351–360 of 415 posts
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How would vaccines and new drugs be invented without any profit incentive?
Don't people live long enough already? We can't pay for our retirees. Old age medical care costs $1M+. I know the morally correct thing to do when I get old - give that money to kids instead. Vampires.
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. The lack of real competition, com…
Alternatively, this is the kind of economic distortion that occurs when excessive de-regulation removes the floor of a market, allows local monopolies to flourish, and allows a system in which the most profitable action is to let people die. While such deregulation may have been imposed to increase competition, it also interferes with the incentives of the participants. The lack of real oversight, combined with the i…
The problem is regulatory capture. Regulating an industry that can easily kill people is probably smart government. The problem is this creates a system that allows companies like Pfizer and Moderna, or Siemens, or GE or capture many or all of a given market sector.
I would actually argue regulatory capture is a worse outcome than de-regulation in almost any industry. It's a delicate balance. In our industry we can see this with last mile internet. We can see this with taxes in America where regulatory capture has permitted Intuit to have a license to print money. No different than providers, insurance companies, and medical device manufacturers.
Here's one example. If we took some regulation away from health insurance providers, allowing them to make bigger risk pools through cross-state service, the patients would by and large see better and more consistent outcomes. In fact, this is so scary there are untold billions being pumped into congress to stop it. Instead, we got the abortion of a solution known as the ACA. Sometimes properly applied deregulation creates the environment needed to make an industry better by removing regulatory capture. Competition is a good thing at all levels. Any effort to completely stamp out the competitive nature of human beings always results in worse outcomes for everyone. Imagine if doctors had to compete for patients! The life of a doctor right now couldnt be easier. Make friend with insurance and the wallets-with-pulses are sent directly to you!
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> 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 does that and why? Are they perpetual suckers, unaware of the decades of experience we have doing this? In at least some of the cases, the answer is absolute corruption with PE paying the other party “on the side” to sign off on a deal only a sucker would agree to. See…
Wrong. Banks who provided billions in loans to PE firms for decades, are now getting more cautious. But not because they fear of a failed investment, but certain investors of the bank do and that means problem for the bank. The Banks actually don't care what happens to the company being bought. An investment bank which provides a loan never sits on its debt. They are bundled into financial products like CDO, CLO etc…
(I’m also not talking in general but rather about certain specific cases/forms.)
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This is a nonsensical response. You know what is meant by “profit” in the context of this discussion. You argue in bad faith particularly since you deliberately left off the motive part of my statement. Obviously what is being discussed is that non-workers should not reap monetary rewards from denying care or otherwise siphoning out money from the healthcare system. You may nitpick each word and be as pedantic as pos…
>but none of that will demonstrate that having PE firms in charge of hospitals would be better than a government or nonprofit entity running things. You accuse me of arguing in bad faith while repeatedly implying that I'm arguing for things I haven't even remotely approached?
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> 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.…
After all, what could be more efficient for shareholders than having no competition?
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> You can’t win with the incentive game. I agree that incentives are frequently and perhaps typically exploited, especially when crafted carelessly or not iterated upon, as most incentives seem to be. I would be eager to contemplate a clinical outcome based incentive scheme.
Wouldn't this incentivise doctors to only accept cases with a high chance of quick success? Young child with cancer? Nope, not worth the risk. Patient with mental health problems? Takes too long, outcome not easily measurable. Obese patient with back pain? Let's do surgery instead of investigating and treating the root causes.
Young child - I have trained in mostly adults with some pediatric experience. Can I do a simple procedure on a teen? Probably. If something goes wrong I’m afraid I’ll be punished for not referring them to a pediatric center that specializes in these things. Of course if I’m at my main hospital where they do these often, I feel more comfortable doing pediatric procedures to an extent.
Mental health not really in scope of radiology
Obese back pain - I do a lot of procedures for these and certainly there are some surgeons that will operate on anything but I’d say 80-90% of spine surgeons will refer out to rule out every last cause before operating.
We are kind of incentivized to do procedures right now in American healthcare but I will say all my partners are cautious about just doing stuff.
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> 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.
Not relevant to anything
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That's certainly a possibility, but I wouldn't put it at the top of the list without ruling out the possibility that they actually make money. Where does the claim that PE debt is a loser come from? According to one of the top links on google, state pension returns from PE investments is almost twice that of their stock investments if you look at 2000-2021 (11%/yr vs 6.9%/yr) https://caia.org/blog/2022/07/20/long-ter…
Those returns are completely different. Private equity assets cannot be easily sold. Try realizing that 11% return and you will quickly see it does it not exist. You need to take a substantial haircut to sell.
We're talking about private Equity debt so I would think the 11% would be cash Returns on loans per year.
If you make 11% per year return on your lending portfolio over multiple decades, how is that not comparable to your stock market gains?
Sure, resell of loans might be harder, but they're paying cash interest.
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> 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/...
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> the M&A people will talk someone in the lending department into doing the deal. According to the standard narrative, lenders have been repeatedly duped into throwing billions into bad PE investments for decades. If you had a friend who asked for a thousand dollars every month, always promised to pay you back and never did, how long would you continue to give him a thousand dollars each month? If "talking" alone can…
It's the agency that causes the issue. And a little bit of financial engineering. Say you have a friend who often can't pay back his debts. But he can pay 80% of them. You have another friend who wants to lend to safe debtors. Why not get that safe tranche, the bottom 80%? He needs to show he's safe so he can take more risk. He loves going out to dinner with you. Another guy wants to take some risk. You give him the…