Does Private Equity Investment in Healthcare Benefit Patients? Evidence from Nursing Homes (nber.org) 243
The summary of a study by National Bureau of Economic Research: The past two decades have seen a rapid increase in Private Equity (PE) investment in healthcare, a sector in which intensive government subsidy and market frictions could lead high-powered for-profit incentives to be misaligned with the social goal of affordable, quality care. This paper studies [PDF] the effects of PE ownership on patient welfare at nursing homes. With administrative patient-level data, we use a within-facility differences-in-differences design to address non-random targeting of facilities. We use an instrumental variables strategy to control for the selection of patients into nursing homes.
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 by 11%. We observe operational changes that help to explain these effects, including declines in nursing staff and compliance with standards. Finally, we document a systematic shift in operating costs post-acquisition toward non-patient care items such as monitoring fees, interest, and lease payments.
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 by 11%. We observe operational changes that help to explain these effects, including declines in nursing staff and compliance with standards. Finally, we document a systematic shift in operating costs post-acquisition toward non-patient care items such as monitoring fees, interest, and lease payments.
Wow. Much research (Score:5, Funny)
Who could have possibly guessed private equity firms would be more interested in making money than they are helping people? It's almost as if making money is their job.
Re:Wow. Much research (Score:5, Insightful)
Re:Wow. Much research (Score:5, Funny)
Nah we have to play the game - figure out how to monetize having healthier people, and the PE firms will fall over trying to get those sweet, sweet returns. (Sadly, I'm not even sure if I'm sarcastic here).
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It worked for renewable energy, but it's hard to see how it could be done for health.
Re: Wow. Much research (Score:5, Insightful)
Something's cannot be done by the free market because profit motive is orthogonal to desirable social outcomes. Healthcare and education are the two largest examples of this.
The free market is good, but we should recognise its limits rather than treating it like some all-powerful, infallible god to be worshipped. Sometimes the public sector really is the best way to run things.
Poor implementation of public sector management is not evidence that public sector management is bad. We need to get past the "but that's communism!!!" mentality.
Re: Wow. Much research (Score:4, Interesting)
In Wealth of Nations, Adam Smith hits this over and over; in Capitalism, only things where people make choices based on money can be well-managed with free markets.
For example, higher education isn't Capitalist, the "hand of the market" phenomenon does not arise, because people attend the university with the best reputation that they can afford; nobody chooses a school that they think isn't as good just to save money. If they choose a less expensive school, it is because they think they'll get an equally good education there. So there is no harm in the government competing with private schools by funding public universities.
He's often misquoted as supporting toll roads, but he only actually only compared two types of road system; toll roads vs block grants.
In health care, this is even easier; nobody chooses to die early to save a few dollars on their treatment. So in a Capitalist system, it is natural that you'd still have government-provided health care that would compete with private care.
Whereas, restaurants, or floor tiling, people will in fact choose a lower quality to save money. If the government doesn't compete, but instead looks over everybody's shoulder and regulates the market to protect the interests of small, new entrants, then the Free Hand of the Market appears, and the industry becomes more valuable, most people make more money, and the quality of goods available is higher.
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> nobody chooses a school that they think isn't as good just to save money
This is because "needs blind" admission policies and guarantees from the schools that the students will be able to afford school are complicated by _stunning_ levels of accumulated student debt. The result is a glut of unemployable but exciting degrees, including "culinary arts", "art history", and "communications". Student and parents are being handed enormous loans that their income in their fields does not justify.
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Re: Wow. Much research (Score:4, Informative)
For example, higher education isn't Capitalist, the "hand of the market" phenomenon does not arise, because people attend the university with the best reputation that they can afford; nobody chooses a school that they think isn't as good just to save money. If they choose a less expensive school, it is because they think they'll get an equally good education there. So there is no harm in the government competing with private schools by funding public universities.
I've got to say, I think you're dead wrong here. I don't want to speculate about anonymous strangers on the Internet, but your post has the tone of someone who has, at the very least, been in the economic bubble for a long time. It's a good place to be, but I think you can also lose your perspective pretty easily (think about the politicians who don't have a clue how much a gallon of milk costs).
