This is impressive how far the US has normalised the concept that health is primarily a financial decision. Especially in the HN bubble that consists mostly of wealthy individuals.

Now depending on the issue it is faster to drive/be driven from where I work so an ambulance is often not that useful. For example a while back a coworker ate a tamale off the food truck only to find out that it contained peanuts. After noticing the reaction the owner took him to the ER personally (Coworker used his epipen as soon as it was known he needed it.) It is ~8 mins by car and at best an ambulance would have been 6 here and 6 back for an arrival time of 12 minutes. Now had they not been breathing they probably could have gotten a fire truck here in 2-3 mins to administer some epinephrine but they would still have had to wait the same 12 minutes to make it to the hospital because the fire truck EMT's can only do on site treatment.

So unless it is extremely dire taking a coworker to the hospital can be faster than an ambulance. That said a crushed hand or cut off finger? That is one of those where seconds matter and the fire truck/ambulance combo would be used.

My uncle worked for a place where a vendor CE had a heart attack and died in the early morning in a raised floor space control room. Someone called 911 multiple times and due to bureaucratic fuckery security didn't let the EMS in multiple times. In short, the dead guy was wheeled back and forth by operators for 12 hours, when the plant manager dropped in and lost his shit and took care of it.

Like I said somewhere else, this topic is a corner of the world that sounds insane if you're not in it.

Where I work, 911 has no idea where we are for reasons, and a serious incident where a person isn't vocal requires a floor sweep. The emergency services don't have the time or interest to handle your company's internal stuff, particularly if you have a high call volume.

Unless there is uncontrolled bleeding that is definitely not a "seconds matter" situation. Sure, you want to get to a surgeon sooner rather than later, but an extra 5 minutes isn't going to matter.

Where do you even begin to make that sort of claim?

I just skipped through the comments, and the fact that hardly anybody points out the fact that an employer should care for his employees and follow all applicable regulations is mind boggling.

But it could also point to a general issue regarding SV and SV-style disruption. Build a business around ignoring existing regulations, because of disruption.

HN appears to have a more highly paid engineer out-of-touch with financial reality user base, it's not everyone, and I don't think they're doing it on purpose, but it's certainly noticeable. Even on my barely-enough-to-live wage in Seattle it's tough to not find myself forgetting the struggles of people lower in class than I. Workers rights are not popular here, and I'm guessing it's because engineers and higher paid people are often treated pretty fairly and have workplace freedoms the rest of the workforce could only ever imagine in their dreams.

Also zrue that a person tends to stay in their own social bubble, I do it myself. Lucky me I don't have to worry about money most of the time. But that doesn't mean that you cannot be aware of others that are not in that situation. Not that I care about that often enough. Again something I realized lately.

Bear in mind that europe also has 10%+ unemployment.

Major countries close to 10% are Italy and France with 9.7% and 9.3%. That, obviously, is not good. The country that surprised me was Germany with 3.4%. No idea why this is not celebrated more, I wasn't aware of that number until now and I live in Germany.

What is worrying so is youth unemployment of people between 15 and 24. It is roughly twice as high as the rates mentioned above, in Italy even three times as high. I considee that to be extremely dangerous for a society.

Your post made me want to go deeper in german and came across an interesting bit: german has a very low minimum wage, and also some antics around the lower eschelons. https://www.quora.com/Why-is-the-German-unemployment-rate-co....

That bein said, this is a terrible thing to do to people if you ask me. And maybe not doing it and having higher unemployment would be more humane. But I'm no eypeet, just a guy with an opinion.

Also, out of experience, in Germany you are not officially unemployed if you are in a training program sponsored by your oocal unemployment agency. Also a nice way to optimize your numbers. And the explanation why there is a whole industry built around just these trainings.

When Germany introduced all these thing back in the early 2000s, it was tough. Germany was called the sick man of Europe. Maybe, these initiatives, Agenda 2010 it was called, were not totally wrong. Downside was the creation of whole class of people that aee basically stuck at the lower ranks of the social ladder. So, good for the economy, yes. Good for the country maybe. Good for society, I would say no.

