14 ms·

As private equity dominates wheelchair market, users wait months for repairs

440 points by coloneltcb 2y ago

seanp2k2 2y ago
Don't worry, I'm sure the free market will solve this quickly and efficiently, no need for regulations! /s
tonetheman 2y ago
What you would expect from private equity sadly. Destroyers of value.
- Rinzler89 2y ago
  But, but...muh free market capitalism always leads to the best products supply for the demand...or so we've been told.
  - ElevenLathe 2y ago
    Turns out late hegemonic capitalism has a similar failure mode to late Soviet central planning.
    - vundercind 2y ago
      Relaxing various rules on investment and m&a, and allowing unprecedented levels of market power concentration (it’s a lot worse in many major industries than what promoted our first big wave of “trust busting”) turns out to be less than awesome.
  - readyman 2y ago
    Capitalism works perfectly if you just ignore all the inevitable disasterous consequences and outright failures.
    - ars 2y ago
      And your better alternative is........... ?
      - margalabargala 2y ago
        Capitalism with much stronger consumer-protection regulations?
      - kelipso 2y ago
        China is doing pretty well. In before a wall of text about how China is doomed or whatever.
        realusername 2y ago
        China is doing well is a funny take post covid. The argument worked much better 10 years ago when they still had large growth. "Doomed" I don't know but they seem quite stuck now between a lot of internal problems.
        ausbah 2y ago
        only once they switched to free market principles under deng. iirc as their growth has been slowing it has been due to increasing state clampdown on the economy
        giovannibonetti 2y ago
        I assume you aren't aware of China's housing market bubble [1]. [1] https://en.m.wikipedia.org/wiki/Chinese_property_sector_crisis_(2020%E2%80%93present) https://en.m.wikipedia.org/wiki/Chinese_property_sector_cris...
      - mistermann 2y ago
        Capitalism moderated by various systems emerging from a genuine, sophisticated democratic system would be my advice. We have a lot of work to get from here to there though, and much of it is the undoing of mass psychological condition.
  - mistermann 2y ago
    It is the job of government to regulate and reign in capitalism. We are also told that democracy is the best form of government, and we are also told that our democracy is genuine, and that it must be protected. For some reason, people are unable to wonder if these various stories are true...perhaps because that skill is not innate, and is not taught in school?
  - tomoyoirl 2y ago
    No. It’s only efficient when property rights are enforced, barriers to entry are low, and transaction costs are minimal. Wheelchairs are regulated (barriers to entry), pollution is the nonexistence of property rights, and your take-it-or-leave-it noncompete agreement is a consequence of high transaction costs (job search, legal negotiations).
  - Terr_ 2y ago
    > ... or so we've been told. To expand on this inconsistency, it comes from different people cheer-leading "the free market" with different and conflicting sets of assumptions about what the phrase means. For example, one economist makes an assumption of "perfect information on prices and transactions", and declares that it's the most efficient thing ever. But another one assumes actors are free to make secret deals and private transactions, and concludes that the free-market doesn't have a cartel problem, because individual members will secretly defect and undercut so that it falls apart. Those two assumptions are in direct contradiction, yet somehow the overlap phrase "the free market" still gets touted as having both of the incompatible features.
- 7thaccount 2y ago
  Private Equity really is a pox on society. One reason they may not be able to hire is that they paid a ton to buy out all the competition and now have a bunch of investors wanting to see high rates of return. That requires cutting staff and raising prices. I'm all for a free society that allows private parties to make agreements, but PE is by definition all about breaking markets by creating a monopoly where they have large amounts of market power and where no competition can realistically occur. The end result is consumers getting screwed all over.
  - ars 2y ago
    > Private Equity really is a pox on society. Every single non-public business is "Private Equity". How is every single small business in the entire world "a pox on society"? Perhaps you mean "short term thinking" is a pox on society? Or in, like in this case, a duopoly is the issue? If there were 10 such companies a reputation for slow repair would drive people to other suppliers and things would rapidly get better.
    - eesmith 2y ago
      https://en.wikipedia.org/wiki/Private_equity https://en.wikipedia.org/wiki/Private_equity "In the field of finance, private equity (PE) is capital stock in a private company that does not offer stock to the general public. Private equity is offered instead to specialized investment funds and limited partnerships that take an active role in the management and structuring of the companies. In casual usage, "private equity" can refer to these investment firms rather than the companies that they invest in."
    - hx8 2y ago
      PE is specifically referring to companies not listed on stock exchanges that take money from investors. I agree that we do not want to throw the baby out with the bathwater here, but there is probably merit to limiting the activity of PE funds with lots of investors or lots of money. PE often used as a scheme of raising money and conducting business in a way to avoid the scrutiny of a publicly traded company.
    - 7thaccount 2y ago
- IncreasePosts 2y ago
  Well, a private equity firm owned the wheelchair company for a decade. It was only when a different PE firm came in that the service allegedly declined.
ars 2y ago
"Grau wants more wheelchair users to come into the shop, as repairs happen much faster — only two week’s wait, on average. Wheelchair users are loath to adopt this, as coming into the office can be physically treacherous for them" vs. a technician fixing the chair in the house. But how about something in between? A medium-skill employee who takes the chair from their home to the repair facility? They would need to carefully document what's wrong with it, so they need a little skill but not as much as a full skill repair tech.
- giovannibonetti 2y ago
  It seems like a good job for non-profits. Anyone with a suitable car should be able to volunteer and help their community.
- advisedwang 2y ago
  I'm not a wheelchair user, but I can imagine it being a non-starter to have your wheelchair just taken away from you. What if the tech doesn't bring it back? You're just stranded! Even if they do bring it back, there's potentially a lot of time stranded.
JumpCrisscross 2y ago
What's the barrier to entry?
- ars 2y ago
  Regulation. This is one of the market failures caused by excessive regulation. To make a chair you requires so much paperwork that only a small number of business can do it. I especially like the regulations that make sure only those who need the chair get it, to reduce medical costs, but in the process all the paperwork dramatically drives up the costs.
- alistairSH 2y ago
  Power wheelchairs are regulated (FDA) as medical devices.
  - TechWorld01 2y ago
    I can buy an electric wheelchair at Walmart for $750. What is the issue?
    - mcmcmc 2y ago
      You can also buy pharmaceuticals at Walmart. What is your argument?
