4 ms·

Ah, but deaths… Go up too. https://hms.harvard.edu/news/deaths-rose-emergency-rooms-after-hospitals-were-acquired-private-equity-firms https://hms.harvard.edu/

Ah, but deaths… Go up too. https://hms.harvard.edu/news/deaths-rose-emergency-rooms-after-hospitals-were-acquired-private-equity-firms https://hms.harvard.edu/news/deaths-rose-emergency-rooms-aft... Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person.

cyanydeez 1y ago
I think you mean murder via diffusion of responsibility is good for business. Its like the trolley problem, but instead of one lever thete a chain of them and at least one of them is the final one, any number of them are like tumblers in a lock.
johndhi 1y ago
I hate the US healthcare system but I don't support using the word murder in this context. Murder is very very different from trying to help a person but being greedy while doing it.
- ceejayoz 1y ago
  But it’s not “a person”. It’s millions of them.
  - johndhi 1y ago
    I agree it's really sad and fucked up. But the way we deal with murder is long prison sentences and the death penalty. If we introduce horrible incentives for investing in medicine, we won't get compassionate care, we will just eliminate investment in healthcare. We need really thoughtful incentives and simple policies that let doctors run hospitals. Idk it's hard - I was going to say we should reward them for providing better care but I know the pay for performance system in place also hasn't worked that well.
    - conductr 1y ago
      Single payor system would solve a lot of problems as insurance companies and the economic system/incentives they’ve created in healthcare is the root cause of a lot of the issues. Also, it’s such a large and relatively unnecessary value extraction layer (middleman) that we’d immediately have many more dollars going towards providing care than to running of insurance companies and their owners. Even the hospitals and other providers have to employ armies of people just to understand how to bill things properly in this unnecessarily complex ecosystem. It’s a massive waste of resources in the name of capitalism that does nothing to improve the care provided. It’s even worse when considering these companies profit more by denying care altogether.
- roughly 1y ago
  > trying to help a person but being greedy while doing it. The doctors are trying to help people, the execs are being greedy while doing it. Leadership doesn’t get the benefit of the doubt at this point.
  - mrosett 1y ago
    Plenty of docs making the better part of a million dollars.
    - roughly 1y ago
      Buddy, six figures is about 3 short of the amounts we’re talking about here.
      - ryandrake 1y ago
        Yea, we have to stop villainizing people who are making "a better part of a million dollars." The real villains are the ones making a better part of a billion dollars or more.
- Mistletoe 1y ago
  Yes, it's much worse.
- vjvjvjvjghv 1y ago
  I think murder is an appropriate term. There is a long history of company leadership making decisions that they know will lead to the death of thousands of people. See tobacco, opiates, leaded gas and many others. And they are not trying to help people while being greedy but they are only greedy without being motivated to help people.
  - deleted 1y ago
    [deleted]
  - salawat 1y ago
    Forgot insurance.
mrosett 1y ago
These are two distinct issues. The study you linked concerns whether the hospital is owned by a nonprofit or by a private equity group. The question in this study is whether physicians work for their own practice or for the hospital directly, regardless of the ownership of the hospital.
- ikiris 1y ago
  This issue is much more linked than you think, because its a strategy to upcode to have external practice groups.
  - mrosett 1y ago
    Your assertion runs counter to the original article, which says that acquiring external practice groups raises prices.
deleted 1y ago
[deleted]
cowsandmilk 1y ago
That article isn’t about hospitals acquiring practices, it is about private equity acquiring hospitals. There is sometimes a relation, but not always.
roenxi 1y ago
> Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person. Society is actually quite consistent on that point (unfortunately). The body doing the statistical murder here is the regulator of the hospital system and it is part of the same organisation (the government) that handles the direct murder through the army. People tend to treat horrible missteps in war and medicine about the same. It might be nice in a moral sense if there was some consistency. It isn't too late to disgrace George Bush and make the rest of his days a living hell, for example. But as political strategies go that seems like a bad idea.
tptacek 1y ago
There is no such thing as "statistical murder". No crime was committed here. I don't like health chain consolidation either, but words mean things.
- AdieuToLogic 1y ago
  > There is no such thing as "statistical murder". Sure there is. Denying categories of potentially life-saving treatments due to provincial laws causing hospitals to value legal considerations over medical decisions is one example. Perhaps the phrase "statistical manslaughter" is a better description however.
  - zmgsabst 1y ago
    I don’t think you need the statistical: If you engage in behavior with known and predictable risks, which then kills somebody, it is manslaughter. Like recklessly operating a vehicle or blindly throwing knives. That sometimes your behavior doesn’t kill people is immaterial — manslaughter is being intentionally risky in your actions which leads to a death. Or in the case of UnitedHealthcare, felony murder: their felony fraud in issuing false denials for their clients resulted in deaths — and deaths that result from a felony have a special charge.
    - AdieuToLogic 1y ago
      > If you engage in behavior with known and predictable risks, which then kills somebody, it is manslaughter. > That sometimes your behavior doesn’t kill people is immaterial — manslaughter is being intentionally risky in your actions which leads to a death. I was thinking more about laws enacted in the last couple of years in various US states which have guaranteed a rise in pregnancy-related deaths[0]. 0 - https://news.harvard.edu/gazette/story/2025/04/u-s-pregnancy-related-deaths-continuing-to-rise/ https://news.harvard.edu/gazette/story/2025/04/u-s-pregnancy...