Highest income workers always get the benefits of workers perks first, and this is unavaoidable. Look at google, famous for giving benefits to employees like good, gym, juic etc, but buildings maintained by swathes of contractors that dont have access to these services.

The more of these you pile up, the bigger the divide.

This is in no way a defense of Tesla's on-site medical facility's policy of not calling 911 without authorization, but the location of Tesla (U.S.A) is not somehow responsible for draconian policies, nor is it fair to assume that if Tesla operated in the EU, such policies wouldn't exist.

FYI - from the way the article paints it, Tesla's policies are in clear violation of U.S. law.

It’s to vote, convince and then copy the model from every other 1st world country... super hard sure but perceptible

My insurance for an ER visit would be roughly $4500 right when I walked in, or they wouldn't cover anything. Every time after that though would be $300 until next year when I'd have to pay $4500 again.

There's unfortunately no consensus on how to solve it.

Human life isn't worth anything if the people can't use legal means to protect themselves.

For these US citizens (SV elite), healthcare is akin to a status symbol or a luxury that only rich people or people bestowed by the rich (think: employment) should be able to attain.

And then look at how much hatred there was when Obama tried to implement the Heritage Foundations plan, which was done by Mitt Romney in Massuchusetts. Republican, btw.

These people really don't care about the "rest of us". That's why Trump was elected. He showed he had the similar hatred and focused it. Don't get me wrong- he's done horrible for the US... But that's why.

EDIT: I would love to hear a description why I'm wrong. I've lived through the creation of Obamacare, my diabetes T2 diagnosis under it, and now the structured destruction of it, along with trying to eliminate 'preexisting conditions' exception. In short, if they get their way, I'll be dead sooner. Like 10 years sooner. Lack of health care + diabetes = death sentence.

But in the end, having us "dead weights" dying isn't a bad thing when you boil us down to $$$.

https://en.wikipedia.org/wiki/United_States_presidential_ele...

False. Healthcare is not a human right, but the insane inflation of healthcare costs would be avoided by removing a large portion of the regulation surrounding it. If hospitals actually had to compete to get patients, based on affordability, among other factors, healthcare would be far cheaper, and private charity/need-sharing would take the place of insurance.

Back when people thought that healthcare should not be regulated.

Now, there's a lot of fuckery in the healthcare industry. A lot. Both, business side and gov side. Both are to blame. But just saying regulation is flat out bad. That's stupid. There are many issues and each have to be addressed.

Not just a one MAGIC PILL solution.

And yet there is a Constitutional right to a lawyer in most criminal cases if you can’t afford one. I can assure you, while public defenders might not get paid well and maybe many can’t afford their student loans, they are not slaves.

But that case is more defensible: the enforcing of the rule of law is powerful for freedom. So sacrificing some freedom to get a lot of freedom is an easy case.

Health services do not relate to freedom, but to the cost of insurance. If the government can provide a cheaper healthcare then it should provider a cheaper healthcare, and citizens can choose the government's plan and it will eat out the competition.

Why would the government need to ban the competition if its so good at providing insurance?

In no country ever is private healthcare and competition banned. There is a free* hospital across the street from me and I have private healthcare.

It’s about acknowledging that a) it is cheaper for everyone if people with no money go to the doctor early, because a GP is 1k% less expensive to society than a hospital bed runout. This is one of the reasons healthcare in single payer countries is ~50% per capita.

B) people without money don’t deserve to die because they are poor and should have basic treatments, even when it is their own fault they are poor and make bad decisions.

* I pay tax which pays for the hospital

Thats not factually true: there are many places that ban private healthcare, including canada. Then there are other conditions that punish private disproportionately: like funding public healthcare with taxes, but private healthcare with private funds: that means a person would have to pay 2 insurances to get private services. Also single payer really means there is only 1 insurance, so yes, it bans all other insurances.

> It’s about acknowledging that a) it is cheaper for everyone if people with no money go to the doctor early, because a GP is 1k% less expensive to society than a hospital bed runout. This is one of the reasons healthcare in single payer countries is ~50% per capita.

There are multiple issues why healthcare in the US is more expensive than "single payer systems", and preventative medicine is a small part.