    - happyopossum 2y ago
      That's a powered scooter, not an electric wheelchair. They may look the same to a layperson, but they're not - one is highly regulated and has a lot of people making a lot of money off them, the other is a scooter.
    - deadeye 2y ago
      Some of these wheelchairs are 75k. They're custom made to your body size for maximum comfort and the features are customized to your disability. These aren't off the shelf mobility products. Each one is assembled to specification.
    - 2y ago
nickff 2y ago
Private equity discovered that regulations, compliance requirements, & other similar barriers to entry are the most effective 'moats' which allow businesses to raise prices and have little impact on demand; they are now exploiting this 'hack' ruthlessly.
- tdb7893 2y ago
  We've seen consolidation across the whole economy (which have vastly different regulation schemes) so I'm skeptical of it being just regulation driven
  - JumpCrisscross 2y ago
    > I'm skeptical of it being just regulation driven It seems to be blatantly obviously regulation in this case. There are electric wheelchairs in other countries. What's stopping them from being imported are the regulations.
    - kazinator 2y ago
      Then, how would it fix things then if it wasn't private equity dominating that market? There would still be regulations that would allow public equity wheelchair makers to jack prices.
      - JumpCrisscross 2y ago
        > how would it fix things then if it wasn't private equity dominating that market? I'd start importing them for less than $500 from India [1]. (Versus $1,500 to $6,000 for these jalopies.) [1] https://www.amazon.in/electric-wheelchair/s?k=electric+wheelchair https://www.amazon.in/electric-wheelchair/s?k=electric+wheel...
        MichaelZuo 2y ago
        The regulations don't just disappear to allow for such imports as in your example ...?
throwaway2562 2y ago
[flagged]
- Invictus0 2y ago
  Don't hate the player, hate the game.
  - pseudalopex 2y ago
    Do both.
  - wolverine876 2y ago
    People are responsible for their own behavior. They can't blame the game.
  - bcrosby95 2y ago
    The player also lobbies to keep the game going. So yeah, fuck those motherfuckers.
  - klabb3 2y ago
    There are folks who take shitty jobs because they don’t have anything. Say you’re dealing drugs, or pressuring poor people to buy lifestyle products they can’t afford. Or a closer example, working for data mining companies, or surveillance tech. At the lower end of the socioeconomic ladder, these things are complicated, because making a living is hard. Maybe that’s all you know, and any alternative would be a risky jump where you’d lose money, health care, housing, and providing for your kids. Not saying it’s one way or another, but at least it’s complicated. But plenty of these individuals in PE have everything they need in life. They can retire comfortably early and leave plenty for their children, and have a second home in Hawaii and expensive hobbies. If you are in this position and actively and with full knowledge continue to harm others then you can’t blame “the game”. Nobody is forcing you.
- kachapopopow 2y ago
  I mean fair, but helping people like that teaches empathy which we're severely lacking in today's world. There is something special we humans experience when helping others for nothing and return and I think that a lot of people are blinded by never experiencing what it means to help others. A lot of arguments are "imagine if it was you", but I think a fairer argument would be "what if it was somebody you like/love"? I personally wouldn't mind jumping off a bridge if I became useless, but what about the people who want to continue living who are afraid? And what about the people that like/love me?
alistairSH 2y ago
Almost as troubling, from the article "Customized wheelchairs typically last five years, but most chairs need a major repair or two during that time." What the actual fuck? Power wheelchairs run the spectrum for a few thousand USD to ten thousand plus. And they only last ~5 years, and even then with several major repairs in that period? That sounds like an absolutely atrocious durability/reliability record.
- deadeye 2y ago
  Think about it. For many users, they're in these chairs 12+ hours a day. They're not cars that get driven for an hour a two a day.
  - alistairSH 2y ago
    Sure, but I would have expected them to be modular enough to keep running more than 5 years. More so given they cost as much as a used car.
  - s_m_t 2y ago
    And yet my motorcycle has gone 80,000 miles without ever needing any maintenance except for a new chain and new sets of tires. Well, I've had to replace the headlight and levers and shift peg because I've crashed it off-road multiple times but that's not the motorcycles fault. I bought it for $1000 used.
  - JasserInicide 2y ago
    My fridge has been running 24/7 for 15 years and has never had an issue.
    - toast0 2y ago
      Most fridges are never moved after installation, until they're recycled. Of those that are moved, most are moved away from the wall for cleaning and then moved back. Very few fridges are moved a significant distance on a daily basis.
- 2y ago
ryanong 2y ago
The problem isn't regulation, the problem is that the regulation isn't simple or cheap enough for small companies to get regulated.
- saulrh 2y ago
  Yeah. Don't complain about regulation existing. Complain about regulations being controlled by private equity. Complain about private equity existing. Complain about capitalism. Not about the existence of government.
JumpCrisscross 2y ago
"In 2005, CMS announced requirements for testing of electric-powered wheelchairs as part of efforts to modernize coding (5–7). In this century, CMS, in what might be classified by some as an uncharacteristic move, has provided leadership in evidence-based classification of wheelchairs. Globally, the International Standards Organization (ISO) manages the wheelchair standards. ISO and the RESNA standards committee work collaboratively. ISO and RESNA have often been driven by outside sources to expedite their work and to address needs of consumers and other organizations. In the 1990s, the European Community Medical Device Directive provided impetus to make a number of changes to ISO standards and to create new standards in response to stricter regulation. The European Committee for Standardization (CEN) went its own direction for a while and over time, CEN and ISO standards have begun to merge. American National Standards Institute (ANSI)/RESNA was a driving force for a long time and often had different standards than ISO. However, this has dwindled in the past decade. Concomitantly, the wheelchair industry has exploded over the past 10 years, and the standards have simply not kept pace. There is a clear and present need for change in standards development and support in the United States. Most of the participants in wheelchair standards development are employed by the wheelchair industry, an inherent conflict. Unfortunately, wheelchair users and clinicians have traditionally not had the financial support to participate in sufficient numbers. Interestingly, the same companies that participate in the standards committees develop internal tests not represented by ISO or RESNA as part of their product development programs to protect them against legal liability. Test laboratories do the same thing, creating a number of tests that differ from or improve on ISO or RESNA standards. None of the existing standards (ISO, CEN, or RESNA) is comprehensive enough to cover all areas of wheelchair evaluation." [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1929010/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1929010/ 2006
