It was only a matter of time and I said (half) jokingly at the time that Uber is breaking the dam for everyone else to follow. Any regulated system will have its day in front of "disruptors" where the disruption is simply ignoring the regulation with some flimsy excuse, supported only by the money and lack of morals of VCs and startup combinators.
Uber took an axe to taxi drivers which weren't a popular group to begin with so that was easy. With the "disruption" perfected, next up are doctors, nurses, lawyers, electricians, cooks, engineers, the sky is the limit.
This trend was started in health care by private equity with no inspiration from Uber. Check your local dentists, eye doctors, veterinarians, urgent cares, maybe even hospitals. You'll find very few that are not owned by some large private equity firm these days, who run everything at the highest margins possible. And once you eliminate any higher quality / higher paying positions in an area, moving to pricing on demand and getting rid of full time positions entirely comes next.
Uber "deregulating" everything, means Uber taxing everything... because everything will go through it... and you know the EEE thingy right? better prices until you kill industry, then rise prices...
The good thing is that we will not be fooled this time while checking the dead bird thing...
It has been my observation that the companies all had plans to "disrupt"...but it seems they never had a solid "profitable" plan past when the VC money ran out.
Aside from turning employees into contractors...most of which have not done the math on how much they are losing through having to use your own car with no employee benefits. Doordash/Uber start looking a lot less attractive if you figure in the $.65/mile costs (fuel, repairs, insurance, car purchase price) that you would be paid by most govt or "real" companies.
Almost everyone I know who does Doordash makes about $20/hr (which isn't good anyways) and they are not figuring in the costs of the vehicle.
My wife volunteers during tax seasons to do tax returns for low income people. It always depresses her when people on the lower runs of the ladder come in and have been doing uber, lyft, doordash, etc or some combination and have nothing more than a hand wave estimate of how many miles they drove. She is the one who has to tell them just guesstimating is not allowed and what might have been a $1000 check back to them is instead a $2000 check they need to write to the government. 9 times out of ten they say, "but I don't have that money" and it crushes her. More than a few get mad at her for not being willing to just enter their guesstimate into the form.
I'm not sure if it is because uber (or whomever they work for) didn't make it clear enough to track it properly or if they simply didn't take it seriously.
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).
They tried not to but the law didn't give them a lot of wriggle room and they effectively lost in court when they pushed it.
> 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.
TBF it’s also an engine to push for regulations review. Awful lot of regulations are written for an age that no longer exists and just as many are to make management easier therefore startups pushing the boundaries actually are a correcting mechanism.
Unfortunately some harm can be inflicted bur IMHO it’s better than the alternative.
Not only were taxi drivers not popular but it also wasn't and isn't obvious to most people exactly how or why they were regulated. Especially to people outside of major urban areas.
To what degree is this just another symptom of the US healthcare system being flawed and in need of rework? To what degree would anyone use such a service if the costs remained high?
I used Zocdoc in the past to find a doctor and ended up with a doctor who just charged out-of-pocket instead of insurance, and it worked great. Would an app that shows up-front pricing be better for the consumer?
If you look carefully at the chart, US nurse salaries are high because US salaries are high. The ratio of US nurse salaries to average US salaries is nearly the same as the OECD average.
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"
Uber checked the first few digits of your debit card to filter out police officer credit unions to evade taxi regulation enforcement. They use your phone’s battery level as one factor to estimate your elasticity of demand. They have teams of economists to adjust personalized prices to as high as you can bear and pay for drivers as low as possible.
Among the things that need to give are 1) insurance companies making no money because there's no margin left in the system for them, and 2) several times as many doctors, which means breaking the protection racket that intentionally limits the supply.
A much larger supply of doctors would presumably lower their pay significantly, right? Will people still want to put in the years and years of training to become a doctor if the pay drops significantly?
What is the protection racket that intentionally limits supply? The primary bottleneck to producing more physicians is lack of available residency slots. Teaching hospitals are free to add more but for various reasons choose not to. In part I think they're waiting and hoping that Congress will kick in more subsidies through the Medicare program.
Even if financial constraints were removed, the notion that we could produce twice as many physicians is ludicrous. There simply aren't enough attendings able to supervise a lot more residents, nor are there enough patient cases coming through the teaching hospitals to give that many residents the practical training they would need.
Germany still has non-profit sickness funds (Bismarck model). So you don’t have to ban health insurance companies when rolling out universal healthcare. Their freewheeling excesses have to be reined in. Access is a right. Standardize coverage and prices on both the insurer and hospital/doctor ends. Once everyone is in the same risk pool, there will no longer be a perverse incentive to deny claims for profit. A single standard plan will also have the negotiation power to drive down prices.
