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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

#251

Post by worik »

horsawlarway wrote: post #200
YPCrumble wrote: post #188

Earlier quoted context omitted.

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.

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

No. You heat the leech with a match and it falls off.

Fire is the cure

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

#252

Post by ars »

ryandrake wrote: post #223
ars wrote: post #198

Earlier quoted context omitted.

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 becaus…

“Do this or die” does not imply meaningful choice. It doesn’t matter if that death is from murder or starvation. For all of us who are not independently wealthy “work” is involuntary, but choice of jobs often (but not always) is voluntary.

> “Do this or die” does not imply meaningful choice.

You are upset that the person does not have good options. But that does change anything - deciding to accept a job offer does not make the work involuntary.

You are focusing out the outcome, but outcomes are not the question here, choices are. The employer is not responsible for the way the universe exists, and they are not forcing the person to live in it.

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

#253

Post by lapcat »

tpmoney wrote: post #221
vkou wrote: post #178

Earlier quoted context omitted.

> This doesn't explain why doctors are selling though Retiring doctors are selling because this lets them cash out their practice for way more than they'd otherwise get for closing it and auctioning off the equipment. > Why aren't doctors just not selling their practices and taking a more relaxing job running things themselves? The ones that are selling are the ones exiting the rat race, the downsides aren't affectin…

So why aren't new doctors opening their own practices? What has changed in the last 20/30/40 years that are leading up and coming doctors to choose working for someone else instead of opening their own practice?

Possibly medical school debt.

And of course nobody has sympathy for doctors with student loan debt, but the debt may still have important effects on the economy down the line.

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

#254

Post by mediascreen »

lapcat wrote: post #249
mediascreen wrote: post #246

Earlier quoted context omitted.

People often see the United States as the ultimate free market, but compared to other countries it can be seen as pretty heavily regulated. According to the Heritage Foundation's Economic Freedom ranking, it ranks 25th, well below "socialist" states like Denmark (in 9th place) and Sweden (in 10th place). https://www.heritage.org/index/ranking

That's a political propaganda piece by a notorious right-wing think tank. "The Heritage Foundation (abbreviated to Heritage) is an American conservative think tank based in Washington, D.C. The foundation took a leading role in the conservative movement during the presidency of Ronald Reagan, whose policies were taken from Heritage's policy study Mandate for Leadership." https://en.wikipedia.org/wiki/The_Heritage_Fou…

I know they are a right-wing think tank, that is why I referenced them when it comes to rank "market economy" factors that people who believe in and want to have "free markets" care about.

In what way is it a political propaganda piece? From what I can tell it's a pretty transparent ranking of countries by factors that the organisation cares about.

While the Scandinavian countries have high taxes and regulated labour markets, they have deregulated markets, strong property protections and are very simple to do business in.

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

#255

Post by worik »

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…

> I'm quite familiar with causal analysis [1]. What are your qualifications in the field?

That is nonsense.

This is not a pissing contest about qualifications, or a contest cherry picking research.

It is a rolling catastrophe - decades in the making - for USA people. In general it is that money is being transferred in industrial quantities from everybody to the very rich. Specifically money is getting sucked out of the health system for the benefit of a few at the cost of the many.

FFS socialise your medical system. Spread the cost like sane people and drive out the greed heads

If you can send a rocket to the moon.....

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

#256

Post by bp0017 »

jmoak3 wrote: post #153

PE can be replaced with "Some guys". PE bought your hospital? More like, "some guys" bought your hospital. Ask why "some guys" bought it instead of using their money in the market, or why your hospital sold in the first place. As anyone who's company has been purchased by private equity knows, it's probably because your hospital wasn't doing so hot to begin with and "some guys" were willing to gamble that they could…

See, what I fundamentally disagree with is the notion that hospitals should be "good business." Why are "some guys" allowed to try to make a profit here at the expense of patient care? Healthcare (or government) should not be run like a business, and instead be provided as a service using the taxes we already pay for, much like how roads are built. The health of the public is our most vital infrastructure, and public infrastructure requires investment that you really can't make money on without defeating the whole purpose of public service.

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

#257

Post by projektfu »

In my space (Veterinary) there has been a ton of this. To people who are used to the way things were, it's been very disruptive. Lots of boomers are retiring and a young vet would only be able to pay a 5x multiple, perhaps, but PE is swooping in at 12-15x. They usually lose a bunch of staff at the transition so they have to hire quickly. It's good for workers in the short term, as wages and salaries are much higher. It's hard for clients, prices are up to compensate for the high wage and to increase/juice returns. Sometimes the purchases flop spectacularly, but they must be winning on average.

At the same time, suppliers have consolidated and there's barely any competition. They're also vertically integrating.

10 years ago we were worried there were going to be too many veterinarians. Actually there were, but the wave of age 60+ vets retiring has flipped that around. Now there aren't enough vets or licensed technicians.

I am concerned that the future will have another big swing in the downward direction, while multiple PE firms try to find bag holders at the same time. But maybe there industry will just grow and grow. Who knows?

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

#258

Post by jameshart »

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…

> 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?

The lenders in a PE buyout are securing that loan on the assets of the purchased company. Real estate, brand names, IP, capital equipment. Their worst case scenario is that stuff all gets sold off and they get paid back from the firesale proceeds.

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

#259

Post by thfuran »

synetic wrote: post #232
thfuran wrote: post #177

Earlier quoted context omitted.

That's sophistry. Yes, accountingwise, revenue and profit aren't the same thing, but if healthcare is going to be raking in so much money that the hospitals are throwing fuck you money at the janitors, it's clearly highly profitable for a lot of people, and they want "nobody to profit from healthcare".

You are now engaging in sophistry. Doctors in England can be paid more in their system than they make now without putting in profit motives. In a publicly funded system one can pay lots of money to workers without profit in the system. It’s as if Americans don’t understand that government can provide services and not be profit driven.

>Doctors in England can be paid more in their system than they make now without putting in profit motives

Could their pay increase without the doctors profiting?

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

#260

Post by ahzhou »

everybodyknows wrote: post #229
civilized wrote: post #109

Earlier quoted context omitted.

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…

> ... 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 listened to a podcast interview with a financial professional who advises public pension fund boards. What he said in all but words was that, yes, the political appointees who actually vote on decisions are perpetual suckers.

Pensions are very rarely lenders. They may invest in lenders but tend to look at historical performance.

Political appointees are not the ones making investment decisions. At most they are setting very broad themes. For example, political appointees are the ones that say all investments must be carbon-neutral.

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