jhjhjhjhjj 2y ago
[flagged]
roody15 2y ago
Private Equity = we have a bunch of money and use it to control markets and politics. Almost a new form of feudalism. Get back to work IT surfs while we continue to extract wealth from your labor.
hi-v-rocknroll 2y ago
Vulture capitalism - def. (noun): A strategy applied to a company or multiple companies in a market category whereby profits are maximally extracted without regard to long-term sustainability of customer relationships, brand reputation, or company viability. Not saying it's not a viable possible strategy for the investor, but that it's perhaps a suboptimal strategy if greater net profits were desired long-term.
neilv 2y ago
We frequently hear about "private equity" doing something sociopathic. We sometimes don't even hear the names of the companies, just "private equity". Do we need to systematically trace and publish which individuals and institutions benefit from the nasty companies?
- ben_jones 2y ago
  We should publish the b-school, and b-school networking graph through the career of a malicious individual. People will take action faster if they knew Thaddeus Wrappesalot went straight from lacrosse captain to executive chairmen hiking veterinarian costs.
throwaway050324 2y ago
Sigh. I dealt with NSM a few years ago to get a new manual wheelchair. The tech who fitted me for it, and delivered it, was great, but very obviously always in a rush. The chair itself was not made to spec, so it was just not useable for me as-is. After many months of trying (and failing) to get NSM to help me mod it and get it as close to spec as possible, I gave up and just continued using my old chair. But even more frustrating than that? NSM continued sending me phony bills for parts that I did not order. I just trashed them until it went to collections. (Fortunately, the collection agency they use is even more incompetent than they are, and I've been able to put them off with standard anti-collections form letters.) I figured I'd go with Numotion when insurance is ready to re-up me for a new chair, but reading this article, it doesn't seem that would be any better.
- stronglikedan 2y ago
  Maybe The Paradox Project (by JerryRigEverything) is for you: https://notawheelchair.com/products/the-paradox-project https://notawheelchair.com/products/the-paradox-project
  - throwaway050324 2y ago
    Thank you - definitely always nice to see people trying new things in this space. It might be a bit risky to rely on a wheelchair that doesn't have a good support ecosystem, though, unfortunately. This actually touches on something that seems to have changed in the past 10-15 years: in my experience, shops now absolutely refuse to touch wheelchairs that they did not themselves provide. I'm lucky that I can generally do my own maintenance, because even something simple like a deep cleaning is met with worries of voided warranties, etc. etc. I'm not sure when this changed, but throughout the aughts I was able to get service at shops in multiple different cities without any issues.
minusLik 2y ago
What the article does not seem to mention is that an usual electric wheelchair costs about $65,000 (and is intended to be replaced every six years or so). This and the non-availability of replacement parts is why some wheelchair users started a project to open-source a wheelchair from standard parts: https://themif.org/ https://themif.org/ Louis Rossmann interviewed the founder of the project here: https://www.youtube.com/watch?v=eaAj59025Kk https://www.youtube.com/watch?v=eaAj59025Kk
- renewiltord 2y ago
  This is a great project. I didn't realize that FDA Class I regulations were this easy to comply with.
  - readyman 2y ago
    >I didn't realize that FDA Class I regulations were this easy to comply with. They definitely won't be once this open source effort shows any sign of success. You can't solve political problems with technical solutions. At best, you may be able to displace them, but even that is rare.
    - minusLik 2y ago
      > You can't solve political problems with technical solutions. Yes, that's what I've been thinking too. Tom Quiter even mentions in the interview that there already have been companies which tried to offer cheap wheelchairs, but the quasi-monopolists had the FDA alter the regulations in a way with which the newbies couldn't comply. However, since the MIF already attracted suppliers, I hope they can gain some leverage.
    - renewiltord 2y ago
      I only just noticed that the wheelchair https://libertymemesfoundation.org/donations/endurance-the-open-source-wheelchair/ https://libertymemesfoundation.org/donations/endurance-the-o... is actually a Class 2 device. That sounds really hard to get past the FDA. I think it's pretty cool still because folks with the knowhow could make their own, but the disabled are probably SOL because you can't really make these for sale without that. I suppose the FDA's reasoning is that they're better off having no mobility than having a device that doesn't work properly.
sskates 2y ago
Public company CEO here. One of my rules that has served me well is "don't ever be on the other side of a transaction from private equity". They have blatantly anticompetitive playbooks where they buy up all the competition in a market and then raise prices as a cartel. Mostly recently, the DOJ has opened a criminal probe into RealPage for price fixing in real estate. What a scourge on capitalism.
RecycledEle 2y ago
I deal with wheelchairs, electric wheelchairs, oxygen systems, CPAPs, spirometry, and more every day. Electric wheelchairs are built to be very rugged and dirt simple. There are 2 problems: The first problem is insurance. People expect their insurance to cover everything. If they need a new set of 35 AH SLA batteries, they will throw their old chair away and ask for a new chair on insurance. The second problem is that wheelchair users are disabled. As an able-bodied nerd with a socket set and a few wrenches, I can repair an electric wheelchair. A disabled person usually can not do that. They can not even follow the (good) advice to use an external charger instead of the (garbage) charger built into most wheelchairs; they physically can not get to the relevant parts. Home oxygen companies send people out on short notice to debug, repair, or replace home oxygen equipment. If you want insurance to cover electric wheelchairs, then rent them instead of selling them and include service visits. The problem with shipping an electric wheelchair back for service is that this thing weighs almost 100 pounds without batteries and is a very odd shape. Before anyone complains, you want it to be heavy so it will not tip over when the human (who is high up) leans over, takes a corner, or drives sideways on a slope. If you want a less-insurance-intensive solution, pass a right-to-repair law that (1) requires all electric wheelchair parts to be marked with a manufacturer and part number, and (2) requires all electric wheelchair makers to sell parts for a decade or two after they stop selling the chairs. If they use industry-standard parts, and mark the parts as such, they should be relieved of the obligation to carry the parts for 20 years. Here's an example: Include a label on the chair saying that all bolts are either m6x60mm or m4x25mm and that all red and black electrical connectors are PP75 series Anderson Power Poles. Here is a case that drove me nuts: I was dealing with an electric wheelchair that had some odd version of Anderson PowerPoles connecting the batteries and motors. These connectors had been knock-offs, and the reseller of these (Chinese-made) connectors lost a patent lawsuit to Anderson (before their patent expired.) One connector broke and was impossible to replace. I would gladly pay $100 for a single connector, but they do not exist. Before someone says to replace both ends of the connector, this is a connector mounted in a custom bracket with almost zero clearance as the chair's seat fits right on top of the bracket, connectors, and wires.