Most hospitals (both for-profit and non-profit) are terribly inefficient. They burn up clinician time on administrative tasks that could be automated or performed by cheaper office staff or not done at all. And employees often waste a lot of time just waiting around because no one has optimized workflows to shorten queues or eliminate bottlenecks. The incentives are structured in a such a way that there's often little reason to improve.
Most software development shops (both for-profit and non-profit) are terribly inefficient. They burn up programmer time on administrative tasks that could be automated or performed by cheaper office staff or not done at all. And employees often waste a lot of time just waiting around because no one has optimized workflows to shorten queues or eliminate bottlenecks. The incentives are structured in such a way that there's often little reason to improve.
This is certainly true. With modern AI agents, it is entirely possible that the duty cycle of a software engineering enterprise is not actually the 8h/24h we have today but closer to a 24h/24h system. Certainly my ideal is to proceed software engineering organizations closer to the latter system.
Ha ha, but it's a matter of degree. Every organization has some level of inefficiency but having seen how the sausage is made I can guarantee you that the average software development shop in a US tech company is significantly more efficient than the average hospital. It's not something that you can quantify in a directly comparable way but anyone familiar with the industry will tell you the same.
It’s a complex problem because a lot of those hospitals are non profit, so they have zero incentives to have high margins because no shareholders to return money to. Higher salaries for executives though…
It’s important to note that in most countries the law even states that they need to pay competitive salaries for these positions, so they can’t even pay them much lower amounts than their non profit counterparts
Traveling nurses make more than lots of doctors though, so I dont think they're being taken advantage of. However, Im sure this company is trying to take a piece of that traveling nurse pie.
The exact profit margins of hospitals as a whole doesn't matter. Hospitals are where health care happens but financially, they are simply a platform for a multitude of other private entities which make profits on top of the simple hospital fees - the "Uber For Nurses" thing is just one of many ways this happens, you have everything from data management companies to separately own MRI machines adding to the patient's bill and having a voice in the management of the hospital.
Yeah, maybe it's the idea that hospitals should make profit that should give?
Like, sorry, but not being from the US the whole idea of a "margin" when running a hospital is insane. Hospitals are paid from our ample taxes and the patient pays nothing - there is no room for profit there, not should there be one.
How much does your country’s medical professionals make, how long do patients wait for care and what is the level of care as measured by variety and efficacy? Seems hard to compare without normalizing these things.
Trying to compare national healthcare systems based on life expectancy is a total non sequitur. Most of the factors which limit US life expectancy relative to other developed countries have little or nothing to do with healthcare (or lack thereof). It's mainly other problems like car crashes, suicide, violence, substance abuse, and sedentary lifestyles.
Could I use this app to hire a nurse and get a diagnosis from home? If we can start getting even meagre medical treatment to skip insurance / other middle men, I could see this having a great impact on healthcare prices, especially since AI is such a good information extractor, which is 90% of the role doctors play anyway.
Generally speaking nurses in the united states cannot provide a diagnosis, at least without jeopardizing their license. You can already find a doctor using a service like Zocdoc who may cut out middlemen, though regulatory capture has made it close to impossible to meaningfully reduce costs in this way. I would not recommend using AI to diagnose or treat yourself (https://www.nytimes.com/2026/10/27/well/ai-chatgpt-medicatio..., for instance) without the help of somebody highly trained to interpret this information and make good decisions.
Nurses don't really do diagnosis, but follow the ones doctors give.
(Except for trivial things)
Otherwise I unfortunately know plenty of doctors that could easily be replaced by an LLM, but for now I prefer a diagnosis from a real doctor (who may use AI as a tool).
If you really believe that information extraction is 90% of what doctors do then you're deeply ignorant about how healthcare actually works and not qualified to even have an opinion on this subject.
> A companion Roosevelt Institute brief found that some platforms "use data-brokers to determine nurse debt levels and offer lower wages to those with highest debt loads."
When something sounds too bad to be true, I think it's fair that we should ask for some kind of evidence to be produced. They cite a Roosevelt Institute article that says
"Gig nursing apps MAY [my caps] determine pay by what the firm knows about how much a nurse was willing to accept for a previous assignment, how often they bid for shifts, or how much credit card or other kinds of debt they might hold."
That kind of sounds like they are overselling a hypothetical. Even just an "insiders familiar with the matter have told us that it IS happening", would make me believe it more.
