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Bill to Ban Private Equity from Owning Medical Practices
- jimbob45 5d agoBi…cameral legislation?
- defterGoose 5d ago...meaning both houses of Congress.
- jimbob45 5d agoAs opposed to the many famous cases of unicameral American legislation?
- gs17 5d agoYes, a lot of bills are introduced in one chamber and die in that same chamber. This case is referring to it being introduced by "Senators Elizabeth Warren (D-Mass.), Ron Wyden (D-Ore.), and Jeff Merkley (D-Ore.), along with Representatives Val Hoyle (D-Ore.), Alexandria Ocasio-Cortez (D-N.Y.), and Suhas Subramanyam (D-Va.)", presumably there's a companion bill for the house, since the links seem to only have the Senate version.
- deleted 5d ago[deleted]
- NegativeK 5d agoCan someone steelman private equity, please? I'm honestly looking for the upsides (for non-investors) of when PE moves into an industry like medicine and begins buying up businesses that traditionally aren't already large chains. I already hear the downsides frequently from someone whose work is directly affected.
- twoodfin 5d agoThe upside is to the folks who sold the businesses they owned. Should they be outlawed from selling to certain classes of investor? Which?
- Grombobulous 5d agoIt should be more about making certain levels of consolidation and deep erosion of local ownership illegal. We have run this country on an assumption that we must give businesses a high amount of freedom. An argument can be made that businesses have been given too much freedom in our system. We’ve allowed Amazon and Ticketmaster and Walmart to exist and they shouldn’t exist in their present form. Healthcare practices that provide necessary care shouldn’t even really be allowed to be for-profit entities if you ask me. The incentives become too perverse as a result.
- deleted 5d ago[deleted]
- lotsofpulp 5d agoCan you define profit? Would a doctor be allowed to earn more than $200 per hour? $300 per hour? $400 per hour? Is a doctor allowed to be paid per procedure or time? How much would you want to sacrifice your 20s and early 30s? How much would you need to work in the middle of nowhere where your kids won’t have the best opportunities?
- Grombobulous 5d agoI updated my comment, I mean a for-profit entity versus non-profit, which the IRS already defines. Not-for-profit entities can still pay market rate wages to employees and owners.
- tekla 5d agoShould Doctors have a legally enforced max pay? Same with the web devs, max $150K, anything else is just profit driven bullshit right?
- thrance 5d agoNothing a few bills slipped to republican and "moderate" democratic senators won't fix!
- djfobbz 5d agoThey'll still manage to figure out some loophole to do it anyway. PE really is cancer to most industries.
- janalsncm 5d ago> employers expect health care plan costs to rise by an average of 11 percent per worker in 2027, unless benefits are cut I am sure most workers would prefer to get that extra 11% as a cash raise, but because healthcare costs are out of control the same care costs 11% more. Certainly some companies will throw up their arms and hire someone overseas instead.
- Avicebron 5d agoLook up "Medical Loss Ratio" from the ACA if you want to find out where the perverse incentives for health care pricing comes from..
- smallmancontrov 5d agoThe cap is generous. If an insurance company is hitting it, competition is failing to keep them in check and lifting the cap would just let them gouge deeper. Of course, that doesn't keep them from constantly yapping this talking point, as if it wasn't that way before, as if we don't have evidence that it wouldn't work. "Just lift our profit cap" is self-serving baloney.
- Avicebron 5d agoThat's not the issue, it's because an insurer's absolute profit only grows if the premium base grows. This removes any reason to compete on reduced costs and an incentive to have the costs go up.
- rileymat2 5d agoExcept you can grow the premium base by adding customers as well, as you are featured in a direct price comparison on the ACA website. Higher premiums mean less customers, unless you are offering more services that they find valuable.
- dd8601fn 5d agoHow about just “cannot sell for 20 years”? The usual complaint is going full extractive mode, desperately squeezing profit and selling inside 3-7 years. So, yeah, we can keep private investment. But they're fucking stuck with it, trying to maintain a healthy business for 20 years.
- elliotto 5d agoAustralia is on its way down this path after Brookfield / Healthscope was holding a private hospital hostage against the government and had performance so degraded a child died. Hopefully we (aus) continue down this path of burning off the rot. https://www.abc.net.au/news/2025-03-27/nsw-government-joes-law-hospital-services-partnerships/105101938 https://www.abc.net.au/news/2025-03-27/nsw-government-joes-l...
- fsckboy 5d agoperformance soooo degraded a child died? when people talk about how healthcare needs to be better and better and more and more, I say "tell me under your plan what diseases/injuries to what extant will not be treated: who do you say "no" to? Every country could spend every collective nickel they have, and some people still would not live to see the next morning, but in a way that's ok because there probably wouldn't be any breakfast either, that money was spent on healthcare. What exactly are you calling for? I thought millenial and genz home ownership was the problem we need to fix. Are we going to sacrifice hipster housing for healthcare? Since most healthcare today is probably needed by boomers, think carefully about your answer.
