put a
number on that while you're healthy, let alone in the midst of an emergency or
life-threatening illness.

------
joshvm
Coming from a country where ambulance usage is free for citizens, it would be
interesting to see the stats in Uber cities. The only reason not to call an
ambulance here is if you feel it would be unethical (e.g. if you broke your
arm and your partner could drive you).

EDIT: That is, I imagine you might be able to see whether Uber provides a
better alternative than the local cabs. This still holds in US cities though,
why is Uber specifically good? Why don't people consider calling their local
cab company, which will still be much cheaper than a $250 ride.

~~~
dazc
I also come from a country where ambulance usage is free but I can tell you
from experience that getting one of these ambulances isn't as simple as one
might think.

I imagine, maybe, there are keywords or phrases that result in instant
dispatch but the default behaviour seems to be to frustrate you as much as
possible to the point where you just hang up and drive yourself to the nearest
hospital accident and emergency department.

This is, I suppose, a result of the service being costed and allocated to
different departments who are all under pressure to manage their own budgets?

Accident and emergency departments obviously get the brunt of all this because
they don't have anyone to pass the buck to.

So, yeah, maybe utilising a service such as Uber is actually going to be a way
around this problem?

~~~
jopsen
Free ambulances are always going to come with the problem of abuse, followed
by a reluctance to send an ambulance.

Resulting in news stories of how some people call of help and don't get any.
But these stories are rare, it's seem better than letting poor people die.

This said, we probably should add a tiny ambulance fee ($50), and apply a fine
for inappropriate use.

~~~
dazc
'This said, we probably should add a tiny ambulance fee ($50), and apply a
fine for inappropriate use.'

I agree although reclaiming this fee from those who abuse the system is likely
to prove difficult?

I can remember a time in the UK when ambulance and, IIRC, fire service would
bill you after the event for attendance.

Not sure if this was every case or just where they deemed it appropriate? But,
I do remember, it was common knowledge there was no penalty or follow-up if
you didn't pay.

~~~
jopsen
> I agree although reclaiming this fee from those who abuse the system is
> likely to prove difficult?

You assume everybody that abuses free services are broke. We need data to tell
whether that's the case. I would assume that a significant portion of the
abusers mostly just lack manners.

Anyways, the point isn't to kick the ones who are down (poor). It's only to
limit abuse... But first maybe it should be assessed of abuse is a problem.

And maybe, having a deal with taxi company is a better solution...

------
Spooky23
I’d be more interested to see the reduction in medicab or medivan usage.

My father had the misfortune of having a stroke, and transporting him via van
is outrageous — you’re talking >$250 for a 15 mile drive, in what amounts to a
cargo van with zero service beyond driving.

It’s one of those weird markets where the pricing is driven by the Medicaid
reimbursement, which is a price floor.

~~~
chiefalchemist
Same situation for me, and I've seen the same with regards to price.

That said, I also suspect the med transport niche is heavily regulated (a la
taxi service). Special training for drivers, insurance, etc. I don't think
that covers the full $250; just saying they're not identical to a Uber.

~~~
kelnos
Right. If the Uber driver fails to get you to the hospital in time to save
your life for any reason, they have no liability or consequences whatsoever,
because they're not intended to be a life-saving or emergency service.

If the ambulance driver screws up in some way, they're in for a world of
trouble and legal liability.

------
jdietrich
Here in the UK, there has been a major campaign to try and reduce the usage of
ambulances and emergency departments. Many of our ambulances literally have
"this is not a taxi" written on them.

[https://i.pinimg.com/originals/5c/ff/1e/5cff1eac4bef3b52f76d...](https://i.pinimg.com/originals/5c/ff/1e/5cff1eac4bef3b52f76d3ca92b041bec.jpg)

Because it's free to use, a lot of people call ambulances when they really
don't need them. Women in the early stages of an uncomplicated labour. Young
people with minor injuries. Elderly people who want a repeat prescription.
Discouraging these people from abusing the service without putting off people
who are genuinely in need of an ambulance is a complex and delicate task.

The US healthcare system is clearly an unmitigated disaster, but our single-
payer utopia has a different set of problems.

~~~
orcdork
Your example is the result of years of government failure to provide adequate
funding and support to the health system, not some kind of fantastical
moocher, using ambulances for no reason.

~~~
DanBC
Not sure why you got downvoted, what you say is true.