While I do understand the importance of training, degrees and experience I see that people in the medical field beyond Doctors seem to have a very holier than thou attitude probably because they have 10 edge cases of how MRI can go wrong drilled into them (MRI technicians), not everyone is comfortable with needles and human body (nurses) and because it seems that only Pharmacists can sort and provide us the right medicines when in fact it can be easily done by some robots.
In before someone says that your reasoning is flawed because that is very incorrect perception of the field. All I see is that regulatory capture has worked very well here and is simply stopping totally novel and practical ideas which work on tradeoffs from even taking off
This sounds like pure insecurity with a sprinkle of Dunning Kruger. Unless I'm missing the joke somewhere? Nurses don't mind needles is the only difference? I must be missing the joke.
On the one hand, a good nurse is invaluable. They do the hard work that doctors won’t/don’t do, and can be so kind and generous during your time of need.
On the other ones, there are so many who mail it in and are just milking the system
Healthcare is so expensive - some nurses are making 500k a year - their union contracts base vary from 200k to 300k for something like 32-36 hours per week
On top of that, they can pretty much work unlimited overtime with zero restrictions. They can work enough overtime hours such that they can nearly double their salary. And that’s how you come up with the 500k figure I posted
Granted, that’s at the top of the range, I’m talking about somewhere like the Bay Area, and does require a ton of overtime, but those extra 100s of thousands add up. These hours can’t be spread around to minimize the amount of time and a half or double pay paid out, per contract they go in order of seniority
This is just nurses and I imagine it’s something similar but with higher rates for specialists like anesthesiologists and still beyond that doctors and surgeons
I don’t begrudge anyone’s salaries, but it’s a zero sum game. There’s a reason why, aside from typical corporate profit maximization, you wind up with a 30k bill for a short visit. Even if you account for the lower rates insurance companies pay, it’s still in the thousands of dollars for treatment where you were seen for less than 30 minutes
Like I said, to be clear, I don’t begrudge anyone’s salaries - this is just an under discussed point when we talk about healthcare costs
Labor is generally reported as 60% of the costs of hospitals - so if you’d ever want to talk about making healthcare affordable you’d have to address this which I feel like is a bit of a taboo subject. Many nurses are in a union which makes it an even more difficult conversation
All that is to say, I can see the motivation behind stuff like this, even if I don’t agree with it
The entire 'gig economy' model is exploitation. It only works because of income inequality. It requires a large pool of workers who don't make enough money to support themselves (due to insane healthcare and housing costs, and low wages and benefits) and thus will take any money they can get, despite the poor pay, long hours, and lack of benefits. It's taking a person slowly dying of thirst and offering them a thimble of water in exchange for knitting a sock.
Everyone wants healthcare expenses to go down but the biggest healthcare expense is the salaries of providers. So, hard to give the masses what they want without making a smaller group of people who benefit from the status quo angry.
to be a bit pedantic, that says they account for only 15% of the excess healthcare spending, relative to other countries. It's not surprising given doctors in the united states have a higher level of training compared with many peer countries, and _all_ salaries are much higher in the united states compared with almost any country.
The 15% extra administrative cost of insurance and 15% extra administrative burden of applying care are the big culprits, in addition to extra costs on medicine and machinery. But it's interesting. Why is it that a comparatively deregulated and privatized system has so much extra pricing cost from bureaucracy?
In Sweden we had this in the news: https://www.svt.se/nyheter/lokalt/uppsala/hon-pendlar-860-mi...
A US nurse moved to Sweden and preferred to fly to San Fransisco to work ten days at a time, then fly back to be off for six weeks, rather than taking a job as a nurse in Sweden. The salaries are very different.
Much like home prices. Everybody says they want homes to be more affordable, but all actions are designed to keep them high and if they did actually fall it would be treated as an emergency.
Physician salary is only 9% of total healthcare cost. The rest of the labor pool is administrative - clerks, management, etc.
Physicians also make 2-3x more than physicians in other countries. Why? Their education cost is also 2-3x higher than in other countries.
Hospitals and procedures are expensive, in part because of insurance. Insurance is high because our society is too litigious. It's also expensive because of consolidated private healthcare systems that can control and mark up prices due to lack of competition.
Other countries spend half what we do on healthcare. And their people are often healthier.
Nurses already deserve higher wages than what they already get, but introducing "dynamic pricing" and competition to under-bid each other is just disgusting.
Nurses form the backbone of healthcare. Treat them as such.
Edit: To those downvoting me, talk to a real nurse and I bet you wouldn't take twice the pay to do half the work they have to deal with.
