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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

#231

Post by lucaspm98 »

lordnacho wrote: post #207
oatmeal1 wrote: post #90

Earlier quoted context omitted.

Strongly disagree with this comment. The most powerful monopoly one can hold is one entrenched by the will of the government. Every time the people have asked the government to step in and regulate healthcare, corporate lobbyists have crafted the laws in such a way to weigh down any potential competitors. In the US, the more regulated a market is, the more likely people are to demand further regulation, because they…

> the person paying for healthcare isn't the one receiving it, so it is no wonder patients receive poor care. This works fine in fields like the restaurant business or the haircutting business, where people can decide for themselves what they want to eat or how they want their hair, and they can decide for themselves whether their food or their haircut is satisfying. The sector where it is least applicable is healthc…

I don't completely disagree, but that's the edge cases of mystery diseases or rare cancers that make for good headlines.

The vast majority of healthcare is basic screenings (physicals, x-rays, bloodwork) and chronic disease management (birth control, blood pressure). These services are more or less understood and interchangeable, and absolutely can compete on service, quality, and price.

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

#232

Post by synetic »

thfuran wrote: post #177
dcow wrote: post #111

Earlier quoted context omitted.

Honestly I've had this happen multiple times recently, where people don't understand revenue vs profit. Profit is what you put in the business bank account after you pay operating costs which includes salaries. You can make fuck you money by making idk $2MM per year. That doesn't come out of profits. Profits are commonly paid out to owners/investors in the form of dividends.

That's sophistry. Yes, accountingwise, revenue and profit aren't the same thing, but if healthcare is going to be raking in so much money that the hospitals are throwing fuck you money at the janitors, it's clearly highly profitable for a lot of people, and they want "nobody to profit from healthcare".

You are now engaging in sophistry. Doctors in England can be paid more in their system than they make now without putting in profit motives. In a publicly funded system one can pay lots of money to workers without profit in the system.

It’s as if Americans don’t understand that government can provide services and not be profit driven.

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

#233

Post by alistairSH »

Mordisquitos wrote: post #219
candiodari wrote: post #190

Earlier quoted context omitted.

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…

> 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 Excuse my ignorance as a non-American, but I don't understand how Medicare and Medicaid can be called "single-payer", even if we bunch both of them together for the sake of the argument. Are certain healthcare providers restricted so as to only accept Medicare and/or Med…

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.

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

#234

Post by HWR_14 »

sgregnt wrote: post #179
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,…

For me and my friends free market is not a religion, it is thoroughly thought out concept that proved it self over and over again. I this your count misrepresent the reality. In my mind, people who oppose free market capitalism usually don't understand how it works. The good thing is that reality is what settles the debate. What happens is that people vote with their feet --- and millions of ambisious people from cou…

> millions of ambisious people from countries where there is less free market economy are desperately trying to come to US to realize their full potential, but not the other way around.

I'd like to see your statistics on immigration and emigration. Most people coming to America are coming from Mexico or the Caribbean, which I would consider to be free market capitalist societies, just poorer ones. How is the free market more restrained there than in the US?

(Note, for the purposes of the statistics I looked at, both Venezuela and Cuba are not generalized to "Caribbean" but have their own categories)

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

#235

Post by 8note »

userabchn wrote: post #92
digdugdirk wrote: post #47

Earlier quoted context omitted.

Patient options and choices such as "go to the doctor" vs "go into crippling debt while trying to navigate a labyrinthine billing nightmare"? Just as an alternative point of view - you describe these regulations as "government-imposed". Would it not be equally (if not more) likely that these regulations are being created and supported by the industry players themselves? This lack of real competition that you mention…

I think choices was meant to mean things like being able to choose between competing healthcare providers. Created and supported by big industry players that get them turned into law (and thus "government-imposed" - classic regulatory capture. On the Mexican side of the border there are clusters of doctors, dentists, etc., offering lower cost treatment. I imagine that a large part of the decreased cost is due to redu…

That's describing two different services, preventative care, and reactive care.

Your only choice for reactive care is generally only the closest place, and you may not even get a choice on the provider because you were unconscious when it was chosen.

Once you're there hooked up to a machine, how are you changing provider now that you know their services aren't right for you?

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

#236

Post by burkaman »

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.

Doesn't this apply to all jobs? You're sort of suggesting that salaried employment can't work, because employees will be incentivized to do the easiest or least work. Clearly it does work in practice though, despite this alleged fundamental flaw.

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

#237

Post by swsieber »

wpietri wrote: post #81
cscurmudgeon wrote: post #71

Earlier quoted context omitted.

That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.

If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.

I mean... people who go to cancer clinic have cancer at a higher rate than those who don't. Cancer clinics cause cancer. And therapists create mentally unstable people, etc.

You wouldn't have to fork the universe. I think a randomly distributed trial would work, and could be reasonably made to work. Not sure though.

FWIW, I think we should prevent private equity in lots of places, especially hospitals.

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

#238

Post by swsieber »

wpietri wrote: post #81
cscurmudgeon wrote: post #71

Earlier quoted context omitted.

That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.

If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.

I mean... people who go to cancer clinic have cancer at a higher rate than those who don't. Cancer clinics cause cancer. And therapists create mentally unstable people, etc.

You wouldn't have to fork the universe. I think a randomly distributed trial would work, and could be reasonably made to work (woth Gov. help). Not sure though.

FWIW, I think we should prevent private equity in lots of places, especially hospitals.

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

#239

Post by lapcat »

alistairSH wrote: post #233
Mordisquitos wrote: post #219

Earlier quoted context omitted.

> 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 Excuse my ignorance as a non-American, but I don't understand how Medicare and Medicaid can be called "single-payer", even if we bunch both of them together for the sake of the argument. Are certain healthcare providers restricted so as to only accept Medicare and/or Med…

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.

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

#240

Post by bowyakka »

mfer wrote: post #162
lapcat wrote: post #140

Earlier quoted context omitted.

> 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?

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

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