- elliotto 5d agoVery strange comment. I would encourage you to read the specifics of the actual case. The hospital was severely under resourced resulting in a simple case being neglected and the child dying. The child could have received basic treatment and they would have survived. Underresourcing the hospital was a deliberate decision by Brookfield to push for a government bail-out. Anyone who made money off this should be in jail. Absolutely no idea what the rest of your comment is about. Our hospitals should have the resources to treat a sick child. Some might say that's the entire point of society.
- devilsdata 5d agoYou're fighting a losing battle advocating for public stewardship of anything on this website. The majority of people I've spoken with here are American, doing very well for themselves, and aspirational entrepreneurs. They have no concept of how much cheaper medical care can be. They don't realise there is enough for everyone. They are blind to the fact that many other countries care for all of their people for a fraction of the price. The people on this forum live in a strange parallel reality where there is only enough to go around, even though that hasn't been true for a very long time. So when people ask why they don't provide for the poor or fix their broken healthcare system by introducing single-payer healthcare, they'll speak to you like you're an idiot or a child. "Who is going to pay for that?", they ask, while paying an order of magnitude more for a GP visit than any other citizen of any other nation does. To them, you just have a poor understanding of economics.
- mhh__ 5d agoYou know what american healthcare really needs is more regulation!
- nielsbot 5d agoAre you saying it needs less? Why do you think that?
- mhh__ 5d agoyes. It's completely insane that health insurance A) does all price discovery B) is tied to your employer. Ask an American hospital how much something costs - you will get a completely fake price back, this is a sign of a totally broken market.
- riddley 5d agoA and B are due to regulations?
- vjvjvjvjghv 5d agoI am good with getting rid of B). A) can probably only be fixed with regulation. Why would hospitals and insurance otherwise make prices transparent? The current state serves them really well.
- mhh__ 5d agoBecause in a fair market they would be competed away - prices of food, computers, bonds, etc are not transparent because of regulation - it's largely because of the tax incentive as far as I've read from healthcare economists.
- nielsbot 5d agohealthcare isn’t really a market economy and neither should it be. we should make it a public a service without a profit motive
- mentalgear 5d agoMost importantly to fight it as Private Equity is creeping like a cancer into good health systems globally, even in Europe, to slowly but surely siphon away all that is good. It's important to fight it now before it is too late and other places also fall apart into a degraded, predatory, dystopian US system !
- JumpCrisscross 5d agoMake it a leverage limit. Otherwise you’ll have other players come in and replicate the playbook. The short-term fix is banning PE. The long-term one is restricting the leverage these groups can take. Then put limits on upstream leverage. We have these across our economy. We just don’t apply them to this sector.
- kasey_junk 5d agoThis is the right response. Most state bar associations require a lawyer (or group of them) to own law firms. That _doesnt_ prevent law firms from doing crazy deals to gain liquidity for their partners, including from private equity. Dictating who has to “own” something just incentivizes people to separate ownership from financial benefit. In most cases that’s just plain worse than letting real ownership happen. If there is a business practice you don’t like, regulate the practice, not the corporate structure.
- frisco 5d agoMedicine is extremely capex intensive and only become more so. Sucking private capital out of healthcare is going to make it vastly worse for everyone; higher prices and less innovation. I think we can criticize the often ruthlessness of PE while realizing that limiting medicine's ability to invest would be a huge self-own and only force further centralization into the biggest non-profit centers. Medicine is already held back enough by the lack of ability to use debt to finance its sales, unlike almost every other industry; you can repossess a car but you can't repo an implant or administered drug, forcing everything to be paid for in cash upfront. Medicine needs as much access to capital as it can get.
- BugsJustFindMe 5d ago> Sucking private capital out of healthcare is going to make it vastly worse for everyone; higher prices and less innovation. Injecting PE into healthcare is what made it vastly worse for everyone in the first place. You can't have it both ways.
- frisco 5d agoI'm sorry, compared to what? We're not talking about a routine doctor's office for healthy people. Advanced care is extremely technologically intensive and your local surgeon is not personally buying the $20M in infrastructure required for many modern advanced treatments. Venture capital has been essential for progress in medicine, and many advanced therapies are going to be increasingly delivered vertically integrated for the widest accessibility and best outcomes.
