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Moving to California is better than killing yourself most of the time.
Private equity looks for "pricing power". This just means "inelastic demand". So housing, vets, healthcare, food and utilities are great targets because you can't opt out of basic needs. Healthcare (and vets) have the added layer that PE tends to buy all the practices in an area at the same time so there's no competition. And, like you say, they sign all the medical providers with these big contracts with onerous non-competes
Those non-competes, while onerous, tend to be regional. The region can be large however but if you moved (which, admittedly, most people don't want to do) then you could practice medicine elsewhere.
Here are two big ways PE is trying to corner these markets with mixed success:
1. Some states (eg Oregon) have laws that forbid companies from "practicing medicine" so when Apollo came and tried to buy their way into emergency care (so the hospitals fired the physician-owned emergency medicine group that had been running it for decades), they try this convoluted corporate structure where there's a company that ostensibly owns the new healthcare operation and it has some doctor placed as the chief but really it's a Trojan horse for the PE firm. So far, judges in Oregon have rejected this end-run around the law; and
2. Envision Healthcare was a massive PE failure because of a law change. Here's how it worked. Whatever insurance you have will have in-network and out-of-network providers. In a hospital environment you generally have little control over the various providers who see you. This has led to some surprises where, say, the anesthesiologist for your surgery might be out-of-network while your surgeion was in-network. The surgeon is getting an in-network fee of $8000 but the out-of-network anesthesioligist is charging $100,000. Unscrupulous doctors would evngage in revenuemaxxing by intentionally bringing in an out-of-network provider then splitting the much higher fee rather than using the residents in the hospital, which were essentially "free".
That was Envision's entire business model: surprise out-of-network billing. Then in 2021, the No Surprises Act was passed that basically outlawed this practice. It forced hospitals to only receive in-network rates for things like this. And the entire $6.5B purchase of Envision imploded.
This is partially why I get so angry when people try and defend PE as a concept. It's entirely parasitic. It's not even theoretically making a business more efficient. It's just hiking prices in a way where people have no choice. That's it.
The interesting part is that the PE firm will try and exit by IPOing the "restructured" company, which will only last a few years before the complicated debt structure implodes, a bit like subprime loans. A textbook structure is to "sell" all the real estate to a holding company and that's not listed and then you have complciated leaseback contracts that only keep going up in rent.
One of favorite "fun" facts about healthcare is when passing the Affordable Care Act, somebody snuck in a provision that made physician-owned hospitals illegal. Who? Nobody really knows as best as I can tell. It just made it into the final bill. Someobody argued doctors would have an unfair advantage or something. Who? Insurance companies.
Honestly, this entire system needs to be burned to the ground, Boudicca style.
The idea that a company can restrict at-will employee’s post-separation employment is absurd if they aren’t compensating the individual.
In many US states and countries outside the US, the enforcement of non-competes is very very hard. The problem is that they create a RISK of enforcement.
* If they want to tell someone personally what to do or not to do, is some form of employment.
* If it is not paid, it can be considered slavery.
* It is usually possible to quit jobs.
If there's a market-dominating company, and execs are allowed to leave said company, start a competitor, get some investor dollars behind them, then start poaching employees from the old company, the market can have a really viable competitor quite quickly.
Without that ability, little monopolies spring up throughout the economy and use their size to crush upstarts, under-compensate their employees, overcharge their customers, and squeeze their suppliers.
Banning non-competes is an absolute requirement for free-market capitalism to function properly.
One of the other respondents mentioned one of the main issues with a DIY attitude towards modifying NCDs is the advent of digital signing of NCDs now, and I concur that NC documents really should be paper (though I can see an argument for adding a blockchain-like element/step with a digitized document that would capture the crossed-out sections). I used to deal with sections of NC forms I did not like this way myself.
A lot of people don't like non-competes but I think people give them a bad reputation sometimes. Not when they are being abused (like the case of the doctor and PE mentioned elsewhere, and as I said in some cases NCs make little sense to me; if it is isn't research-related, and/or doesn't involve some sort of patent or novel procedure or tech or research, it clearly makes less sense), but certainly when they serve to prevent people from running off and starting a new company and competing with the company they just left (e.g., how the AI field especially is getting very glutty and 'competitive' now; it resembles less of a free-market and more like Battle Royale in ways).
Pretty sure non-competes prevent economic collapses, layoffs and bankruptcies for many companies.
The danger is abuse of them, not their existence. I don't think banning them outright is good. Especially in Fintech, which is a field rife with moral and ethical quandaries.
I do want to point out that it irks me when people make a big deal complaining about a non-compete afterwards, when they know they signed a non-compete prior to a meeting or job or role somewhere. Part of the point of non-competes is that generally the people that want you to sign them know there is a reason you would want to talk about something or use it elsewhere.
Abuse should be prevented and preventable by both sides of the non-compete and NDA processes though.
Should someone be prevented from working with models after working with them at another company? Maybe. If you sign and say yes and you are paid (even if it is not after you leave; you were given notice, though clearly you may not like it; the ability to renegotiate should exist before leaving), then, like it or not, you signed it. But a better approach is just more specific NC clauses (specific sorts of models or specific fields being ruled out, not the whole shebang).
But as I said, I see good reasons for them existing.
I'm darkly-amused by how this really makes Amazon sound like a quasi-governmental entity.
AFAICT a lawsuit (Burns v. Amazon) on that is ongoing.
I don’t even negotiate these clauses I just have so much assurance the state is going to throw out the case that I just let the client shoot themselves in the foot, and silently get invested in seeing which other ways they’ll mess up
"The only winning move is not to play."
Meta is an awful company but they don't have Enemy of the State level surveillance.
If you met someone in real life and then Facebook recommended them to you the leak here was almost certainly a human one, eg. the person you met googled you and clicked your Facebook profile when it showed up (while they themselves were logged into Facebook) and that's how Facebook made the connection.
So don't kill yourself. Life is very short anyway, enjoy the absurdity of it while you can.
An AI simulation of you would post on HN.
Welcome to the future.
As always 99% of it is poor quality slop...