> people without money don’t deserve to die because they are poor and should have basic treatments, even when it is their own fault they are poor and make bad decisions.

Is this moral line of yours defined by the country? Because if you want to save people's lives, single payer systems are very expensive. Its a lot better to open immigration and bring poor people from abroad.

Isn't that all forced "slave labor" by this same argument?

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…”[1]

[1] Article 25 UN Declaration of Human Rights

My point is definitely that you have an obligation to provide society funding for healthcare even if they don’t pay. Just like the military will defend them even if they don’t pay, or a firefighter will put out their house.

The right to be provided something is the right to take from someone else. There is no escape to this, its a right that infringes on the right of others.

Theft cannot be a human right, and i would strongly reject anyone that defends such a thing, including the UN.

This thread is going nowhere, you clearly value money more than the health of people less fortunate than you. Systemic poverty and sick people, who cares right.

You mention a trade-off with money and health, but the very idea of taking from some to give another is a violent expression. You might justify to yourself that is fine to rob and murder for the sakes of others. Others will think the same way.

I’m no longer participating in this thread, and won’t read any replies.

I mean, your argument holds true for everything. And yet, look around us and compare to any instance of communism on various extents. Capitalism is always better.

Modern mixed economies are better, but there is a reason capitalism as a system (rather than a component of another system) died sooner than Soviet-style communism, to the extent that we now unironically call mixed economies with large socialized elements “capitalism”.

Among mixed economies, it's not the more strongly capitalist ones that have the most efficient, effective, or publicly popular health care systems, either.

Enjoy bartering and purchasing your way across private property to something distant. (Yeah, fat chance you actually hold to your criticisms.)

Edit: Also, I grew up in a country (India) where healthcare was definitely part of the market economy. And what that meant (and still does) was that people with money get high quality immediate care, and those without get shafted. That's what the market does to healthcare.

Pay up for the nearest facility, IF you have the funds to do so.

Or die.

....So it can only be for the rich.

Insurance is simple - you have a group pool their risk together so that everyone's protected.

Yet, when we try to discuss making an insurance pool the size of the country, for everyone, people like you go all "not a right".

When I see "not a right", I read into it as "Fuck you I got mine".. when there is plenty to go around for everyone.

> If hospitals actually had to compete to get patients, based on affordability, among other factors, healthcare would be far cheaper

Citation needed: prices are NOT linked to how much thing is, but how much the market will bear. Stating falsehoods to cover up your intent is disgusting. We know how c(r)apitalism works. We're rejecting that. Tried it, didn't work. Reiterating for better.

> private charity/need-sharing would take the place of insurance.

Uh huh. So non-christians need not apply? I know how this plays out... This is a citizenry issue, for the whole country. And you end up wanting to make it a fractured "small group" issue. People fall in cracks, and you don't care. Some "mythical" group will fix it.

This statement is incorrect. Libertarians want competition in the emergency medical transport industry. If someone can offer a better service and at a lower cost, then that service should be an option.

All other things being equal, if it takes an ambulance 20 minutes to arrive on scene versus a ride share that takes 5 minutes, which is preferred? Granted ambulances provide more than simply transporting someone to a hospital, but those services could easily be applied under legal alternatives and done in a safe, effective, and efficient manner.

The libertarian argument is that it should not be illegal to let the market provide alternatives.

Really? A couple years ago I brought my buddy to the hospital in an Uber and he was pretty close to dying, nobody at the hospital seemed to have any issues with it. I later emailed Uber to praise the driver and they thanked me for the writeup of what happened and said they distributed it on their internal listserv. Definitely did not feel like anything illegal was happening throughout process.

In your role as on-site physician for a corporation?

this might be because they had more important things to attend to, like your dying friend.

    https://slate.com/technology/2018/02/when-should-you-uber-to-the-hospital-and-when-should-you-call-an-ambulance.html
    https://www.webmd.com/health-insurance/news/20170515/uber-lyft-er-trips#1
    https://www.rewire.org/living/uber-emergency-room/

https://www.usatoday.com/story/tech/news/2018/03/01/doctors-...