Two of my best friends from highschool were in exactly this boat. One got into MIT and a state school. He got a full ride at the state school and nothing at MIT. He went to the state school. He was acutely aware that this state school (not even the highest ranked public in the state), was no MIT... I think he sometimes regrets this, but he also has worked at Apple for like 15 years now, so he's doing just fine.
A second friend got into a local top 10/top 15 private school and a local very good public. She wanted to go to the private, but she felt that the additional cost was not worth it. She made the decision (in part due to a family health crisis) to save the money to get an education and experience that while not exactly the same, was at least a similar level. She absolutely put a price on a level of education and the value of a degree. (She also eventually went to an expensive private for a grad degree, so maybe she regretted it too!)
So yeah, people make monetary decisions around college all the time.
People also make monetary decisions around doctors and hospitals all the time. One of my colleagues, when pregnant, literally called every hospital around, worked out a flat rate, cash up front deal, and paid a LOT less money to deliver than many other people.
Re: Wow. Much research (Score:5, Insightful)
>One of my colleagues, when pregnant, literally called every hospital around, worked out a flat rate, cash up front deal, and paid a LOT less money to deliver than many other people
I still find it obscene that people live in a country where that is necessary
Re: Wow. Much research (Score:5, Informative)
Re: Wow. Much research (Score:5, Insightful)
If you lived in Sweden or Finland, you'd give pay roughly $50,000 of your income to the government. Let's assume you're in a lower-tax US state and go with the higher $20,000 differential.
For that the Finn or Swede gets a much better deal on health care, university tuition for their two kids, and retirement benefits.
The American family needs $28,000 per year for medical care. If they are in an average employer-sponsored health plan.
https://www.beckershospitalrev... [beckershos...review.com]
Already, the Swede or Finn is up on the American by about $8,000 per year. Don't even bother comparing quality of the product in the USA to that in Finnland or Sweden. By all society-wide measures, they're healthier and live longer and spend less. American Health Care, you can get better outcomes, but you cannot spend more.
Add in the differentials in university tuition (a very large cost for American parents) and the "Heat, food, housing or healthcare, you can have any two you like" retirement program that is the US Social Security/Medicare mess and the average Swedish or Finnish family is far better off than financially average Americans.
Why is it this way? Welp, the American system is not setup for the benefit of the majority of the population. It's setup to fleece the majority for the benefit of the Plutarchs. The majority of Americans are suckers who have been sold a "USA is the greatest at everything" bill of goods.
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imagine if everyone at your pay grade or higher had to pay 30%. Instead people like Romney pay 14%.
"2018, the average effective tax rate paid by the richest 400 families in the country was 23 percent, a full percentage point lower than the 24.2 percent rate paid by the bottom half of American households."
So I say again imagine if everyone your pay grade or higher paid the 30%.
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You need to stop listening to private health industry propaganda.
Public health insurance DOES NOT add 20% to your income tax. It's nowhere near that.
In Australia, for example, the public health insurance system is called "Medicare", and the Medicare Levy is 2% of your taxable income. e.g. if you earn $50K in a year, your medicare levy is $1000 for that year.
source: https://www.ato.gov.au/Individ... [ato.gov.au]
That's $1000 for the entire year, which is considerably less than the $495/month (or $5940/year) that "Profess
Re: Wow. Much research (Score:5, Interesting)
I think the OPs point wasn't that people 'don't' have to do this, but rather they 'shouldn't' have to do this. I think your examples prove the point, since neither case was the ideal outcome.
I honestly don't think Americans can appreciate the difference a public health service brings. Its not just a monetary thing. Living in the UK I have never, not once, had to question what I'd do if I was injured or sick - I literally don't have to think or worry about it. I've never had to think about which policy to take, or whether changing job will affect my medical care, or what to do if I'm unemployed (or starting my own business on a shoestring) and get sick, if I can afford (medically) to have a baby, or think about whether to visit the doctor or not. I also know that everyone in my country has the same, no matter their circumstance. I'd sacrifice my 'freedom of choice' a thousand times over for that liberation.
