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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

#301

Post by jbaber »

tryptophan wrote: post #35
alach11 wrote: post #4

When possible, I prefer people who work for me to have incentives that are aligned with mine. PE-owned medical practices and even many private practices throw that out the window, with financial incentives to do procedures or run tests. I was talking to my wife’s obstetrician about this last week and he also feels strongly about it. He’s paid a flat salary and gets no financial benefit for a c-section vs. an inductio…

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.

Am I a Pollyanna for believing all other things being equal, doctors want to do the ethical thing and that direct financial incentive to do otherwise is an obstacle they have to overcome.

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

#302

Post by s1artibartfast »

coryrc wrote: post #299
s1artibartfast wrote: post #220

Earlier quoted context omitted.

Regarding 2, the still requires you to believe that either Banks or Pension funds are fine with hemorrhaging millions or billions of dollars buying PE debt and haven't figured it out over the course of a half century. I think the real answer is more unsettling for some. PE debt has volatility but is on net a profitable investment. You can smooth out volatility with volume and by spreading it around. This is the only…

> still requires you to believe that either Banks or Pension funds are fine with hemorrhaging millions or billions of dollars buying PE debt The managers of those funds make money based on deals and they move on before the deal goes south. Principal agent problem. EDIT: lordnacho explains better: https://news.ycombinator.com/item?id=36751012

That's certainly a possibility, but I wouldn't put it at the top of the list without ruling out the possibility that they actually make money.

Where does the claim that PE debt is a loser come from?

According to one of the top links on google, state pension returns from PE investments is almost twice that of their stock investments if you look at 2000-2021 (11%/yr vs 6.9%/yr)

https://caia.org/blog/2022/07/20/long-term-private-equity-pe...

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

#303

Post by candiodari »

lapcat wrote: post #239
alistairSH wrote: post #233

Earlier quoted context omitted.

Single-payer as in the government pays. We have Medicare, Medicaid, and veterans all covered by the government. If a provider wants to serve those markets (old, poor, vets) they have to accept the rates offered by the government.

> Single-payer as in the government pays. Those aren't the same things. The government paying for services in a private market is not single payer.

Single payer in the US simply means the patient doesn't front any money. The doctor/hospital/... just gets the money for medical services rendered directly from insurance (and insurance collects things like a deductible from the patient, not the doctor. Essentially, insurance guarantees payment to the medical provider and deals with all patient financial matters). Medicare and medicaid are single payer.

Things aren't called the same thing everywhere. For example, "single payer" is called "third payer" in Northwest Europe.

Expensive (e.g. expat) insurance tends to be single payer/third payer even though it is 100% private insurance. You just go to a doctor, they help, other than your insurance card, no questions asked.

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

#304

Post by multicast »

It is a free market, about 30% of all hospitals and doctor offices in the US are a for profit private corporation, thus they can be acquired as any other business by anyone. Like with pharma, most people have the very big misconception that just because its about health, that hospitals are excluded from free market and capitalistic principles. When someone offers hospital services or starts developing a new drug, he can charge whatever price he wants, and he will do it as long as profits are maximized and don't start to plunge due to too large price hikes (+ conflicts with insurance companies etc.). Hospitals in countries like Switzerland are known for the best medical treatment because they are almost 100% for profit - private / investor owned. Running a hospital is a business as any other + 95% of the US population has a healthcare insurance anyway. At topics like healthcare, most people are simply too much Hollywood educated and debate with irrelevant individual experiences.

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

#306

Post by YetAnotherNick »

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…

> The risk is entirely on all the other interested parties: employees and customers.

How is PE increasing their risk in any way?

Maybe you are right that PE are getting more wealth than they create value but unless you want PE to be banned because of jealousy, you haven't pointed on any negative consequence due to them.

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

#307

Post by danielmarkbruce »

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…

There is a lot of survivorship bias in reporting. Buying companies and trying to make money at it is an incredibly competitive game to be in. Yeah, the winners make billions, but so does Lebron.

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

#308

Post by ars »

lordnacho wrote: post #273
ars wrote: post #248

Earlier quoted context omitted.

Your sentence is not written carefully. Rephrasing: As long as there are two independent people making offers, your choice between the two offers is voluntary. (Do not forget the 3rd option: accept neither offer.)

Would you like to work for the Garbage Collection Company of America? Would you like to work for the American Garbage Collection Company? Would you like to starve? Aha, you've volunteered to work as a garbage collector. I think this isn't what people think of as voluntary. Sophie's Choice is a better description.

You clearly didn't read what I wrote, because your options do not match the situation I wrote.

I mean you wrote two basically the same companies, while I clearly said "independent", and you wrote "Would you like to starve", i.e. these companies are telling him work for us or don't work at all, while I clearly wrote that the person giving the choice must NOT create the choice.

And in Sophie's Choice the camp Dr setup both options.

I have to ask: If you are going to ignore what people say to you, why do you even bother replying? If you just want to tell people your opinion post it as a top level comment, not a low effort reply.

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

#309

Post by pessimizer »

rcme wrote: post #138
classichasclass wrote: post #77

Earlier quoted context omitted.

No. My late father started his own solo vet practice in 1983, in that less capital intensive environment, and he still required a substantial amount of seed capital to procure and retrofit the building to meet regulations and have enough in the tank to keep it going through the initial lean business years. (There were other complications related to the specific property and title liens not relevant here.) In these da…

Not sure what your point is. I'm not saying you can open a vet for free. All businesses require capital. But, as evidenced by your father, opening a new vet practice is not some totally new thing no one has ever done before. People have done it and people will continue to do it.

> opening a new vet practice is not some totally new thing no one has ever done before.

No one claimed no one had ever opened a vet practice. What they are claiming is that it is expensive. Nobody is accusing you of saying that someone can open a vet practice for free. What they are claiming is that it is expensive.

> People have done it and people will continue to do it.

Everyone knows this that independent vet practices have been opened in the past, and that some are likely to be opened in the future.

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

#310

Post by ars »

AndrewKemendo wrote: post #298
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…

You're suggesting a different definition of "voluntary" which is: >the person giving you the choice is not the one creating the choices Who is creating the choices if not the people who are offering the jobs? >So your choice is "work", or "starve and die" So then you've answered my second question above, which is, if there is a persistent acceptable choice of "die" then any alternative must be voluntary. My question…

> Who is creating the choices if not the people who are offering the jobs?

Is that a real question? The universe create the choices. This person offered a job - they are not God, they do not have control over the person. They simply offered a job. I guess you would rather they didn't offer the job?

> My question is, from your perspective unless someone is physically restrained then anything they do is purely voluntary?

Obviously. Although there are other kinds of restraints, threats for example.

I mean, any other definition leads to contradictions and ridiculous situations where employers are blamed for offering jobs to low value occupations.

I can't find it right now, but someone wrote an essay that basically boiled down to how when people help others, instead of getting credit for what they did do, they get blamed for what they could have done.

That's what you are trying to do. In such a world no one is willing to help anyone.

Don't do that, it leads to a horrible world.

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