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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

#321

Post by chimeracoder »

stubybubs wrote: post #115
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 on…

> I live in Canada, where we have socialized medicine. Our survival rates for major cancers are on par the US

That's not really true. Cancer is one area that has been extensively studied over multiple rounds of years-long comparative studies, and while Canada is not as far behind the US in survival rates for cancers as other developed countries are, it's still decisively behind the US.

You're correct that the middlemen here serve no purpose and are effectively leeches upon the system (with patients paying the price in the end, with both their wallets and their health). However, cancer is not the example that proves this point - it's one are where the US system does quite well, by the numbers.

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

#323

Post by gruez »

balderdash wrote: post #274
gruez wrote: post #203

Earlier quoted context omitted.

> 2) this is a solved problem as it relates to other professional service firm (law firms, investment banks (back in the day)). How was it solved?

When people are invited to become partners, usually they needed to write a check, but also buy-in over a number of years using a percentage of their earnings, as well as the firm potentially providing financing to buy their partnership interest. On retirement, partners were bought out (in many cases, getting paid out over a time until they were fully bought out)

>When people are invited to become partners, usually they needed to write a check, but also buy-in over a number of years using a percentage of their earnings, as well as the firm potentially providing financing to buy their partnership interest

This doesn't address any of the main problem I brought up, which is that hospitals are capital intensive. "Writing a check" is easy to do when there isn't much capital tied up in the business in the first place, but what do you do when the hospital costs $100M to build and there are 100 doctors? I can't see how the numbers would work out using the methods you described.

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

#324

Post by idontpost »

s1artibartfast wrote: post #220
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…

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…

> This is the only explanation that doesn't depend on a source of dumb money that can never learn buying this debt.

No it isn't. A simpler explanation is that the people making the decision aren't the ones paying for the failure. I see this all the time at the executive level in finance -- people will knowingly make bad deals if it gets them their bonus.

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

#325

Post by jlawson »

ars wrote: post #310
AndrewKemendo wrote: post #298

Earlier quoted context omitted.

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 voluntar…

I believe you may be referring to the Copenhagen Interpretation of Ethics [0].

"The Copenhagen Interpretation of Ethics says that when you observe or interact with a problem in any way, you can be blamed for it."

[0] https://forum.effectivealtruism.org/posts/QXpxioWSQcNuNnNTy/...

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

#326

Post by chmod600 »

Buttons840 wrote: post #215
lapcat wrote: post #114

Earlier quoted context omitted.

> 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,…

I want a political cartoon that shows "The Free Market Ideal" with a bustling market full of wooden stands with fruit and produce, handmade goods, handmade signs, lots of people making choices and talking with the merchants one-on-one, haggling over prices, etc. The next cartoon pane shows "The Free Market Reality", and it's a bunch of tired looking people standing in line for one of two automated computer terminals.…

That would be a great cartoon.

For what it’s worth, I don’t like a lot of government meddling. Not because the free market is so great but because the meddling works out poorly and is subject to worse kinds of corruption and power games.

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

#327

Post by lapcat »

alistairSH wrote: post #320
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.

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 wou…

I linked to that very Wikipedia article and said Medicare for All would be single payer in another comment half an hour before yours: https://news.ycombinator.com/item?id=36751975

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

#328

Post by verteu »

multicast wrote: post #304

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…

The Swiss system isn't quite lassiez-faire capitalist:

> "The Swiss government... does keep down overall spending by regulating drug prices and fees for lab tests and medical devices

> Swiss insurance companies [must] offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.

It does seem like a promising approach that's (largely) market-driven.

[1] https://www.nytimes.com/2009/10/01/health/policy/01swiss.htm...

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

#329

Post by idontpost »

ars wrote: post #198
AndrewKemendo wrote: post #183

Earlier quoted context omitted.

>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 becaus…

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