Re: Wow. Much research (Score:4, Insightful)
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One of my colleagues, when pregnant, literally called every hospital around, worked out a flat rate, cash up front deal, and paid a LOT less money to deliver than many other people.
That's great for her. Do you think she'd do the same thing if she accidentally cut off a finger with a kitchen knife? Do you think her spouse would do the same thing if they came home one day and found her unconscious on the floor?
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One of my colleagues, when pregnant, literally called every hospital around, worked out a flat rate, cash up front deal, and paid a LOT less money to deliver than many other people.
She had 9 months advance notice to plan and negotiate.
Not all medical needs are like that.
Re: Wow. Much research (Score:4, Interesting)
The Wealth of Nations by Adam Smith:
"I'm a upper-class twit with no experience of the real world and a wildly optimistic vision of everyone being like the friends I hang around with at the club. None of them would ever dream of abusing a free market - they told me so and they're gentlemen so that's settled. So it is inconceivable that anyone with the moral character needed to become wealthy would ever do anything so, well, common as to manipulate a market or instigate actions which caused a reduction in the quality of life for their employees just to increase profit. What a clever chap I am; all my friends say so. Here's some things poor people have been doing for centuries but which were of absolutely no interest until I put them on paper..."
Smith did not understand people and therefore he did not understand markets which are driven by people, often irrational and/or foolish people. Worst of all, he completely failed to grasp the concept of greed.
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...people attend the university with the best reputation that they can afford; nobody chooses a school that they think isn't as good just to save money. If they choose a less expensive school, it is because they think they'll get an equally good education there...
My college roommate (in the 1980's) at Columbia University School of Engineering was in the PhD program in Mechanical Engineering. He was a Vietnamese immigrant whose family settled in Kansas. He went to community college to meet his core requirements because that was what he could afford. Then he proceeded to graduate from Berkeley College #1 in his class in Mechanical Eng
Re: Wow. Much research (Score:5, Insightful)
We need to get past the "but that's communism!!!" mentality.
100%, and that is what does my head in. I watched some politician in Texas on the "news" today crowing about how he's proud that Texas has an independent power grid, specifically saying that it's so the Federal government regulations (which, in this case, would have mitigated the disastrous results this past week) can't touch it.
Then, literally in the same breath went on to say how much they need Federal money to help with the very disaster his attitude helped create.
"Communism" to him and others like him apparently means that there are responsibilities (gasp!) that accompany handouts, rather than whatever system they prefer where they get the handouts for nothing.
Unreal.
Re: Wow. Much research (Score:4, Insightful)
No no no... "communism" to him and others like him means "anything that doesn't help the wealthy become more wealthy" and anything that does help concentrate wealth into the hands of the already-wealthy is solid trickle down economic policy that should be implemented immediately.
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Its rare to see someone miss the point so much that they prove the point.
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One thing that is hard to quantify is quality of life in a nursing home— a 10% increase in short-term morbidity might actually be a healthy change. Many people going into nursing homes (especially today compared to 20 years ago) are already on borrowed time. I know my mom (mid 80’s) planned to age in-place, and really hopes to never spend a day in a nursing home.
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How would a 10% increase in morbidity ever be a good thing?
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How would a 10% increase in morbidity ever be a good thing?
Because it could mean that seniors are living longer with their families.
If they spend their last decade in a facility, the morbidity rate will be 10%.
If they stay home for 9 of those years and only spend their last year in a facility, the morbidity rate will be 100%.
Re: Wow. Much research (Score:5, Informative)
You're thinking MORTALITY. Morbidity is non lethal bad outcomes. For example, if you have a stroke and lose the use of your left arm, that's morbidity. If you die, that's mortality.
Either way, if you're at home, you're not part of the stats collected in TFA. Changes in the nursing home don't affect your ability to stay home with your family. They only affect your quality of life once you are no longer able to stay at home.
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Wasn't it mostly huge gov't subsidies (Score:2)
The problem here is we've got a universal problem we're trying to solve with private industry. The trouble with *that* is that it's so much more profitable to control a limited supply...
Re:Wow. Much research (Score:5, Insightful)
figure out how to monetize having healthier people
That is very difficult to do in most areas of healthcare.
