[minusLik]

What the article does not seem to mention is that an usual electric wheelchair costs about $65,000 (and is intended to be replaced every six years or so). This and the non-availability of replacement parts is why some wheelchair users started a project to open-source a wheelchair from standard parts:

https://themif.org/

Louis Rossmann interviewed the founder of the project here: https://www.youtube.com/watch?v=eaAj59025Kk

[somethoughts]

To be honest - it actually seems like a risky Private Equity play as I bet the $65000 sticker price is due to the fact that Medicare is footing the bill. Medicare is likely what is requiring a regulation grade wheel chair, not the users themselves.

I bet a huge segment of the user base could easily self purchase a mobility scooter and achieve the same quality of life if the price point was such that they could out of pocket the purchase and there was decent quality/repairability/safety.

There do seem to be a fair number that are approaching "geez I might as well just buy an over the counter version" (i.e. sub-$2000) instead of going through the paperwork hassle of getting a free Medicare "prescription" for one.

[heyoni]

In my experience, the chairs and how they’re built aren’t what adds to the price tag; the fact that an insurance company is paying is what is.

My daughter literally just got approved for a talking device that would otherwise cost us $4000. It’s a Samsung tablet with $300 software and an attached speaker and comes with some sort of repair agreement. I can buy and break 20 iPads for that price…and we did end up buying one with the software on its own.

If you want to know who’s causing waste, look to the ones who stand to benefit from it.

[newsclues]

It’s similar to defence procurement.

If the customer is government with endless budget, inflate costs, and use regulatory capture to maintain the cash flow.

[jandrewrogers]

I used to work at an org that audits defense programs. A surprising amount of the unreasonable cost is self-inflicted, which is a valid cost to the vendor. If it wasn’t, the auditors have the power to clawback the excess cost.

In defense procurement the costs are frequently inflated greatly by the procurement process overhead and the government imposing last minute changes of scope, requirements, or delivery dates. The government customer is also often slow or delayed on their contracted deliverables, so they can end up spending a lot of money to essentially keep idle capacity warm on the vendor side while they sort out delivery of their part. And then there are the budget rug-pulls at the 11th after the vendor has already committed significant internal resources, which are often a pure loss to the vendor. All of this is endemic to the process. The government knows they are a difficult and expensive customer to work with, and they do try to compensate vendors for the overhead costs this imposes.

People like to talk about $2000 hammers etc but if you actually look at the audits, more often than not the cost was justified. Not because a hammer should cost that much but because that is how much it ends up costing after you account for the government procurement process overhead and the way in which the government executed the contract.

[gregwebs]

Sometimes this gets taken advantage of by the vendor. The government doesn't have the ability to design and specify things properly themselves when the deal is signed. The vendor might know that things are wrong at that point but wait until afterwards to point out all the problems and correctly claim changes in scope and requirements at significant expense. At least I was told that happened on the California rail project.

[WanderPanda]

Just that in this case the end-customer is a person that could shop around for what he/she needs. Such a competitive market would instantly vaporate the current, rent-seeking margins

[konfusinomicon]

some senator just held up a bag on bushings for use on fighter jets suring a speech..the cost for a sandwich bag full...$90k

[SpaceNoodled]

Well no wonder, he keeps sneaking in with baggies and stealing them.

[konfusinomicon]

so that's the secret side hussle that all the senators and congressmen get rich off of. forget insider trading and shady political contributions, bushings are where the money is at lol

[justinclift]

Any idea if they're precision engineered out of something exotic? Maybe machined from single-crystal titanium or something.

Asking because there's a bit of a different between standard consumer grade stuff, and specialist high performance things designed for a specific exotic environment.

[gravescale]

Also each one probably also has its own fully traceable and auditable supply chain, with a record of every step, including who signed off on it, when and where, from the moment it entered the refinery, and the records are guaranteed to be kept available for decades, along with storage and maintenance of the tooling and capacity to make more at short notice indefinitely. Plus the costs of getting the contract sorted and the part specced and signed off on in the first place, amortised across the relatively small initial batch.

Presumably there for political protection as much as anything else: "Bushinggate topples Senator after it's revealed a Russian company supplied the titanium" or "Scandal of the aircraft parts Anerica has forgotten how to make".

