12 ms·

You Can Thank Private Equity for That Enormous Doctor's Bill

189 points by wallflower 2y ago

fennecbutt 2y ago
*in America
nolongerthere 2y ago
Article is paywalled but the healthcare system is death by a thousand cuts, there's no one boogeyman to blame, it's a very classic tragedy of the commons. Anyone claiming they've found the root cause of the broken healthcare system is selling you a bill of goods.
- bookofjoe 2y ago
  Try this: https://www.wsj.com/health/healthcare/you-can-thank-private-equity-for-that-enormous-doctors-bill-3a2fc90b?st=0kgfqua8mo3pui4&reflink=desktopwebshare_permalink https://www.wsj.com/health/healthcare/you-can-thank-private-...
- llamaimperative 2y ago
  True but “there’s no one boogeyman to blame” should read as “there are many, many boogeymen, all of whom bear blame, and all of whom need to corrected/removed/circumvented/improved.”
  - Galatians4_16 2y ago
    If only we could take our money elsewhere, but we are mandated to pay with insurance, which makes them the defacto customer, to decide with the doctors, cutting us out of the process (which is handy under circumstances where the patient can't talk; There's a use case for everything, but coercion and blanket enforcement seems to ruin everything)
    - bluGill 2y ago
      We can't even choose our insurance - it comes from your employer with no choice (or no real choice - I have two slightly different choices from United Health Care). All the negotiation on how it works is done by HR not me, and HR likes the current rules as it makes it hard for me to leave. In theory I can bypass my employer insurance - but if I do I throw away thousands of dollars that my employer is paying directly and so anything I find elsewhere either cannot be as good, or is has to cost a lot more money.
      - tracker1 2y ago
        Even then, good luck... I couldn't find a personal plan either the Health gov compliant plans or out of pocket that matched my employer insurance... I'm pretty sure if I try again, I'll wind up creating a company again, using one of the HR based collective payroll options just for better Insurance options. The system sucks a lot, and for a lot of different reasons. Namely is that there's no room for individual negotiation, and there are dozens of pricing models for the same drugs, procedures, etc.
  - ToucanLoucan 2y ago
    We don't do that in America. We pick whichever boogeymen are more scary to our given political team and make that the only cause while arguing back and forth and not actually doing anything while we all get robbed fucking blind and pay our politicians six figure salaries for doing fuck-all. I fucking hate it here.
    - llamaimperative 2y ago
      Not really. The current administration has been going after healthcare on several fronts: lots of FTC enforcement against PE in healthcare; increased number of funded medical residency slots; allowed Medicare to negotiate prices directly with drug companies; attempted to stop excessive consolidation in healthcare businesses. All of these are reasonable attempts to solve big, important problems and I don't think it's helpful to throw your hands in the air and say no one is trying to do anything.
      - ToucanLoucan 2y ago
        And the next republican president, Trump or otherwise, will undo it all on day one. We need ACTUAL SOLUTIONS. Changes to existing laws, or new laws. Consensus governance, not just executive orders.
        llamaimperative 2y ago
        Sure, but that's not a "both sides" problem. Lay blame where blame lies.
        ToucanLoucan 2y ago
        I do. We have the Democrats who are mostly alright and well meaning, with exceptions but in practice are not capable of handling what the Republicans have become, which is theocratic-fascists. And the Republicans are filling the legislature with dipshits who scream about Jewish space-lasers and want to regress us socially to the 1920's. They both suck, one side notably more so.
- DaveExeter 2y ago
  The problem is health insurance! Get rid of that and most problems vanish.
  - schmidtleonard 2y ago
    Providers point at insurance and drug companies. Insurance points at providers and drug companies. Drug companies point at providers and insurance. Don't let any of them fool you, there are three heads on this monster and when they aren't busy blaming the other two heads they do a remarkably even job of splitting the loot.
    - jewayne 2y ago
      This. They all benefit from the lack of price consistency/transparency. Nothing in our system has a single price - why charge what the market will bear, when you can charge the individual as much as they can personally bear, and make 3X as much?
  - lenerdenator 2y ago
    A problem is that health insurance has no bare minimum to compete against. There is no saying "alright, fine, your rates are insane so I'm gonna just go with the state-operated option". That's more-or-less what happens in most Western countries; you can still get private insurance which gets you faster/better treatment, but if you're a fairly healthy person who just wants to cover their bases for a catastrophic occurrence, the state will do that for you. If the private guy wants any of your money, he has to justify it with more than "what happens if you get in a bad car accident or get a cancer diagnosis?". In the US private insurance is the only way to go, and many of them are operated by people who have profit motives, even if they themselves work for an entity that is non-profit.
    - bluGill 2y ago
      In the US private insurance from your employer is the only way to go. My company puts in a lot of money towards my health insurance that I lose if try to find someone else. I can in theory find a different private insurance but there is no competition as no private can afford to compete with deal my company has - either they have to provide substantially worse service or they have to charge substantially more than my employer. Since I don't have a real choice nobody tries to serve me. Complex billing and codes I don't understand - the people paying the bills like that.
- jewayne 2y ago
  I think the root cause is transparent for all to see. Humans need their bodies. And profit-maximizing entities of multiple kinds have figured this out, and bought politicians to prevent laws from reining them in. That's all.
thepuppet33r 2y ago
