Residency requirements are defined by ACGME. The AMA is a member of ACGME but ACGME operates independently. If you think that residency requirements should be changed then make a specific proposal instead of wasting our time with snarky, low-effort comments.
Every serious analysis of the US healthcare system I've ever seen comes away with the takeaway "Americans consume a lot of healthcare services and the expensive part of that is the providers' salaries"
It’s pretty well known that vertical integration has been the issue with driving up costs. Salaries for physicians aren’t all that big of a cost, compared to all the administrative BS that hospitals and insurance companies drive up, and conveniently have agreements to heavily discount.
For example, on a roughly 400k surgery, maybe 4-5k of that goes to the providers (anesthesia and the surgeon), dependent one on the codes billed for the procedure.
There are private groups that purposely do not take insurance and bill purely out of pocket with a one time fee including all follow up’s and subsequent care, related to that procedure, and it is significantly lower (like 90%+ less) than what an average hospital is charging.
> There are private groups that purposely do not take insurance and bill purely out of pocket with a one time fee including all follow up’s and subsequent care, related to that procedure, and it is significantly lower (like 90%+ less) than what an average hospital is charging.
I would bet a LOT of money that it is 90% lower for a "typical" patient but not 90% lower (and very likely pretty comparable) on average.
To state it more plainly: every time you pay for medical care in the US, you are subsidizing a half dozen people who consume 5x the services you do and do not pay.
That's why "fee only" medical (which always conveniently has no emergency services, you'll notice) can offer such low rates.
Taxi drivers were not more "regulated" in any meaningful way, in fact oversight of them was significantly worse than the community-driven Uber rating system (not that that doesn't also have flaws).
Some regulation is bad, some regulation is good. There's basically nothing at all that's good about guild systems and I will celebrate each of them facing open market competition.
> Taxi drivers were not more "regulated" in any meaningful way, in fact oversight of them was significantly worse than the community-driven Uber rating system (not that that doesn't also have flaws).
You are defaulting to the US here (and I doubt Taxi regulation in the US is that homologous either tbh given the complexity of 50 states and then cities on top of that).
Taking the country I'm most familiar with (the UK), Taxis fall into two categories (only one of which is technically a taxi by law if not convention - Hackney and private hire vehicles) bothare licensed in different but similar ways by the licensing authorities (usually the local council but not always), some of those laws go back centuries.
Also worth noting, in the UK Uber does operate under the Private Hire Vehicle laws and does have to comply with applicable licensing same as any other "taxi" (private hire vehicle) operator.
They tried to argue otherwise and lost (at the UK Supreme Court so it's essentially settled case law) so they are classed as a PHV Operator and must ensure they only use a properly licensed PHV vehicle and drivers and can't pull the "but they are independent contractors" card out when it explodes in their faces.
It was a little more nuanced than that. The actual case was about whether a private hire operator accepting a booking had to contract with the customer as principal, rather than merely acting as an agent arranging a contract between the customer and driver (which was essentially Uber's argument).
The (UK) Supreme Court said "nah, it's you, nice try though".
They actually lost thrice - in 2017 TFL pulled their PHV licence because Uber London Limited wasn't considered to be a 'fit and proper person', Uber thought they could brazen it out only to find that TFL is beholden only to the Mayor and they ended up having to come back on bended knee, and then it was further refused in 2019 but returned on appeal - https://www.judiciary.uk/wp-content/uploads/2020/09/Uber-v-T...), which lists significant failings by Uber that they had since remedied.
The third outing with the Supreme Court was about employment rights - were the drivers workers, or genuine independent contractors for whom Uber are merely acting as a booking agent (which the Uber model relies almost entirely on).
The Employment Tribunal, The Employment Appeal Tribunal, The Court of Appeal and finally the Supreme Court all said "nah fam, you ain't fooling nobody" and the original ET was especially scathing:
> It seems to us that the Respondents' general case and the written terms on which they rely do not correspond with the practical reality. The notion that Uber in London is a mosaic of 30,000 small businesses linked by a common 'platform' is to our minds faintly ridiculous. In each case the 'business' consists of a man with a car seeking to make a living by driving it.
Aye, it's been interesting (by which I mean highly entertaining) to watch them run face first into the pole repeatedly since their attitude of "We got away with this elsewhere" worked until it didn't.
They did get away with it in London. They broke laws, argued unfaithfully in court, got denied a license, got an extended probationary period from a magistrate, and finally are operating in the clear.
Very very few other businesses get to act so brazenly and dangerously, then get an extended period of time and support to do the bare minimum to qualify as compliant.
I think it's fair to say regulation existed and exists in the West for taxi drivers. I understand their point to be the degree. I've taken many taxis in the UK and prior to Uber, the experience sucked outside of a black cab (which are very expensive). Ditto for New Zealand, Australia, Italy, France, Greece, etc. I'm lucky to be well travelled and I can say that sentiment for taxi drivers was terrible prior to Uber. Regulation existed, but that didn't stop drivers from being terrible in many ways.
Uber made it very clear who the terrible drivers were. It turned it into a real service industry where good service was expected. Suddenly scammers couldn't hide behind anonymity. To this day I would rather pay 2x as much for an Uber than take a regular taxi. That's how much they sucked.
I once had a 6 foot 7 taxi driver in Croatia try to shake me down for twice the agreed amount of cash. He tried to take away my phone and force me physically to give him more money. I had no information on him or desire to stay longer to press charges and waste my vacation.
I got a fond appreciation of uber and other marketplaces that provide accountability using technology ever since.
> Taxi drivers were not more "regulated" in any meaningful way, in fact oversight of them was significantly worse than the community-driven Uber rating system (not that that doesn't also have flaws).
Taxis have standardized rates set by the municipality and use standardized meters that are periodically inspected. Ride sharing apps have dynamic pricing and no transparency.
