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Discussion (98 Comments)Read Original on HackerNews
https://www.abc.net.au/news/2025-03-27/nsw-government-joes-l...
when people talk about how healthcare needs to be better and better and more and more, I say "tell me under your plan what diseases/injuries to what extant will not be treated: who do you say "no" to? Every country could spend every collective nickel they have, and some people still would not live to see the next morning, but in a way that's ok because there probably wouldn't be any breakfast either, that money was spent on healthcare.
What exactly are you calling for? I thought millenial and genz home ownership was the problem we need to fix. Are we going to sacrifice hipster housing for healthcare? Since most healthcare today is probably needed by boomers, think carefully about your answer.
I already hear the downsides frequently from someone whose work is directly affected.
Maybe they find a buyer in a doctor, maybe they don't, but PE provides them an exit that keeps the practice operating in the community.
Many people don't really run businesses efficiently. There was an interesting video I saw recently where a sole doctor practice made a few changes to their workflow that allowed them to hire more doctors and handle 2x as many people - I would expect a PE firm would pursue similar changes that help increase the number of people they can service, increasing competitiveness and lowering prices in the long run.
I don't know how these tradeoffs interact with patient care, but I wouldn't inherently expect PE to be worse at this than any other operating model.
I'm not a huge fan of PE but the point of economics to deliver cheap and quality goods to consumers not keep people in a job.
In healthcare in US in particular I think the main thing that capital should be (if regulators allow) boutique / specialists that e.g. are the best in the biz at doing MRI scans, in some states my understanding is that it's literally illegal to start a business aiming to make one small part of the process better.
Contrary to popular belief, being intelligent in one thing does correlate with being intelligent at other things[1]. For doctors, the comparison with private equity (MBAs?) might be close, but it's not hard to imagine the targets of other PE rollups have owners that are more average in intelligence, think plumbing or roofing.
[1] https://en.wikipedia.org/wiki/G_factor_(psychometrics)
It's a steelman argument to be clear I'm not entirely convinced by it.
They buy one (or more) companies, often with only the slimmest understanding of what those companies do, slash opex by gutting the company with layoffs (yay EBITDA), maybe staple a few such companies together with leveraged buy-outs, then resell the whole bundle for more than they paid.
From experience, they don't give a single crap whether the resulting mess still functions. They care about selling the company for more than they bought it for. That prospect is only tenuously and at best accidentally related to whether the company still functions.
The private equity companies I've had to deal with were full of braindead MBA spreadsheet monkeys and used car salesmen. Their chief differentiator was that they worked 80 hours a week and were enthusiastic about laying people off without much deliberation.
Thinking private equity is "more intelligent" than business owners is like thinking house flippers are "more intelligent" than home owners. No. They know how to rip out carpet and replace it with laminate on the cheap. They know how to cut corners and hide it. They know buyers will over value a fresh veneer of paint. They don't give a shit about the long-term health or value of the house. They are not better stewards of houses. They specialize in short-term profit maximization and that is literally it.
It makes sense to me that someone could come in and say "hey, let me run the business + finance side of the house while you practice medicine" and at least on paper I can see a real world where that works out for everybody.
Of course, soon you end up with dentists pushing unnecessary procedures and more, so it doesn't always works out that way.
I'm not arguing with you; I'm legitimately curious what happened to that model and why PE has swooped in as more attractive to doctors. Maybe it's the payout and/or the fact that they don't have to handle business owner decisions at _all_ anymore?
Should they be outlawed from selling to certain classes of investor? Which?
Yes.
I'd expand that to any type of business that has effectively inelastic demand through the ability to hold people emotionally hostage.
So, for example, in addition to hospitals also include veterinarians, funeral services, family planning, etc.
Soulless PE vultures should be barred from all of this.
We have run this country on an assumption that we must give businesses a high amount of freedom. An argument can be made that businesses have been given too much freedom in our system. We’ve allowed Amazon and Ticketmaster and Walmart to exist and they shouldn’t exist in their present form.
Healthcare practices that provide necessary care shouldn’t even really be allowed to be for-profit entities if you ask me. The incentives become too perverse as a result.
You don't need to disallow them for necessary care to be provided. You can just have public healthcare programs. That can look like publicly-owned hospitals or regulation that private hospitals must provide certain services under certain conditions if they want to keep operating. Private healthcare then works to provide more than that basic service that fulfills necessary care, to the benefit of the public that can afford more.
Why stop at healthcare? Why not other essentials of life, like food or toilet paper?
How much would you want to sacrifice your 20s and early 30s? How much would you need to work in the middle of nowhere where your kids won’t have the best opportunities?
Do you realize that when Walmart moves into a community, prices charged for everyday things overall drop significantly, both at Walmart and their competition, which means that poor families are able to buy more with every dollar.
What do you have against poor people?
https://www.bloomberg.com/news/articles/2025-06-06/private-e...
https://archive.is/27tJr
People who are vehemently against PE generally do not have any idea of how the system works
[0] https://www.ey.com/en_us/insights/private-equity/pulse
The short-term fix is banning PE. The long-term one is restricting the leverage these groups can take. Then put limits on upstream leverage. We have these across our economy. We just don’t apply them to this sector.
It's important to fight it now before it is too late and other places also fall apart into a degraded, predatory, dystopian US system !
Ask an American hospital how much something costs - you will get a completely fake price back, this is a sign of a totally broken market.
The usual complaint is going full extractive mode, desperately squeezing profit and selling inside 3-7 years.
So, yeah, we can keep private investment. But they're fucking stuck with it, trying to maintain a healthy business for 20 years.
I am sure most workers would prefer to get that extra 11% as a cash raise, but because healthcare costs are out of control the same care costs 11% more.
Certainly some companies will throw up their arms and hire someone overseas instead.
Medicine is already held back enough by the lack of ability to use debt to finance its sales, unlike almost every other industry; you can repossess a car but you can't repo an implant or administered drug, forcing everything to be paid for in cash upfront. Medicine needs as much access to capital as it can get.
Injecting PE into healthcare is what made it vastly worse for everyone in the first place. You can't have it both ways.
VC's can still fund companies that are making expensive new products.
Banks (and PE...) can still underwrite loans for these things.
We have many solutions for capex-intensive businesses and have had these for over four hundred years. LBO-type PE is not even fifty years old yet
Apologies if an AI summary is offensive to some, but here we go:
> The US is a world leader in advanced and specialist medicine, but its overall system for providing affordable, accessible, equitable medical care to its citizens ranks poorly—last among the 10 comparable high-income countries in the strongest recent comparison.
Both sources are the same site:
https://www.commonwealthfund.org/sites/default/files/2024-09...
https://www.commonwealthfund.org/publications/fund-reports/2...
"Innovation" as in marketing expenses and stock buybacks?