I don't have a link, but I remember reading an article years ago that compared doctors by looking at health outcomes and then compared them to peer ratings.
They found that the doctors with the worst outcomes were rated by their peers as the best doctors.
Digging deeper, they concluded that the best explanation for this was that the best doctors took on the most difficult cases.
A naively implemented financial incentive for "better results" may just lead to better filtering to only treat the easy patients.
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figure out how to monetize having healthier people
That is very difficult to do in most areas of healthcare.
That was the original concept behind the Health Maintenance Organization (now usually just called "HMO") idea. You pay them a constant amount, and they take care of you. The idea was that they are now invested in keeping you healthy, since it costs them money to care for you if you get sick.
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A big problem with HMOs is that people hate them.
When you go to a normal doctor, the doctor has an incentive to give you whatever you want and provide expensive treatments, because the doctor can bill your insurance company for his fees.
When you go to an HMO, the doctor is on salary, has little incentive to give you more than you need, and is often under pressure from management to restrain expenses.
Disclaimer: I get my healthcare through an HMO (Kaiser) and am happy with them. But I am in good health, so
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Then, big surprise, the people who figured out how to nail the invisible hand to a tree managed to subvert that concept as well.
With the dizzying array of in-netywork vs out of network, deductable, co-pay, etc, it's hard to know if you even actually have insurance.
Re:Wow. Much research (Score:5, Insightful)
Nah we have to play the game - figure out how to monetize having healthier people...
No. Use the right tool for the job.
The fundamental philosophy underlying Capitalism is based on supply and demand. If people are willing to empty their savings (or even commit serious crimes) to save the life of a loved one then you don't get prices dropping down to some tiny fraction above cost, instead you get outrageous prices and really convoluted payment plans. Sound familiar?
Re:Wow. Much research (Score:5, Insightful)
Exactly this. It's why the market has not and can not solve the healthcare issue.
Well that and there being so many situations where you don't even get a choice.
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If there's competition and transparency, then you DO get prices dropping down to some tiny fraction above cost.
People will pay extra for vital goods if necessary, but not if unnecessary.
I would pay my entire life savings for a supply of water if the alternative were dying of thirst. But I won't pay for bottled water when I already have tap water.
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There's not and there's not because we've got a layer of convolution called 'insurance'.
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There can, and should be, competition in the insurance industry as well.
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I think any sane application of general market economics to health care has achieved all the benefits it can while failing to meaningfully solve any problems.
It's been bypassed for all the usual tricks of capitalism to boost profits. Information asymmetry, lack of pricing transparency, shifting externalities onto others, and then the bag of ugly tricks like hidden fees, keeping practice members out of network and putting them on a patient's care without their knowledge or consent (the doctor who shows up w
Re:Wow. Much research (Score:5, Insightful)
Another possible incentive would be to require all retired healthcare CEOs to be institutionalized in the care facilities they formerly managed.
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Re:Wow. Much research (Score:5, Interesting)
I think this seriously depends - here in NZ we have a hybrid system, where public healthcare is available for pretty much everyone for emergency purposes, and residents and citizens can get public assistance for nursing care in a care home.
The problem is, publicly funded care homes here (and in my native UK) are not somewhere I would ever want to be - they are invariably understaffed, over populated and depressing at best.
Due to my wife's job, I have visited a lot of 100% private care homes over the past few years here, and by and large they are substantially better for the patients - better staff to patient ratio, better standard of living, more engaging etc. I know where I would rather end up when the time comes, thats for sure.
Nursing homes are one of the few areas where I feel public healthcare investment is sorely lacking both here in NZ and in the UK - I wouldnt wish away either countries healthcare systems at all (having just had my appendix removed after it burst, with absolutely no financial burden to myself, excellent care in a very clean, well staffed hospital), but when it comes to nursing and retirement homes, thats where it pays to spend a bit of your own cash with a private company imho.
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thats where it pays to spend a bit of your own cash
"A bit" is fine, depending on your definition. Vacuuming up just about every cent of savings, property, and life insurance payouts to pay for 2 years in a retirement home (the US system) isn't that great either. But, I would tend to agree with you, I'm not living in some government run hellhole in my final years just so my kids can inherit a pile of cash.
