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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

#191

Post by tsunamifury »

uLogMicheal wrote: post #73
engcoach wrote: post #43

Earlier quoted context omitted.

I wonder if public co-ops can rival the influence / power of PE firms?

Public co-ops do not get free FED money. Gap inducing inflation has been forced upon us, certain players get to use the leverage to buy up everything, the rest are left arguing over scraps. This is a side-effect of a central banking system without proper checks and balances.

I see that now, I was 24 when that policy started and I’m 38 now. And I feel like the entire world was bought out from under me with free money to those with capital leverage.

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

#192

Post by therealdrag0 »

Brybry wrote: post #181
tryptophan wrote: post #35

Earlier quoted context omitted.

Flat salary is an incentive to do the easiest option or least work. You can’t win with the incentive game. One nasty way that can manifest is to under test because if you don’t find anything you don’t have to do anything.

Do doctors need an incentive game? We're already selecting a highly motivated subset of the population with the med school process.

Incentives are unavoidable. So best to try to identify them whether you want to change them or not. “Highly motivated” in a way means even more driven by incentives, just a particular set of them.

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

#193

Post by chewz »

civilized wrote: post #109
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…

1) NIRP and search for yield

2) Older doctors, stomatologists etc... Running an individual practice is a challenge, requires constant investment and learning and at some point in life there is an incentive of larger cash out.

And why? Because as West deindustrialized potenial for profit lays in high-value services. Instead of an aluminium smelter you purchase 100 of orthodontist practices. After purchase you cut on costs, raise prices and the investment pays out rather quickly....

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

#194

Post by wpietri »

starcraft2wol wrote: post #105
verteu wrote: post #94

Earlier quoted context omitted.

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.

I think it's hilarious that somebody who has been here for all of 11 days wants to tell somebody who is coming up on their 10-year HNiversary what "we generally prefer".

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

#195

Post by rr808 »

This seems just part of corporatization of nearly all jobs. It isn't just doctors, its restaurants, pharmacies, taxi firms, clothing stores, law firms, home builders. We used to have lots of small independent firms doing this, now people just work for bigger and bigger companies.

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

#196

Post by verteu »

kjghkjghkjgh wrote: post #41
verteu wrote: post #3

Reminds me of "Does Private Equity Investment in Healthcare Benefit Patients?" [1]. > Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases…

That is a "working paper" and has not been peer reviewed.

Excellent point -- I'll look for a meta-analysis of the peer reviewed ressearch.

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

#197

Post by wpietri »

MattGaiser wrote: post #185
wpietri wrote: post #176

Earlier quoted context omitted.

That doesn't mean that. That is what one might infer if one believed the conclusion were true. But that's only persuasive to those predisposed to believe it. Which I am not. Regardless, running a business has always been more hassle than it's worth for people who would just rather have a job . But it has been worth it for those who prefer independence. If you wanted to claim that things were radically worse, you coul…

Did he say what lead him to sell then?

It is frustrating to me when I respond in detail to somebody's querulous points and they just abandon everything discussed to hare off in some new direction. It certainly doesn't motivate me to write a quality reply.

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

#198

Post by ars »

AndrewKemendo wrote: post #183
sgregnt wrote: post #170

Earlier quoted context omitted.

Volanturelly, in my mind, means that you can decide how to employ your resources as you wish (e.g., time education, capital, skills). If your resources allow you only ever a few options, like sorting garbage, you are still doing it voluntarily. If you have many resources (not necessarily material, e.g., education) this will give you more options. Your abilities are teaded agains all other ppl's abilities in a free ma…

>You can decide how to employ your resources as you wish Thank you. So would you say the following is a correct interpretation of your argument: "Any action or set of actions is voluntary, provided there are at least two choices" Follow up question which I do not mean sarcastically or anything other than explicit: Do you consider "Die/cease to function" a persistent choice? That is to say, if there are only the follo…

Your question is wrong. Voluntary means that the person giving you the choice is not the one creating the choices.

So your choice is "work", or "starve and die" - the person offering the job is not creating the "starve and die" choice, therefor it is voluntary.

Your choice is "work", "I will beat you" - this in involuntary.

Your choice is "work for $1,000,000", or "work for a bar of gold" - this is involuntary because the person offering the choices created the choices.

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

#199

Post by tholman »

I'd noticed some strange changes at our veterinary office, where they'd usually give my dog a full round of shots once a year, suddenly they decided to break it up into multiple different rounds, meaning I'd pay 3 times instead of the one. After a little research I'd found that they'd been bought by a private equity firm, and on further inspection had found a lot (NYC) of practices had changed hands the last few years.

There's been some antitrust cases, but the FTC clearly can't block many. The changes are clearly costing everyone more money for no reason, but can anyone really block this?

- [1] https://www.ftc.gov/news-events/news/press-releases/2022/06/...

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

#200

Post by horsawlarway »

YPCrumble wrote: post #188
lordnacho wrote: post #136

Earlier quoted context omitted.

My current working theory. Happy to hear from any of the actual PE people who are reading this. 1. As you can imagine, not everyone has the wherewithal to launch a PE firm. Only people who are well connected in the financial world will get access to the funds. People who have friends in the investment sector for instance. There's plenty of stories about how VC (which isn't the same thing) investment is hard to get a…

It feels like most answers to “who is at the losing end of any transaction” is pension funds, which are guaranteed by the government. So by your theory PE firms are sucking in taxpayer money by fleecing pension funds run by financiers who aren’t smart enough to get into PE. Basically until pension funds aren’t bailed out by the government this will continue.

You don't stop making blood to get rid of leeches. You pull the leech off.
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