With Uber Health, a doctor can send an Uber to pick a patient up to transport them to the doctor's office, and many doctors have offices in hospitals, so this service would then be illegal according to you, but it isn't.

What you probably meant to say is a medical practitioner can't call a non-medical transport for a patient in an emergency, which also doesn't seem true, but I can't find any articles that directly say that (why would someone write such a thing?).

Whether that should have been used in the cases described in the attached article is a reasonable debate. I'm more confident in the people on the ground making this choice than the news reporter.

Medical practitioners, however, cannot send someone in a cab. It's a huge liability issue for them. If someone is injured and needs medical transport, they need to use proper medical transport. This is what Tesla is accused of violating. Their on-site nurses are licensed medical professionals. It's worlds different from random person taking a cab to a hospital.

State law regulates drivers, medical transport is a subsection and medical transport is further broken down into emergency transportation and non-emergency transportation. What the law says is you can’t just start offering medical transportation services to the public in exchange for money without complying with the law/regulations.

Further, as you might imagine doctors are regulated, and if you are treating a patient who needs to be transported to an ER for emergency services, the doctor should understand a Lyft/Uber isn’t the appropriate standard of care and is per se illegal under those facts. The doctor may have had his/her heart in the right place be not calling an abmbulance to reserve that for a hypothetical life/death patient, but it’s hard to argue this isn’t an emergency when your a doctor sending your patient to the ER, at which point emergency medical transportation laws/regulations apply.

My wife drive me by nothing stopped me from using a taxi or ride share.

Doctors definitely have a duty of care that must consider emergency transport, but it's be surprised if laws explicitly stated you need to call an ambulance for stable patients that need emergency treatment.

However, the medical practitioner themselves cannot tell you to take an Uber to the hospital. Which is sensible.

I gp is rarely going to be in a situation where they need to call an ambulance for a patient; generally it's going to be the organization (like a nursing home) or management/administrator to avoid potential liability

Tell that to the California Department of Heath Care Services...and the 49 other states who have similar regulations and regulatory agencies in place.

Lyft/Uber giving rides to people in no way means or suggests those rides are legal. And there is a differnce between non-emergency transportation and emergency transportation...but it is all highly regulated. Still doctors and drivers should both know these laws that affect them directly. If a doctor is dumb enough to put an employee with a workplace injury in a rideshare, the onus is on the driver to deny the ride and tell the rider they are licensed/insured to take a patient to the ER and they should call 911...that doesn’t happen because ride share drivers are not professional drivers who actually know the laws that regulate them.

They should not be used for emergency transport, and that is part of the argument. Again, that is worthy of debate, but blanket statements about Lyft not being usable for "medical transport" aren't really useful.

Pretty sure my comment you replied to acknowledges there is a difference between emergency and non-emergency transportation.

If you want to argue how a worker with a crushed hand/severed fingers going to the Emergency Room for emergency medical treatment isn’t an emergency...go nuts, and please feel free to be liberal with the case Law you cite.

>And there is a differnce between non-emergency transportation and emergency transportation...but it is all highly regulated.

Nevertheless, I am right. Even to provide non-emergency medical transportation you must be registered (hold appropriate licenses/insurance), a random ride-share driver can not legally offer non-emergency medical services...unless they are registered with the government to provide those services.

Still none of them can provide emergency transport services to the public for money. So now you can continue debating that a patient with a crushed hand/severed fingers diagnosed by their doctor as needing emergency treatment in an ER is not an emergency requiring emergency transport under the law.

Please can you link to the law that you're talking about?

I think you mean the "private EMS lobby". Individual EMTs are equally opposed to most of the legislation being pushed by big EMS companies (notably Prop 11, being voted on today, which is an attempt by AMR to avoid having to comply with meal break rules)

Usually, when employees in an industry oppose an initiative, they actually file opposition to it; Prop. 11 was unusual in having no opposing argument filed, which usually only happens with non-controversial proposals.