- sokoloff 2y ago
  I’ve worked on cars and other mechanical things for most of 3 decades. I’ve never needed a sticker telling me what size standard bolts were. On the broken, ruled as patent-infringing part, what do you want to happen that would comply with patent law? If it was compatible with Anderson, you’d just buy that. Since it wasn’t and the original company isn’t allowed to keep making them…
azinman2 2y ago
Banning private equity (not sure how) is necessary to prevent enshitification of all health care and related services.
- srackey 2y ago
  Yes, because communism (what else is “banning private equity”?) NEVER results in “enshitification” of ANY kind. Seriously, the issue here can most likely be tracked to private equity taking advantage of existing regulations. Not sure why MORE state involvement in the economy would be the solution.
  - tenuousemphasis 2y ago
    It doesn't sound like you understand what Private Equity means. Allow me to assist you in your quest for enlightenment. >Private equity describes investment partnerships that buy and manage companies before selling them.
    - srackey 2y ago
      And it sounds like you’re a communist, unless how you can explain how you can ban “investment partnerships buying companies” without doing away with private ownership more broadly? The issue people have isn’t with “private equity”. If it was a publicly traded company doing this people would be equally upset.
      - azinman2 2y ago
        Notice my “not sure how” There is a very negative behavior right now by companies that call themselves private equity to buy up your local vet, doctors office, etc. Then they fire staff, reduce services, and increase costs. We the people are losing, even if some of our 401ks grow because those funds invested in these PE vehicles. This practice imho should be banned. How? I don’t know. But the U.S. will become shittier and shittier because of it.
- bsder 2y ago
neocritter 2y ago
A good comic on the difference between what most people think when they hear wheelchair vs what wheelchair users need to be independent: https://www.tumblr.com/calvin-arium/184341867538/its-here-the-guide-for-two-legged-people-who https://www.tumblr.com/calvin-arium/184341867538/its-here-th...
jmyeet 2y ago
Private equity is great for exposing the flaws in our economic system. The consequences are of course awful and it would be better that they didn't happen. But since they are happening, hopefully more people will start to realize it. When exposed to this kind of thing you can generally have one of two reactions: The first is that you say that this kind of thing is good. It's all part of capitalism. The market will work it out. People will say this kind of thing with a straight face. The second is to say that it is bad. But why is it bad? The first stage is you believe that there are bad apples. Private equity is simply a few bad actors who may or may not need to be dealth with by way of legislation, regulation and/or prosecution. Lots of people believe this because they still fundamentally believe in our current economic system. The second stage is you realize that private equity isn't an outlier and isn't a few bad apples. It is exactly what our system is designed to produce: to financialize and rent-seek in every aspect of our lives as a means of extracting wealth from the poor to the already vastly wealthy. Private equity is taking over every aspect of your life by buying up homes, mobile home parks, vets, medical practices, hospitals, etc. There probably isn't a single aspect of our lives that hasn't been tainted by private equity. And the playbook is exactly the same: 1. Jack up the prices, usually by cornering a market by either buying up all the competition or through legislatively creating enclosures; 2. Cut costs. Use noncompete agreements and and the like to suppress wages; and 3. Load up the entity with exploding debt and sell it to the market before the debt explodes. This is capitalism working as intended. No more, no less. On wheelchairs in particular, it's truly disgusting what we as a society put wheelchair users through. One of the most egeregious examples is how airlines will routinely destroy wheelchairs. We are steadily marching towrads a future where almost all of us will be a permanent underclass devoid of any kind of security. Every aspect of our lives will be at the mercy of our overlords. Capitalism inevitably leads to neofeudalism.
Ozzie_osman 2y ago
If you want to hear more about the negative impact of private equity on various industries, like retirement homes etc, I'd recommend the book Plunder. Eye-opening stuff.
48864w6ui 2y ago
Is private equity this century's equivalent of the LBO? https://www.latimes.com/archives/la-xpm-1990-03-23-me-521-story.html https://www.latimes.com/archives/la-xpm-1990-03-23-me-521-st...
IndySun 2y ago
Not bugs, deliberate software additions. Not bugs, intentional from v1. Not bugs, deeply contrived. Oh, sorry, wrong meeting...?
- IndySun 2y ago
  How extremely odd. I did not post this comment here, but in my comments listed, it sends me here as its parent.
HumblyTossed 2y ago
Is there anything at all P.E. hasn't fucked up? At this point I feel it really should be illegal.
digger495 2y ago
Also fun, in Oklahoma, most (2/3rds or so) of the certified professionals who do the fittings are employees of NSM or NuMotion.
iancmceachern 2y ago
I can design and build these, source parts, whatever. This is what I have done for a living for 20 years. If anyone wants to solve this problem reach out, contact info is in my bio.
tchbnl 2y ago
PE is such a cancer
hwbunny 2y ago
[flagged]
PierceJoy 2y ago
When are we going to have mass protests against the private equity takeover of everything? Besides climate change and war, I’m hard pressed to think of anything that will have as much of a negative impact on society.
golem14 2y ago
And yet, you can buy nice electrified wheelchairs on Aliexpress for less than $3000. My guess is, like for hearing aids from costco, you won't get reimbursed by insurance if you buy it yourself.
jordanb 2y ago
Our whole economy is feeling increasingly Soviet. Somehow our business leaders have decided that the best business is one that does not serve its customers, and that providing a good or service efficiently and effectively is poor management because it is "leaking value" to counterparties. I guess the next phase is going to be you need to know people if you want your medical device delivered, your car repaired, or for your internet to quit dropping.
- croes 2y ago
  Welcome to capitalism
- AzzyHN 2y ago
  My brother in Christ you are witnessing the consequences of capitalism
- noobermin 2y ago
  In Capitalist Realism, Mark Fisher talked about how capitalism through the institution of the corporation developed the very byzantine bureaucracies and middle men that had long been called out as failures of the Soviet system, and in some ways, proved to be even more inefficient.
Friedduck 2y ago
Is there any market or sector that PE hasn’t made worse?