      - pyuser583 1y ago
        Which laws do you mean?
john01dav 1y ago
While I agree that what you call "statistical murder" needs to be handled differently, I see problems with doing so that need to be solved. Namely, what counts? Your example of statistical murder is prioritization can be abstracted as profit over life. A first thought might be to condemn any prioritization of anything over life, but this leads to likely unwanted consequences: it is illegal to drive, ever; it is illegal to feed someone food that is not of the optimal health for their particular situation, ever; it is illegal to sell a product, even used, that California has determined a carcinogen. All of these are related to leading causes of death: traffic accidents, low quality food causing obesity and its myriad of consequences, and cancer. We could use improvement in all of these cases, but such absolute bans go too far. So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder?
- atmavatar 1y ago
  So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder? A necessary first step is to hand that decision over to someone who does not personally gain from choosing death. Life-or-death care almost certainly needs to be a government-run, single-payer system. If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it.
  - john01dav 1y ago
    > If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it I agree. I want to expand on this and make my question more explicit. In my previous post I tried to give one extreme (where we clearly do not want restrictions on behavior). This is the other extreme (where we clearly do want restrictions on behavior). There must be some line drawn in between in order to enforce either of these extremes (that we clearly want to enforce).
  - snapplebobapple 1y ago
    We have that in canada and it does not work that way at all. Single payer turns into a big en(ugh line item that there is political "otivation to limit supply and it all goes to crap just in a different way than it has in america. The solution is way simpler: ensuring there is enough supply that price raising bs fails. That gives you a bunch of different ways to get to the solution that will all work vut they all have ensuring enough supply to limit shenanigans at their base.
renewiltord 1y ago
Interesting. The cost to save a human life is about $4k. Anyone with $4m then is a statistical murderer. Acting to enrich themselves over saving these 1000 lives. Fascinating. Donations to the Rust Foundation have statistically killed thousands. By setting up the Rust Foundation I wonder how many have been murdered statistically.
rich_sasha 1y ago
It's the beauty of a commercial system, no? Businesses have a duty to make a profit for their shareholders first, second to their clients (keeping their customers happy), and no obligation to the wider society, other than following regulation. If a private hospital figures out that by jacking prices up by 50% they make more profit, keep their fewer customers happier (not even necessarily more alive!) and treat less people, they are 100% following their mission as a private business. A European PoV might be that you can counterbalance a private system with a public system, whose goals are explicitly to keep the society healthy and help as many people as possible. The NHS, admittedly not the gold standard for anything good recently, optimises for maximising "quality-adjusted life expectancy improvement" over the whole society. It's not a metric you could ever replicate with private businesses.
- throw0101a 1y ago
  > Businesses have a duty to make a profit for their shareholders first […] [citation needed] This idea gets bandied about, but it is only one way of thinking that happened to gain popularity in a certain (recent) time period: * https://en.wikipedia.org/wiki/Friedman_doctrine https://en.wikipedia.org/wiki/Friedman_doctrine * https://en.wikipedia.org/wiki/Shareholder_primacy https://en.wikipedia.org/wiki/Shareholder_primacy There are others: * https://en.wikipedia.org/wiki/Stakeholder_theory https://en.wikipedia.org/wiki/Stakeholder_theory There is no legal duty/requirement to do so: * https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2277141 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2277141 * https://rpc.cfainstitute.org/research/multimedia/2013/the-shareholder-value-myth https://rpc.cfainstitute.org/research/multimedia/2013/the-sh... * https://skeptics.stackexchange.com/questions/8146/are-u-s-companies-legally-obligated-to-maximize-profits-for-shareholders https://skeptics.stackexchange.com/questions/8146/are-u-s-co... Also: shareholders are not the owners of company.
  - danaris 1y ago
    There's even a specific court case setting precedent that there is no "fiduciary duty" to screw people over in pursuit of higher profits: > Burwell v. Hobby Lobby Stores, Inc. - https://www.law.cornell.edu/supremecourt/text/13-354 https://www.law.cornell.edu/supremecourt/text/13-354 > While it is certainly true that a central objective of for-profit corporations is to make money, modern corporate law does not require for-profit corporations to pursue profit at the expense of everything else, and many do not do so. For-profit corporations, with ownership approval, support a wide variety of charitable causes, and it is not at all uncommon for such corporations to further humanitarian and other altruistic objectives. Many examples come readily to mind. So long as its owners agree, a for-profit corporation may take costly pollution-control and energy-conservation measures that go beyond what the law requires. A for-profit corporation that operates facilities in other countries may exceed the requirements of local law regarding working conditions and benefits.
mcbrit 1y ago
Counting in people rather than people-days is problematic, and then you get to qol-people-days. Saying murder is not helpful; see how folks have responded to you.

