It’s not a crime if we do it (to nurses) with an app
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If I could abolish one piece of received wisdom about tech policy, it would be this: "Tech moves at the speed of innovation and regulation moves at the speed of government, so regulation will always lag behind tech."
(If I could abolish two pieces of received wisdom about tech policy, the other one would be "If you're not paying for the product, you're the product." Decent treatment is not a customer reward program, and "voting with your wallet" only works if you're a billionaire whose wallet is thicker than all the other wallets put together.)
To be clear, there are times when tech enables new forms of conduct that don't fit neatly into the existing policy framework. For example, we apply copyright to anyone who makes or handles a copy of a creative work, and that used to be a pretty good proxy for "someone in the supply chain of the media industry."
The problem is that computers work by making dozens and dozens of copies every time you click your mouse, and we all use computers for everything, and clicking a mouse doesn't make you part of the entertainment business. The fact that we've had hyperinflation in "making and handling copies" but continued to apply an esoteric industrial framework to pretty much everything everyone does all the time is a huge problem that desperately needs fixing:
Copyright notwithstanding, tech generally does not outrun our capacity to regulate it. Rather, tech bosses come up with incredibly flimsy reasons why their business doesn't fit into the existing regulatory framework, and policymakers accept these ridiculous excuses so readily that one can only assume they're in on the racket.
Take "fintech," all those neobanks and the cryptocurrency junk and shitcoins and stablecoins and NFTs and so on that a group of pump-and-dumpers, money launderers and stock swindlers have pushed for more than a decade now. As Trashfuture's Riley Quinn says, "Whenever you hear 'fintech,' you should think 'unregulated bank.'" It's not hard to apply existing regulations to these companies: they fall under banking law, usury law, securities law and gambling law.
There's no (good) reason not to apply these legal frameworks to the crypto industry – but there are plenty of bad reasons not to. The most obvious reason not to apply those regulations is that you are on the same side as the pump-and-dumpers, money launderers and stock swindlers. The reason we struggle to regulate fintech is that we just don't want to.
Then there's Uber, which claimed that it wasn't a taxi company, it was a "transportation network company," which meant that none of the regulations we apply to taxis should apply to Uber. To call this a transparent ruse is to do great violence to the good, hardworking transparent ruses putting in the hard yards to run honest scams. "Uber isn't a taxi company, it's a transportation network company" is about as plausible as those t-shirts that read "It's not a bald spot, it's a solar-panel for a sex-machine."
Emboldened by the success of the "transportation network company" wheeze, Uber launched Uber Eats, claiming that it wasn't a "food delivery company" but rather a "delivery network company." This set up the template for a remorseless tide of new sex-machine solar-panels that have pushed Uber's system of wage-theft and worker misclassification into an expanding constellation of labor categories.
From fintech to price-fixing to gig-work, the entire industry runs on the very stupid proposition that "it's not a crime if we do it with an app":
One of the worst of these sex-machine solar-panels is to be found in nursing, where a cluster of heavily capitalized apps that nurses must rely on to get shifts insist that they aren't "healthcare staffing agencies," rather, they are "healthcare worker platforms" that should be exempted from the regulations that we started applying to the former after a string of calamities and disasters.
This phenomenon is detailed in eye-watering detail in "Uber For Nursing," a must-read new report by Katie J Wells, Maya Pinto, and Funda Ustek Spilda for the AI Now Institute:
If "Uber for nursing" rings a bell, you might be thinking of "Uber for Nursing: How an AI-Powered Gig Model Is Threatening Health Care," an earlier report that Wells and Spilda wrote for the Roosevelt Institute in late 2024:
The Roosevelt Institute report contained many eye-popping findings, most notably that at least some of the leading national nursing gig-work platforms were using data-brokers to find out how much debt nurses were carrying, and offered lower wages to the nurses with the most debt, on the grounds that the most economically desperate nurses will accept the lowest pay:
The new report describes how, in the absence of a muscular policy response, these nursing gig-work companies have raised fantastic sums of money, some of which they have diverted to regulatory capture projects in a bid to states to recognize their solar-panel sex-machines, with great success. These companies haven't merely refined their lobbying game, either – as a sphincter-puckering appendix detailing the experience of nurses with these apps shows, they have also made great strides in immiserating nurses and transferring their earning power to gig platforms and the hospitals that rely on them.
This degradation of the work experience is characteristic of the new world of AI-powered jobs. AI isn't taking workers' jobs, but it is enshittifying them, with degrading, neurosis-inducing surveillance and high-handed discipline:
But gig-work companies remain laser-focused on healthcare workers, likely because that is one of the only growing professions left in America. They're trying to screw over healthcare workers for the same reason Willie Sutton robbed banks: "That's where the money is." The implication here is that the 15% of the American workforce that is employed in the healthcare industry is on the front lines of the battle against gig-work and algorithmic management.