There's no concept of "deserving higher wages". It's a popular online meme but what on Earth does it even capture? If you value the work higher, then pay them more and you'll win the market for that labour.
There's a good argument to say that sufficiently aggregated marketplaces can launder price collusion, and if we were in such an aggregated marketplace then you could make that argument. But we're not in that situation right now.
The 'Edit:' is even more confusing. If I talk to someone in a profession and I wouldn't take twice the pay they receive to do half the work they do then they deserve higher wages? But that list is huge. Congressmen, Senators, many CEOs, Wagner-group mercenaries, ICE officers, drone pilots. In fact, almost every profession has this 4x effective slippage you're talking about.
Ahh yes, its the $30.00 an hour nurses that drive up the costs and not the incestuous and corrupt monopolies of hospital groups and insurance companies who've been caught a hundred times cartelizing the health care sector.
Insurance companies were the largest purchasers of private jets last year because they were so flush with cash.
Go ahead and downvote me for this, but the medical field in the US especially when it comes to RNs needs a shake up. This is going to sound very crass, but the only skill that your average person on the street doesn’t have that nurses have is to stick a needle in a vein and that’s something that can be taught to a lay person over a week. Pretty much everything else are skills that any person off the street possesses and we would do well to have a lower bar for entry for it.
Uber took an axe to taxi drivers which weren't a popular group to begin with so that was easy. With the "disruption" perfected, next up are doctors, nurses, lawyers, electricians, cooks, engineers, the sky is the limit.
The good thing is that we will not be fooled this time while checking the dead bird thing...
Aside from turning employees into contractors...most of which have not done the math on how much they are losing through having to use your own car with no employee benefits. Doordash/Uber start looking a lot less attractive if you figure in the $.65/mile costs (fuel, repairs, insurance, car purchase price) that you would be paid by most govt or "real" companies. Almost everyone I know who does Doordash makes about $20/hr (which isn't good anyways) and they are not figuring in the costs of the vehicle.
I'm not sure if it is because uber (or whomever they work for) didn't make it clear enough to track it properly or if they simply didn't take it seriously.
https://help.uber.com/en/driving-and-delivering/article/wher...
Sadly she is just another poor tax. Highly paid tax preparers are happy to fudge numbers. I've seen it personally - every year.
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.
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) both are 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).
They tried not to but the law didn't give them a lot of wriggle room and they effectively lost in court when they pushed it.
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.
Unfortunately some harm can be inflicted bur IMHO it’s better than the alternative.
I do not think this will hold with nursing.
I can't wait until they disrupt something a cartel or the mafia are in on.
https://hiring.amazon.com/promotions/anytime-shifts
I used Zocdoc in the past to find a doctor and ended up with a doctor who just charged out-of-pocket instead of insurance, and it worked great. Would an app that shows up-front pricing be better for the consumer?
To see how this is possible, enumerate all the other people getting paid, and then compare to a country with a working health care system.
The most obvious difference is that the US spends an absurd amount of money administering health insurance.
https://www.oecd.org/en/publications/2025/11/health-at-a-gla...
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"
You know the videos of those couriers eating your food and claiming that it was delivered?
see also: https://en.wikipedia.org/wiki/Hippocratic_Oath
We can assume all gig economy companies do this? Brave new world indeed.
https://www.kff.org/health-costs/key-facts-about-hospitals/?...
It is also unclear how this is any different than traveling nurses which operate similarly.
What is the solution that doesn’t result in at least some large group of people making less money?
The USA doesn't recognize those other doctors (in more ways than 1 apparently) and that is an aspect of the issue.
https://savegme.org/
Even if financial constraints were removed, the notion that we could produce twice as many physicians is ludicrous. There simply aren't enough attendings able to supervise a lot more residents, nor are there enough patient cases coming through the teaching hospitals to give that many residents the practical training they would need.
It's the AMA.
"Free to add more" is hiding a LOT of important nuts and bolts of the guild system that discourages new entrants.
Can you imagine if that website were for programmers?
"Waaaah we need more Staff Engineers at OpenAI but we just can't afford training them due to Congress not doling out enough for it, boo hoo".
They have no stock holders to pay, but the people running them will pay themselves multi million dollar wages if they can!
Like, sorry, but not being from the US the whole idea of a "margin" when running a hospital is insane. Hospitals are paid from our ample taxes and the patient pays nothing - there is no room for profit there, not should there be one.
Let's assume UK. Less. US physicians earn about twice what their UK peers do, US RNs about 1.5x https://www.commonwealthfund.org/publications/issue-briefs/2...