Dr. Glaucomflecken on YouTube has a funny but informative series of shorts on private equity and their effect on hospitals and the medical system. In case you have people in your life with short attention spans but who still need to hear it. https://youtu.be/R5C4v22y3C0 https://youtu.be/R5C4v22y3C0
JamesonNetworks 2y ago
The whole system is rife with widespread, unreportable fraud. I’m on hour 8 of trying to get a 46 dollar charge for my annual preventative bloodwork reversed since its literally the only benefit of my plan that should be covered, but because the mysterious incantation of CPT and diagnostic codes are wrong, my previous provider is still sending me a bill once a month.
- bookofjoe 2y ago
  $46/8 hours = $5.75/hour. Would you take a job that paid that wage? Perhaps it's better to concede that they've ripped you off, write a check and move on. Not a hill worth dying on.
  - bombcar 2y ago
    The hill is to document and report to the state agency that handles it, and at least make it their problem somewhat.
    - bookofjoe 2y ago
      "Document and report": There's another half hour of your life done and dusted with your time and effort disappearing into a never to be responded to black hole.
      - rajamaka 2y ago
        I'm happy to get paid purely in spite instead
        bombcar 2y ago
        Exactly - you do it only for spite, otherwise pay and move on. But if everyone acted spitefully to the limit of their ability, the entire thing would collapse.
  - willis936 2y ago
Galatians4_16 2y ago
Brief video succinctly describing, just how private equity ruined healthcare. 1. https://www.youtube.com/watch?v=fFoXyFmmGBQ https://www.youtube.com/watch?v=fFoXyFmmGBQ (5:25)
- pmayrgundter 2y ago
  Great video, but actually talks about market takeover by medical cartels and their corruption of government No mention of PE?
roenxi 2y ago
Paywalled. But the title is provocative in pointing a finger at private equity. The US healthcare system is a textbook example of thoughtless regulations that create needless bottlenecks and localised monopolies. When private equity does something destructive it is remarkably like a maggot infestation - usually don't happen in well functioning systems.
rwmj 2y ago
And in the UK for your large vet bill: https://archive.ph/bTwcD https://archive.ph/bTwcD https://archive.ph/Dk0dn https://archive.ph/Dk0dn
bko 2y ago
The article tries to paint a naive example where private equity buys everything and jacks up the prices. But why doesn't this happen to restaurants, or super markets or car mechanics? You have to ask yourself what makes healthcare unique to nearly every other well functioning market in the US. The bigger issue is there is third party paying for things. Try to ask your doctor how much something costs and they'll stare at you like you have two heads. Imagine getting your car fixed without knowing how much it's going to cost The other problem is the regulation and groups like AMA. Why don't new cardiologists enter the field? Because there is a cap of graduates that the AMA controls. Why doesn't a new hospital open up? Because there is often a "certificate of need" to open a new health care facility and other health care providers in the vicinity get to determine who is allowed in. What would happen to restaurants if new waiters had to go to school for 8 years and there was a cap on how many can graduate and you need to go to a board of neighboring restaurants to decide if you can open yours, and diners are forced to sign up for some company to pay for all the meals. https://www.ncsl.org/health/certificate-of-need-state-laws https://www.ncsl.org/health/certificate-of-need-state-laws
- ldayley 2y ago
  >But why doesn't this happen to restaurants, or super markets or car mechanics? It DOES happen with car mechanics. Leonard Green LP owns Caliber Collision, Carlyle Group owns Service King, and Icahn Enterprises owns AAMCO, Pep Boys, and Precision Tune Auto Care. While I don't have a specific example in my head about restaurants and grocery stores, I have to think that there are steps in the value chain that are absolutely owned and influenced by PE. Logistics? Real Estate? Real Estate is a great example: most commercial real estate is held inside PE portfolios via Real Estate Investment Trusts, and lease rents are an extremely non-trivial portion of business costs for EVERYBODY, espcially grocery stores and restaurants. But I agree about the many social and regulatory complexities regarding health care specifically. Often that complexity is what makes industries like health care such a lucrative investment for PE as it can be easier to hide incentive structures.
- seligerasmus 2y ago
  >But why doesn't this happen to restaurants, or super markets or car mechanics? This is a bafflingly underinformed rhetorical given the previous sentence. It happens all the time with the exact counter-examples you list. I'm honestly shocked you mentioned restaurants when articles were floating around HN less than a week ago about the death of Red Lobster by way of private equity: https://news.ycombinator.com/item?id=40233029 https://news.ycombinator.com/item?id=40233029 https://finance.yahoo.com/news/private-equity-keeps-failing-brands-091616738.html https://finance.yahoo.com/news/private-equity-keeps-failing-... https://www.pepboys.com/about-pep-boys/media-center/press-releases/2016/icahn-enterprises-completes-acquisition-of-pep-boys https://www.pepboys.com/about-pep-boys/media-center/press-re... https://www.reuters.com/breakingviews/private-equity-superstores-overstock-shelves-2023-11-08/ https://www.reuters.com/breakingviews/private-equity-superst... > Why don't new cardiologists enter the field? Because there is a cap of graduates that the AMA controls. The AMA doesn't have the authority to cap anything, and I encourage you to devote more research to your premises before relying so heavily on them. The cap on new doctors arises from a complex set of competing laws, policies, and blended public/private billing models for how doctors get trained and paid during residencies, which itself is downstream of how hospitals are funded and operated. There is no singular "do this -> get more doctors" solution; it is enormously complicated, often by both design and necessity, and is not easily untangled with the naive techie "just make a pull