People sat similar things as GP about A&E - "the problem is all the people who
use it who shouldn't". No. Those people are easily triaged and sent away. The
problems with A&E are all the people who need a hospital bed who spend hours
on a trolley in a corridor.

------
an4rchy
I've been wondering about this for a while but, is there a reason why Uber or
an alternative cannot/should not get into the Ambulance space, if it were able
to get qualified staff.

I feel like Ambulances/Hospitals charge way too much and using the app/tech at
a basic level to connect the ambulances with patients addresses may be a good
start for everyone and also the increase in supply may reduce costs.

~~~
switch007
Are paramedics/ambulances so unregulated in the US that it's /not/ a bat-shit
crazy idea to suggest Uber Ambulances?

~~~
adventured
There are a lot of private ambulance services in the US, they're anything but
unregulated though as you'd expect with anything in the US medical field (one
of the most regulated industries on earth).

There's no theoretical reason why Uber couldn't get into the driving side of
the business, with human drivers. Their future is in autonomous however, which
will never be the ambulance business (it will _never_ be autonomous, ambulance
drivers frequently have to break standard driving laws in emergencies, drive
at high speeds, drive around vehicles, etc).

~~~
switch007
> It will never be autonomous, ambulance drivers frequently have to break
> standard driving laws in emergencies, drive at high speeds, drive around
> vehicles, etc).

And because they have to perform emergency medical treatment, right?!

Are we talking about different things - a mini hospital on wheels staffed by
highly trained paramedics, and glorified taxis for the elderly/non-critical?

~~~
kelnos
Some ambulances are just glorified taxis, others are staffed with EMTs who can
do more.

If it weren't for the need to drive in a "non-standard" manner, you could
likely save on costs by having an autonomous vehicle staffed by an EMT. The
EMT can't also drive the vehicle, after all.

------
nmca
Healthcare in the US sounds nightmarish. I'm a UK citizen and broke my leg
badly in France; ambulance etc. Whole thing was <75 GBP. That was for the cost
of crutches and medicine in France, X-ray+ER visit was free. Then after I got
my train back to the UK I had complex reconstructive surgery for free on the
NHS.

------
will4274
A relevant personal anecdote - I hit my head earlier this year and gave myself
a concussion, but did not realize it at the time. The next day, I began
experiencing severe headaches, sensitivity to noise, sensitivity to light,
etc. and decided to go to a hospital. I called an Uber.

I'm not sure what I would have done without Uber. I guess I could call a cab,
but I don't know that I would have wanted my ride to the hospital to be 30
minutes late, to refuse to turn the music down, and to tell me the credit card
reader is broken when I get to my destination and then insist on taking me to
an ATM. So I might well have called an ambulance.

~~~
mysterypie
> my ride to the hospital to be 30 minutes late, to refuse to turn the music
> down, and to tell me the credit card reader is broken

As much as I'd like to stick it to taxis because of their decades of price
gouging due to being granted a monopoly, I have not had many bad experiences
riding a taxi. If I had to put a number on it, I'd say that less than 5% of my
taxi rides were in any way unpleasant other than for the cost. What city or
country are you in if I might ask? Are taxi experiences really that bad for
most people?

~~~
WhyNotHugo
This really depends on where you live. Harassing and other similar situations
are very common in Taxis where I live, while Uber drivers seem to be well-
behaved.