cyanydeez 1y ago

I think you mean murder via diffusion of responsibility is good for business. Its like the trolley problem, but instead of one lever thete a chain of them and at least one of them is the final one, any number of them are like tumblers in a lock.

johndhi 1y ago

I hate the US healthcare system but I don't support using the word murder in this context. Murder is very very different from trying to help a person but being greedy while doing it.

ceejayoz 1y ago
But it’s not “a person”. It’s millions of them.
- johndhi 1y ago
  I agree it's really sad and fucked up. But the way we deal with murder is long prison sentences and the death penalty. If we introduce horrible incentives for investing in medicine, we won't get compassionate care, we will just eliminate investment in healthcare. We need really thoughtful incentives and simple policies that let doctors run hospitals. Idk it's hard - I was going to say we should reward them for providing better care but I know the pay for performance system in place also hasn't worked that well.
  - conductr 1y ago
    Single payor system would solve a lot of problems as insurance companies and the economic system/incentives they’ve created in healthcare is the root cause of a lot of the issues. Also, it’s such a large and relatively unnecessary value extraction layer (middleman) that we’d immediately have many more dollars going towards providing care than to running of insurance companies and their owners. Even the hospitals and other providers have to employ armies of people just to understand how to bill things properly in this unnecessarily complex ecosystem. It’s a massive waste of resources in the name of capitalism that does nothing to improve the care provided. It’s even worse when considering these companies profit more by denying care altogether.
roughly 1y ago
> trying to help a person but being greedy while doing it. The doctors are trying to help people, the execs are being greedy while doing it. Leadership doesn’t get the benefit of the doubt at this point.
- mrosett 1y ago
  Plenty of docs making the better part of a million dollars.
  - roughly 1y ago
    Buddy, six figures is about 3 short of the amounts we’re talking about here.
    - ryandrake 1y ago
      Yea, we have to stop villainizing people who are making "a better part of a million dollars." The real villains are the ones making a better part of a billion dollars or more.
Mistletoe 1y ago
Yes, it's much worse.
vjvjvjvjghv 1y ago
I think murder is an appropriate term. There is a long history of company leadership making decisions that they know will lead to the death of thousands of people. See tobacco, opiates, leaded gas and many others. And they are not trying to help people while being greedy but they are only greedy without being motivated to help people.
- deleted 1y ago
  [deleted]
- salawat 1y ago
  Forgot insurance.