440 points by coloneltcb 2y ago

seanp2k2 2y ago

Don't worry, I'm sure the free market will solve this quickly and efficiently, no need for regulations! /s

tonetheman 2y ago

What you would expect from private equity sadly. Destroyers of value.

Rinzler89 2y ago
But, but...muh free market capitalism always leads to the best products supply for the demand...or so we've been told.
- ElevenLathe 2y ago
  Turns out late hegemonic capitalism has a similar failure mode to late Soviet central planning.
  - vundercind 2y ago
    Relaxing various rules on investment and m&a, and allowing unprecedented levels of market power concentration (it’s a lot worse in many major industries than what promoted our first big wave of “trust busting”) turns out to be less than awesome.
- readyman 2y ago
  Capitalism works perfectly if you just ignore all the inevitable disasterous consequences and outright failures.
  - ars 2y ago
    And your better alternative is........... ?
    - margalabargala 2y ago
      Capitalism with much stronger consumer-protection regulations?
    - kelipso 2y ago
      China is doing pretty well. In before a wall of text about how China is doomed or whatever.
      - realusername 2y ago
        China is doing well is a funny take post covid. The argument worked much better 10 years ago when they still had large growth. "Doomed" I don't know but they seem quite stuck now between a lot of internal problems.
      - ausbah 2y ago
        only once they switched to free market principles under deng. iirc as their growth has been slowing it has been due to increasing state clampdown on the economy
      - giovannibonetti 2y ago
        I assume you aren't aware of China's housing market bubble [1]. [1] https://en.m.wikipedia.org/wiki/Chinese_property_sector_crisis_(2020%E2%80%93present) https://en.m.wikipedia.org/wiki/Chinese_property_sector_cris...
    - mistermann 2y ago
      Capitalism moderated by various systems emerging from a genuine, sophisticated democratic system would be my advice. We have a lot of work to get from here to there though, and much of it is the undoing of mass psychological condition.
- mistermann 2y ago
  It is the job of government to regulate and reign in capitalism. We are also told that democracy is the best form of government, and we are also told that our democracy is genuine, and that it must be protected. For some reason, people are unable to wonder if these various stories are true...perhaps because that skill is not innate, and is not taught in school?
- tomoyoirl 2y ago
  No. It’s only efficient when property rights are enforced, barriers to entry are low, and transaction costs are minimal. Wheelchairs are regulated (barriers to entry), pollution is the nonexistence of property rights, and your take-it-or-leave-it noncompete agreement is a consequence of high transaction costs (job search, legal negotiations).
- Terr_ 2y ago
  > ... or so we've been told. To expand on this inconsistency, it comes from different people cheer-leading "the free market" with different and conflicting sets of assumptions about what the phrase means. For example, one economist makes an assumption of "perfect information on prices and transactions", and declares that it's the most efficient thing ever. But another one assumes actors are free to make secret deals and private transactions, and concludes that the free-market doesn't have a cartel problem, because individual members will secretly defect and undercut so that it falls apart. Those two assumptions are in direct contradiction, yet somehow the overlap phrase "the free market" still gets touted as having both of the incompatible features.
7thaccount 2y ago
Private Equity really is a pox on society. One reason they may not be able to hire is that they paid a ton to buy out all the competition and now have a bunch of investors wanting to see high rates of return. That requires cutting staff and raising prices. I'm all for a free society that allows private parties to make agreements, but PE is by definition all about breaking markets by creating a monopoly where they have large amounts of market power and where no competition can realistically occur. The end result is consumers getting screwed all over.
- ars 2y ago
  > Private Equity really is a pox on society. Every single non-public business is "Private Equity". How is every single small business in the entire world "a pox on society"? Perhaps you mean "short term thinking" is a pox on society? Or in, like in this case, a duopoly is the issue? If there were 10 such companies a reputation for slow repair would drive people to other suppliers and things would rapidly get better.
  - eesmith 2y ago
    https://en.wikipedia.org/wiki/Private_equity https://en.wikipedia.org/wiki/Private_equity "In the field of finance, private equity (PE) is capital stock in a private company that does not offer stock to the general public. Private equity is offered instead to specialized investment funds and limited partnerships that take an active role in the management and structuring of the companies. In casual usage, "private equity" can refer to these investment firms rather than the companies that they invest in."
  - hx8 2y ago
    PE is specifically referring to companies not listed on stock exchanges that take money from investors. I agree that we do not want to throw the baby out with the bathwater here, but there is probably merit to limiting the activity of PE funds with lots of investors or lots of money. PE often used as a scheme of raising money and conducting business in a way to avoid the scrutiny of a publicly traded company.
  - 7thaccount 2y ago
IncreasePosts 2y ago
Well, a private equity firm owned the wheelchair company for a decade. It was only when a different PE firm came in that the service allegedly declined.

ars 2y ago

"Grau wants more wheelchair users to come into the shop, as repairs happen much faster — only two week’s wait, on average. Wheelchair users are loath to adopt this, as coming into the office can be physically treacherous for them" vs. a technician fixing the chair in the house. But how about something in between? A medium-skill employee who takes the chair from their home to the repair facility? They would need to carefully document what's wrong with it, so they need a little skill but not as much as a full skill repair tech.

giovannibonetti 2y ago
It seems like a good job for non-profits. Anyone with a suitable car should be able to volunteer and help their community.
advisedwang 2y ago
I'm not a wheelchair user, but I can imagine it being a non-starter to have your wheelchair just taken away from you. What if the tech doesn't bring it back? You're just stranded! Even if they do bring it back, there's potentially a lot of time stranded.

