8 ms·

The landlord gutting America’s hospitals

76 points by hhs 1y ago

toomuchtodo 1y ago
Medical Properties Trust
jmyeet 1y ago
The US spends far more per-capita on healthcare than other OECD nations [1] and has objectively less coverage and worse outcomes [2]. Buying up property then leasing it back is straight from the private equity playbook. It almost always ends badly. And it's driving up the cost of everything. Hospitals, vets, housing, etc. At some point you have to realize that the only innovation under capitalism is building enclosures and rent-seeking. Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours. The US government, regardless of party, operates to transfer wealth from the young and poor to the old and wealthy, and the "old" part is on shaky ground. And it can't go on like this. I think by 2100 we'll see a collapse of this system, the kind that ends in land reform, guillotines, nationalization and sovereign debt default. [1]: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20expenditures%20per%20capita,%20U.S.%20dollars,%202023%20(current%20prices%20and%20PPP%20adjusted) https://www.healthsystemtracker.org/chart-collection/health-... [2]: https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 https://www.commonwealthfund.org/publications/issue-briefs/2...
- jjice 1y ago
  Why do we spend so much and still have such a busted system? Is it that the money goes towards price gouged services, or Americans have bad preventative health practices? Other things? Likely a combination of a lot?
  - votepaunchy 1y ago
    Yes, from what I have read it is that Americans pay for more for doctors, drugs, and services. And when attempts are made to begin to curtail these costs, the lobbyists swoop in and buy off our politicians.
  - victorbjorklund 1y ago
    Americans also consume a lot more healthcare than others. Yes, if you are poor and uninsured in US it sucks. But americans go way more to the doctor and wait less in time than in Europe.
    - masfuerte 1y ago
      Sure, you wait less time per visit but you spend far more time overall on medical nonsense for worse outcomes. What is the point?
      - victorbjorklund 1y ago
        In Sweden we can wait 6 months for a doctors visit. My impression is americans expect same day visit.
        const_cast 1y ago
        Okay, but you understand this isn't actually beneficial, right? Because American spend more, but Sweden has significantly better healthcare outcomes. So the American system is just worse, period. Also: on the topic of same-day visits because I think there's some confusion here. American can, maybe, get same-day visits if and only if they have a PCP, which is increasingly rare. Your PCP cannot do jack fucking shit. At best, they can swab your throat. Every type of condition management outside of Strep MUST go to a specialist. Your tummy been hurting a lot? That's a job for a gastroenterologist, not your PCP. For specialists, it's not uncommon to wait many months or even a year. Especially because most insurance plans require a referral - so you have to see two doctors.
    - theragra 1y ago
- gruez 1y ago
  >Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours. It's less because China is a command economy (ie. the government determines the allocation of capital), and more to do with the fact that it's an authoritarian state where the local population and interest groups basically has zero ability to object/block construction projects.
  - jeroenhd 1y ago
    There are plenty of examples of invidiuals who do object. However, unlike in other countries, developers and the government are free to bully them and ruin their lives for daring not to sell their homes. Plenty of examples of houses in the middle of highways (one famously literally in the middle of the road), packed between huge flats, in the middle of active construction sites, placed on top of huge hills or pits when land height is altered, and other places where you'd never want to live. That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree. My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged. The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.
  - ceejayoz 1y ago
    The line between "authoritarian state" and "entire region run by NIMBYs" can be… blurry.
ck2 1y ago
Well that's now their second biggest problem 13 Million people about to lose insurance and ACA premiums about to double so people will drop that too to buy food/rent means America is returning to emergency-room as primary care with unpaid massive bills so many, many hospitals will close We're basically going to ride this broken system into the ground ie. bridges are never repaired in USA until they completely collapse
- jaybrendansmith 1y ago
  Agree. If this was the movie studios, or the record industry, then this kind of creative destruction would be ok, but we are talking about regulatory arbitrage and financialization leading to a market failure, and in this case it is our health system. Traveling 50-75 miles to the nearest ER will most often just lead to death. This is perhaps the most basic service a modern economy can provide ... third world countries will have better options than many US citizens.
- tptacek 1y ago
  Most Americans don't get insurance from ACA exchanges.
  - yuliyp 1y ago
    Right, but over 20 million people do. And those are generally less wealthy people for whom price increases would be quite a hardship.
    - tptacek 1y ago
      I'm just saying: that isn't the system driving into the ground. Even after this administration royally screws up the ACA, we'll still be in a better position than we were prior to the passage of the ACA.
RainyDayTmrw 1y ago
Asset stripping is evil. I think we should have more regulations against asset stripping. How would those regulations be written, though? In my opinion, as a lay person who reads the news, asset stripping seems to be a way of "hacking the system" - doing a series of things, individually permissible by the rules, to achieve personal gain at the cost of social harm. I think, we should forbid dumping negative externalities on people. But which step is the actual wrong?
- cameldrv 1y ago
  We shouldn’t have for profit hospitals.
  - phkahler 1y ago
    I think by asset stripping the parent is including other plays. Private equity buys a company, sells the real-estate to their friends and leases it back to the company on a long term lease. Then after other shenanigans they IPO and dump the company back on the public. It's better than in the old days because they don't fire everyone and sell the assets. They may even make some positive changes, but the company now has to pay rent.
    - gruez 1y ago
      >I think by asset stripping the parent is including other plays. Private equity buys a company, sells the real-estate to their friends and leases it back to the company on a long term lease. Then after other shenanigans they IPO and dump the company back on the public. Your wording strongly implies you think there's something shady going on, but what's the actual issue here? It's a private company, after all. Minus the concern of minority shareholders getting screwed over by the transaction, there isn't anything obviously intrinsically wrong with restructuring the ownership structure of a company you own. If a given company is only limping along because it owns real estate and pays $0 in rent, arguably the right thing to do is let the company fold - creative destruction and all that.
      - 1y ago
horcrux 1y ago
[dead]
spwa4 1y ago
What I just find incredibly hard to believe is that we are accepting comments about inequality and profiteering "in cooperation" with Al-Jazeera. Seriously? From the Qatari government? Does it really need to be stated that this is propaganda? Really? Are we to believe that these people are worried about the rights of poor patients in the US? https://en.wikipedia.org/wiki/Slavery_in_Qatar https://en.wikipedia.org/wiki/Slavery_in_Qatar