request" mentality that pervades the HN comments section. You also seem to misunderstand what the AMA does and have miscast it as some sort of central licensing authority when most of what they due is effete lobbying and begging physicians for donations/dues. They're annoying and probably a net negative for public health at this point, but they're not some boogeyman holding back the libertarian fantasy of an unregulated healthcare market. >Try to ask your doctor how much something costs and they'll stare at you like you have two heads. Imagine getting your car fixed without knowing how much it's going to cost I can't help but notice that you didn't mention the role of private health insurance when that undergirds much of the grousing. Doctors can't give you an answer on what your procedure will cost because they have to play a multi-stage game of Price is Right with a cartel of investor-driven private health insurers with the express business model of avoiding paying for those services whenever possible. The fact that everyone BUT the investors suffer from this arrangement is the actual, literal point of the article - it's even in the byline!
infecto 2y ago
I am a big fan of direct primary care doctors now, these are doctors that don't accept insurance. As a family of 3 we pay $200 a month to have unlimited access (person, phone, text, email) to our doctor. We pair this with a high deductible plan from work and it works out really well. It might not be the answer for everyone but it makes sense at the primary care level. As I have gotten slightly older I have appreciated having continuity of care (not One Medical) and also not have strict timelimits to discuss my health. When I see the specialist I am fine with it, give me my allotted time, I probably only have a very specific need to discuss.
- gbnvc 2y ago
  What country is this? There’s no plan in America that’s anywhere near that good, where the catch?
  - infecto 2y ago
    No catch. This is in the US, you can easily look it up. Its becoming a model that more primary care docs are adopting because there is immense overhead if you work with insurance companies. It ranges from the low end to the "concierge" doctor level where I have seen some charging in the thousands per month. We still pay for consumables out of pocket including Rx medications. We still have a high deductible plan on top of this to cover emergencies/major illness. But I prefer this model as we get higher quality of care for roughly the same price as a non-high deductible plan.
    - xyzzy_plugh 2y ago
      I'm struggling to see how this works well for a family. You're basically uninsured. If you have sudden large expenses, like very expensive medication, it's not clear how you can make that work without hemorrhaging money. The high deductible isn't going to help you if it doesn't cover prescriptions.
      - tracker1 2y ago
        High deductible might cover prescriptions but have a deductible amount. If you're in a position with enough savings, hsa or the like, you can hold enough per year to cover those deductibles. It will also shape the level of service you get. I'm paying for a PPO plan with a decently big deductible and max out of pocket so I can keep seeing one of the Mayo specialists I've been seeing for a few years now. It's not the easiest option if I were making half as much with young children though.
knapcio 2y ago
You can thank the government for all the regulations which make it ultra hard for new companies to enter the market. You can thank the government for not fighting monopolies. Don’t blame the free market as it basically doesn’t exist.
- ivolimmen 2y ago
  The government is you. It's a democracy you are living in. The root problem is greed. I am not American but it's also in my country. The government listens to companies that make sure they can keep squeezing us for more. I lost my faith in it all for some time now.
  - rchaud 2y ago
    "Democracy" is not a silver bullet to solving public policy problems, especially in republic-style systems such as the US. Voting in a new government doesn't change the fact that a lot of the ultimate legislative power rests with the Supreme Court. It was the court that decided that election funding can be ultra-opaque, a decision that in effect removed all restrictions to political contributions by allowing them to be funneled through PACs rather than individual donations that do have limits. This creates a system where career politicians have an enormous financial advantage over anyone else attempting to run for office. Politicians have term limits, but SC judges get lifetime tenure and are appointed by presidents on the basis of ideological fealty. That's why topics like the legality of abortion can keep coming up, whereas in other countries, this has long been a settled issue. And that is just at the federal (nationwide) level. Individual states have significant autonomy on how they operate as well, and usually resist any legislation giving federal government more say on state matters.
    - tracker1 2y ago
      A lot of that comes down to having a large standing govt bureaucracy to begin with. Even a lot of State govts are too big, with a lot of political appointees embedded in the systems and hard to displace. It's not just the SC, it's legislative and executive bodies that are entrenched. As to abortion, the original SC decision on Roe v Wade was probably incorrect from a US Constitution level, the more recent decision kicked it back to the States. The States are no reeling from laws that haven't been addressed in at least half a century as well as a US Congress that is ill inclined to actually act. It's something that could have been codified for years. The Democrats have had a majority in both houses of Congress and the White House a few times, Obama even promised as much his first term and didn't deliver. The issue, is that most would agree there should be some limit to how late an a voluntary abortion should be generally allowed. The vocal minorities on both sides push the extremes.
lenerdenator 2y ago
Can we take a moment to appreciate the fact that PE is such a problem for our society, that even the publication which suggested people adjust to stagnant wages by not eating breakfast makes a deep dive on how finance bros are screwing the healthcare system?
- skizm 2y ago