Taxis have (almost) no transparency. Outside of a few limited places where there are fixed fees for certain routes, you never know how much you're going to have to pay when you get in. With ride share apps the pricing is upfront and transparent.
In certain cases the literal definition of "upfront" is practically useless. You can check the price of a ride app before your flight and by the time you land it can double. This never happen(s/ed) with taxis. Alleged surge pricing is not transparent. After eliminating taxis, ride app companies create duopolies that can arbitrarily increase ride prices and lobby more effectively against worker rights.
Except when the "meter is broken" or they take the scenic route. My grandmother with dementia routinely got charged double or triple the expected rate for trips to medical appointments, until we figured out what was going on and started booking her rideshares.
Just curious what happens if there is a major event going on in the proximity of one of the doctors appointments?
It could turn out to be 2-3x the "normal" cost due to surge pricing. This often happens to people who go out drinking and think "I'll just grab an Uber later".
Recently heard someone complaining about the $45 cost to go 3 miles.
*Sidenote: people with dementia should probably have someone in the car with them to be sure they get to the appointments. That solves the issue of shady people taking advantage of them for the most part.
To clarify I was referring to her getting upcharged by unscrupulous taxi drivers, not rideshares. Rideshares were an improvement since we could book her a ride with a known up-front cost, and get pick-up/ drop-off notifications.
> *Sidenote: people with dementia should probably have someone in the car with them to be sure they get to the appointments. That solves the issue of shady people taking advantage of them for the most part.
Her dementia was still fairly mild at that point, she could easily manage taking a taxi from A to B, she just wouldn't push back if the guy said it was $30 when it should have been $10. It's tricky to figure out the right supports and boundaries at that stage, especially for elderly people used to being self-sufficient. Convincing her to stop driving was hard enough...
>To clarify I was referring to her getting upcharged by unscrupulous taxi drivers, not rideshares. Rideshares were an improvement since we could book her a ride with a known up-front cost, and get pick-up/ drop-off notifications.
Understood, IMHO...it is easier to find a reputable taxi company than it is to predict surge pricing. Or at least it used to be when you had a choice.
I'm new to HN. Does it always get like this before US elections?
I was really enjoying the apolitical vibes, but then that all went off a cliff about two weeks ago. Hard to tell if it's astroturfing or if it's just on people's minds.
It's pretty hard to ignore if your government not only intertwines with the tech industry in ways that no government should with any industry, but even starts changing language used in the field by decree [0] in a 1984-esque way. Us non-USers run into these kind of things on platforms we use everyday (platforms that are gracefully provided by the US, for sure! Although we have our own here in the EU, the US still sets the standard... for now) like [1].
I'm surprised you've had an apolitical experience up until two weeks ago. HN has always had politics creep onto the front page, less so during the off-season, but still pretty present IME. Especially prevalent over the last two years. Lots of side conversation bickering in random threads.
It's definitely been increasing compared to what it used to be, but this may also be natural consequence of the fact that big tech itself has become much more "political". It didn't use to be the case that the owners and managers of technology corporations displayed their political preferences quite so brazenly (in the case of Elon Musk, even to the point of taking on a leading government position).
Of course, corporations have always had policy preferences, but those tended to be mostly about taxation and regulation, where debate is less emotionally charged, and compromise is more achievable. These days, though, it seems that tech and political culture have become almost inextricably linked.
Because the us government leaders have become extreme and have also taken drastic steps that effect the economy in bad ways, people naturally post more on this in more places since often people only start caring and talking about things when it effects them economically
It's a very ugly thing about political polarization. It's easier to destroy than to build, and both sides seem gleeful about tearing down whatever is (rightfully or not) perceived to be aligned with the 'other'.
The reaction to Charlie Kirk's murder (not even the murder itself, but the celebration of it) made it the most shocking political event for me personally, in my lifetime. And it seems like it might be like this from now on - ripping things apart, destroying lives, and then cheering about it.
When Pinochet died, people threw parties in Chile. It's always been like this when things are taken to the extreme (and these days everything is extreme)
Did anyone aside from terminally online edgelords cheer for that though? I don't know that I saw anyone serious celebrating his death, certainly no members of congress. I do find it odd that the reaction from twitter and reddit bottom feeders (and the likes) stirred you so much. For me politicians actual vile comments and complete indifference to the assassination (or attempts) of state representatives and their families is much more disturbing than what people on some Sopranos meme subreddit had to say about Kirk - but perhaps the Hortman's were those 'others' you mentioned?
It's the volume that I found disturbing. There were Twitter posts celebrating or mocking Kirk's death, using images of his murder, with nearly 1MM likes, hours after he was killed. At the time, it was being reported his wife and toddler daughter had been in the audience (thankfully later revealed to not be true).
I haven't seen anything comparable for Hortman but if I had, I agree I would find those incredibly disturbing too.
I think with the kirk issue it was because most of the time when someone is killed for political reasons, they were the right kind of divisive. Kennedy killed over civil rights for example. Kirk though might be one of the few cases where someone who was inflammatory and the wrong kind of divisive was killed. For that, you can expect some dancing in the streets. Expect fireworks and a week of partying whenever Trump kicks the bucket.
it was more shocking than when multiple state legislators were gunned down and the shooting was blamed by Trump on Marxists? Or when Rob Reiner was shot by his son and Trump implied he had it coming?
nobody is trying to tear down AI companies. but there is a general reaction to companies and their leaders who imply that 'risk to civilization is non zero', or they need unemployment is likely, while pushing for the state to backstop them.
Political riots and Trump being a scumbag are well integrated into my worldview.
My coworkers making gleeful cracks about a podcaster bleeding out in front of his toddler was new information for me. I didn't realize we were so far gone.
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