mrosett 1y ago

These are two distinct issues. The study you linked concerns whether the hospital is owned by a nonprofit or by a private equity group. The question in this study is whether physicians work for their own practice or for the hospital directly, regardless of the ownership of the hospital.

ikiris 1y ago
This issue is much more linked than you think, because its a strategy to upcode to have external practice groups.
- mrosett 1y ago
  Your assertion runs counter to the original article, which says that acquiring external practice groups raises prices.

deleted 1y ago

[deleted]

cowsandmilk 1y ago

That article isn’t about hospitals acquiring practices, it is about private equity acquiring hospitals. There is sometimes a relation, but not always.

roenxi 1y ago

> Part of the problem of modern society is that statistical murder of thousands is treated as less of a crime than a normal murder of one person. Society is actually quite consistent on that point (unfortunately). The body doing the statistical murder here is the regulator of the hospital system and it is part of the same organisation (the government) that handles the direct murder through the army. People tend to treat horrible missteps in war and medicine about the same. It might be nice in a moral sense if there was some consistency. It isn't too late to disgrace George Bush and make the rest of his days a living hell, for example. But as political strategies go that seems like a bad idea.

tptacek 1y ago

There is no such thing as "statistical murder". No crime was committed here. I don't like health chain consolidation either, but words mean things.

AdieuToLogic 1y ago
> There is no such thing as "statistical murder". Sure there is. Denying categories of potentially life-saving treatments due to provincial laws causing hospitals to value legal considerations over medical decisions is one example. Perhaps the phrase "statistical manslaughter" is a better description however.
- zmgsabst 1y ago
  I don’t think you need the statistical: If you engage in behavior with known and predictable risks, which then kills somebody, it is manslaughter. Like recklessly operating a vehicle or blindly throwing knives. That sometimes your behavior doesn’t kill people is immaterial — manslaughter is being intentionally risky in your actions which leads to a death. Or in the case of UnitedHealthcare, felony murder: their felony fraud in issuing false denials for their clients resulted in deaths — and deaths that result from a felony have a special charge.
  - AdieuToLogic 1y ago
    > If you engage in behavior with known and predictable risks, which then kills somebody, it is manslaughter. > That sometimes your behavior doesn’t kill people is immaterial — manslaughter is being intentionally risky in your actions which leads to a death. I was thinking more about laws enacted in the last couple of years in various US states which have guaranteed a rise in pregnancy-related deaths[0]. 0 - https://news.harvard.edu/gazette/story/2025/04/u-s-pregnancy-related-deaths-continuing-to-rise/ https://news.harvard.edu/gazette/story/2025/04/u-s-pregnancy...
    - pyuser583 1y ago
      Which laws do you mean?

john01dav 1y ago

While I agree that what you call "statistical murder" needs to be handled differently, I see problems with doing so that need to be solved. Namely, what counts? Your example of statistical murder is prioritization can be abstracted as profit over life. A first thought might be to condemn any prioritization of anything over life, but this leads to likely unwanted consequences: it is illegal to drive, ever; it is illegal to feed someone food that is not of the optimal health for their particular situation, ever; it is illegal to sell a product, even used, that California has determined a carcinogen. All of these are related to leading causes of death: traffic accidents, low quality food causing obesity and its myriad of consequences, and cancer. We could use improvement in all of these cases, but such absolute bans go too far. So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder?