  Do you have a link to the article where wsj suggests not eating breakfast? I'm actually curious to read it now.
  - rjbwork 2y ago
    https://www.wsj.com/livecoverage/cpi-report-today-january-2023-inflation/card/to-save-money-maybe-you-should-skip-breakfast-fSd6mz0miaAPhUFb2jgy https://www.wsj.com/livecoverage/cpi-report-today-january-20... that was very easy to find
paganel 2y ago
[flagged]
qp11 2y ago
Medical schools need to be running their own finance/biz programmes coming up with their own models of how to run health care. The current system outsources this thinking to b-schools and has become to dependent on unsustainable financial engineering dogma that flows out of there.
- bookofjoe 2y ago
  https://hub.jhu.edu/2017/03/31/med-school-should-require-business-management-classes/ https://hub.jhu.edu/2017/03/31/med-school-should-require-bus...
jccalhoun 2y ago
The insurance industry in the USA is so screwed. A few years ago I had to go to the emergency room (turns out it was my gall bladder) and afterwards I got separate bills from the hospital, the anesthesiologist, and the mri. It was one hospital but it turns out it was 3 separate companies. Of course I didn't get the bills right away. No I got them for months afterwards. I got the main bill, I called up the hospital to pay and they said they would give me a discount for paying all at once. What? it didn't say that anywhere on the bill. So if I had paid it online I would have paid the full amount and not the discounted price which was a couple hundred less? Another time I got a bill from the hospital and I didn't know what it was for so I called them and they said "ok. We'll resubmit it to your insurance." and I never heard about it again. If I hadn't called I would have paid a bill for over a thousand dollars. I got one bill for $20 a year after. The address was in another city so I was skeptical. I went to their website and put in the account number and it said I didn't owe anything. Was it a scam? Who knows. Another time I had an mri scheduled for something else and I get a call from the insurance company asking if I would be willing to reschedule to another hospital 90 minutes away because it was cheaper. I can't imagine how terrible it would be if I had some serious or long term illness. Imagine if any other industry was this sloppy and confusing in their billing.
- Workaccount2 2y ago
  At the end of last year my doctor prescribed a list of blood tests, some of them rather esoteric and cutting edge. As a precaution, I wanted to see if they would all be covered and how much my out of pocket cost would be for these if not (or if partially covered). It took _a week_, composed of two different lab visits and about 4 hours of phone time between the doctor, the lab, and my insurance to figure it out. And in the end, the values ultimately provided to me weren't even correct. Like what the fuck is going on behind the scenes here?
  - kristjansson 2y ago
    > behind the scenes here? Two giant companies, trying to fuck each other as hard as possible, while not violating the law so egregiously they are made to stop. Healthcare is an incidental byproduct.
black_13 2y ago
[dead]
internet101010 2y ago
Prices at doctor and dentist offices are high because they know what your insurance policy is and adjust their prices to maximize.
daft_pink 2y ago
I’m generally a free marketer, but have you ever gone to a private equity dentist’s office. They clearly recommend way more procedures than make sense compared to other dentists.
- tracker1 2y ago
  They also seem to be unduly rushed... makes me nervous to say the least.
dostick 2y ago
Capitalism is the problem. We couldn’t fix inequality and corruption in 100 years. There’s no country on earth where we could say capitalism works. Total failure in every country. Capitalism is a dead end and it’s getting worse with time. Why nobody talks about that? Isn’t it a problem of all problems? Now, why there is no replacement system of society and economics? We have institutions for physics, biology, construction, logistics and other sciences. And all of them make discoveries and move science forward. Except for one. Why nobody is working on a replacement society and economics system? Why only this specific science is in standstill? starts to look like a conspiracy, or does capitalism cause it?
- CivBase 2y ago
  > Why nobody talks about that? People talk about it all the time. Everything gets blamed on capitalism these days. Problem is nobody is offering good alternatives. Good luck finding one.
  - nathan_compton 2y ago
    This is a really weird thing to say when there are clearly alternatives that work better than whatever is happening in the U.S.
    - tracker1 2y ago
      Such as..?
      - nathan_compton 2y ago
        Any country with socialized medicine?
        tracker1 2y ago
        Most countries with socialized medicine are still capitalist nations.
  - 2y ago
deleted 2y ago
[deleted]
complaintdept 2y ago
PE bought up the local chain of doctor's offices a few years ago in my area, and it was an instant drop in quality. They started dropping patients for missed appointments a decade prior when they were a minor (one was being treated for depression after a suicide attempt). Then their doctors started leaving and they had to bring in people to fill the labor gap, but these pepple were not of high quality and malpractice suits became more common. Then they had to start dropping patients. Entire families suddenly had no primary care doctor, and what's worse is that this was the major providor for medical care in the area. Some people are now driving ~100 miles or more each way to get a primary care physician. Outside of medicine, I've seen PE fuck up at least three decent tool companies. Their products are basically garbage now. PE sucks, too many glaring examples of it messing things up in my day to day.
resource_waste 2y ago
Nah, skip the article and just look at reality: https://www.opensecrets.org/federal-lobbying/top-spenders?cycle=a https://www.opensecrets.org/federal-lobbying/top-spenders?cy... Its bribery: Hospitals, your local physician, pharma, and insurance companies. We should begin fighting these Stronger powers. We can resent people in these professions, demand justice for decades of exploitation, etc... "Universal Healthcare" isnt stopping corruption. Its codifying it.