JumpCrisscross 2y ago

What's the barrier to entry?

ars 2y ago
Regulation. This is one of the market failures caused by excessive regulation. To make a chair you requires so much paperwork that only a small number of business can do it. I especially like the regulations that make sure only those who need the chair get it, to reduce medical costs, but in the process all the paperwork dramatically drives up the costs.
alistairSH 2y ago
Power wheelchairs are regulated (FDA) as medical devices.
- TechWorld01 2y ago
  I can buy an electric wheelchair at Walmart for $750. What is the issue?
  - mcmcmc 2y ago
    You can also buy pharmaceuticals at Walmart. What is your argument?
  - happyopossum 2y ago
    That's a powered scooter, not an electric wheelchair. They may look the same to a layperson, but they're not - one is highly regulated and has a lot of people making a lot of money off them, the other is a scooter.
  - deadeye 2y ago
    Some of these wheelchairs are 75k. They're custom made to your body size for maximum comfort and the features are customized to your disability. These aren't off the shelf mobility products. Each one is assembled to specification.
  - 2y ago

nickff 2y ago

Private equity discovered that regulations, compliance requirements, & other similar barriers to entry are the most effective 'moats' which allow businesses to raise prices and have little impact on demand; they are now exploiting this 'hack' ruthlessly.

tdb7893 2y ago
We've seen consolidation across the whole economy (which have vastly different regulation schemes) so I'm skeptical of it being just regulation driven
- JumpCrisscross 2y ago
  > I'm skeptical of it being just regulation driven It seems to be blatantly obviously regulation in this case. There are electric wheelchairs in other countries. What's stopping them from being imported are the regulations.
  - kazinator 2y ago
    Then, how would it fix things then if it wasn't private equity dominating that market? There would still be regulations that would allow public equity wheelchair makers to jack prices.
    - JumpCrisscross 2y ago
      > how would it fix things then if it wasn't private equity dominating that market? I'd start importing them for less than $500 from India [1]. (Versus $1,500 to $6,000 for these jalopies.) [1] https://www.amazon.in/electric-wheelchair/s?k=electric+wheelchair https://www.amazon.in/electric-wheelchair/s?k=electric+wheel...
      - MichaelZuo 2y ago
        The regulations don't just disappear to allow for such imports as in your example ...?

throwaway2562 2y ago

[flagged]

Invictus0 2y ago
Don't hate the player, hate the game.
- pseudalopex 2y ago
  Do both.
- wolverine876 2y ago
  People are responsible for their own behavior. They can't blame the game.
- bcrosby95 2y ago
  The player also lobbies to keep the game going. So yeah, fuck those motherfuckers.
- klabb3 2y ago
  There are folks who take shitty jobs because they don’t have anything. Say you’re dealing drugs, or pressuring poor people to buy lifestyle products they can’t afford. Or a closer example, working for data mining companies, or surveillance tech. At the lower end of the socioeconomic ladder, these things are complicated, because making a living is hard. Maybe that’s all you know, and any alternative would be a risky jump where you’d lose money, health care, housing, and providing for your kids. Not saying it’s one way or another, but at least it’s complicated. But plenty of these individuals in PE have everything they need in life. They can retire comfortably early and leave plenty for their children, and have a second home in Hawaii and expensive hobbies. If you are in this position and actively and with full knowledge continue to harm others then you can’t blame “the game”. Nobody is forcing you.
kachapopopow 2y ago
I mean fair, but helping people like that teaches empathy which we're severely lacking in today's world. There is something special we humans experience when helping others for nothing and return and I think that a lot of people are blinded by never experiencing what it means to help others. A lot of arguments are "imagine if it was you", but I think a fairer argument would be "what if it was somebody you like/love"? I personally wouldn't mind jumping off a bridge if I became useless, but what about the people who want to continue living who are afraid? And what about the people that like/love me?

alistairSH 2y ago

Almost as troubling, from the article "Customized wheelchairs typically last five years, but most chairs need a major repair or two during that time." What the actual fuck? Power wheelchairs run the spectrum for a few thousand USD to ten thousand plus. And they only last ~5 years, and even then with several major repairs in that period? That sounds like an absolutely atrocious durability/reliability record.

deadeye 2y ago
Think about it. For many users, they're in these chairs 12+ hours a day. They're not cars that get driven for an hour a two a day.
- alistairSH 2y ago
  Sure, but I would have expected them to be modular enough to keep running more than 5 years. More so given they cost as much as a used car.
- s_m_t 2y ago
  And yet my motorcycle has gone 80,000 miles without ever needing any maintenance except for a new chain and new sets of tires. Well, I've had to replace the headlight and levers and shift peg because I've crashed it off-road multiple times but that's not the motorcycles fault. I bought it for $1000 used.
- JasserInicide 2y ago
  My fridge has been running 24/7 for 15 years and has never had an issue.
  - toast0 2y ago
    Most fridges are never moved after installation, until they're recycled. Of those that are moved, most are moved away from the wall for cleaning and then moved back. Very few fridges are moved a significant distance on a daily basis.
2y ago

ryanong 2y ago

The problem isn't regulation, the problem is that the regulation isn't simple or cheap enough for small companies to get regulated.

saulrh 2y ago
Yeah. Don't complain about regulation existing. Complain about regulations being controlled by private equity. Complain about private equity existing. Complain about capitalism. Not about the existence of government.

JumpCrisscross 2y ago

"In 2005, CMS announced requirements for testing of electric-powered wheelchairs as part of efforts to modernize coding (5–7). In this century, CMS, in what might be classified by some as an uncharacteristic move, has provided leadership in evidence-based classification of wheelchairs. Globally, the International Standards Organization (ISO) manages the wheelchair standards. ISO and the RESNA standards committee work collaboratively. ISO and RESNA have often been driven by outside sources to expedite their work and to address needs of consumers and other organizations. In the 1990s, the European Community Medical Device Directive provided impetus to make a number of changes to ISO standards and to create new standards in response to stricter regulation. The European Committee for Standardization (CEN) went its own direction for a while and over time, CEN and ISO standards have begun to merge. American National Standards Institute (ANSI)/RESNA was a driving force for a long time and often had different standards than ISO. However, this has dwindled in the past decade. Concomitantly, the wheelchair industry has exploded over the past 10 years, and the standards have simply not kept pace. There is a clear and present need for change in standards development and support in the United States. Most of the participants in wheelchair standards development are employed by the wheelchair industry, an inherent conflict. Unfortunately, wheelchair users and clinicians have traditionally not had the financial support to participate in sufficient numbers. Interestingly, the same companies that participate in the standards committees develop internal tests not represented by ISO or RESNA as part of their product development programs to protect them against legal liability. Test laboratories do the same thing, creating a number of tests that differ from or improve on ISO or RESNA standards. None of the existing standards (ISO, CEN, or RESNA) is comprehensive enough to cover all areas of wheelchair evaluation." [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1929010/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1929010/ 2006

jhjhjhjhjj 2y ago

[flagged]

roody15 2y ago

Private Equity = we have a bunch of money and use it to control markets and politics. Almost a new form of feudalism. Get back to work IT surfs while we continue to extract wealth from your labor.

