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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

#111

Post by dcow »

thfuran wrote: post #64
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 are people going to make fuck you money if there's no profit?

Honestly I've had this happen multiple times recently, where people don't understand revenue vs profit. Profit is what you put in the business bank account after you pay operating costs which includes salaries. You can make fuck you money by making idk $2MM per year. That doesn't come out of profits. Profits are commonly paid out to owners/investors in the form of dividends.

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

#112

Post by AndrewKemendo »

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…

You really nailed the problem with the financialization of everything.

I’m busy figuring out how we got here, and how to get out of it but you’ve perfectly described how the incentives are flipped.

I’d further add that regulatory capture means that financialization is a ratchet process, so undoing it is multiples more difficult than putting it into place.

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

#113

Post by doodlebugging »

My former dermatologist practice had several offices in this region staffed by good, trained physicians. It was a pleasant place to visit for the every so often check-up. During the first months of the pandemic I cancelled a regular appointment because our area was hot with COVID.

Late last year I finally decided to reschedule that appointment. The whole practice had sold out to PE. It had been renamed with a name that has religious connotations though all the doctors were still there.

I'm always suspicious of mixing religion with health care but in this area, north Texas, it isn't unusual to see that type of branding in business names any more. It seems that everyone from your yard person to your doctor wants you to know how patriotic or pious they are so they stick it in their business name or logo. Pretty disgusting to me and I dodge those outfits almost as a rule because they tend to be full of hypocritical assholes who smell the extra income that can flow their way if they just add a little Jesus or veteran reference somewhere.

The markets decided a long time ago to use the tools that actually worked and that's why we have trained physicians doing the health care instead of preachers.

Anyway, after that appointment I have decided that I will not return and if I ever need to visit another dermatologist I will look for one that is still independent. That old practice has allied with a sketchy compounding pharmacy and they encourage you to use that pharmacy instead of using Walgreens, CVS, etc. probably because there is some level of kick-back in action from referrals.

It all seems so broken and filled with greed. It reminds me of the software world where everyone wants you to subscribe and pay perpetually for apps that in most cases offer no long term value and which will inevitably be abandonware when the coder moves on to the next big grift. SaaS is a huge scam infecting the business world. Everyone should offer the option to pay based on actual usage or to buy a perpetual license to use a single version with the option to buy upgrades as they are available, based on the individual's own needs.

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

#114

Post by lapcat »

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…

> To me it seems like PE has simply discovered a loophole in the system.

The fundamental loophole is that "the free market" is practically a religion in the United States (the so-called Invisible Hand taking the role of a god doling out rewards and punishments), and a significant portion of the population is vehemently opposed to any regulation of capital. You can even see this attitude in some of the comments here, where commenters are claiming that the problem is too much regulation rather than too little.

Moreover, political campaigns are financed by private "donations" (i.e., legal bribes), so the lawmakers themselves are practically indebted to wealthy interests who don't want to be regulated.

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

#115

Post by stubybubs »

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 live in Canada, where we have socialized medicine. Our survival rates for major cancers are on par the US and our infant mortality rate is lower, though we spend far less. We certainly have problems related to physician pay and cost of living crisis, but we are dealing with them. A lot of the problems we have here are the same as in the US: not enough nurses due to burnout, retiring physicians, etc.

I have never once in my life thought "I sure wish there was somebody in the middle extracting value from this whole situation." Contributes absolutely nothing. Doctors are plenty efficient (pathologically so) and no MBA is going to speed things up. Long term outcomes are ideologically opposed to short-term capitalism. You cannot relate a reduction in type 2 diabetes or stroke cases 20 years later to a quarterly report. It's insanity to have them involved at all.

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

#116

Post by synetic »

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?

A large majority of people going into scientific research do so for a love of the subject and not to become rich. They just want to make enough money to live a decent life and pursue knowledge.

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

#117

Post by verteu »

starcraft2wol wrote: post #110
wpietri wrote: post #81

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. 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.

By this standard, should we not believe that smoking causes lung cancer? After all, a controlled experiment on humans has never been done.

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

#118

Post by starcraft2wol »

callmeal wrote: post #106
kjghkjghkjgh wrote: post #60

Earlier quoted context omitted.

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,…

Individuals often respond to social status incentives more than cash. Undoubtedly this invention helped Salk's financial and personal outlook in other ways.

Also the models of development of these is just completely different from what modern medicines often requires. Specifically, operateing large research labs (which are heavily regulated) and then pursuing the marathon that is FDA approval. Individuals will still tinker, but those industrial scale developments are not going to happen without funding.

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

#119

Post by akomtu »

gmd63 wrote: post #58
peyton wrote: post #12

Earlier quoted context omitted.

Nah the grift is that insurers are price-takers in a local area (if you want to provide insurance to businesses in Seattle, you need to cover e.g. cardiology in Seattle), so PE buys up all the cardiology practices in Seattle and charges more.

It's so frustrating that such a basic, non-intelligent move is the go-to by the biggest players that can afford such a strategy. It's completely counter to the presumption that wealthier players are more suited to allocate resources for efficient outcomes.

Isn't it the basic winning strategy in the monopoly game? Buy up all prisons, then bankrupt your competitors.

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

#120

Post by kjghkjghkjgh »

callmeal wrote: post #106
kjghkjghkjgh wrote: post #60

Earlier quoted context omitted.

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,…

Modern vaccines and new drugs are vastly more expensive. It costs for example over $1 billion to fund a new drug.
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