[konfusinomicon]

I think his argument was that the alternative on the free market met FAA standards, which are in his words, the most audited parts in the world, and were a fraction of the cost

[underlipton]

Regulatory capture is likely the most important component. People complain about government spending, but those close to progressive issues can tell you that it's just as likely, if not more likely, to be remarkably stingy when it wants to be. The issue isn't government, it's who's using government; access to capital on top of that government influence gets you a lot closer to that bottomless wallet.

[eru]

> The issue isn't government, it's who's using government; access to capital on top of that government influence gets you a lot closer to that bottomless wallet.

One issue is a big disconnect between user and payer. Government is especially prone to that, but any big organisation can have this problem.

[beaeglebeachh]

This is why I'm for total deregulation of healthcare. Government fucks it up so bad hamstringing access that some hack work with 15 minutes of YouTube training plus whatever pills drop out the dark web is often better than not being able to access it at all.

Right now we basically end up going to Mexico if we can help it, where there's basically no real oversight or regulation to raise cost so long as the doc/pharmacy pays off the cartels.

[newsclues]

Regulations should be voluntary and exist in a market with options.

I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.

[justinclift]

> This is why I'm for total deregulation of healthcare.

Is that a good idea for an industry that seems filled with completely immoral bastards that'll screw over everyone ("they'd sell their own grandmother!") to make an extra cent, or save themselves a cent?

I could see it might be a good thing where an industry has a good reputation for fair dealing. US health care doesn't seem to fit that description though.

[underlipton]

All of the responses to this post are unhinged and it truly makes me despair for this country.

[wisty]

People assume this serves no-one, but a well heeled public servant with good insurance (or some other member of our new moral rulers) might think it's a fair deal, especially if R&D is amorised by having poor people also forced to pay. They would pay a bit more for the extra safety.

[boredpeter]

Not only that but also lobby the government to start more wars so there’s a need for their product.

https://x.com/snmrrw/status/1717906441925751223

[nullindividual]

That tablet and software cost a large sum to be validated. Those CFRs get extremely expensive.

[heyoni]

You can buy the same exact app on the app store for $300.

[gavry]

Wow - just curious, what's the name of the talking device?

[heyoni]

https://www.prc-saltillo.com/

[JJMcJ]

I saw a catalog of mobility aids and they had self-pay electric wheelchairs for around $2 to $3 thousand, just as an example.

[whynotkeithberg]

For most people on here, they're more likely to believe that the disabled people are needy & expecting way to much rather than the companies behind it including insurance being greedy as hell.

[zamadatix]

What prompted you say this in the top voted comment chain where each ancestor comment says the exact opposite of said view?

[wolverine876]

> I bet a huge segment of the user base could easily self purchase a mobility scooter and achieve the same quality of life

What is that based on? Do you have experience or know anyone who does? A news article or research?

[PontifexMinimus]

You can buy mobility scooters for under £2000. e.g. https://www.mobilitypower.co.uk/product/fastest/

$65k is an obvious rip-off.

> Medicare is likely what is requiring a regulation grade wheel chair, not the users themselves.

It's a shame Medicare can't just give the users cash and allow them to choose their own wheelchair; both Medicare and the users would win.

[KennyBlanken]

Are you serious? Wheelchairs are not mobility scooters. I don't know much about them, but I can point out some obvious likely differences:

1)The chair has to be comfortable enough to be in almost constantly - for someone whose body may not be shaped the same as most other people's. It may need to be designed in a way that makes it easier for the user to get in and out of, unassisted. That means a substantial part of it is customized to each user, probably in consultation with medical professionals. It may need to carry medical devices/equipment.

2)The chair has to be navigable in indoor spaces with a fine degree of control, by someone who may have lower motor skills and range of motion than others. So it may need customizable response time, input smoothing, and acceleration.

3)The chair cannot, under any circumstances, make an un-commanded motion - which could easily kill the occupant (ie going into traffic, or down a steep hill, or off into water.) That has implications for the physical controls, the electronic controls, and mechanical drives (I'm guessing many chairs have electrical locking, and can use the motors for braking.) Similarly, the chair has to be very reliable, or that could kill the occupant (say, a fire or other emergency where they are) or otherwise be a major inconvenience. If you're unable to move much from your chair and, say, your cell phone is in another room - you're varying levels of screwed.