189 points by wallflower 2y ago

*in America

Article is paywalled but the healthcare system is death by a thousand cuts, there's no one boogeyman to blame, it's a very classic tragedy of the commons. Anyone claiming they've found the root cause of the broken healthcare system is selling you a bill of goods.

bookofjoe 2y ago
Try this: https://www.wsj.com/health/healthcare/you-can-thank-private-equity-for-that-enormous-doctors-bill-3a2fc90b?st=0kgfqua8mo3pui4&reflink=desktopwebshare_permalink https://www.wsj.com/health/healthcare/you-can-thank-private-...
llamaimperative 2y ago
True but “there’s no one boogeyman to blame” should read as “there are many, many boogeymen, all of whom bear blame, and all of whom need to corrected/removed/circumvented/improved.”
- Galatians4_16 2y ago
  If only we could take our money elsewhere, but we are mandated to pay with insurance, which makes them the defacto customer, to decide with the doctors, cutting us out of the process (which is handy under circumstances where the patient can't talk; There's a use case for everything, but coercion and blanket enforcement seems to ruin everything)
  - bluGill 2y ago
    We can't even choose our insurance - it comes from your employer with no choice (or no real choice - I have two slightly different choices from United Health Care). All the negotiation on how it works is done by HR not me, and HR likes the current rules as it makes it hard for me to leave. In theory I can bypass my employer insurance - but if I do I throw away thousands of dollars that my employer is paying directly and so anything I find elsewhere either cannot be as good, or is has to cost a lot more money.
    - tracker1 2y ago
      Even then, good luck... I couldn't find a personal plan either the Health gov compliant plans or out of pocket that matched my employer insurance... I'm pretty sure if I try again, I'll wind up creating a company again, using one of the HR based collective payroll options just for better Insurance options. The system sucks a lot, and for a lot of different reasons. Namely is that there's no room for individual negotiation, and there are dozens of pricing models for the same drugs, procedures, etc.
- ToucanLoucan 2y ago
  We don't do that in America. We pick whichever boogeymen are more scary to our given political team and make that the only cause while arguing back and forth and not actually doing anything while we all get robbed fucking blind and pay our politicians six figure salaries for doing fuck-all. I fucking hate it here.
  - llamaimperative 2y ago
    Not really. The current administration has been going after healthcare on several fronts: lots of FTC enforcement against PE in healthcare; increased number of funded medical residency slots; allowed Medicare to negotiate prices directly with drug companies; attempted to stop excessive consolidation in healthcare businesses. All of these are reasonable attempts to solve big, important problems and I don't think it's helpful to throw your hands in the air and say no one is trying to do anything.
    - ToucanLoucan 2y ago
      And the next republican president, Trump or otherwise, will undo it all on day one. We need ACTUAL SOLUTIONS. Changes to existing laws, or new laws. Consensus governance, not just executive orders.
      - llamaimperative 2y ago
        Sure, but that's not a "both sides" problem. Lay blame where blame lies.
        ToucanLoucan 2y ago
        I do. We have the Democrats who are mostly alright and well meaning, with exceptions but in practice are not capable of handling what the Republicans have become, which is theocratic-fascists. And the Republicans are filling the legislature with dipshits who scream about Jewish space-lasers and want to regress us socially to the 1920's. They both suck, one side notably more so.
DaveExeter 2y ago
The problem is health insurance! Get rid of that and most problems vanish.
- schmidtleonard 2y ago
  Providers point at insurance and drug companies. Insurance points at providers and drug companies. Drug companies point at providers and insurance. Don't let any of them fool you, there are three heads on this monster and when they aren't busy blaming the other two heads they do a remarkably even job of splitting the loot.
  - jewayne 2y ago
    This. They all benefit from the lack of price consistency/transparency. Nothing in our system has a single price - why charge what the market will bear, when you can charge the individual as much as they can personally bear, and make 3X as much?
- lenerdenator 2y ago
  A problem is that health insurance has no bare minimum to compete against. There is no saying "alright, fine, your rates are insane so I'm gonna just go with the state-operated option". That's more-or-less what happens in most Western countries; you can still get private insurance which gets you faster/better treatment, but if you're a fairly healthy person who just wants to cover their bases for a catastrophic occurrence, the state will do that for you. If the private guy wants any of your money, he has to justify it with more than "what happens if you get in a bad car accident or get a cancer diagnosis?". In the US private insurance is the only way to go, and many of them are operated by people who have profit motives, even if they themselves work for an entity that is non-profit.
  - bluGill 2y ago
    In the US private insurance from your employer is the only way to go. My company puts in a lot of money towards my health insurance that I lose if try to find someone else. I can in theory find a different private insurance but there is no competition as no private can afford to compete with deal my company has - either they have to provide substantially worse service or they have to charge substantially more than my employer. Since I don't have a real choice nobody tries to serve me. Complex billing and codes I don't understand - the people paying the bills like that.
jewayne 2y ago
I think the root cause is transparent for all to see. Humans need their bodies. And profit-maximizing entities of multiple kinds have figured this out, and bought politicians to prevent laws from reining them in. That's all.