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Where are you going to be when "every cent of savings" is spent? The retirement home will dump your sick arse into a government-run hell-hole.
Early death is always an option and should be: If one is in institutionalised care, life likely isn't good and definitely won't get better.
Re:Wow. Much research (Score:4, Funny)
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That's dependent on the facility. Many, yes. Most, probably. All, no. There are some nursing homes that have a huge upfront fee BUT once you are it you don't get booted even if you outlive your money. The one I'm most familiar with began it's existence as a home for the widows of clergy. The lower levels are now assisted living type accommodations with nursing care on the top floor. Impoverished widows of clergy, I believe, still get in for cheap while everyone else pays well to get in.
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This suggests to me that having a primarily public system of healthcare is vital. Places like NZ, UK, Australia all have a public system as the first line. As you say, it falls down in a few areas, but that's where the private system can pick up the slack and offer a better quality of care. But in order to make a decent profit the private company has the provide a higher standard of care. They have to essentially compete against the free service provided by the government. Free market economists would be ag
Re:Wow. Much research (Score:5, Insightful)
I don't think the problem is profit per se. I think the problem is assuming market economics will create an optimal solution in a system where people may have little choice, demand is inelastic, and price and value are opaque to the actual consumer.
The US has kind of the worst combination of socialized medicine and market-driven medicine; a system ruled by the profit motive and run by faceless bureaucrats users don't have even direct influence over.
The ACA, Affordable Care Act, accomplished a lot. (Score:4, Informative)
published Nov. 17, 2020
See page 713 for an index of ACA, Affordable Care Act, references. The ACA moved U.S. health care in a very beneficial direction.
The book provides detailed information about how the top levels of the U.S. government are operated. Every U.S. citizen needs to build an understanding of the government.
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For the end user, that is a distinction without a difference. I do know that commoditizing someone's healthcare is an abomination. I also know that healthcare CEO's are profiteering gluttons.
The administrative overhead for Medicare is in the single digits. Administrative overhead for Blue Cross was recently 45%. Governments in other countries (eg Germany) are *at cost* full stop. Their cost per capita is nearly half of the US' cost, with similar or better results. The insurance companies all operate in Ger
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Let's be be more clear: the sooner we can get Private Equity out of the world, we'll be better off.
Re:Wow. Much research (Score:4, Insightful)
And of course the customer in this situation is the shareholder, not the resident. Residential users are part of the cost index, and a income stream component. What ever you do, don't consider them to be people.
Re: Wow. Much research (Score:3, Insightful)
How did that concepr ever become legitimate though?
I mean, honestly, how is profit... not earned money... not what you get for honest work ... but the part you make on top, that you did not work for... that you get money for,.from a person who herself *had* to work for that money ... How is that profit any different thant theft or robbery or the like?
Explain to me, people who think that is OK, what I "don't get". Let me learn, correct my errors, and mend my ways. Use human concepts, not Ferengi concepts, pl
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I'm communist, but even I know the answer to that. Because the ability to allocate capital effectively is also a skill.
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Sure, it's a skill. So pay the people who know how to do it well 150-200K a year, just as you would a surgeon or top notch engineer.
Think about it, the guy who makes sure the reactor doesn't explode like Chernobyl and render much of the state uninhabitable makes far less money than the guy that gave us the pet rock.
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I don't think there is any question of what it is, just a question of it's justification as the basis for an economy.
I can easily explain to you how to do basic soldering with an old butter knife and a propane torch. That doesn't make it the best way to solder.
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Not only does it produce a perverse incentive to provide as few services as possible, it's the functional equivalent of embezzlement - if I collected 5000 bucks from boss to buy new lab equipment, bought a piece of chinesium crap for $1000 and pocketed the difference as 'profit'
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The definition fits, but it needs to be applied much more liberally.
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The title of the paper suggests that NBER has unusual biases. Most laymen would look at the private equity scams of the last couple of years (Toys R Us, Sears/Kmart) and assume that private equity controlled healthcare will kill us all. But NBER asks the impotrant question-- can opening Pandora's Box solve our most important problems?