4)It has to be designed such that fire would be a very low risk.

Are they probably more expensive than they need to be? Yeah. But I'm sure it's nowhere near an order of magnitude, and your comment is pretty ignorant.

[eru]

> I bet a huge segment of the user base could easily self purchase a mobility scooter and achieve the same quality of life [...]

Probably even a higher quality of life, because the manufacturer can make arbitrary changes to the unregulated scooter in response to market demands.

[JTbane]

Is this why hearing aids are $4000 when they probably have $0.50 of components?

[Spooky23]

The Medicare wheelchairs are lowest bidder affairs procured as commodities regionally. There’s no margin there.

The crackdown on scooters was going after blatant and obvious fraud.

[cogman10]

Really cool that an electric wheelchair costs more than a luxury EV and is somehow less reliable.

[VHRanger]

Wheelchair users have no bargaining power against wheelchair makers.

Car buyers have leverage.

Normally this exorbitant price would incentivize competition in a healthy market, but the private equity players presumably make that difficult. There might also be barriers to entry in the market.

[WorkerBee28474]

> but the private equity players presumably make that difficult

There's no reason to think this is true. Unless the barrier to market entry is access to huge amounts of capital, it should be no different than if the entire space owned by mom and pop shops.

[cjalmeida]

PE shops are great targets for being the “bad guys” in whatever situation, of course they are no different than your run of the mill investor or founder when it comes to greed.

[raincole]

I'm feeling it's not the full story here. Presumably it shouldn't be extremely hard to produce a wheelchair, right? So why aren't there more people trying to get in this business?

[harimau777]

Perhaps the wheelchair is considered a medical device and therefore has to go through more expensive safety tests and/or liability insurance?

[ptero]

I suspect in the US the lack of competition is due to regulation and liability, not VCs.

[SllX]

It’s more the divorce between the receiver, the seller and the buyer. Sellers are not selling to the people using the wheelchairs, they’re selling to insurance companies and the government. Both types of entities have a proclivity for overpaying.

This is also true for most drugs. If we removed private insurance companies, Medicare and Medicaid in their totality from the equation, the market rate for drugs and medical equipment would drop into the abyss compared to where they’re at now.

[readams]

You also need the unreasonable barriers to entry for the scam to work. Otherwise new entrants would still drive down the price. So the FDA is doing its part to keep prices high.

[SllX]

In terms of everything keeping health care costs sky high, you are correct. What I outlined is the tip of the iceberg, if the iceberg was Antarctica.

[WalterBright]

Consider the public schools. You have the customer (the students), the buyers (the taxpayers) and the service provider (the teachers), which are accountable to neither.

[tombert]

Define "accountable"? If a teacher does something awful to a student (e.g. sexually harass them), a taxpayer-funded entity (the school board, the police, or the courts depending on the severity and what happend) will reprimand the teacher.

With something less egregious like "giving a the students a bad education", we still have some level of accountability based on standardized testing and school funding. Standardized testing is far from perfect, and it can be an example of Goodhart's Law, but it's still accountability.

[xp84]

lol. The teachers have very little say in anything. The service provider is the school board and the administrators, the teachers are just like an instrument they operate as they see fit.

[akira2501]

There have been a lot of acquisitions and rollups in this space. We have regulations against this, but they are not enforced, and the VCs have the money to push through this layer anyways.

It's both.

The US lacks serious competition in _most_ of it's industries right now.

[notfromhere]

It’s the natural end result of the consumer price standard for antitrust

[sgregnt]

Only in the industries, where the government is involved.

[akira2501]

There have been recent monopolization plays on cheer leading, on diving schools, and grocery stores. This is not a polite machine with boundaries.

[makmanalp]

Isn't the auto industry notoriously jam packed with regulation?

[TkTech]

Weirdly, not really in the US. The regulations are all a little pointless because it's a "self-regulated" industry. Look at the cyber truck - stuck floor pedals and trunk closer that cuts off fingers, or trivial to clone car fobs.

[evilduck]

Same for Kia and Hyundai being able to sell cars with compromised security. Something other countries regulate.

[wolverine876]

It's not surprising that a nearly bespoke vehicle would cost more than, and be less reliable than, a mass produced one. Just think of the engineering resources invested in the two vehicles and in their manufacturing processes.

