Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Who employs your doctor? Increasingly, a private equity firm

nytimes.com

Post reply on HN
Print view View original

281–290 of 415 posts

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

#281

Post by flippinburgers »

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…

Regarding burnout I know individuals in the medical field who wish they could control their schedules by reducing the number of clients per day, but they simply are not allowed to because leadership expects them to turn certain levels of profit.

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

#282

Post by underlipton »

fiprofessor wrote: post #226
underlipton wrote: post #217

Earlier quoted context omitted.

>Other (public) businesses in the market? That. Or, you have been shorting the company for some time, because you know it has been targeted for demolition. A PE takeover is the signal that you no longer need to hedge those shorts; the company, loaded with the debt used to purchase it, will soon go bankrupt, and you will be absolved of closing your short positions, for all practical purposes. This may not apply to the…

> A PE takeover is the signal that you no longer need to hedge those shorts; the company, loaded with the debt used to purchase it, will soon go bankrupt, and you will be absolved of closing your short positions, for all practical purposes. I think it's just the opposite: you'll be forced to close your short position when the PE company buys. When PE firms "take over" a public firm, they generally take it private, an…

I don't know if that's necessarily the case, in practice. Aside from the cases where a PE firm does keep the company public, there's at least one case where short-sellers weren't made to close out their positions when a company was taken private (Next Bridge Hydrocarbons, if you're curious).

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

#283

Post by anigbrowl »

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…

You should have read back up the thread, and see who turned it into a pissing contest and ended up distracting from the moral and ethical arguments by vague quibbling about the methodology.

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

#284

Post by anigbrowl »

kjghkjghkjgh wrote: post #60
dcow wrote: post #52

Earlier quoted context omitted.

Nobody should profit from healthcare at all. I don't care if doctors and nurses and board members and janitors all make fuck you money, or if hospitals reinvest tons of money to perpetually have state of the art facilities. But the profit dynamic is too much.

How would vaccines and new drugs be invented without any profit incentive?

Some people like fixing problems for their own sake and giving away the fruits of their labor to maximize the overall benefit. The notion that the profit motive is the only reason anyone gets up in the morning is false.

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

#285

Post by elishah »

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

Sure, but even that cherry looks a whole lot more like the rest of the numbers I've found than the one grandparent comment offered.

The study you cite only examines the costs for cardiometabolic disease, not all healthcare costs. And then says that suboptimal diet is responsible for 18% of that specific category.

"18% of the costs of the one category most closely linked" and "5-10% of all healthcare costs" seem like plausibly compatible measures. Whereas the grandparent comment's claim remains out of synch with those by an order of magnitude.

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

#286

Post by vkou »

tpmoney wrote: post #221
vkou wrote: post #178

Earlier quoted context omitted.

> This doesn't explain why doctors are selling though Retiring doctors are selling because this lets them cash out their practice for way more than they'd otherwise get for closing it and auctioning off the equipment. > Why aren't doctors just not selling their practices and taking a more relaxing job running things themselves? The ones that are selling are the ones exiting the rat race, the downsides aren't affectin…

So why aren't new doctors opening their own practices? What has changed in the last 20/30/40 years that are leading up and coming doctors to choose working for someone else instead of opening their own practice?

> So why aren't new doctors opening their own practices?

For the same reason that nobody builds out a second set of power lines to compete with an incumbent power utility.

It's capital-intensive, the size of the medical market for the area is fixed, and you'll just be fighting the established practice for it in a zero-sum game.

You can win, but it's going to be way more work for less reward than just finding a PE practice that's hiring/a traditional practice with spare space that's looking for a partner.

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

#287

Post by rqtwteye »

verteu wrote: post #3

Reminds me of "Does Private Equity Investment in Healthcare Benefit Patients?" [1]. > Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases…

“while taxpayer spending per patient episode increases by 11%. “

I am sure they are already working on increasing this from only 11% to much more.

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

#288

Post by anigbrowl »

rcme wrote: post #141
RALaBarge wrote: post #104

Earlier quoted context omitted.

Other than the doctorate, of course.

Presumably there is already a supply of licensed veterinarians, unless the PE vet practices are hiring unlicensed practitioners.

How many of them have easy access to a million bucks?

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

#289

Post by rqtwteye »

I still remember when my dentist sold his practice to a larger group. Suddenly they found things that needed to be fixed immediately during every teeth cleaning. After two years I went I another dentist and suddenly my teeth were healthy again.

I think private equity will break capitalism. Instead of people being interested in something and also making profits, with PR you have people that only care about profit and have no passion for the product.

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

#290

Post by wnc3141 »

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 its more of a systematized rentiership rather than fraud. There's no difference between local ownership and private equity except for the level of systematization.

With that said, I do agree that we've rewarded this form of rentiership and also enhanced the barriers to entry for other forms of private ownership (like a partner owned firm). This is in place of value created as a source of wealth, which the tax system has entirely devalued

The whole practice of a LBO does seem like a fraud almost. I dont understand how a buyer can "lend" to the purchased firm without bearing actual risk perhaps I don't understand the mechanics there fully

Post reply on HN