76 points by hhs 1y ago

Medical Properties Trust

The US spends far more per-capita on healthcare than other OECD nations [1] and has objectively less coverage and worse outcomes [2]. Buying up property then leasing it back is straight from the private equity playbook. It almost always ends badly. And it's driving up the cost of everything. Hospitals, vets, housing, etc. At some point you have to realize that the only innovation under capitalism is building enclosures and rent-seeking. Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours. The US government, regardless of party, operates to transfer wealth from the young and poor to the old and wealthy, and the "old" part is on shaky ground. And it can't go on like this. I think by 2100 we'll see a collapse of this system, the kind that ends in land reform, guillotines, nationalization and sovereign debt default. [1]: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#Health%20expenditures%20per%20capita,%20U.S.%20dollars,%202023%20(current%20prices%20and%20PPP%20adjusted) https://www.healthsystemtracker.org/chart-collection/health-... [2]: https://www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022 https://www.commonwealthfund.org/publications/issue-briefs/2...

jjice 1y ago
Why do we spend so much and still have such a busted system? Is it that the money goes towards price gouged services, or Americans have bad preventative health practices? Other things? Likely a combination of a lot?
- votepaunchy 1y ago
  Yes, from what I have read it is that Americans pay for more for doctors, drugs, and services. And when attempts are made to begin to curtail these costs, the lobbyists swoop in and buy off our politicians.
- victorbjorklund 1y ago
  Americans also consume a lot more healthcare than others. Yes, if you are poor and uninsured in US it sucks. But americans go way more to the doctor and wait less in time than in Europe.
  - masfuerte 1y ago
    Sure, you wait less time per visit but you spend far more time overall on medical nonsense for worse outcomes. What is the point?
    - victorbjorklund 1y ago
      In Sweden we can wait 6 months for a doctors visit. My impression is americans expect same day visit.
      - const_cast 1y ago
        Okay, but you understand this isn't actually beneficial, right? Because American spend more, but Sweden has significantly better healthcare outcomes. So the American system is just worse, period. Also: on the topic of same-day visits because I think there's some confusion here. American can, maybe, get same-day visits if and only if they have a PCP, which is increasingly rare. Your PCP cannot do jack fucking shit. At best, they can swab your throat. Every type of condition management outside of Strep MUST go to a specialist. Your tummy been hurting a lot? That's a job for a gastroenterologist, not your PCP. For specialists, it's not uncommon to wait many months or even a year. Especially because most insurance plans require a referral - so you have to see two doctors.
  - theragra 1y ago
gruez 1y ago
>Whereas in China, a command economy, they've built 20,000km+ of high speed rail in <20 years and just unveiled a 600kmh maglev train (note: that's faster than commercial aircraft) that will go from beijing to Shangai, over 1000km, in 2.5 hours. It's less because China is a command economy (ie. the government determines the allocation of capital), and more to do with the fact that it's an authoritarian state where the local population and interest groups basically has zero ability to object/block construction projects.
- jeroenhd 1y ago
  There are plenty of examples of invidiuals who do object. However, unlike in other countries, developers and the government are free to bully them and ruin their lives for daring not to sell their homes. Plenty of examples of houses in the middle of highways (one famously literally in the middle of the road), packed between huge flats, in the middle of active construction sites, placed on top of huge hills or pits when land height is altered, and other places where you'd never want to live. That said, the Chinese state is also doing this by spending a lot of money on infrastructure. This isn't unlike what the west did when everybody got electricity, phone lines, clean water, sewers, heating, and things like bridges and infrastructure. Of course the government helped rollout of rail infrastructure in populated areas by creating the necessary laws and ordinances (less populated land was still cheap enough that companies could just buy land). That approach worked fine, until populations grew so there was less cheap land and property became a method of investment that drove up prices to a ridiculous degree. My country's rail network has been reduced to the essentials, after several mergers and services that became unprofitable were shut down (despite them working fine as independent companies). Building new rail now takes decades of negotiations instead of a few years of laying tracks, if funding can even be secured, as politicians seem to hate the idea of investing in public transport when we could add Just One More Land. The entire system has been clogged. The authoritarian system is one way to work around the problems of modern high-density society, but it's not necessarily the only way. The trouble lies in convincing enough people to accept the downsides, and to stop the greedy fraudsters from bleeding any development plan dry in any way they can.
- ceejayoz 1y ago
  The line between "authoritarian state" and "entire region run by NIMBYs" can be… blurry.

