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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

#161

Post by dingusdew »

shadowfox wrote: post #155
monero-xmr wrote: post #122

Earlier quoted context omitted.

Unlike in Europe and the UK, where such political influence from corporations and the wealthy never happens /s At least in the US we (try) and make donations public. The places where it’s “banned” are black holes.

> At least in the US we (try) and make donations public. The places where it’s “banned” are black holes. That is definitely an interesting take. So, is your ideal society one where anybody is allowed to give and take bribes as long as it is public?

[dead]

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

#162

Post by mfer »

lapcat wrote: post #140
throw47474777j wrote: post #132

Earlier quoted context omitted.

> The fundamental loophole is that "the free market" is practically a religion in the United States Blaming something for being practically a religion is about as empty a piece of reasoning as it's possible to make. Why not actually suggest a solution rather than just throwing your hand up at the whole thing?

> Why not actually suggest a solution rather than just throwing your hand up at the whole thing? A solution to which problem? The solution to the problem of private equity running the medical system is government-run health care, like in most other nations, who spend less on health care per person than the US but whose populations are nonetheless healthier. Or are you talking about the problem of the severe ideologic…

> 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?

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

#163

Post by lapcat »

renewiltord wrote: post #148
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,…

If you believe this, you should find it pretty easy to indemnify me for the hospital I am starting where I will operate and practice medicine. Be aware that I have no degree in medicine and have majored in Mathematics. Since the free market is a true religion, there must be no regulation preventing this. My hospital is able to compete on pure outcomes. Of course, I don't actually think you believe this bit about the…

You scoff, but read some of the other comments here:

"More like running many kinds of businesses has become more hassle than its worth. Medical malpractice premiums are very high"

"This is the kind of economic distortion that should be expected when onerous government-imposed regulation of practitioners, medication, and medical devices creates barriers to entry that reduce competition. While such regulation may have been imposed to try to increase safety, quality, and consistency, for example, it also ends up interfering with the incentives of the participants."

> Of course, I don't actually think you believe this bit about the free market.

I do believe it. What I said was "a significant portion of the population is vehemently opposed to any regulation of capital", which is not to say that the entire population is opposed. In fact, the population is very divided over this. There's more than one religion. :-)

In any case, the problem as I see it is that capital is very creative and inventive and coming up with new and terrible ways to extract profit, and regulation of these new terrible things comes far too slowly, if ever, precisely because the public is so divided, creating legal gridlock.

You're talking about old regulation. Of course long ago we've established regulations for the provision of medical care. Whereas private equity taking over everything is a relatively new phenomenon.

> I think you've been trained to rant here because this community rewards views like that.

Oh, I've been ranting for decades.

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

#164

Post by monero-xmr »

shadowfox wrote: post #155
monero-xmr wrote: post #122

Earlier quoted context omitted.

Unlike in Europe and the UK, where such political influence from corporations and the wealthy never happens /s At least in the US we (try) and make donations public. The places where it’s “banned” are black holes.

> At least in the US we (try) and make donations public. The places where it’s “banned” are black holes. That is definitely an interesting take. So, is your ideal society one where anybody is allowed to give and take bribes as long as it is public?

I think the world is so complex that a politician - especially the sort democracies typically elect - cannot be expected to be an expert in all subjects and things they are supposed to vote on and make rules for. Lacking perfect knowledge, they must rely on outside advice, directly from those affected or indirectly from their assistants and technocrats who advise them. At all points it’s possible to manipulate the outcome.

Given that influence and manipulation is impossible to stamp out, and then realizing that some of those that want to influence are some of the richest and most powerful entities on earth, I would personally rather allow lobbying and donations to be legal, but require all of it to be public. That way you can tell who is taking money from who.

Otherwise, it’s just the mafia and insiders games all the way up the chain.