[loceng]

Reminds me of the military industrial complex.

[Eggs-n-Jakey]

Ya this reminded my of a Palmer Lucky interview where he explained how the prices are created. Can't remember off the top of my head but there was substantial incentive to build with the most expensive materials, doesn't seem like the case here though.

[Spivak]

From a friend who is a Navy engineer this is apparently on purpose is done as a form of economic stimulus. Overpay 10x for things to support the local economy around the base.

[CodeWriter23]

> is why some wheelchair users started a project to open-source a wheelchair from standard parts: https://themif.org/

Can you point to any project site that has released anything along this line? Blueprints, bills of material, code? There's nothing on the site you linked having any such resources. The closest thing is a block diagram including an RS-485 motor controller, which doesn't really seem like an alternative to standard parts at first glance.

[timschmidt]

We have collected all the documentation from the WHIM Wheelchair development effort at https://wiki.replimat.org/wiki/Wheelchairs

[hedora]

Since the US ones are disposable anyway, here are come comparables for well under $3K (often under $1K)

https://www.aliexpress.us/w/wholesale-Electric-wheelchair.ht...

No idea if it makes more sense to buy those, design from scratch, use those for inspiration, or buy one, tear it down, and rip off the bill of materials.

[CodeWriter23]

Thanks! I love it, ++using the extruded steel posts commonly used for street signs

[ashton314]

> usual electric wheelchair costs about $65,000

This puts the Bluey episode "Granny Mobile" in context, where the grouchy granny wants to buy the used wheelchair for a mere $100. $1,200 is still an incredible deal.

[digger495]

They do not. I just was fitted for one. I asked "how much is this retail, out the door, cash?"

$24,000.

So if Medicare is paying $65k, something is seriously wrong.

[silisili]

With all due respect, that figure is still absolutely insane.

[CodeWriter23]

Welcome to American healthcare. I bought a CPAP machine for $800 cash about 10 years ago but signed paperwork saying it cost $2500 and assigning them the right to collect from my insurer. I had none at the time. Don't know if the billed Medi-Cal on my behalf [scratches chin].

[cjalmeida]

This smells like the supplier is running some sort of insurance fraud scheme

[CodeWriter23]

I think it’s pretty standard in the medical industry. Signed similar at doctors offices and hospitals. Everything is cheaper if you self-pay.

[tdeck]

I was curious what parts they were using in their design but couldn't find any actual open source design content. The website seems to be 100% fundraising copy. The idea seems good, I hope this doesn't turn out to be another piece of accessible tech vaporware.

[seventytwo]

How hard would it be to do a project like the voron printer project where it’s just the plans and BOM?

[tdeck]

I imagine developing the project would be a significant effort, but I think publishing some intermediate progress is a good idea. It's very suspicious to me that this site is full of biographies and fundraising CTAs and yet there's no detail about the technical side of the project. At best, that's not likely to lead to a meaningful open hardware outcome that others can use and collaborate on.

[dukeyukey]

How tf does an electric wheelchair cost that when a standard wheelchair is a few hundred and a solid e-bike is a couple grand?

[wolverine876]

These are not just powered wheelchairs, but specialized vehicles for particular needs. Someone else in the thread describes them.

[rdtsc]

Captured market. Some of the costs are paid by insurance, so it's seen as "not hurting consumers, since, hey! insurance pays for it anyway".

The article does mention this bit to sort of justify the cost:

> To get such a chair, a person needs a prescription, authorization from their insurance company, and a custom fitting from an assistive technology professional. Like a tailor crafting an exquisite suit, these technicians meticulously measure a client’s body to ensure the device’s specifications will match.

In many cases, yeah the wheelchair is specialized and has features that each individual needs. My friend with muscular dystrophy had one of those. But the drivetrain and the lead acid batteries seemed generic enough though possibly a higher quality, but it was definitely not something that should cost $65k.

[WanderPanda]

Seems like the best way forward would be to give some smaller amount, lets say $30,000 to the one in need and let them shop around for the best solution and keep the (probably still sizable) difference

[renewiltord]

This is a great project. I didn't realize that FDA Class I regulations were this easy to comply with.

[readyman]

>I didn't realize that FDA Class I regulations were this easy to comply with.

They definitely won't be once this open source effort shows any sign of success. You can't solve political problems with technical solutions. At best, you may be able to displace them, but even that is rare.