None of my female friends dare get into a Taxi due to, well, harassment, (some
have stories of groping, attempted rapes, etc.). Generally, they'd only take a
taxi in groups, or walk. Uber seems to be working well in that regard (at
least for now).

~~~
GFischer
In my country, Uber service is far better than taxis by a mile... many taxi
drivers are poorly-paid employees which don't care much, and they're basically
immune to any kind of incentive or threat.

On the other hand, Uber drivers with a bad score are usually suspended or
banned from the app, keeping out the bad apples, and they're usually the car
owners themselves, thus having an incentive to drive better and take more
rides.

I believe than something similar to Uber scores for taxis with similar effects
(removing bad drivers from the service) would create a huge improvement.

Another unfortunate side effect is that there's some segmentation - poorer and
older people still take taxis, while more affluent people take Ubers.

------
Slippery_John
Well yeah. I had a kidney stone earlier this year. Pain so bad I couldn't move
or think. Went to the hospital in an ambulance and ended up paying nearly $3k
for the ride. First round they thought it was muscle spasms, so when I
inevitably had to go back again I got an uber. The only reason I wouldn't take
that option again is if I was bleeding / puking / doing something that would
make a mess in the car.

------
taxicabjesus
Various insurance companies had contracts with the taxi company I drove for.
Part of our usual fares were taking people to and from emergency rooms. If a
person with Medicaid had a problem they'd call their insurance company, whose
representative decided whether to send an ambulance or a taxi.

The hospitals also had contracts to send their patients home. One pre-
obamacare passenger comes to mind: she didn't have a problem that wasn't
related to being poor/homeless/childhood abuse, but the E.R. couldn't address
her actual problems, and gave her a prescription for "something". She waved
the prescription and said, "I can't afford these pills..." The hospital sent
her to her sister's apartment. I called twice to check up. She was doing okay
the first time. The second time the passenger's sister said she was at the
State's psychiatric hospital.

A non-insurance passenger with a non-life-threatening injury asked to go to an
emergency room. I suggested going to the full-service emergency room at the
heart hospital. They got in & out in a fraction of the time that people
usually spent at the big hospitals.

I knew of that emergency room because the Fire Department had a contract with
the taxi company too. They sent people who didn't need an ambulance via taxi
to the nearest emergency room. That guy was homeless, iirc.

------
t3rmi
I'm currently a student in the Bay Area. One of the first thing that my
seniors told me here was if you are ever injured or in an accident do not call
911 unless its life threatening as the ambulance bill can bankrupt you. We do
have insurance but the system is too complicated and the consequences are the
too scary if we don't get reimbursed.

~~~
froindt
Are you from the Bay Area? Is there anything in particular that would cause it
to be extra expensive?

During undergrad in the Midwest, I heard a freshman who was way too drunk fall
off his lofted bed around 4 in the morning during the last couple days of the
year. I heard his roommates discussing whether or not to call the ambulance
because last time this guy got super wasted and hit his head drunk, the
ambulance ride was a couple thousand dollars.

It was so messed up to hear them talking. He could have a brain bleed going on
and they were discussing how handle the situation. Ultimately they did call
911 and he was fine the next morning.

------
vincnetas
I'm happy that in Lithuania (northern Europe) you can call ambulance even if
you have fever and it's free (paid by you with taxes). Of course it's not
perfect, medical personal don't earn much, and yes, it could take longer than
Uber (except might be rush hours when ambulances can skip the congestions).

------
jrlocke
I've personally found this to work great, the only exception being the moment
of surprise and confusion when I asked the driver to pull around to the
emergency entrance.

------
k__
Medical stories from the US always sound like from third world countries to
me...

~~~
saas_co_de
Yeah, most people don't tell the stories about how they go to luxuriously
built hospitals that make most corporate offices and hotels seem cheap by
comparison, with parking lots full of BMW's, Mercedes, and other 6-figure
foreign cars, and are treated by teams of highly paid people using millions of
dollars of the best equipment in the world ...

As long as you have money the US is great.

~~~
qaq
"As long as you have money the US is great" even if you have money you will
still have to go to the local hospital for emergency and will have to wait for
specialist appointment some stupid amount of time unless you actively spend
time and money donating to the hospital some serious $ so you have direct
numbers of people in charge etc.

~~~
saas_co_de
It depends on where you live. The US tends to be highly segregated by
income/wealth. In the high income places they have ERs advertising to get more
business because they are underutilized.

~~~
qaq
I live in a third county by per capita income in US and #1 and #2 are right
next to me.

------
BrainInAJar
Notably, in the US.

this speaks more to a failure of the healthcare system than it does to the
success of ridesharing

------
StreamBright
Article should have "in the US" qualifier.

------
chiefalchemist
Good stat but there's nothing about outcomes. Uber might save money for
transportation but how does the lack of a proper ambulance effect outcomes?

~~~
xor1
I imagine most of the cases involving people opting for an Uber instead of an
ambulance aren't in obvious risk of dying if they don't make it to the
hospital in time. The first things that come to mind are broken bones,
lacerations, and severed digits. Then again, there are plenty of things that
can be fatal without being readily apparent, especially if the only person
making that judgment call is the patient.

~~~
chiefalchemist
I don't disagree. But let's see the data and not assume. One or two extreme
cases could make any savings moot.

------
heisenbit
> Researchers often cite costly transportation as a significant barrier to
> receiving quality healthcare. A study by Samina T. Syed and Lisa K. Sharp,
> doctors at the Kalamazoo College, suggests that cost-efficient access to a
> vehicle is consistently associated with increased access to health care.