The group behind Prop 11, Californians for Emergency Preparedness and Safety, is an AMR shell corp. AMR provided all of its funding, and it's CEO, Thomas Wagner, is the CEO of AMR's Western Region operation.

https://projects.propublica.org/graphics/workers-compensatio...

you need to add professional cleaning cost and lost revenue while cleaning to the bill.

and not just professional cleaning... the injured person could've a serious illness (think HIV), so it will probably cost even more

i'd wager you'll need at least twice that amount

*Truly ideally there wouldn't be ambulance bills stuck on people, but I mean within the framework of what's currently in practice.

A person with a severe impact might not have much external signs or pain, but could be bleeding internally. That would present a problem in the backseat of an uber on the highway.

Without stabilization, a broken bone can cut or puncture any number of blood vessels or organs (for a rib).

There's a reason we use medical transport after injuries -- you don't really know what might follow.

If the cost is the concern, using cheap transport isn't the answer. Either socialize the care or force workplaces to pay the EMT fees for workplace injuries. Sending someone in a cab is just not acceptable if a doctor deems medical transport necessary.

Now, all of this hinges on the particulars and accuracy of the description of the situation, which I can't really judge from the outside. But if otherwise independent medical professionals are being urged to reduce ambulance use in order to save face for the factory, that's a real problem. I'm inclined to believe the ousted clinicians and former employees, though.

They are medical professionals, and thus held to the standard of only being allowed to call an ambulance. That was the whole point.

If your partner goes into cardiac arrest while you're driving, what are you going to do? Stop to apply CPR and while simultaneously calling 911? Start driving faster, running red lights, and hope you both survive the trip?

Or is your partner offering emergency services to the public in exchange for money? If so is your partner properly licensed and registered to provide those services? Is your partner insured to provide those services?

If you went to a licensed medical professional with your foot cut off, they're not allowed to call you a cab. They have to call an ambulance. You can tell them, to hell with your fancy EMT's and expensive rides, I'll just have my wife take me over to the ER to get this foot sewn back on, but they have to call an ambulance if you need transport. This is a liability and safety issue. It's also a kickback issue.

TL;dr- No, it shouldn't, and nobody wants to make that illegal.

I counseled Will on the difference between subjective complaints of pain, which cannot be proven and are often magnified, and objective signs found only on careful clinical examination by an experienced physician. I even mailed Will a copy of a relevant chapter from the American Medical Association Return to Work Guidelines and offered to make myself available for additional questions. Research and evidence-based medicine indicate that deconditioning injuries involving sore muscles should not be treated with inactivity as this only exacerbates the problem, but should instead be treated by proactive conditioning, ergonomic modifications and supportive care. Not all patients in pain should be off work, at home and on opioids. In fact, it is most often in these patients’ best interest to have supportive care that enhances their activity, their function, and their well-being.

As a physician, my foremost obligation is to perform a careful history and physical examination, order additional tests when clinically indicated, make an accurate diagnosis, and deliver the absolute best care possible. If patients are injured and continued work presents safety issues for the patient, myself and my fellow physicians prescribe the appropriate work restrictions. Any suggestion that myself or any of my medical team at AOC allow external factors to influence our medical care in any way is false and inaccurate.

I advised Will on why ambulances should be reserved for life or limb threatening injuries and that every ambulance that is thoughtlessly called for a non-life-threatening injury is one less ambulance that is available to actually save a life rather than be used as a convenience. Most importantly, all members of my team are empowered to call 911 for any limb or life-threatening condition.

Rather than deliver an informative and balanced piece of journalism, Reveal has instead chosen to hitch its wagon to Ms. Anna Watson, a provider with whom we severed ties after less than two weeks at our clinic and about whom I cannot provide any additional comment as she is currently the subject of an investigation by the California Medical Board. Instead of highlighting the tremendous progress being made in both patient safety and patient care at Tesla, this report uses poor sourcing to tell a story consistent with a predetermined agenda.”

26 PM_ME_UR_Definitions • 1h Maybe you don't believe this guy? Maybe you think he's a genius? It doesn't really matter, leaving out this kind of information from someone you interviewed is the definition of bias. The reporter was filtering out information not because it's inaccurate, but because it didn't fit with the narrative they wanted to tell."