[minusLik]

> You can't solve political problems with technical solutions.

Yes, that's what I've been thinking too. Tom Quiter even mentions in the interview that there already have been companies which tried to offer cheap wheelchairs, but the quasi-monopolists had the FDA alter the regulations in a way with which the newbies couldn't comply.

However, since the MIF already attracted suppliers, I hope they can gain some leverage.

[renewiltord]

I only just noticed that the wheelchair https://libertymemesfoundation.org/donations/endurance-the-o... is actually a Class 2 device. That sounds really hard to get past the FDA. I think it's pretty cool still because folks with the knowhow could make their own, but the disabled are probably SOL because you can't really make these for sale without that.

I suppose the FDA's reasoning is that they're better off having no mobility than having a device that doesn't work properly.

[HillRat]

Without commenting on the specific standards and regulations, the parade of horribles that could go wrong with a powered wheelchair is pretty extensive, when realizing that when a wheelchair goes wrong the user cannot move away from it. Consider the risks of a battery fire you can't escape, a drivetrain that could grab loose clothing around a pair of immobile legs, or a user whose wheelchair dies on an empty street at night at -10°F because it couldn't handle the cold for long enough. This doesn't mean the incumbents aren't fixing the regulations to ensure they've got a manufacturing moat -- this being healthcare, I assume that's exactly what they're doing -- but the FDA definitely has reasons to make sure these are regulated.

[zmgsabst]

Do they?

I don’t think the FDA is in a position to asses whether those risks versus the benefits of mobility are an appropriate trade off for any individual.

The FDA is deciding that some people should have no mobility so that others have… what, exactly?

The people who bought $65,000 chairs still could — and they’d be equally reliable. But because one person needs to use it in Alaska, all people need to pay a premium… even if they live somewhere that cold rating is completely irrelevant and adding a needless $5000-10000 to the price.

While there’s a reason to regulate for truth in advertising and basic safety, eg, not catching fire on its own, the actual regulations extend far beyond that into adjudicating personal risk management without clear benefit.

I’m not a fan of technocracy — I think people themselves know what’s best for them.

[harimau777]

Under that model, what about the people who can't afford a more reliable wheelchair because insurance is no longer obligated to cover it?

[wolverine876]

> I don’t think the FDA is in a position to asses whether those risks versus the benefits of mobility are an appropriate trade off for any individual.

Why wouldn't the FDA, which employs experts for that exact task, assess risks? Who is in a better position?

> I think people themselves know what’s best for them.

How can anyone but an expert evaluate the safety of a powered wheelchair?

[icegreentea2]

I don't think powered wheelchairs should be Class II, but we should be a bit kinder to the FDA.

The FDA is not comparing no mobility and simply an inoperable device, the FDA is comparing no mobility vs the possible outcomes of an malfunctioning device. Like perhaps what happens if the throttle gets stuck on forward.

[readyman]

The FDA serves many compromised purposes that, in sum, prioritize the interests of the capitalists who predominately control it. The same can be said for the entire US government.

[wolverine876]

Everyone keeps repeating it, but could you give evidence of that happening? Who are the commissioners? What about the staff?

[throwaway173738]

I can assure you that the FDA does no such thing, as I have been through a very difficult 510k at a previous employer.

[Der_Einzige]

When replicators are invented, most political problems will disappear. Star Trek got it right.

[krapp]

Star Trek style replicators can't be invented. The laws of physics won't allow it. It will always cost more energy and be vastly less efficient to assemble a cup of coffee atom by atom than it would to just grow the beans, have them picked, packaged and shipped, and make it yourself, and unlike in Star Trek, energy in the real world isn't free.

You might say we could come close with advanced 3D printing and some kind of nanotech,but no such technology will ever be so cheap or ubiquitous as to render politics obsolete. History is replete with advancements and inventions which were supposed to usher in utopia, and all they have ever done is further the means by which the powerful enslave and control us. Technology cannot solve human nature.

[serf]

>History is replete with advancements and inventions which were supposed to usher in utopia, and all they have ever done is further the means by which the powerful enslave and control us. Technology cannot solve human nature.

humans are more sovereign than ever before in most calculable metrics.

[krapp]

What "calculable metrics?" By what definition of "sovereign?" Objectively, this is a meaningless statement to me.