Uber is using venture capital to subsidize rides. Drivers are often providing
the services by going underpaid and putting up their own capital without
getting the appropriate rent.

This is not a sustainable model. If there is a real need that is currently not
met it has to be provided through other means in the long run.

------
Improvotter
Never ever have I thought this would be a side effect of not having any proper
health care. I've never had to take an ambulance, but it's a second nature
where I live in Europe to just call the equivalent of 911 and they'll send out
the best unit depending on the injury. It can be a plain ambulance or a faster
car with doctors that definitely is very expensive if you weren't covered.

What a shame.

------
trts
Had a bad bicycle accident about five years ago. No taxi would stop for me as
it probably looked like I'd been in a drunken brawl. Uber or Lyft would have
been nice, as I could have probably texted the driver not to be alarmed but
that I needed a lift to the ER (at that point I still had not gotten a
smartphone). I ended up walking 2.5 miles to the nearest hospital.

------
doorty
They (uber/lyft) work well for my dog emergencies too.

~~~
lstyls
Drivers don't have issues with an uninvited dog passenger? As a dog owner, I
find this surprising. But if drivers are OK with it it would be a great option
for me because I don't own a car.

~~~
smelendez
It depends on the city, culturally, and it's a good idea to call and ask
first.

Obviously if it's a service dog they're required to transport it, but from
knowing people with service dogs, it's still worth calling because some
drivers are allergic and would rather you call another

~~~
amelius
> if it's a service dog they're required to transport it

But Uber is not a cab service; instead, they are trying to evade all the
rules.

------
cardiffspaceman
We can view this as either a positive for how Uber works or a negative for how
taxi cabs work. If the pervasive means of transportation other than ambulances
are unresponsive or expensive compared to ambulances, then obviously
ambulances are the choice. One might also drive oneself, get a ride from a
friend or family member, or hope that a city bus will be fast enough. An Uber
ride could be faster than a ride from friend or family and safer than driving
oneself.

~~~
CydeWeys
I took a taxi to an urgent care clinic when I broke my ankle in a bike
accident. Would've taken an Uber or Lyft if taxis hadn't been around, but
there were a lot of them. Whatever was fastest. I really wasn't worried about
saving a few bucks on a ride at that point.

------
saas_co_de
Does nobody else wonder how an un-peer-reviewed paper from Kalamazoo College
is being reported by a tech blogger from NPR?

Why would anyone take this seriously?

------
formerchamp
Good, former EMT and Paramedic for busy metropolitan city here. Your
exorbitant costs are subsidizing the homeless, system abusers, and illegals
who can't be billed. 90% of the calls we were dispatched to were not acute
emergencies. And 90% of those calls were people of the lower socioeconomic
demographic systematically abusing medicaid.

------
arximboldi
> 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 is where a popular ride-sharing app can step in, while also
> freeing up the ambulances for those who need them most.

The rich?

------
jacquesm
Cities with Taxis have lower rates of ambulance usage too.

In fact, any kind of public transportation will result in lower ambulance
usage. Because when there are alternatives some %age of ambulance rides will
be replaced by some %age of public transportation rides.

------
m333t
Would be nice to have a service like Uber where you have a virtual doctor's
visit by phone in the car on the way to the pharmacy or to the hospital if it
turns out to be more serious.

~~~
Johnny555
What are you going to do if it turns more serious during the ride? The Uber
driver (probably) has no medical training and certainly has no advanced
medical equipment, the best he can do is pull over and hope that a real
ambulance can meet you at his car before you die.

If you have a condition that is so serious that you feel you have to keep in
contact with a doctor while you're transported to the hospital in case it gets
worse, call an ambulance since they can actually treat you in-route.

------
ajasmin
How is Uber any different than taking a taxi to the hospital?

~~~
Malician
If Uber says 5 minutes, it might be 7, or even possibly 15 if things go very,
very wrong. Heck, if it's gonna be 15 you know this ahead of time because you
can see the driver making wrong turns.

If you call a taxi service, and they say "15 minutes," it could be 30, 45, or
60. Maybe they're mussing with the truth, maybe they're outright lying. You
don't know, and without the map showing the driver, you have no way of
knowing.

~~~
djsumdog
A lot of modern taxi services have apps (often written by just a few big shops
and contracted/branded out, but still). So you can start to get some of the
same assurances from Taxis that you could get from Uber.

Also even before Uber/apps, I never had a problem with calling a Taxi and it
not showing up within a few min, and I've lived a lot of places.