What????? (Score:5, Insightful)
What's really amusing is this: the second that retirement home goes private, they start cherry-picking the healthy and wealthy people to live there, adding to the burden on the public resources. Even with a HEALTHIER POPULATION of old folks, they STILL manage to KILL THEM FASTER. Hey, at least the CEO will get his bonus and the investors will make a healthy ROI. That's what really matters, eh?
working as designed (Score:5, Funny)
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But most of us would prefer that it be later rather than sooner.
No, it doesn't. (Score:3, Interesting)
In my experience PE firms have been buying up all of the local doctors. As soon as they do that, the prices they charge double, and the quality of care declines. Basically you have more people wanting a cut of the pie so something has to give.
And the Affordable Care Act was anything but affordable. Our monthly premium has gone up $400.00 per month in the last 3 years. There is no way we could afford healthcare or health insurance without the government subsidy. Before all of this started we could afford it.
Re:No, it doesn't. (Score:5, Insightful)
Re:No, it doesn't. (Score:4)
See how dumb you sound?
I must be too dumb to understand the point you are trying to make.
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A public owned hospital doesn't have a profit motive, or even a funding motive. it has an outcome motive.
People Not Dying is the outcome, specifically. So no, they don't want you dead quick.
You're too busy thinking like the MBA that should never be put in charge of a Hospital.
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And the Affordable Care Act was anything but affordable. Our monthly premium has gone up $400.00 per month in the last 3 years.
Isn't that when the Republican's tweaked the ACA as they were trying to replace it?
The ACA was a Republican plan (Score:4, Interesting)
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The result was a crap bill, but still a vast improvement over the previous status quo.
Accurate description.
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Ours quadrupled from day one of ACA. And my wife had to switch specialists - twice in two years. (Once going onto ACA, the next time the next year when she had to switch to the HMO because the PPO wasn't doing the job. Only two options (though several tiers in each) in CA, of course.)
In my experience PE firms have been buying up all of the local doctors. As soon as they do that,
They're slashing staffing (Score:5, Insightful)
We need to stop letting these people buy up all the necessities in life and sell them back to us. We need to stop pretending there's such a thing as a free market for things you need to survive.
Re:They're slashing staffing (Score:5, Interesting)
My friend is an RN in colorado. They do shit like refused to test for Covid because if they did and the patient tested positive, they would have to build a quarantine room which means less beds which means more money in expenses and less in income (which puts to rest all those "they make money with covid diagnoses!" No, they don't they lose revenue and it costs them more to take care of covid patients). Granted, part of her ward were hospice patients and the management's attitude was "they're going to die anyway" and she's like "yeah, sure, but he's going to die of this, but he's got a massive respiratory problem that doesn't have anything to do with that and if he's positive, he's spreading it to the others in the ward an potentially infecting the staff." Well, they told her to STFU and a couple weeks later the national guard had to come in and force test everyone in the facility because it was statistically impossible for a hospital in the middle of a hot spot to have exactly 1 covid case and sure enough, just in her wing alone over a dozen tested positive amongst the staff and over 30 patients. "Oh but we didn't know! they weren't symptomatic!" (yes they were, fucking liars. They were just calling it "influenza" and "pneumonia" and "upper respiratory symptoms" and refusing to test). Jesus christ after this is all over I hope there's some wrongful death lawsuits to shut these fuckers down.
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Yeah but traveling nurses are raking in the dough [khn.org]. And good for them.
This is my shocked face (Score:5, Informative)
I get that studies like this need to be done, but this is obvious to anyone except an opponent of universal healthcare.
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Universal healthcare can still see nursing homes contracted out and the corresponding shitty outcomes. It's why there were such bad Covid outbreaks in some of Canada's Provinces nursing homes. (Provinces run their healthcare)
Healthcare is expensive and eventually you get a government who wants to do the public/private thing where the public foots the bill and the private profits, because, you know, private is always more efficient.
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But see, if the government isn't touching my healthcare AND I'm filthy rich - this trailer I live in in Florida is just temporary, see, while I work on my new business idea at at 56 - I can get the best care possible! While if the government takes over, they will put in death panels to distribute the resources in ways that might help young minority patients!
