Salmon Upstream, LLC

Developing and implementing real-world community solutions.

Curing Our Community's Disease

People are suffering and dying, but you can do something about it. These are not people in a distant land, and they don’t have a communicable disease, these are people all around you, of all walks of life, of all races, young and old.

People are suffering and dying, but you can do something about it. These are not people in a distant land, and they don’t have a communicable disease, these are people all around you, of all walks of life, of all races, young and old. Their malady will never be listed on a death certificate, not even as a contributing factor. But the suffering and death are just as real, as is our ability to fix the problem.

I am talking about a lack of transportation.

When people stack up in an ICU during a pandemic and the scenes are described and circulated on social media, the connection between disease and suffering and death is impossible to ignore. When the disease is insidious and invisible and has simply become an accepted part of life, it is almost impossible to see unless you find yourself in the same predicament.

And every single one of us will if we live long enough.

Over the past few months, our team has implemented a solution as proof of concept. In doing so, we have been exposed to the tremendous need, and we are on the verge of being overwhelmed. We are only six people, and we are starting to feel like providers in an overcrowded ER, surrounded by desperate faces, with more and more everywhere we turn. We can’t go on like this, but we can show you that the solution works. As a community, we have everything we need, right here, right now. We just need to act.

First, here is a list of things we are actively doing (this is not theoretical, this is ongoing): moving people to work; moving young people to in-person education; moving people to and from doctor’s offices, the cancer center, and the hospital; moving people to be vaccinated; moving people to shopping, whether necessities, food, or pharmacy. Most importantly, we are able to safely move people at the direction of others, whether that is a family member or caregiver such as a nurse or social worker.

You can’t do any of this effectively with a bus.

Though seemingly frivolous, the falcon doors on a Tesla Model X make it the easiest car to enter and exit for a person with limited mobility. For a variety of reasons, these are perfect for public transport. You are probably thinking they are far too expensive, so let’s look at some numbers. Operating one of these fully electric vehicles for 60 hours a week including storage, maintenance, power, insurance, paying a driver $20 an hour (yes, you read that correctly), and throwing in a few hundred extra for incidentals comes to almost $9000 a month. To put this figure into perspective, the next time you see an empty city bus, recognize that its monthly operating expenses are four times greater than a Tesla, each of which can do all of the things described above and more. More importantly, people will actually pay for this type of service, so the process is financially self-sustaining.

Or we can continue to pour vast amounts of money into a hole as our neighbors continue to suffer and die.

At the end of 2019, I submitted what seemed like a preposterous grant proposal to the VA Department of Rail and Public Transit to sequentially purchase 40 Teslas over 2 years at an estimated expense of 1.8 million dollars (including purchasing the cars). Not only is this less than 10% of the GLTC budget, I estimated that the system would be financially self-sustaining by Q2 the second year.

I was wrong. It can be financially self-sustaining in about a month.

To make money on a service, you need paying customers, but it’s not like there is a shortage. The problem is we don’t have a genuine solution for the most valuable market: non-emergent medical transportation. These desperate customers have no way to get what they need, regardless of the funding.

This is the secret to powering an effective, efficient, useful public transportation system that works for all of us.

Let’s run a few more numbers: a taxi in the City of Lynchburg is mandated to charge $2.80 a mile. For the average person going 12,000 miles a year, that’s $33.600, or more than enough to buy a nice, new car annually. Uber is about $2, so it’s still so expensive that the only people regularly using the service are people who can afford to buy and insure their own car. Meanwhile, our team is operating at our target of $1.25 a mile, but for us, this is not sustainable.

Non-emergent medical transportation – the kind of thing that commercial insurance companies and Medicare and Medicaid will pay for – reimburses at a much higher rate, because no-shows to medical appointments in the US cost an estimated 150 billion dollars annually just based on lost overhead expenses alone, not even considering the downstream adverse effects from people not getting the care they need. Which means if we have a service that can fill all of these needs, we can charge a livable rate for people in the city doing regular city things and recover the losses serving these more valuable needs while fixing a massive and continuous problem for the health system.

And then stop pouring millions of dollars into that same hole, day after day, month after month, year after year.

The only thing we need to do is be able to serve those insurance companies and Medicare and Medicaid, and that is something that my team is simply not able to do. I am just a doctor with a few screws loose and some crazy ideas, driving around town with a handful of like-minded activists trying to push for change. We have put together everything needed to fix the problem, we have proven the concept, we are trying our best to meet the needs that we can meet. Despite years of pleading, we have no financial support from the local, state, or federal governments, no grants, and no help from the healthcare system. Furthermore, we are underinsured, and despite being overqualified and using vehicles that have been proven to be the safest ever tested, we cannot overcome the regulations and requirements to make contracts with healthcare systems and insurance companies.

But the Greater Lynchburg Transit Company can. Immediately.

All they need to do is to park a single bus and redirect a fraction of those funds to digitally-connected cars that can actually begin to meet the voracious needs of our community in all its diversity. And as the money for that service comes in, we expand the fleet, progressively disposing of these buses that we long ago proved to be ineffective. But my team can’t do any more than we have done; we can’t tell the GLTC or City Council or the VA DRPT what to do. We have brought them everything they need, but they are the ones that must seize this opportunity.

Imagine our city with 40 Teslas all working in synergy to cure this plague that is so ubiquitous it goes unnoticed yet kills with the same relentlessness as a novel virus. Imagine our city with 60 additional rewarding jobs that don’t require a decade of education costing a fortune, and yet serve the greater good on a very personal level. Imagine our city leading the way in adopting clean energy and fully autonomous vehicles. And imagine that this is all just the beginning of a system of connectivity that unifies instead of divides and enables the next generation to take control of their own destiny by building solutions that work.

If this seems preferable to turning a blind eye to our neighbors in desperate need, please contact City Council and insist that they act both locally and at the state level, enabling GLTC to not only serve our collective transportation needs but opening them to paying customers searching for solutions; and pressing Shannon Valentine, the Secretary of Transportation for the State of VA, and Dan Carey, the Secretary of Health and Human Resources to support these efforts so that the lessons learned here can be applied elsewhere in the state.

Lynchburg City Council

Shannon Valentine, VA Secretary of Transportation

Dan Carey, MD