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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

#181

Post by Brybry »

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.

Do doctors need an incentive game?

We're already selecting a highly motivated subset of the population with the med school process.

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

#182

Post by sgregnt »

brightball wrote: post #134
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,…

In the US, the problem is too much regulation but that regulation comes from different levels like insurance companies, medicare, medicaid, etc. I know somebody who owns a therapy business. Medicaid rates have not increased in 15 years and increasingly make it harder and harder to do your job. The level of stress and pressure it creates is intense. What do you think is going to happen when private equity comes around…

I also agree with you.

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

#183

Post by AndrewKemendo »

sgregnt wrote: post #170
AndrewKemendo wrote: post #149

Earlier quoted context omitted.

>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 ma…

>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 following options: [x, die] then because die is an option, anything for x is always voluntary?

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

#184

Post by [deleted] »

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…

[deleted]

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

#185

Post by MattGaiser »

wpietri wrote: post #176
MattGaiser wrote: post #156

Earlier quoted context omitted.

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.

That doesn't mean that. That is what one might infer if one believed the conclusion were true. But that's only persuasive to those predisposed to believe it. Which I am not. Regardless, running a business has always been more hassle than it's worth for people who would just rather have a job . But it has been worth it for those who prefer independence. If you wanted to claim that things were radically worse, you coul…

Did he say what lead him to sell then?

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

#186

Post by Calavar »

lr4444lr wrote: post #59
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…

More like running many kinds of businesses has become more hassle than its worth. Medical malpractice premiums are very high, insurance payouts are stingier, and medicine has become more capital intensive than ever as newer medicines and diagnostics increasingly dominate, along with an aging population that needs more intensive care. Doctors report being more burnt out than ever. It's an attractive proposition to out…

> Doctors report being more burnt out than ever. It's an attractive proposition to outsource the hard and messy stuff to a firm that knows the business angle well so that they can keep their sanity and focus on what got them interested in medicine in the first place while still getting a great salary.

The corporatization of medicine is one of the major causes of burnout, not an escape from it. I am not aware of any physician who enjoys things like things like "all hands" meetings with the CEO and CMO to talk about the "new vision" for the group. Or doing several different annual/biannual compliance trainings for meaningless BS. Or having to go through several layers of internal bureacracy if they want to buy a new piece of equipment. Or having zero say in the hiring process for the ancillary staff that they work with. Or having very little say in how many patients they see during the day, or during which hours, or which types of diagnoses, or how the clinic staff does intake and rooming.

The docs who are selling their practices to PE are doing so to cash out right as they go into retirement, not to outsource their admin work. Admin work is already outsourced in the private practice model. The practice hires ancillary staff for clerical work and contracts an accounting firm for help with the financials.

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

#187

Post by prepend »

lordnacho wrote: post #169
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.

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

Citizens united makes it easy to donate any amount of money to political causes. But there’s still some limited visibility into who is funding the PACs.

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

#188

Post by YPCrumble »

lordnacho wrote: post #136
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…

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…

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.

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

#189

Post by candiodari »

prepend wrote: post #180
ericjmorey wrote: post #126

Earlier quoted context omitted.

The victims never consent to the sale. They have no say in the transactions that victimize them. You're looking at two parties making a transaction and assume that those are the only two parties that are part of the transaction.

> The victims never consent to the sale. It’s extremely rare for a forced sale. Usually it’s a public company and shares are purchased on public exchanges, or for privately held companies the board and shareholders approve the sale. It’s not that these are the only people impacted by the sale, but it’s the best method possible to govern sales.

I think the idea here is that the "victims" are people needing or wanting medical treatment, and find it's made impossible for them to get it. Yes, they're not really involved in the transaction but still have something taken away from them.

You could argue that it's the government, medicaid and medicare especially that are taking away from them ... but that doesn't make as good a scapegoat as banks and pension funds. Sorry, not pension funds, I mean evil private equity investors ...

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

#190

Post by candiodari »

lapcat wrote: post #151
brightball wrote: post #134

Earlier quoted context omitted.

In the US, the problem is too much regulation but that regulation comes from different levels like insurance companies, medicare, medicaid, etc. I know somebody who owns a therapy business. Medicaid rates have not increased in 15 years and increasingly make it harder and harder to do your job. The level of stress and pressure it creates is intense. What do you think is going to happen when private equity comes around…

> In the US, the problem is too much regulation but that regulation comes from different levels like insurance companies, medicare, medicaid, etc. If only there were a single payer. ;-) Seriously, there should be single-payer health care. Also, there's the fundamental question of whether you view health care as a political right or as a personal privilege. The free market is very good at serving the privileged, not s…

The problem is not single payer health care, it's that the single payer that does exist (both medicare and medicaid are single payer) has decided not to increase the amount of money available, not even inflation adjustments, for 15 years.

How good would you feel about your job, even if well-paid initially, after 15 years of no raise. Not even inflation or cost-of-living adjustments.

And would you sell if someone came and offered you money for your customers, knowing they'd get screwed sooner or later?

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