atmavatar 1y ago
So, how do we determine when it is legitimate to prioritize something over life, or when it's statistical murder? A necessary first step is to hand that decision over to someone who does not personally gain from choosing death. Life-or-death care almost certainly needs to be a government-run, single-payer system. If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it.
- john01dav 1y ago
  > If giving another kid their cancer meds means one less gold-leaf-covered item in the presidential ballroom, so be it I agree. I want to expand on this and make my question more explicit. In my previous post I tried to give one extreme (where we clearly do not want restrictions on behavior). This is the other extreme (where we clearly do want restrictions on behavior). There must be some line drawn in between in order to enforce either of these extremes (that we clearly want to enforce).
- snapplebobapple 1y ago
  We have that in canada and it does not work that way at all. Single payer turns into a big en(ugh line item that there is political "otivation to limit supply and it all goes to crap just in a different way than it has in america. The solution is way simpler: ensuring there is enough supply that price raising bs fails. That gives you a bunch of different ways to get to the solution that will all work vut they all have ensuring enough supply to limit shenanigans at their base.

renewiltord 1y ago

Interesting. The cost to save a human life is about $4k. Anyone with $4m then is a statistical murderer. Acting to enrich themselves over saving these 1000 lives. Fascinating. Donations to the Rust Foundation have statistically killed thousands. By setting up the Rust Foundation I wonder how many have been murdered statistically.

rich_sasha 1y ago

It's the beauty of a commercial system, no? Businesses have a duty to make a profit for their shareholders first, second to their clients (keeping their customers happy), and no obligation to the wider society, other than following regulation. If a private hospital figures out that by jacking prices up by 50% they make more profit, keep their fewer customers happier (not even necessarily more alive!) and treat less people, they are 100% following their mission as a private business. A European PoV might be that you can counterbalance a private system with a public system, whose goals are explicitly to keep the society healthy and help as many people as possible. The NHS, admittedly not the gold standard for anything good recently, optimises for maximising "quality-adjusted life expectancy improvement" over the whole society. It's not a metric you could ever replicate with private businesses.

throw0101a 1y ago
> Businesses have a duty to make a profit for their shareholders first […] [citation needed] This idea gets bandied about, but it is only one way of thinking that happened to gain popularity in a certain (recent) time period: * https://en.wikipedia.org/wiki/Friedman_doctrine https://en.wikipedia.org/wiki/Friedman_doctrine * https://en.wikipedia.org/wiki/Shareholder_primacy https://en.wikipedia.org/wiki/Shareholder_primacy There are others: * https://en.wikipedia.org/wiki/Stakeholder_theory https://en.wikipedia.org/wiki/Stakeholder_theory There is no legal duty/requirement to do so: * https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2277141 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2277141 * https://rpc.cfainstitute.org/research/multimedia/2013/the-shareholder-value-myth https://rpc.cfainstitute.org/research/multimedia/2013/the-sh... * https://skeptics.stackexchange.com/questions/8146/are-u-s-companies-legally-obligated-to-maximize-profits-for-shareholders https://skeptics.stackexchange.com/questions/8146/are-u-s-co... Also: shareholders are not the owners of company.
- danaris 1y ago
  There's even a specific court case setting precedent that there is no "fiduciary duty" to screw people over in pursuit of higher profits: > Burwell v. Hobby Lobby Stores, Inc. - https://www.law.cornell.edu/supremecourt/text/13-354 https://www.law.cornell.edu/supremecourt/text/13-354 > While it is certainly true that a central objective of for-profit corporations is to make money, modern corporate law does not require for-profit corporations to pursue profit at the expense of everything else, and many do not do so. For-profit corporations, with ownership approval, support a wide variety of charitable causes, and it is not at all uncommon for such corporations to further humanitarian and other altruistic objectives. Many examples come readily to mind. So long as its owners agree, a for-profit corporation may take costly pollution-control and energy-conservation measures that go beyond what the law requires. A for-profit corporation that operates facilities in other countries may exceed the requirements of local law regarding working conditions and benefits.

mcbrit 1y ago

Counting in people rather than people-days is problematic, and then you get to qol-people-days. Saying murder is not helpful; see how folks have responded to you.