No it doesn't. Obviously. This is not Ferenginar. (Score:5, Insightful)
How is this even up for discussion?
Healtcare is the last thing that should ever come even close to the concept of profit.
You'd have to be an absolute libertarian-psychopath to allow an abomination of a concept like "equity investment" to buy up anything related to healthcare.
Because it means your life is literally dependent on somebody ripping somebody off. If it wasn't, they'd be out-competed by somebody more evil who gives profit a higher priority. Ditto for quality of service (least), versus cost (most). "Shareholders demand it." literally becomes "Shareholders demand death." Unless, of course, your time is actually up. Then you are kept alive anyway, as long as that vegetable got a wallet. (Pray it's not lock-in syndrome.)
Also, in general, in actual practice, "private equity" is like a vampire that is also your pimp. Your business is pimped out to look good, and completely hollowed out inside, all life blood drained, and then sold off to the biggest sucker who's unknowingly buying a cat in a bag. While the "equity" firm is off with ALL the money. "But the numbers looked great!" Whoopsie!
In any civilized countries, this shit must be made completely illegal. With prison sentences comparable to what you'd get for having murdered all those actual damn people that died in the name of ... profit.
Re:No it doesn't. Obviously. This is not Ferengina (Score:4, Insightful)
"Because it means your life is literally dependent on somebody ripping somebody off. If it wasn't, they'd be out-competed by somebody more evil who gives profit a higher priority..." ... like government. If you think government is some huge benevolent nonprofit, you're the biggest fucking idiot ever to walk the face of the Earth.
You need a system where the voters can and will punish corruption. Multiple parties with people not treating it like a football game where there are two teams, one of which is yours, along with an election system that depends on raising as much money as possible and designed by the politicians to keep it that way.
The salient question... (Score:2)
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Sure, if the patients are wealthy enough to assure lots of profit. I understand the really wealthy in America get excellent medical care.
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According to the summary, it does not.
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The study isn't about "healthcare for profit". Most care homes are privately owned, and run for profit. They frequently have better care outcomes than care homes run by charities, local authorities etc.
Many successful care home owners have set up multiple care homes, and in some cases created a company/corporate structure to manage them. Many of these homes are also well run.
Some private equity firms have crunched the numbers for the larger chains of care homes, and decided that they could get a better retu
wow (Score:5, Insightful)
PE ownership increases the short-term mortality of Medicare patients by 10%
That's not little. That's massive. That should be front-page news.
It's obvious that focussing on profit over patient welfare comes with a price - in humans, not in dollars. If it's not immediately obvious it's easy to see that sooner or later some situation will arise in which decision A is better for profit (short-term, long-term, no matter how you look at it) and decision B is better for the patient or patients.
It should also be obvious by now that capitalism and free markets are excellent at certain allocation questions and that's it. We are now a few centuries into misunderstanding capitalism as a philosophy or culture instead of seing it as an economical tool. The damage that has done to humanity is yet to be measured, and it may well turn out to be bigger than all the good it has done on the other hand (or not - the question is open).
But it is high time that we ask ourselves which things we want to intentionally take out of the hands of financial consultants and market experts. Because the pendulum is swinging the other way too much already - for example in practical terms, we have already established a system where the political decisions are auctioned to the highest bidder. Not yet directly, officially and individually, but in all western nations, money strongly affects who does how well in the elections. Campaign spending in the US, party finances in most of Europe.
The medical sphere also makes some treatments available only to those who can afford them. A rational allocation would be different. For a simple thought-experiment, if you have an expensive treatment for disease X that has a chance of 80% to save patient A, but only 20% to save patient B, who are otherwise identical (in age or other factors you may want to consider) then the logical choice is to give it to patient A, if you can only afford one. In our system, those numbers mean nothing and the wealth of the two patients will decide. That's irrational and, economically speaking, ineffective.