thepuppet33r 2y ago

Dr. Glaucomflecken on YouTube has a funny but informative series of shorts on private equity and their effect on hospitals and the medical system. In case you have people in your life with short attention spans but who still need to hear it. https://youtu.be/R5C4v22y3C0 https://youtu.be/R5C4v22y3C0

JamesonNetworks 2y ago

The whole system is rife with widespread, unreportable fraud. I’m on hour 8 of trying to get a 46 dollar charge for my annual preventative bloodwork reversed since its literally the only benefit of my plan that should be covered, but because the mysterious incantation of CPT and diagnostic codes are wrong, my previous provider is still sending me a bill once a month.

bookofjoe 2y ago
$46/8 hours = $5.75/hour. Would you take a job that paid that wage? Perhaps it's better to concede that they've ripped you off, write a check and move on. Not a hill worth dying on.
- bombcar 2y ago
  The hill is to document and report to the state agency that handles it, and at least make it their problem somewhat.
  - bookofjoe 2y ago
    "Document and report": There's another half hour of your life done and dusted with your time and effort disappearing into a never to be responded to black hole.
    - rajamaka 2y ago
      I'm happy to get paid purely in spite instead
      - bombcar 2y ago
        Exactly - you do it only for spite, otherwise pay and move on. But if everyone acted spitefully to the limit of their ability, the entire thing would collapse.
- willis936 2y ago

Galatians4_16 2y ago

Brief video succinctly describing, just how private equity ruined healthcare. 1. https://www.youtube.com/watch?v=fFoXyFmmGBQ https://www.youtube.com/watch?v=fFoXyFmmGBQ (5:25)

pmayrgundter 2y ago
Great video, but actually talks about market takeover by medical cartels and their corruption of government No mention of PE?

roenxi 2y ago

Paywalled. But the title is provocative in pointing a finger at private equity. The US healthcare system is a textbook example of thoughtless regulations that create needless bottlenecks and localised monopolies. When private equity does something destructive it is remarkably like a maggot infestation - usually don't happen in well functioning systems.

rwmj 2y ago

And in the UK for your large vet bill: https://archive.ph/bTwcD https://archive.ph/bTwcD https://archive.ph/Dk0dn https://archive.ph/Dk0dn

bko 2y ago

The article tries to paint a naive example where private equity buys everything and jacks up the prices. But why doesn't this happen to restaurants, or super markets or car mechanics? You have to ask yourself what makes healthcare unique to nearly every other well functioning market in the US. The bigger issue is there is third party paying for things. Try to ask your doctor how much something costs and they'll stare at you like you have two heads. Imagine getting your car fixed without knowing how much it's going to cost The other problem is the regulation and groups like AMA. Why don't new cardiologists enter the field? Because there is a cap of graduates that the AMA controls. Why doesn't a new hospital open up? Because there is often a "certificate of need" to open a new health care facility and other health care providers in the vicinity get to determine who is allowed in. What would happen to restaurants if new waiters had to go to school for 8 years and there was a cap on how many can graduate and you need to go to a board of neighboring restaurants to decide if you can open yours, and diners are forced to sign up for some company to pay for all the meals. https://www.ncsl.org/health/certificate-of-need-state-laws https://www.ncsl.org/health/certificate-of-need-state-laws

ldayley 2y ago
>But why doesn't this happen to restaurants, or super markets or car mechanics? It DOES happen with car mechanics. Leonard Green LP owns Caliber Collision, Carlyle Group owns Service King, and Icahn Enterprises owns AAMCO, Pep Boys, and Precision Tune Auto Care. While I don't have a specific example in my head about restaurants and grocery stores, I have to think that there are steps in the value chain that are absolutely owned and influenced by PE. Logistics? Real Estate? Real Estate is a great example: most commercial real estate is held inside PE portfolios via Real Estate Investment Trusts, and lease rents are an extremely non-trivial portion of business costs for EVERYBODY, espcially grocery stores and restaurants. But I agree about the many social and regulatory complexities regarding health care specifically. Often that complexity is what makes industries like health care such a lucrative investment for PE as it can be easier to hide incentive structures.
seligerasmus 2y ago
>But why doesn't this happen to restaurants, or super markets or car mechanics? This is a bafflingly underinformed rhetorical given the previous sentence. It happens all the time with the exact counter-examples you list. I'm honestly shocked you mentioned restaurants when articles were floating around HN less than a week ago about the death of Red Lobster by way of private equity: https://news.ycombinator.com/item?id=40233029 https://news.ycombinator.com/item?id=40233029 https://finance.yahoo.com/news/private-equity-keeps-failing-brands-091616738.html https://finance.yahoo.com/news/private-equity-keeps-failing-... https://www.pepboys.com/about-pep-boys/media-center/press-releases/2016/icahn-enterprises-completes-acquisition-of-pep-boys https://www.pepboys.com/about-pep-boys/media-center/press-re... https://www.reuters.com/breakingviews/private-equity-superstores-overstock-shelves-2023-11-08/ https://www.reuters.com/breakingviews/private-equity-superst... > Why don't new cardiologists enter the field? Because there is a cap of graduates that the AMA controls. The AMA doesn't have the authority to cap anything, and I encourage you to devote more research to your premises before relying so heavily on them. The cap on new doctors arises from a complex set of competing laws, policies, and blended public/private billing models for how doctors get trained and paid during residencies, which itself is downstream of how hospitals are funded and operated. There is no singular "do this -> get more doctors" solution; it is enormously complicated, often by both design and necessity, and is not easily untangled with the naive techie "just make a pull request" mentality that pervades the HN comments section. You also seem to misunderstand what the AMA does and have miscast it as some sort of central licensing authority when most of what they due is effete lobbying and begging physicians for donations/dues. They're annoying and probably a net negative for public health at this point, but they're not some boogeyman holding back the libertarian fantasy of an unregulated healthcare market. >Try to ask your doctor how much something costs and they'll stare at you like you have two heads. Imagine getting your car fixed without knowing how much it's going to cost I can't help but notice that you didn't mention the role of private health insurance when that undergirds much of the grousing. Doctors can't give you an answer on what your procedure will cost because they have to play a multi-stage game of Price is Right with a cartel of investor-driven private health insurers with the express business model of avoiding paying for those services whenever possible. The fact that everyone BUT the investors suffer from this arrangement is the actual, literal point of the article - it's even in the byline!

