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Who employs your doctor? Increasingly, a private equity firm

nytimes.com

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Re: Who employs your doctor? Increasingly, a private equity firm

#101

Post by treis »

lordnacho wrote: post #46

To me it seems like PE has simply discovered a loophole in the system. We want a system where creating value for people is rewarded, but PE has found a way to legally get the rewards without improving society. Normally this is called a scam or a fraud, and there are laws for standard stuff like taking people's money without giving them what you promised. For PE however, they've found a way around it, using the machin…

Think the economic reality is that the days of a doctor hiring a couple employees and hanging their shingle are over. The capital requirements are too high and the counter parties too big for individuals to thrive anymore. PE is one of the ways to consolidate and get some economies of scale. Plus I think most doctors prefer doctoring to running a business.

Re: Who employs your doctor? Increasingly, a private equity firm

#102

Post by lotsofpulp »

uLogMicheal wrote: post #83
lordnacho wrote: post #46

To me it seems like PE has simply discovered a loophole in the system. We want a system where creating value for people is rewarded, but PE has found a way to legally get the rewards without improving society. Normally this is called a scam or a fraud, and there are laws for standard stuff like taking people's money without giving them what you promised. For PE however, they've found a way around it, using the machin…

On top of this, most of it is leveraged capital at a fraction of the actual cost, so the risk is almost vacant for the firms. Corrupt banking leads to infinite leverage for the super-wealthy to buy up / control it all. They do not need to care because they risk little and still profit even if it crashes because the tangible assets have shifted to their side of the gap.

Is it leveraged? Or is it often times money from underfunded government employee pension funds and whatnot, seeking higher returns to make up for the underfunding from previous decades?

Re: Who employs your doctor? Increasingly, a private equity firm

#103

Post by xenospn »

cscurmudgeon wrote: post #78
synetic wrote: post #30

Earlier quoted context omitted.

But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare. All systems have ration care but it is immoral for someone to profit by denying care. Profit motive does not make for a good healthcare system.

> But it is not difficult to isolate from common sense. No one should profit from denying someone healthcare How does one profit from denying services?

Ask your health insurer. They have an army of people whose job is exactly that.

Re: Who employs your doctor? Increasingly, a private equity firm

#104

Post by RALaBarge »

rcme wrote: post #69
darth_avocado wrote: post #55

Earlier quoted context omitted.

Capital is the barrier and the requirement is not low in the areas PE takes over.

It seems like a vet would be about as expensive as opening a restaurant, maybe 1-3x as much. That doesn't seem like the most capital intensive thing ever.

Other than the doctorate, of course.

Re: Who employs your doctor? Increasingly, a private equity firm

#105

Post by starcraft2wol »

verteu wrote: post #94
cscurmudgeon wrote: post #85

Earlier quoted context omitted.

> If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. My standard is authors (and random internet commenters) to have an inkling of the progress in causal analysis and related progress in the last two decades. Edit: Some resources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://journals.sagepub.com/doi…

I'm quite familiar with causal analysis [1]. What are your qualifications in the field? The paper performs half a dozen standard robustness checks [2]. Which exactly do you believe are missing? Be specific, and include reasons why we should reasonably expect the opposite outcome. [1] Senior ML Researcher @ Google, top 3 PhD, etc. [2] Placebo analysis, instrumental variables, MTE analysis, breaking down the effect int…

That's nice of you to list where you work. On HN there are many qualified and intelligent people, so we generally prefer to talk about the issues directly.

> half a dozen standard robustness checks

My original comment isn't arguing they used tools improperly, it's an epistemology argument. It's about the limitations of what information could even be gathered from this kind of study.

Re: Who employs your doctor? Increasingly, a private equity firm

#106

Post by callmeal »

kjghkjghkjgh wrote: post #60
dcow wrote: post #52

Earlier quoted context omitted.

Nobody should profit from healthcare at all. I don't care if doctors and nurses and board members and janitors all make fuck you money, or if hospitals reinvest tons of money to perpetually have state of the art facilities. But the profit dynamic is too much.

How would vaccines and new drugs be invented without any profit incentive?

> How would vaccines and new drugs be invented without any profit incentive?

