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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

#311

Post by s1artibartfast »

jameshart wrote: post #258
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? 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…

If that's the case then there are no losers left holding a loss, what seems to be the problem?

That's just a group of people buying a company and selling it off the assets for a profit.

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

#313

Post by ubermonkey »

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.

That's kind of reductive.

Traditional American fee-for-service medicine has been absolutely shown to (a) drive practitioners to do unnecessarily risky and expensive things and (b) fail to produce better outcomes than salaried physician facilities.

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

#314

Post by zone411 »

bowyakka wrote: post #240
mfer wrote: post #162

Earlier quoted context omitted.

> The solution to the problem of private equity running the medical system is government-run health care A super majority of the medical R&D is funded by the US system. The gov run systems pay for a minimum of it. Of the U.S. adopts a system like other gov run countries where does the medical R&D get financed?

Be a shame if someone looked up this on Google and found that it's not as outsized as some think https://data.oecd.org/rd/gross-domestic-spending-on-r-d.htm

Incorrect. You linked to the overall R&D spending data, not medical R&D spending.

You can find the health R&D expenditure data here: https://www.oecd-ilibrary.org/sites/health_glance-2017-72-en...

It shows the U.S. spending 2.4x that of Europe on pharma expenditure as a % of GDP, and 3.2x that of Europe on government R&D health budgets as a % of GDP.

Edit: somewhat newer data is here https://www.oecd-ilibrary.org/sites/fc8b43f4-en/index.html?i...

It shows that the R&D pharma spending gap has actually increased even further to 3.5x.

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

#315

Post by lapcat »

candiodari wrote: post #303
lapcat wrote: post #239

Earlier quoted context omitted.

> 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…

> Single payer in the US simply means the patient doesn't front any money.

No, that's not what it means.

> 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).

You seem to be describing medical insurance in general, not single payer health care.

> Medicare and medicaid are single payer.

No, they're not. "Medicare for All" would be single payer. https://en.wikipedia.org/wiki/Single-payer_healthcare

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

#316

Post by verteu »

worik wrote: post #255
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…

> 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 t…

Agreed! I only mentioned it because "curmudgeon" chose an ad-hominem argument in lieu of a concrete criticism of the methodology.

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

#317

Post by lordnacho »

ars wrote: post #308
lordnacho wrote: post #273

Earlier quoted context omitted.

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…

> 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.)

I then make a very obvious example where there are two independent companies offering similar crappy jobs. Plus your 3rd option.

There's no one person giving the choice, there are two companies and your third option. Perfectly conforming to what you say:

> clearly wrote that the person giving the choice must NOT create the choice

Ok? So there is a situation, a very obvious one, that arises from the conditions that you're claiming making something voluntary. You have two different companies offering substantially the same thing. Now it is voluntary when the outcome is no different from if there were just one company offering the (only) choice.

That is clearly something you will have to explain. I know you can't see how many upvotes a comment has, but I can tell you it doesn't seem like I am the only person who has spotted this.

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

But it is also a term that means "an undesirable decision that has to be made".

Before you accuse other people of not reading, I think it's worthwhile to have a scan for irony.

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

#318

Post by verteu »

worik wrote: post #275
elishah wrote: post #244

Earlier quoted context omitted.

> Metabolic health is responsible for at least 3/5 of healthcare costs. I would love to see a source for that, as it is strongly at odds with all data that I've ever seen. For example: "Medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending." https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-789X.... "Costs attributable to overweight and obesity in Canada were $6.0…

We can cherry pick until we go green... Here is the top result for me at: https://duckduckgo.com/?q=Metabolic+health+share+of+healthca... https://www.hsph.harvard.edu/news/hsph-in-the-news/poor-diet... Starts with: > Unhealthy diets account for almost 20% of U.S. health care costs from heart disease, stroke, and diabetes, according to a new study. Please help yourself to cherries

Yes, 20% of the cost "from heart disease, stroke, and diabetes", which is significantly less than 20% of the total. (The press release has less ambiguous wording: "18 percent of all heart disease, stroke and type 2 diabetes costs in the country").

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

#319

Post by chimeracoder »

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…

> PE-owned medical practices and even many private practices throw that out the window, with financial incentives to do procedures or run tests.

Quite the opposite. They tend to be under capitated contracts with insurers, which means they are responsible for the costs of services they provide, but receive a flat amount for reimbursements. This explicitly encourages underutilization of care.

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

#320

Post by alistairSH »

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.

Uh, that’s pretty much the definition of single-payer, at least as commonly used.

From Wikipedia: Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer").

The difference here being the US has a fractured system, with several government systems (but from the same government). Medicare for All would be try single payer.

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