Like parasites that attack the sick and weak, gig-work and algorithmic management come first for industries that are already bad for workers and the people they serve, making things much worse while insisting that they're just trying to apply a cool digital fix to a broken analog system. That, too, was Uber's playbook: attacking the medallion taxi system as corrupt and sclerotic – while replacing it with a system that's corrupt, extractive and dynamic, able to evade all attempts to improve things for drivers and riders (such as drivers' unions).
That's what's happened with healthcare staffing agencies. These have long been a fixture in healthcare, partly because there was always a large cohort of skilled healthcare professionals who valued the flexibility of short term contracts (for example, "travel nurses") and partly because hospitals love hiring contractors who aren't part of their workers' unions.
Staffing agencies weren't good. A string of scandals led to waves of regulations in states like Colorado, Minnesota and New York that required agencies to "register annually, disclose shareholders and executive officers, certify worker credentials, report to state authorities on the number of workers employed, document service rates charged to facilities, and list average wages paid to workers by job category." These regulations also banned staffing agencies from locking up workers with noncompete agreements and ripping them off with finder's fees.
Rather than strengthening these protections, gig nursing platforms avoid them. Where staffing agencies secure multi-week contracts for travel nurses, gig platforms typically assign workers to single-day shifts. Where staffing agencies let nurses bargain for their scheduling needs, gig platforms present take-it-or-leave-it offers and no opportunities to speak to a human when things go wrong. And where staffing agencies evaluated the workers on their roster based on employer feedback, the gig platforms install apps that continuously surveil and evaluate workers, downranking them and cutting their hours and pay based on algorithmic judgments that are never explained and cannot be appealed.
Platforms match nurses with shifts, claiming to regulators that they're little more than a "job-notice board." But when they pitch hospitals, they tell a different story, about their ability to use algorithms to erode wages and blacklist workers who make trouble. Healthcare gig-work apps push workers to accept shifts that require more travel and pay less, at facilities they don't want to work at. Refusal to accept a shift can permanently compromise your ability to get future shifts, and/or lower the wage you're offered in future.
In addition to these poor working conditions and low wages, gig platforms have resurrected the prohibited practice of charging workers "finder's fees," by layering on junk fees that take money out of every paycheck. Staffing agencies aren't allowed to do this, but the gig-work platforms' "solar panel for a sex-machine" gambit transforms the finder's fee into a "platform fee" that somehow escapes regulators' grasp.
How is it that a regulator can't see that a "platform fee" is exactly equivalent to a "finder's fee?" This is not a case of technology outpacing regulation – it's a case of lawmakers colluding with profitable firms to evade regulation in order to steal from workers.
The platforms are aslosh in investor cash – Clipboard Health, Intelycare, and Shiftkey are all valued at more than $1b, and Shiftkey just completed a $300m private equity raise. This leaves them with lots of ready cash to spend on regulatory entrepreneurship. In Georgia, Clipboard lobbied "to exempt gig nursing platforms from state unemployment insurance and workers’ compensation laws." In Ohio, Shiftkey and Clipboard are pushing a bill "to classify gig nurses as independent contractors, exempting gig platforms from minimum wage and other worker protection laws." In Utah, Nursa is praising a bill that a state senator called "lightest-touch regulation." All in all, 17 states have nurse gig platform deregulation bills underway.
In 2022, the healthcare gig-work platforms tried to get a California ballot measure to carve nursing platforms out of all state labor laws. They withdrew it, but pursued an "under the radar" approach to get the same thing by seeking changes in administrative rules, rather than state laws. Lobbying for administrative law changes to exempt healthcare gig-work platforms from regulation is also underway in Missouri, Louisiana and Utah.
One bright light in all this comes from New York state, where a 2025 law "affirmatively recognizes gig nursing platforms as entities that must comply with the state’s healthcare staffing agency rules." The existence of this law proves that the crisis of gig-work healthcare platforms is not an example of tech racing ahead of regulation. If New York's state leg can figure out that a gig-work platform is just a staffing agency in app form, then other states can do so as well. If they don't figure that out, that's because they don't want to.
Sometime in this century, our political class and our financial class arrived at a consensus that Douglas Rushkoff describes as "go meta," in his 2022 book Survival of the Richest:
The "go meta" ethos insists that the most important, smartest and most valuable move is always away from productive labor. Don't drive a cab: go meta and own a medallion that you rent to a cab driver. Don't own a medallion, go meta and start a gig-work ride-hailing company. Don't start a gig-work ride-hailing company, go meta and invest in a gig-work ride-hailing company. Don't invest in a gig-work ride-hailing company, go meta and buy options in a gig-work ride-hailing company – and so on and so on, into ever more abstracted forms of gambling and rent-collection.
The reorganization of the economy around parasitic middlemen and financial gamblers (but I repeat myself) is the real reason that we can't regulate tech. Once you've decided that the most important party to a transaction is the person who has the option on the share on the platform on the license that the worker who actually does the job requires, of course you're going to see a solar-panel for a sex-machine in every bald spot.
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