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

#165

Post by lordnacho »

SkyMarshal wrote: post #142
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…

> You may have saddled the target with a huge debt I’m not sure that’s the model PE is using in healthcare. My impression is that they’re buying hospitals and medical practices, then obscuring the cost of actually providing care, so they can charge insurance companies not something reasonable like cost+20% but rather the maximum amount they think they can get out of the insurance company. Their financial modelers fig…

You are actually right, I focused too much on the financial angle and not the operational.

I myself was "affected" if buying a shitty burger qualifies as a form of victimization. Ed's Easy Diner here in the UK totally changed their burger after getting acquired, to something inedible.

This PE-driven enshittification is actually the more important thing about it: every damn thing in society is made a little bit worse for the consumer (and the employees) due to people buying up the businesses and quite directly making everything about the service worse.

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

#166

Post by gmd63 »

Aunche wrote: post #108
gmd63 wrote: post #53

Earlier quoted context omitted.

Many arguments for sketchy business moves like ticket scalping or PE / market making is that they "create liquidity" Who is to say that a business should be liquid? Why? What is the value in making it easy to bail on your responsibilities, and why should we encourage people to quickly build a complicated and powerful system and make it easy for them to recuse themselves of that duty?

I see your point, but otherwise you'd be punishing people for pursuing essential lines of work. A software engineer at a FAANG gets to enjoy liquidity without scrutiny even if they're just facilitating the sale of ads. Why shouldn't a doctor who saves lives get to do the same?

The value of your actions is not just the immediate work you do. It's the long term effect of the sum of your choices.

If you save lives only to put your system that you've built in the hands of a price extracting PE firm, it's arguable you are violating the Hippocratic oath. One of the other commenters mentioned a study that measured a 10% increase in mortality after PE acquisition on average.

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

#167

Post by vkou »

MattGaiser wrote: post #156
wpietri wrote: post #74

Earlier quoted context omitted.

This would be a good argument if it were only medical practices where PE was active and having a malign effect. But that's most definitely not the case.

That just means for numerous professions, running a business is more hassle than it is worth. Accounting, dentistry, massage, etc. all come to mind. Those people want to all practice their field, not deal with licenses, paperwork, insurance, and tax. Everything from burnout to higher required investment to increased regulatory hassle applies to other fields as well.

> Those people want to all practice their field, not deal with licenses, paperwork, insurance, and tax.

This problem has been solved for a century, in the form of the practice which employs support staff, sometimes a multi-practitioner practice which shares those staff.

PE rolling into it has been a very recent phenomena.

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

#168

Post by hotpotamus »

renewiltord wrote: post #148
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,…

If you believe this, you should find it pretty easy to indemnify me for the hospital I am starting where I will operate and practice medicine. Be aware that I have no degree in medicine and have majored in Mathematics. Since the free market is a true religion, there must be no regulation preventing this. My hospital is able to compete on pure outcomes. Of course, I don't actually think you believe this bit about the…

As long as you call it "alternative" medicine, you should actually have a lot of latitude to do so. If you get to the point where you actually kill someone after cutting them open and rooting around, or poisoning them too much, then you might run into some regulation. But if you can avoid that, I suspect you'll be fine.

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

#169

Post by lordnacho »

monero-xmr wrote: post #122
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,…

Unlike in Europe and the UK, where such political influence from corporations and the wealthy never happens /s At least in the US we (try) and make donations public. The places where it’s “banned” are black holes.

I thought the whole Citizens United thing served to obscure where money was coming from?

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

#170

Post by sgregnt »

AndrewKemendo wrote: post #149
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…

>Voluntary transactions are occurring This is where discussions break down because there's broad disagreements on what is and is not considered "voluntary" - there are ethical/moral traditions that claim nothing is voluntary, while others that claim everything is. We can gain clarity by defining the opposite then: Involuntary So, what set of circumstances would be required to declare that someone is doing labor "Invo…

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 market.

There are complications to this view, but the example with sorting garbage, in my mind, is actually an easy case. Yes it is definitely voluntary.

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