Nurses Sound Alarm as 'Uber for Nursing' Apps Push to Deregulate Healthcare
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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.
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.
The people driving Uber have mostly figured this out by now.
Maintenance and fuel are a much larger part of the total costs. It is very easy to math out if you break down by the "recommended service intervals" which are largely based on mileage (fluids do require changing with time intervals but normal driving usually matches up with the mileage).
The myth that a car sitting still is losing money has been sold by the insurance companies. It is only cheaper to buy a new car vs fixing one if you account for the loss if someone runs into you and totals the car. My car which I have maintained and is 14 years old is worth way more to me than the amount that is placed on it by people who have it in their interest to say it is worthless due to age.
Sidenote: I tracked all my miles, costs and income while delivering pizzas many years ago. These costs vary greatly depending on the car. The 89 subaru justy I purchased to deliver was $.25/mile whereas my 93 mazda 626 was closer to $.60 (2004 pricing). My current car is ~$.60/mile also. Currently, the IRS mileage rates for business is $.70/mile, do any of the gig economies pay this? [1]
[1] https://www.irs.gov/tax-professionals/standard-mileage-rates
> Currently, the IRS mileage rates for business is $.70/mile, do any of the gig economies pay this? [1]
I used to get paid that rate at my old job and it was an amazing deal, it was way over my actual costs for the vehicle. With a small fuel-efficient car I was covering my gas, insurance, and depreciation with a few trips each year. It was effectively my work paying for a free car I'd get to use the rest of the time.
That's the issue with using one number as a very rough estimate, it has to account for everything from contractors driving work trucks to someone commuting in a Model 3.
Unfortunately some harm can be inflicted bur IMHO it’s better than the alternative.
I do not think this will hold with nursing.
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.
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.
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.
> *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...
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.
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) 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".
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.
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 can't wait until they disrupt something a cartel or the mafia are in on.
The good thing is that we will not be fooled this time while checking the dead bird thing...
Many that haven't succumbed to PE yet know what it brings and appreciate the opportunity to speak to the issue themselves. Many of the best really wish more customers were paying attention and giving them credit for their choice not to sell out.
Meanwhile, many that haven't will either justify their corporate ownership or just kind of dodge the issue.
You can ask other providers for gossip and insight about ones you're curious about -- especially other providers in fields that are connected/adjacent but not directly competitive. The true locals are generally delighted to call out the sell outs.
It's not foolproof, but it's an effective start.
One reason "Uber for X" appears not to have materialized is that the platforms themselves are commoditized, not just the labor. Retailers like Lowe's and Wayfair have built assembly/installation services behind a checkout upsell. They run portals distributing work to their "network of local contractors" .
I got a window into this world through an acquaintance. He has a truck and light trade skills, but mental and reputational legacies of past addiction lock him out of the "anyone good" market. He's on a half dozen platforms, trying to stitch a living doing sink or toilet installs for Lowe's and building bookcases for Wayfair. A negative review gets you demoted from the choice gigs, or even kicked from the platform entirely. It's bleak.
Not sure about the nurses, but my grandmothers were able to afford live-in caretakers in old age, without any government help or having much money, because these are completely unregulated (outside the US; or the regulation is not enforced)... We found good ones thru word of mouth, exactly the approach apps can scale
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?
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"
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.
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.
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...
On the other hand, specialists are more profitable for the "non-profit" healthcare networks we have around here, so they're easy to get appointments with.
You know the videos of those couriers eating your food and claiming that it was delivered?
100%.
Nobody living in a country with healthcare for all with no out of pocket costs would ever care about such a thing.
I spend as much time thinking about “fixing” my healthcare as I do thinking about fixing the supermarket or the roads around here.
Ie not one second because they work perfectly.
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?
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...
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".
State medical boards are the entities which ultimately decide on physician licensing criteria.
This AMA/ACGME protection theory is covered by Yascha Mounk at https://www.persuasion.community/p/deaton and elsewhere.
Discussion of physician protectionism is also found in the 2017 book by John Hopkins political science professor Steven Teles and Niskanen Center vice president Brink Lindsey The Captured Economy: https://global.oup.com/academic/product/the-captured-economy...
The New York Times covered the AMA's lobbying in this 1986 article: https://www.nytimes.com/1986/06/14/us/ama-board-studies-ways...
There's also the 1970 article by University of Chicago economics professor Reuben A. Kessel, The A.M.A. and the Supply of Physicians: https://scholarship.law.duke.edu/lcp/vol35/iss2/4/
There are valid reasons to criticize the AMA but blocking the training of new physicians isn't one of them.
The AMA, and physicians in general, are obviously not the primary obstacle here. Complaining about their past actions won't solve any of the actual problems we have today
The USA doesn't recognize those other doctors (in more ways than 1 apparently) and that is an aspect of the issue.
Prestige and potential higher pay for specialisations will still attract people to the profession, although maybe not if the university costs for medicine remain as high as they currently are.
They have no stock holders to pay, but the people running them will pay themselves multi million dollar wages if they can!
How the board gets approved to be elected is a bit self selected, but in theory it should be controlled by people that have incentives, the same as a public corporation.
Now this is an insurance company and not a provider network,some provider networks are more self owned.
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).
I don't need a platform that takes 25% off of the handyman that I call. All that happens is that I pay 25% more. And if the platform becomes large enough it'll set policies that the handyman cannot offer lower prices outside of the platform...
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.
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?
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.
[1] https://www.trillianthealth.com/market-research/studies/hosp...
Last I heard the AMA controls how many doctors can be educated.
The real fix is to make it so their main job is hydrating enough, or the thing half the country hates the idea of (public fountains). IRS can't do either. Independent contracting is still a valuable mode of work, when the contractors are paid enough. So rather than ban forms of gig work, we need to provide good paying jobs and social services, and get the rich to pay their fair share.
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
You are begrudging someone’s salary. Nurses make 500k by working overtime. You know why they work overtime? Because it’s cheaper for the hospital than to hire 2 nurses. The problem isn’t the nursing salaries. It is the administrative costs that make your healthcare too expensive. Why do you think single payer reduces healthcare costs?
PS: median nursing salaries are still under a $100k. The numbers you pointed to are not the norm.
I also said this was for the Bay Area - it’s not the norm but it’s not infrequent either
Labor costs are 60% or hospital expenses, I didn’t make that number up and you just glossed over.
And again, I said it was just an issue to be discussed. If discussion leads to it’s not worth discussing, that’s great and a great outcome
You did the thing where you just sort of read what you wanted to read in my comment vs addressing what it said
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.
One movie that made me change my perspective on nursing as a field was the Swiss movie Late Shift. It really opened my eyes to what nurses have to deal with. Yes the US might be different in having lower patient to nurse ratios but at the end of the day I think it's still applicable.
I still think their monetary compensation should be provided by market valuation of the utility of the work they do.
Like nurses are just an expense.
Nurses change dressings. Insert catheters. Move heavy patients without hurting themselves. Prepare equipment for surgery. Ensure the sterile field is maintained. Operate specialized equipment. Triage medical emergencies.
And about a million other things that the average person doesn't know how to do.