infecto 2y ago

I am a big fan of direct primary care doctors now, these are doctors that don't accept insurance. As a family of 3 we pay $200 a month to have unlimited access (person, phone, text, email) to our doctor. We pair this with a high deductible plan from work and it works out really well. It might not be the answer for everyone but it makes sense at the primary care level. As I have gotten slightly older I have appreciated having continuity of care (not One Medical) and also not have strict timelimits to discuss my health. When I see the specialist I am fine with it, give me my allotted time, I probably only have a very specific need to discuss.

gbnvc 2y ago
What country is this? There’s no plan in America that’s anywhere near that good, where the catch?
- infecto 2y ago
  No catch. This is in the US, you can easily look it up. Its becoming a model that more primary care docs are adopting because there is immense overhead if you work with insurance companies. It ranges from the low end to the "concierge" doctor level where I have seen some charging in the thousands per month. We still pay for consumables out of pocket including Rx medications. We still have a high deductible plan on top of this to cover emergencies/major illness. But I prefer this model as we get higher quality of care for roughly the same price as a non-high deductible plan.
  - xyzzy_plugh 2y ago
    I'm struggling to see how this works well for a family. You're basically uninsured. If you have sudden large expenses, like very expensive medication, it's not clear how you can make that work without hemorrhaging money. The high deductible isn't going to help you if it doesn't cover prescriptions.
    - tracker1 2y ago
      High deductible might cover prescriptions but have a deductible amount. If you're in a position with enough savings, hsa or the like, you can hold enough per year to cover those deductibles. It will also shape the level of service you get. I'm paying for a PPO plan with a decently big deductible and max out of pocket so I can keep seeing one of the Mayo specialists I've been seeing for a few years now. It's not the easiest option if I were making half as much with young children though.

knapcio 2y ago

You can thank the government for all the regulations which make it ultra hard for new companies to enter the market. You can thank the government for not fighting monopolies. Don’t blame the free market as it basically doesn’t exist.

ivolimmen 2y ago
The government is you. It's a democracy you are living in. The root problem is greed. I am not American but it's also in my country. The government listens to companies that make sure they can keep squeezing us for more. I lost my faith in it all for some time now.
- rchaud 2y ago
  "Democracy" is not a silver bullet to solving public policy problems, especially in republic-style systems such as the US. Voting in a new government doesn't change the fact that a lot of the ultimate legislative power rests with the Supreme Court. It was the court that decided that election funding can be ultra-opaque, a decision that in effect removed all restrictions to political contributions by allowing them to be funneled through PACs rather than individual donations that do have limits. This creates a system where career politicians have an enormous financial advantage over anyone else attempting to run for office. Politicians have term limits, but SC judges get lifetime tenure and are appointed by presidents on the basis of ideological fealty. That's why topics like the legality of abortion can keep coming up, whereas in other countries, this has long been a settled issue. And that is just at the federal (nationwide) level. Individual states have significant autonomy on how they operate as well, and usually resist any legislation giving federal government more say on state matters.
  - tracker1 2y ago
    A lot of that comes down to having a large standing govt bureaucracy to begin with. Even a lot of State govts are too big, with a lot of political appointees embedded in the systems and hard to displace. It's not just the SC, it's legislative and executive bodies that are entrenched. As to abortion, the original SC decision on Roe v Wade was probably incorrect from a US Constitution level, the more recent decision kicked it back to the States. The States are no reeling from laws that haven't been addressed in at least half a century as well as a US Congress that is ill inclined to actually act. It's something that could have been codified for years. The Democrats have had a majority in both houses of Congress and the White House a few times, Obama even promised as much his first term and didn't deliver. The issue, is that most would agree there should be some limit to how late an a voluntary abortion should be generally allowed. The vocal minorities on both sides push the extremes.

lenerdenator 2y ago

Can we take a moment to appreciate the fact that PE is such a problem for our society, that even the publication which suggested people adjust to stagnant wages by not eating breakfast makes a deep dive on how finance bros are screwing the healthcare system?