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I think the issue is two fold: patents that are covered are not in any way incentivized to not take on any and all treatments and are therefore not price-sensitive and patients that are not covered are largely unable to afford the care due to being priced out by covered. There has to be a way to make covered patients to be interested in the cost of treatments.
that can end badly patients to be interested in th (Score:2)
that can end badly patients to be interested in the cost of treatments.
So pay 100K or die OR become an inmate an pay say $100/year MAX copay?
Re: wow (Score:4, Insightful)
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Did you know that hospitals close to Canadian border do quite a bit of business with Canadians offering elective surgeries? As Canadian, you can get an upfront everything-included price over the phone. The same hospitals would
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Sorry, Tom, you should have read the paper. You fell for an old scam. You see "10% increase", and your imagination gets you thinking that it is an increase from 1% to 11% or 10% to 20%, but your rational brain should be asking "is that an absolute percentage increase, or a proportional increase of some potentially small fraction?" The answer to the question your bra
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It's obvious that focusing on profit over patient welfare comes with a price - in humans, not in dollars.
You are correct and incorrect. The human price is self evident. But focusing on profit damages the economy and the profit as well.
There is economy in good results. Say you get sick with dingle-itis. Your doctor tries to treat and cure you. He is a skilled practitioner, and if allowed to render the full course of treatment, your dingle-itis would be cured, or if chronic, controlled well enough for stable home management without future disability or hospitalization. Getting to that goal should take a 10
How the Hell can any thinking person (Score:2)
Why is this here ? (Score:2)
Can someone tell me why this is on Slashdot ? What relevance does it have to IT etc ?
Re:Why is this here ? (Score:4, Insightful)
As a long-time Slashdot reader, I applaud the diversification to topics of interest that concern a Nerds' everyday life. Rather than limit the discussions to complaining about Windows, analyzing some Linux device driver, announcing a new console or argue about Vi vs Emacs, we can discuss more than one thing at once. Politics, health, jobs, lifestyle and so on are (or should be) of interest to Nerds.
Re:Why is this here ? (Score:4, Funny)
Can someone tell me why this is on Slashdot ? What relevance does it have to IT etc ?
Because this is News for Nerds. As a long-time Slashdot reader, I applaud the diversification to topics of interest that concern a Nerds' everyday life.
If people didn't complain that stories shouldn't be on Slashdot, would Slashdot still be Slashdot? No it would not.
Therefore stories must be posted to Slashdot and users must continue to complain that stories should not be posted to Slashdot or Slashdot stops being Slashdot for users to complain stories should not be posted to Slashdot leaving Slashdot to become something which is not Slashdot and we can't have no Slashdot so it's inconceivable that users would stop complaining about stories being posted to Slashdot regardless of the nature of stories posted to Slashdot yet there is no story which some user will not complain should not be on Slashdot so Slashdot will always be Slashdot.
QED.
Private equity should be banned (Score:2)
It's creating more problems in this country that it's worth.
1) contributing to the decline of the middle and lower class
2) destroying jobs or good jobs
3) destroys value in companies
The only good thing is it sometimes creates economic efficiencies. If given the choice I'd rather have the lack of the top three problems and a little less economic efficiency. I'd bet if you were to pool america they would feel the same way. Just say no to PE
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I've never seen a Canadian doctor drive an old car, not take a vacation, etc. And those working in small towns are paid a bonus on top of that as an incentive to not work in a city.
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Religious organizations can be quite corrupt too. Had a lot of problems here in Canada by letting the religious folk run the reeducation camps (Residential Schools).
As for the Doctors, generally if in private practice, they just bill the government, at the rates set by the government, for any care they do. The hospitals are mostly owned by the government, who also pays Doctors a salary or on a piece work basis. The biggest difference is how triage works, the sickest people get help first rather then the wea
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By contrast though, I'd say it's also wrong to demand a medical professional provide care without compensation for his/her effort.
This is such a ridiculous argument it's hard to take anyone who makes it seriously. Forcing them to provide care without compensation is something literally nobody is proposing. It's not how any system works, it's not a system that's even remotely on the table. Socialized healthcare means the government hires and pays (or contracts that) people. Past the hyperbole is a discussion about exactly how much they're payed, which is still a ridiculous argument because every other developed nation is able to pay en