[WalterBright]

> energy in the real world isn't free.

That's because we haven't figured out how to harness it.

For example, 99.9999% of the sun's energy just disappears off into space.

We sit on a hot planet, all that's needed to drive our energy needs is to drill a hole through the mantle. But nobody has figured out how to do that yet.

[throwaway11460]

Energy in Star Trek is not free either, just too cheap to meter. They use fusion and matter-antimatter reactors. Once we get there we will also have more than enough energy to power the potential replicator.

Though I agree we probably won't be using it to replicate a cup of Earl Grey for a very long time.

[atrus]

growing the beans, having them picked, packaged and shipped and making them yourself is assembling building coffee atom by atom. What do you think those plants are doing growing those beans? What do you think pouring that hot water onto the grounds is doing?

[paulddraper]

> a usual electric wheelchair costs about $65,000

A usual one?!?

The MSRP of a 2024 Tesla Model S is $72,990.

---

EDIT: Do you have a source?

[homefree]

A better wheelchair seems like a fun project and if the costs are that extreme probably not so hard to do better (unless the costs are extreme because regulation prohibits a good market).

It’d be fun to take advancements in electric mobility devices to wheelchairs.

[manquer]

there are some projects which are there doing it for fun.

This one from Youtuber Jerry Rig Everything https://notawheelchair.com/products/the-rig

He usually reviews mobile phone durability etc, there are videos on his channel about the chair, this started as project for his wife who was paralyzed in riding accident very young.

Akin to the flamethrower that Musk was selling a while back as long you don’t call it a medical device there isn’t much regulations (hard to differentiate say a Walmart scooter style device from a actual wheelchair)

Of course if it’s not a medical device it won’t qualify for insurance or Medicare , but you can still sell it for reasonable prices

[carabiner]

Should be "a usual" because "usual" starts with a consonant sound. Otherwise could sound like "unusual."

[dumpsterdiver]

It would be better to simply use the adverb form "usually" and apply it to the word "cost", instead of using the adjective "usual" and applying it to "electric wheelchair".

"Electric wheelchairs usually cost a lot of money."

vs.

"A usual electric wheelchair costs a lot of money."

The second form begs the question, what is it that comprises a "usual" electric wheelchair? What would make an electric wheelchair seem "unusual"? A custom muffler? The statement creates more questions than it provides answers.

The first form however is simple and clear. What about these wheelchairs can be considered "usual"? The cost. They cost about the same. What would make a wheelchair expressed in this context unusual? The cost. It's either cheaper or more expensive. No additional unanswered questions have been created by expressing the statement in this form.

[floxy]

>an usual electric wheelchair costs about $65,000

Can you go into what that statement means? I'm having a hard time parsing "an usual". Seems like there are some electric wheelchairs for ~$2,000:

https://www.forbes.com/health/accessibility/best-electric-wh...

...maybe some specialized wheelchairs cost considerably more?

[serf]

none of those chairs in that article is realistically a full-time use electric chair; they're more akin to 'adult scooters' than that. The purpose of most of the chairs in the article linked is to make ease of travel easier; that's why they mostly all fold.

Here's an example of a real full-time use electric chair. [0] It's front wheel drive, has standard attachment points for medical devices, a standardized controller interface that can be adapted to just about anyone, false bogey-arm suspension for stability sake, and all the certs.

It starts around 8k-ish out of pocket. I don't use electric chairs myself, so i'm unfamiliar with what insurance/medicare costs would be.

I pay ~2-4k out of pocket for a manual wheelchairs 20% co-pay through medicare, to give an example of the costs of things. Electric full-time use chairs are astronomically more expensive.

[0]: https://rehab.invacare.com/Power-Mobility/Invacare-AVIVA-FX-...

[tyingq]

It's a complex set of sub-markets. Like, for example, if your kid has one...it has to be NHSTA crash test certified to put on a school bus.

Or, for people with very limited mobility, they need very special cushioning to avoid bedsore type problems.

Just 2 examples, there are many more. Though $65k still strikes me as unusual.

[lagniappe]

Some folks in europe have a hard time knowing when to use a or an because there are so many exceptions, (a before consonant, an before open vowel sound) particularly in areas that pronounce it as oo-sual and not you-shual.