A few days ago, I was in New York City and headed to the airport from my hotel near Times Square. Though some tourists get excited about using a traditional New York taxi cab, I do my best not to support cartels, so I ordered an Uber instead.
Normally, the level of service you find with Uber is top-notch, but this time I found myself waiting for quite some time.
Like a flock of vultures, the taxi cabs swarmed around me offering me to take me right away. Some even offered to match the price. As tempting as the offers were, I try not to ever support the taxi cartel if I can help it.
But then, a limousine pulled up. One of those fancy stretch ones. The driver offered the same price as my Uber was offering, and I thought, why not? This is definitely something to scratch off my bucket list.
As I sat in the back taking plenty of selfies and enjoying greater luxury for the same price, I found myself reflecting on how far transport has come over the last 15 years.
How Uber Disrupted the Medical Industry
15 years ago, I recall spending nearly $100 getting a taxi to the airport in New York City. The entire round trip flight had cost me only $500, making the extra $200 in taxi expenses a crazy sum.
To top it all off, the driver was rude, the car smelled It was a really unpleasant experience overall. But now, things are different. And it’s all thanks to Uber.
The key difference with how transport works now is simply down to competition. Previously, there was a single monopoly provider of on-demand transportation.
In order to be a taxi driver, you had to get a government-approved permit, called a medallion. The number of medallions issued were kept extremely limited, and as a result the prices for acquiring one were extremely high—even surpassing a million dollars. All for the right to drive a yellow car and pick up people who asked you for a ride.
Once in the yellow cab club, you could do pretty much anything you liked. You could be rude and charge what you wanted. It didn’t make a difference, because there were no other options.
That all changed once Uber came onto the scene. Now, everyone has a choice. And as a result, taxis, limousines and Uber drivers all have to hustle to compete for your business. They’re going to compete on price, they’re going to compete on luxury, and they even have an incentive to be polite. When you open up the market in any industry you get lower prices, higher quality, and better service. And that’s how I got to ride in a limo for the price of an Uber.
An Uber Revolution in Medical Care
Now why am I, as a doctor, talking about taxis? Because this is exactly the kind of disruption that the medical industry needs.
When I was standing on the side of the road a dozen different drivers came up to offer me their service. I’d like to start seeing that in medicine. Just imagine if you had a health problem, and a dozen different doctors came to you to offer you their services.
Right now, if you’re sick, you go to a clinic. You sit for a long time in the waiting room and pay through the nose in co-pay to be seen by a doctor that spends more time looking at his computer than he does at you. And you have to put up with it because it’s not a free market. Just like taxis, the number of doctors is artificially restricted through licensing giving them protection against competition.
Instead, I’d like to see a system where the customer rules. Where you can choose the doctor who offers you the best combination of price and services, and where other doctors have an incentive to play the game and try to offer you something even better.
As you can imagine, this is a very, very unpopular idea in medicine. Most doctors love the idea of being scarce. They love the idea of being prestigious, and special. You’ll find this when you hear doctors speak very derisively about mid-level providers because they are hostile to economic competition.
You’ll also find this when doctors make snide comments about patients who go online and do their own research about medical care and then want to discuss it with them. In many cases, this is viewed by doctors as a threat to their own prestige because if the patient can figure something out, the doctor is no longer the special priest in a white robe. He’s just another service provider.
The truth is that’s all we are, we’re men and women who provide services. We provide services that are tremendously valuable, but as things are now, we have no incentive to provide that service well. We don’t need to compete, we don’t need to convince patients to come to us instead of others.
The current state of medicine in the US is depressing. Medical cartels rule and the people suffer as a result. Instead, I would like to transform the system so that all of the patients in the United States are treated like I was on that Time Square street. Where I was able to ride in a limo for the price of an UberX.
This is what happens when markets are open to competition, and it’s what we need in medicine in order to have much better care and outcomes.