~~~
Zarel
I've called a taxi three times in my life.

The first time was in 2012 because Microsoft was paying for it. It was from
downtown Bellevue (so not an obscure place). I called them, they estimated 15
minutes, and it took them 40 minutes to show up. I'd never called a taxi
before so I didn't realize this was normal; I called them back a few times to
ask what was wrong, and they just said "soon!"

The second time was in 2015 in a country that didn't have Uber. They had an
app. The app didn't work. They also didn't answer the phone. I tried multiple
times, including an hour later after eating lunch. I gave up and spent 50
minutes walking home in ridiculous heat.

The third time was in 2016 because it was in a small town in the US that
didn't have Uber. They did have an app. Their "app" displayed a phone number
and told me to call it. That was the entire app. I called it, they estimated
30 minutes and showed up in 45 minutes, and they charged me $40 for a ten
minute ride. Small town so I can understand the wait, but the price was
definitely because they knew I had no other choice.

Meanwhile, I get annoyed when Ubers take longer than 5 minutes to show up
because they take wrong turns.

I think it's definitely a matter of luck and location. Some places have
horrible taxi services, some places have okay taxi services. Some places only
have okay taxi services now because of competition from Uber. Ubers are still
nearly always a huge margin better.

------
assafmo
Can't you pay directly for private insurance in the US?

I pay directly to the insurance company. It costs me about 145 usd/month and
includes health insurance (with urgent care), long term care insurance, life
insurance (about 500k usd) and some more.

I could have done it through my employer, but when I leave for another place
I'll have to renegotiate the price with the insurance company, and also this
option has less good of coverage IMO. It is cheaper by 70% tough.

~~~
hak8or
What's the name of the insurance company? Oscar? Thay seems incredibly cheap.

------
s_esser
Correlation != causation

~~~
bckygldstn
The title of the NPR article would be more accurate as "Cities See a Reduction
in Ambulance Usage After Uber is Introduced".

The paper looks at 700 different cities, each with a different Uber market
entry time over a two year period. The researchers also control for some
seasonality effects.

Perhaps more covariates could have been considered, but this seems like a
pretty decent design to measure a before/after causal effect.

------
pixelbill
I'm curious, this article spins the whole "lower rates of ambulance usage" as
a positive thing, but is there enough evidence to say that?

From the article:

_______ 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. _______

Okay they claim the study says "emergency personnel have been able reach
critical patients faster" but decreased usage does not necessarily equal
faster response time. It would have been much more solid if they actually
looked at the ambulance response time, not just how many are being used. (My
skeptical side leads me to think this is because _that_ data-set didn't match
their narrative.)

There is also the question of: Is this actually a good thing? Are those 7%
less people using ambulances all not having serious health issues? Especially
when something is wrong, you are often not a good judge of your own health.

How many people having chest pain thought it wasn't too bad so they called an
Uber instead of an ambulance and died on the way to the hospital? Might not
have turned out that way if they just called an ambulance in the first place..

Need more data to decide if this is an Uber propaganda piece.

~~~
djsumdog
I agree. 7% is a really low number, and people shouldn't be afraid to call an
ambulance just to save money. That's fucked up. Especially with comments
talking about strokes and heart attacks. In most western countries, this isn't
even an issue.

I honestly question of the numbers are even statically significant, but even
if they are, this is seriously fucked up and not something Americans should be
proud of at all!

------
gaius
Here in the UK ambulances are paid for by the NHS, to which Uber steadfastly
evades contributing to. Now that their drivers have been legally classified as
employees, there’s a shed load of back NI they owe us.

------
averagewall
It may be an overall improvement in efficiency, but it's not going to help
patients long term. Whoever pays for the ambulances is going to eventually
reduce their funding because they're being under used and revert them to the
same state they were in before. If that wasn't the case, then they would have
already been paying for more ambulances before Uber came along.

~~~
Robotbeat
This is simplistic and probably wrong. Part of the reason ambulances are
expensive is not because of the intrinsic /cost/ of the service but because
the consumers have no choice but to choose the ambulance. They are, in effect,
a monopoly and therefore can charge monopoly rents. And Uber (or whatever) is
helping to break that monopoly.

(It doesn't have to be that way. Other countries have managed to keep
ambulance services affordable.)