hi-v-rocknroll 2y ago

Vulture capitalism - def. (noun): A strategy applied to a company or multiple companies in a market category whereby profits are maximally extracted without regard to long-term sustainability of customer relationships, brand reputation, or company viability. Not saying it's not a viable possible strategy for the investor, but that it's perhaps a suboptimal strategy if greater net profits were desired long-term.

neilv 2y ago

We frequently hear about "private equity" doing something sociopathic. We sometimes don't even hear the names of the companies, just "private equity". Do we need to systematically trace and publish which individuals and institutions benefit from the nasty companies?

ben_jones 2y ago
We should publish the b-school, and b-school networking graph through the career of a malicious individual. People will take action faster if they knew Thaddeus Wrappesalot went straight from lacrosse captain to executive chairmen hiking veterinarian costs.

throwaway050324 2y ago

Sigh. I dealt with NSM a few years ago to get a new manual wheelchair. The tech who fitted me for it, and delivered it, was great, but very obviously always in a rush. The chair itself was not made to spec, so it was just not useable for me as-is. After many months of trying (and failing) to get NSM to help me mod it and get it as close to spec as possible, I gave up and just continued using my old chair. But even more frustrating than that? NSM continued sending me phony bills for parts that I did not order. I just trashed them until it went to collections. (Fortunately, the collection agency they use is even more incompetent than they are, and I've been able to put them off with standard anti-collections form letters.) I figured I'd go with Numotion when insurance is ready to re-up me for a new chair, but reading this article, it doesn't seem that would be any better.

stronglikedan 2y ago
Maybe The Paradox Project (by JerryRigEverything) is for you: https://notawheelchair.com/products/the-paradox-project https://notawheelchair.com/products/the-paradox-project
- throwaway050324 2y ago
  Thank you - definitely always nice to see people trying new things in this space. It might be a bit risky to rely on a wheelchair that doesn't have a good support ecosystem, though, unfortunately. This actually touches on something that seems to have changed in the past 10-15 years: in my experience, shops now absolutely refuse to touch wheelchairs that they did not themselves provide. I'm lucky that I can generally do my own maintenance, because even something simple like a deep cleaning is met with worries of voided warranties, etc. etc. I'm not sure when this changed, but throughout the aughts I was able to get service at shops in multiple different cities without any issues.

minusLik 2y ago

What the article does not seem to mention is that an usual electric wheelchair costs about $65,000 (and is intended to be replaced every six years or so). This and the non-availability of replacement parts is why some wheelchair users started a project to open-source a wheelchair from standard parts: https://themif.org/ https://themif.org/ Louis Rossmann interviewed the founder of the project here: https://www.youtube.com/watch?v=eaAj59025Kk https://www.youtube.com/watch?v=eaAj59025Kk

renewiltord 2y ago
This is a great project. I didn't realize that FDA Class I regulations were this easy to comply with.
- readyman 2y ago
  >I didn't realize that FDA Class I regulations were this easy to comply with. They definitely won't be once this open source effort shows any sign of success. You can't solve political problems with technical solutions. At best, you may be able to displace them, but even that is rare.
  - minusLik 2y ago
    > You can't solve political problems with technical solutions. Yes, that's what I've been thinking too. Tom Quiter even mentions in the interview that there already have been companies which tried to offer cheap wheelchairs, but the quasi-monopolists had the FDA alter the regulations in a way with which the newbies couldn't comply. However, since the MIF already attracted suppliers, I hope they can gain some leverage.
  - renewiltord 2y ago
    I only just noticed that the wheelchair https://libertymemesfoundation.org/donations/endurance-the-open-source-wheelchair/ https://libertymemesfoundation.org/donations/endurance-the-o... is actually a Class 2 device. That sounds really hard to get past the FDA. I think it's pretty cool still because folks with the knowhow could make their own, but the disabled are probably SOL because you can't really make these for sale without that. I suppose the FDA's reasoning is that they're better off having no mobility than having a device that doesn't work properly.

sskates 2y ago

Public company CEO here. One of my rules that has served me well is "don't ever be on the other side of a transaction from private equity". They have blatantly anticompetitive playbooks where they buy up all the competition in a market and then raise prices as a cartel. Mostly recently, the DOJ has opened a criminal probe into RealPage for price fixing in real estate. What a scourge on capitalism.

RecycledEle 2y ago

I deal with wheelchairs, electric wheelchairs, oxygen systems, CPAPs, spirometry, and more every day. Electric wheelchairs are built to be very rugged and dirt simple. There are 2 problems: The first problem is insurance. People expect their insurance to cover everything. If they need a new set of 35 AH SLA batteries, they will throw their old chair away and ask for a new chair on insurance. The second problem is that wheelchair users are disabled. As an able-bodied nerd with a socket set and a few wrenches, I can repair an electric wheelchair. A disabled person usually can not do that. They can not even follow the (good) advice to use an external charger instead of the (garbage) charger built into most wheelchairs; they physically can not get to the relevant parts. Home oxygen companies send people out on short notice to debug, repair, or replace home oxygen equipment. If you want insurance to cover electric wheelchairs, then rent them instead of selling them and include service visits. The problem with shipping an electric wheelchair back for service is that this thing weighs almost 100 pounds without batteries and is a very odd shape. Before anyone complains, you want it to be heavy so it will not tip over when the human (who is high up) leans over, takes a corner, or drives sideways on a slope. If you want a less-insurance-intensive solution, pass a right-to-repair law that (1) requires all electric wheelchair parts to be marked with a manufacturer and part number, and (2) requires all electric wheelchair makers to sell parts for a decade or two after they stop selling the chairs. If they use industry-standard parts, and mark the parts as such, they should be relieved of the obligation to carry the parts for 20 years. Here's an example: Include a label on the chair saying that all bolts are either m6x60mm or m4x25mm and that all red and black electrical connectors are PP75 series Anderson Power Poles. Here is a case that drove me nuts: I was dealing with an electric wheelchair that had some odd version of Anderson PowerPoles connecting the batteries and motors. These connectors had been knock-offs, and the reseller of these (Chinese-made) connectors lost a patent lawsuit to Anderson (before their patent expired.) One connector broke and was impossible to replace. I would gladly pay $100 for a single connector, but they do not exist. Before someone says to replace both ends of the connector, this is a connector mounted in a custom bracket with almost zero clearance as the chair's seat fits right on top of the bracket, connectors, and wires.