skizm 2y ago
Do you have a link to the article where wsj suggests not eating breakfast? I'm actually curious to read it now.
- rjbwork 2y ago
  https://www.wsj.com/livecoverage/cpi-report-today-january-2023-inflation/card/to-save-money-maybe-you-should-skip-breakfast-fSd6mz0miaAPhUFb2jgy https://www.wsj.com/livecoverage/cpi-report-today-january-20... that was very easy to find

paganel 2y ago

[flagged]

qp11 2y ago

Medical schools need to be running their own finance/biz programmes coming up with their own models of how to run health care. The current system outsources this thinking to b-schools and has become to dependent on unsustainable financial engineering dogma that flows out of there.

bookofjoe 2y ago
https://hub.jhu.edu/2017/03/31/med-school-should-require-business-management-classes/ https://hub.jhu.edu/2017/03/31/med-school-should-require-bus...

jccalhoun 2y ago

The insurance industry in the USA is so screwed. A few years ago I had to go to the emergency room (turns out it was my gall bladder) and afterwards I got separate bills from the hospital, the anesthesiologist, and the mri. It was one hospital but it turns out it was 3 separate companies. Of course I didn't get the bills right away. No I got them for months afterwards. I got the main bill, I called up the hospital to pay and they said they would give me a discount for paying all at once. What? it didn't say that anywhere on the bill. So if I had paid it online I would have paid the full amount and not the discounted price which was a couple hundred less? Another time I got a bill from the hospital and I didn't know what it was for so I called them and they said "ok. We'll resubmit it to your insurance." and I never heard about it again. If I hadn't called I would have paid a bill for over a thousand dollars. I got one bill for $20 a year after. The address was in another city so I was skeptical. I went to their website and put in the account number and it said I didn't owe anything. Was it a scam? Who knows. Another time I had an mri scheduled for something else and I get a call from the insurance company asking if I would be willing to reschedule to another hospital 90 minutes away because it was cheaper. I can't imagine how terrible it would be if I had some serious or long term illness. Imagine if any other industry was this sloppy and confusing in their billing.

Workaccount2 2y ago
At the end of last year my doctor prescribed a list of blood tests, some of them rather esoteric and cutting edge. As a precaution, I wanted to see if they would all be covered and how much my out of pocket cost would be for these if not (or if partially covered). It took _a week_, composed of two different lab visits and about 4 hours of phone time between the doctor, the lab, and my insurance to figure it out. And in the end, the values ultimately provided to me weren't even correct. Like what the fuck is going on behind the scenes here?
- kristjansson 2y ago
  > behind the scenes here? Two giant companies, trying to fuck each other as hard as possible, while not violating the law so egregiously they are made to stop. Healthcare is an incidental byproduct.

black_13 2y ago

[dead]

internet101010 2y ago

Prices at doctor and dentist offices are high because they know what your insurance policy is and adjust their prices to maximize.

daft_pink 2y ago

I’m generally a free marketer, but have you ever gone to a private equity dentist’s office. They clearly recommend way more procedures than make sense compared to other dentists.

tracker1 2y ago
They also seem to be unduly rushed... makes me nervous to say the least.

dostick 2y ago

Capitalism is the problem. We couldn’t fix inequality and corruption in 100 years. There’s no country on earth where we could say capitalism works. Total failure in every country. Capitalism is a dead end and it’s getting worse with time. Why nobody talks about that? Isn’t it a problem of all problems? Now, why there is no replacement system of society and economics? We have institutions for physics, biology, construction, logistics and other sciences. And all of them make discoveries and move science forward. Except for one. Why nobody is working on a replacement society and economics system? Why only this specific science is in standstill? starts to look like a conspiracy, or does capitalism cause it?

CivBase 2y ago
> Why nobody talks about that? People talk about it all the time. Everything gets blamed on capitalism these days. Problem is nobody is offering good alternatives. Good luck finding one.
- nathan_compton 2y ago
  This is a really weird thing to say when there are clearly alternatives that work better than whatever is happening in the U.S.
  - tracker1 2y ago
    Such as..?
    - nathan_compton 2y ago
      Any country with socialized medicine?
      - tracker1 2y ago
        Most countries with socialized medicine are still capitalist nations.
- 2y ago

deleted 2y ago

[deleted]

complaintdept 2y ago

PE bought up the local chain of doctor's offices a few years ago in my area, and it was an instant drop in quality. They started dropping patients for missed appointments a decade prior when they were a minor (one was being treated for depression after a suicide attempt). Then their doctors started leaving and they had to bring in people to fill the labor gap, but these pepple were not of high quality and malpractice suits became more common. Then they had to start dropping patients. Entire families suddenly had no primary care doctor, and what's worse is that this was the major providor for medical care in the area. Some people are now driving ~100 miles or more each way to get a primary care physician. Outside of medicine, I've seen PE fuck up at least three decent tool companies. Their products are basically garbage now. PE sucks, too many glaring examples of it messing things up in my day to day.

resource_waste 2y ago

Nah, skip the article and just look at reality: https://www.opensecrets.org/federal-lobbying/top-spenders?cycle=a https://www.opensecrets.org/federal-lobbying/top-spenders?cy... Its bribery: Hospitals, your local physician, pharma, and insurance companies. We should begin fighting these Stronger powers. We can resent people in these professions, demand justice for decades of exploitation, etc... "Universal Healthcare" isnt stopping corruption. Its codifying it.