>how long do patients wait for care
About the same or longer, in general UK consumes less healthcare per person, but...
>what is the level of care
Better outcomes in the UK https://www.pgpf.org/article/how-does-the-us-healthcare-syst... and longer UK life expectancy https://www.oecd.org/en/publications/2025/11/health-at-a-gla... (and of course US has higher levels of chronic illness https://www.healthsystemtracker.org/chart-collection/how-has...
All for far less (share of GDP) than US https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locat...
Otherwise I unfortunately know plenty of doctors that could easily be replaced by an LLM, but for now I prefer a diagnosis from a real doctor (who may use AI as a tool).
If you think your doctor isn't claudeing it up at their little station you're sorely mistaken.
Ripe for disruption!
thanks free market
"Gig nursing apps MAY [my caps] determine pay by what the firm knows about how much a nurse was willing to accept for a previous assignment, how often they bid for shifts, or how much credit card or other kinds of debt they might hold."
That kind of sounds like they are overselling a hypothetical. Even just an "insiders familiar with the matter have told us that it IS happening", would make me believe it more.
In before someone says that your reasoning is flawed because that is very incorrect perception of the field. All I see is that regulatory capture has worked very well here and is simply stopping totally novel and practical ideas which work on tradeoffs from even taking off
On the one hand, a good nurse is invaluable. They do the hard work that doctors won’t/don’t do, and can be so kind and generous during your time of need.
On the other ones, there are so many who mail it in and are just milking the system
Healthcare is so expensive - some nurses are making 500k a year - their union contracts base vary from 200k to 300k for something like 32-36 hours per week
On top of that, they can pretty much work unlimited overtime with zero restrictions. They can work enough overtime hours such that they can nearly double their salary. And that’s how you come up with the 500k figure I posted
Granted, that’s at the top of the range, I’m talking about somewhere like the Bay Area, and does require a ton of overtime, but those extra 100s of thousands add up. These hours can’t be spread around to minimize the amount of time and a half or double pay paid out, per contract they go in order of seniority
This is just nurses and I imagine it’s something similar but with higher rates for specialists like anesthesiologists and still beyond that doctors and surgeons
I don’t begrudge anyone’s salaries, but it’s a zero sum game. There’s a reason why, aside from typical corporate profit maximization, you wind up with a 30k bill for a short visit. Even if you account for the lower rates insurance companies pay, it’s still in the thousands of dollars for treatment where you were seen for less than 30 minutes
Like I said, to be clear, I don’t begrudge anyone’s salaries - this is just an under discussed point when we talk about healthcare costs
Labor is generally reported as 60% of the costs of hospitals - so if you’d ever want to talk about making healthcare affordable you’d have to address this which I feel like is a bit of a taboo subject. Many nurses are in a union which makes it an even more difficult conversation
All that is to say, I can see the motivation behind stuff like this, even if I don’t agree with it
https://www.commonwealthfund.org/publications/issue-briefs/2...
The 15% extra administrative cost of insurance and 15% extra administrative burden of applying care are the big culprits, in addition to extra costs on medicine and machinery. But it's interesting. Why is it that a comparatively deregulated and privatized system has so much extra pricing cost from bureaucracy?
[1] https://www.trillianthealth.com/market-research/studies/hosp...
Last I heard the AMA controls how many doctors can be educated.
Physicians also make 2-3x more than physicians in other countries. Why? Their education cost is also 2-3x higher than in other countries.
Hospitals and procedures are expensive, in part because of insurance. Insurance is high because our society is too litigious. It's also expensive because of consolidated private healthcare systems that can control and mark up prices due to lack of competition.
Other countries spend half what we do on healthcare. And their people are often healthier.
Nurses form the backbone of healthcare. Treat them as such.
Edit: To those downvoting me, talk to a real nurse and I bet you wouldn't take twice the pay to do half the work they have to deal with.
There's a good argument to say that sufficiently aggregated marketplaces can launder price collusion, and if we were in such an aggregated marketplace then you could make that argument. But we're not in that situation right now.
The 'Edit:' is even more confusing. If I talk to someone in a profession and I wouldn't take twice the pay they receive to do half the work they do then they deserve higher wages? But that list is huge. Congressmen, Senators, many CEOs, Wagner-group mercenaries, ICE officers, drone pilots. In fact, almost every profession has this 4x effective slippage you're talking about.
Like nurses are just an expense.
Insurance companies were the largest purchasers of private jets last year because they were so flush with cash.