ck2 1y ago

Well that's now their second biggest problem 13 Million people about to lose insurance and ACA premiums about to double so people will drop that too to buy food/rent means America is returning to emergency-room as primary care with unpaid massive bills so many, many hospitals will close We're basically going to ride this broken system into the ground ie. bridges are never repaired in USA until they completely collapse

jaybrendansmith 1y ago
Agree. If this was the movie studios, or the record industry, then this kind of creative destruction would be ok, but we are talking about regulatory arbitrage and financialization leading to a market failure, and in this case it is our health system. Traveling 50-75 miles to the nearest ER will most often just lead to death. This is perhaps the most basic service a modern economy can provide ... third world countries will have better options than many US citizens.
tptacek 1y ago
Most Americans don't get insurance from ACA exchanges.
- yuliyp 1y ago
  Right, but over 20 million people do. And those are generally less wealthy people for whom price increases would be quite a hardship.
  - tptacek 1y ago
    I'm just saying: that isn't the system driving into the ground. Even after this administration royally screws up the ACA, we'll still be in a better position than we were prior to the passage of the ACA.

RainyDayTmrw 1y ago

Asset stripping is evil. I think we should have more regulations against asset stripping. How would those regulations be written, though? In my opinion, as a lay person who reads the news, asset stripping seems to be a way of "hacking the system" - doing a series of things, individually permissible by the rules, to achieve personal gain at the cost of social harm. I think, we should forbid dumping negative externalities on people. But which step is the actual wrong?

cameldrv 1y ago
We shouldn’t have for profit hospitals.
- phkahler 1y ago
  I think by asset stripping the parent is including other plays. Private equity buys a company, sells the real-estate to their friends and leases it back to the company on a long term lease. Then after other shenanigans they IPO and dump the company back on the public. It's better than in the old days because they don't fire everyone and sell the assets. They may even make some positive changes, but the company now has to pay rent.
  - gruez 1y ago
    >I think by asset stripping the parent is including other plays. Private equity buys a company, sells the real-estate to their friends and leases it back to the company on a long term lease. Then after other shenanigans they IPO and dump the company back on the public. Your wording strongly implies you think there's something shady going on, but what's the actual issue here? It's a private company, after all. Minus the concern of minority shareholders getting screwed over by the transaction, there isn't anything obviously intrinsically wrong with restructuring the ownership structure of a company you own. If a given company is only limping along because it owns real estate and pays $0 in rent, arguably the right thing to do is let the company fold - creative destruction and all that.
    - 1y ago

horcrux 1y ago

[dead]

spwa4 1y ago

What I just find incredibly hard to believe is that we are accepting comments about inequality and profiteering "in cooperation" with Al-Jazeera. Seriously? From the Qatari government? Does it really need to be stated that this is propaganda? Really? Are we to believe that these people are worried about the rights of poor patients in the US? https://en.wikipedia.org/wiki/Slavery_in_Qatar https://en.wikipedia.org/wiki/Slavery_in_Qatar