sokoloff 2y ago
I’ve worked on cars and other mechanical things for most of 3 decades. I’ve never needed a sticker telling me what size standard bolts were. On the broken, ruled as patent-infringing part, what do you want to happen that would comply with patent law? If it was compatible with Anderson, you’d just buy that. Since it wasn’t and the original company isn’t allowed to keep making them…

azinman2 2y ago

Banning private equity (not sure how) is necessary to prevent enshitification of all health care and related services.

srackey 2y ago
Yes, because communism (what else is “banning private equity”?) NEVER results in “enshitification” of ANY kind. Seriously, the issue here can most likely be tracked to private equity taking advantage of existing regulations. Not sure why MORE state involvement in the economy would be the solution.
- tenuousemphasis 2y ago
  It doesn't sound like you understand what Private Equity means. Allow me to assist you in your quest for enlightenment. >Private equity describes investment partnerships that buy and manage companies before selling them.
  - srackey 2y ago
    And it sounds like you’re a communist, unless how you can explain how you can ban “investment partnerships buying companies” without doing away with private ownership more broadly? The issue people have isn’t with “private equity”. If it was a publicly traded company doing this people would be equally upset.
    - azinman2 2y ago
      Notice my “not sure how” There is a very negative behavior right now by companies that call themselves private equity to buy up your local vet, doctors office, etc. Then they fire staff, reduce services, and increase costs. We the people are losing, even if some of our 401ks grow because those funds invested in these PE vehicles. This practice imho should be banned. How? I don’t know. But the U.S. will become shittier and shittier because of it.
bsder 2y ago

neocritter 2y ago

A good comic on the difference between what most people think when they hear wheelchair vs what wheelchair users need to be independent: https://www.tumblr.com/calvin-arium/184341867538/its-here-the-guide-for-two-legged-people-who https://www.tumblr.com/calvin-arium/184341867538/its-here-th...

jmyeet 2y ago

Private equity is great for exposing the flaws in our economic system. The consequences are of course awful and it would be better that they didn't happen. But since they are happening, hopefully more people will start to realize it. When exposed to this kind of thing you can generally have one of two reactions: The first is that you say that this kind of thing is good. It's all part of capitalism. The market will work it out. People will say this kind of thing with a straight face. The second is to say that it is bad. But why is it bad? The first stage is you believe that there are bad apples. Private equity is simply a few bad actors who may or may not need to be dealth with by way of legislation, regulation and/or prosecution. Lots of people believe this because they still fundamentally believe in our current economic system. The second stage is you realize that private equity isn't an outlier and isn't a few bad apples. It is exactly what our system is designed to produce: to financialize and rent-seek in every aspect of our lives as a means of extracting wealth from the poor to the already vastly wealthy. Private equity is taking over every aspect of your life by buying up homes, mobile home parks, vets, medical practices, hospitals, etc. There probably isn't a single aspect of our lives that hasn't been tainted by private equity. And the playbook is exactly the same: 1. Jack up the prices, usually by cornering a market by either buying up all the competition or through legislatively creating enclosures; 2. Cut costs. Use noncompete agreements and and the like to suppress wages; and 3. Load up the entity with exploding debt and sell it to the market before the debt explodes. This is capitalism working as intended. No more, no less. On wheelchairs in particular, it's truly disgusting what we as a society put wheelchair users through. One of the most egeregious examples is how airlines will routinely destroy wheelchairs. We are steadily marching towrads a future where almost all of us will be a permanent underclass devoid of any kind of security. Every aspect of our lives will be at the mercy of our overlords. Capitalism inevitably leads to neofeudalism.

Ozzie_osman 2y ago

If you want to hear more about the negative impact of private equity on various industries, like retirement homes etc, I'd recommend the book Plunder. Eye-opening stuff.

48864w6ui 2y ago

Is private equity this century's equivalent of the LBO? https://www.latimes.com/archives/la-xpm-1990-03-23-me-521-story.html https://www.latimes.com/archives/la-xpm-1990-03-23-me-521-st...

IndySun 2y ago

Not bugs, deliberate software additions. Not bugs, intentional from v1. Not bugs, deeply contrived. Oh, sorry, wrong meeting...?

IndySun 2y ago
How extremely odd. I did not post this comment here, but in my comments listed, it sends me here as its parent.

HumblyTossed 2y ago

Is there anything at all P.E. hasn't fucked up? At this point I feel it really should be illegal.

digger495 2y ago

Also fun, in Oklahoma, most (2/3rds or so) of the certified professionals who do the fittings are employees of NSM or NuMotion.

iancmceachern 2y ago

I can design and build these, source parts, whatever. This is what I have done for a living for 20 years. If anyone wants to solve this problem reach out, contact info is in my bio.

tchbnl 2y ago

PE is such a cancer

hwbunny 2y ago

[flagged]

PierceJoy 2y ago

When are we going to have mass protests against the private equity takeover of everything? Besides climate change and war, I’m hard pressed to think of anything that will have as much of a negative impact on society.

golem14 2y ago

And yet, you can buy nice electrified wheelchairs on Aliexpress for less than $3000. My guess is, like for hearing aids from costco, you won't get reimbursed by insurance if you buy it yourself.

jordanb 2y ago

Our whole economy is feeling increasingly Soviet. Somehow our business leaders have decided that the best business is one that does not serve its customers, and that providing a good or service efficiently and effectively is poor management because it is "leaking value" to counterparties. I guess the next phase is going to be you need to know people if you want your medical device delivered, your car repaired, or for your internet to quit dropping.

croes 2y ago
Welcome to capitalism
AzzyHN 2y ago
My brother in Christ you are witnessing the consequences of capitalism
noobermin 2y ago
In Capitalist Realism, Mark Fisher talked about how capitalism through the institution of the corporation developed the very byzantine bureaucracies and middle men that had long been called out as failures of the Soviet system, and in some ways, proved to be even more inefficient.

Friedduck 2y ago

Is there any market or sector that PE hasn’t made worse?