The same way they were invented before.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351694/

    An interviewer once inquired about the ownership of the polio vaccine patent, to which Salk famously answered, “Well, the people, I would say. There is no patent. Could you patent the sun?”
https://www.t1international.com/100years/

    On January 23rd, 1923 Banting, Best, and Collip were awarded the American patents for insulin. They sold the patent to the University of Toronto for $1 each. Banting notably said: “Insulin does not belong to me, it belongs to the world.” His desire was for everyone who needed access to it to have it.

Re: Who employs your doctor? Increasingly, a private equity firm

#107

Post by brentis »

raphman wrote: post #66
leoh wrote: post #44

Earlier quoted context omitted.

> You can’t win with the incentive game. I agree that incentives are frequently and perhaps typically exploited, especially when crafted carelessly or not iterated upon, as most incentives seem to be. I would be eager to contemplate a clinical outcome based incentive scheme.

Wouldn't this incentivise doctors to only accept cases with a high chance of quick success? Young child with cancer? Nope, not worth the risk. Patient with mental health problems? Takes too long, outcome not easily measurable. Obese patient with back pain? Let's do surgery instead of investigating and treating the root causes.

Came here looking for this angle. Seeing doctors now feels like talking to someone who has memorized an actuary-like table for the doctor's risk/reward versus patients benefit/outcome as in the past.

Have a torn meniscus and given age is dumped into "excise meniscus tear" bucket. While Dr knows that shortens the path to knee replacement (which he no less pointed out on several occasions).

Going to Dr. Now seems like you are a walking revenue center vs. patient in need.

(ps. Many current accredited studies suggest repair attempt vs. removal)

Re: Who employs your doctor? Increasingly, a private equity firm

#108

Post by Aunche »

gmd63 wrote: post #53
lordnacho wrote: post #46

To me it seems like PE has simply discovered a loophole in the system. We want a system where creating value for people is rewarded, but PE has found a way to legally get the rewards without improving society. Normally this is called a scam or a fraud, and there are laws for standard stuff like taking people's money without giving them what you promised. For PE however, they've found a way around it, using the machin…

Many arguments for sketchy business moves like ticket scalping or PE / market making is that they "create liquidity" Who is to say that a business should be liquid? Why? What is the value in making it easy to bail on your responsibilities, and why should we encourage people to quickly build a complicated and powerful system and make it easy for them to recuse themselves of that duty?

I see your point, but otherwise you'd be punishing people for pursuing essential lines of work. A software engineer at a FAANG gets to enjoy liquidity without scrutiny even if they're just facilitating the sale of ads. Why shouldn't a doctor who saves lives get to do the same?

Re: Who employs your doctor? Increasingly, a private equity firm

#109

Post by civilized »

lordnacho wrote: post #46

To me it seems like PE has simply discovered a loophole in the system. We want a system where creating value for people is rewarded, but PE has found a way to legally get the rewards without improving society. Normally this is called a scam or a fraud, and there are laws for standard stuff like taking people's money without giving them what you promised. For PE however, they've found a way around it, using the machin…

I think it should be illuminating to balance narratives like this with simple questions along classical economic lines:

1. Why is private equity ending up with all these resources? Who is selling to them and why? Why didn't this happen before? It's not like PE is new.

2. When PE loads up a firm with supposedly unsustainable billions of debt, someone is on the other side of that transaction, lending the billions. Who does that and why? Are they perpetual suckers, unaware of the decades of experience we have doing this?

I don't necessarily think the conventional prestige media narrative around PE is wrong, but it never seems to get around to asking these basic economic questions. It can't be as simple as some metaphor where bandits are roaming the economic countryside pillaging innocent victims. Voluntary transactions are occurring and we need to understand why to address any underlying issues.

"Unpleasant things are happening, we need some sort of regulation" doesn't seem like a sufficient basis for socially beneficial action. Whatever underlying issues are making healthcare an attractive PE target will probably persist, and maybe get worse, if all we do is pass some kind of "PE bad, stop PE" law.

Re: Who employs your doctor? Increasingly, a private equity firm

#110

Post by starcraft2wol »

wpietri wrote: post #81
cscurmudgeon wrote: post #71

Earlier quoted context omitted.

That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.

If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.

> study must fork the universe to compare the same business with different timeline

Unfortunately, that might be what's necessary to know. I am not knocking the research quality, but there are limits on what we can conclude, and obviously other important factors have not been sufficiently isolated.

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