- bonsai_spool 5d ago> Venture capital has been essential for progress in medicine VC's can still fund companies that are making expensive new products. Banks (and PE...) can still underwrite loans for these things. We have many solutions for capex-intensive businesses and have had these for over four hundred years. LBO-type PE is not even fifty years old yet
- naveen99 5d agoI wonder if ai can help doctors reclaim their practices, as the bureaucracy of dealing with insurance may become easier. Administrative overhead must be cheaper with ai. It was the main reason for consolidation and giving up management to hospitals and private equity.
- Buttons840 5d agoI think it's more likely AI will cause disruption by ruthlessly optimizing on behalf of individuals. Private Equity can afford to have people sitting around all day figuring out tricks and optimizations to save a buck here and there, and this is a power imbalance because the plebs care about things like spending time with their family, and they don't spend all their time trying to save a buck. Maybe one day the AIs will optimize for us while we spend time with our families. And if a new vet opens that costs $15 less, the AI will route customers to the new business, driving prices down, until we reach 0 profit margin across all industries. There's probably like a 10 trillion dollar incentive to not allow AI to truly work on behalf of individuals though, so we'll see what happens. For instance, just look at the ad industry alone; if AIs are shopping truly on behalf of individuals, and this becomes wide spread, then the ad industry is just gone.
- naveen99 5d agoOptimization of medical care in usa is mostly limited by regulation and fear of lawsuits. Neither of which is going away. You can always get cheaper care in other parts of the world. Vets see animals, not humans.
- nradov 5d agoAI can help doctors with the administrative side but insurance companies are also deploying AI. We're seeing an escalating arms race with provider AIs battling against payer AIs. That's only one part of economies of scale. The technical and legal compliance costs for running a provider organization are also killing small practices. And provider organizations also consolidate in order to gain power for negotiating rates with commercial insurers.
- throwaway13337 5d agoThere's a pattern to the kinds of companies PE buys and I think it points to the real problem. They like companies with some kind of moat that makes it hard to unseat them. Basically, companies where there is no alternative for the consumer. That way, they can inflict abuse but know there will be nowhere to run. There are two different ways to achieve this. Monopoly and regulation. Hospitals have both government granted locational monopoly and tons of regulations that make it impossible to compete. Private equity is the symptom, not the disease. Until we get at the disease, new monsters will be born with different name filling the same ecological niche. It's economic natural selection played out in the environment we created.
- Waterluvian 5d agoThe Americans simply will not reject their broken for-profit medical system wholesale. What I see is one more attempt at chipping away at it in hopes that maybe they can succeed piecemeal.
- claytongulick 5d agoI'm not sure anyone has solved the problem, though. "For profit" isn't really the problem, fee for service is. Value based arrangements and capitated payment structures are real improvements. When you don't have any market forces constraining utilization, you get massive access problems.
- Gigachad 5d agoI don’t think it’s useful to categorise these things as “solved” or “not solved”. They always exist on a scale. I can tell you I am infinitely more happy living with the Australian medical system than what the US has even if it isn’t flawless with zero issues left to deal with.
- robmccoll 5d agoThe United States has both market forces and massive access problems. I'm not sure you can establish that causal relationship.
- mmooss 5d agoIf for-profit healthcare is allowed then it could be regulated like banking, with requirements to prevent failure (including requirements for financial health), and if there is failure, to ensure customers are protected and provide for continuity. Like banks, failure of a healthcare institution can be destructive for its customers and the community. If a bank goes under, especially a significant one for the community, regulators see that it's acquired by a surviving institution - often with only a weekend of downtime.
- balderdash 5d agoI feel like medical practices should be like law firms where effectively non-lawyers can’t own equity and equity owners have to comply with ethics and code of conduct rules…
- twoodfin 5d agoBecause lawyers are notoriously affordable and transparent in their pricing & quality? There’s a reason very few guild-like professions have survived to the present day.
- nradov 5d agoMost doctors don't want to be business owners. It used to be that they were kind of forced to operate in partnerships but now most choose to become employees. This might be worse for patients but for better or worse there's no going back.
- octoberfranklin 5d agoMost doctors don't want to be business owners. Then they should work for the doctors who do. Also, I don't think they're particularly opposed to owning their practice. I can understand them not wanting to manage a business. But for that problem, they can hire professional managers. Which is basically how hospitals work; if the doctors all want the CEO replaced, he gets fired. There's a physicians board and the trustees tend to listen to it.
- nradov 5d agoSo you're proposing to create a privileged class of investors with MD degrees who are protected from competition and will be able to earn above-market returns on their equity? Why would we want provider organizations to have a higher cost of capital? Makes no sense at all.
- balderdash 5d agoYes they will earn above market return on a lower capital base with medical shares in medical practice trading closer to book value - and the economics are the profit share not equity value of the firm. Earning $250k/yr on a $1m capital contribution requires a whole lot less rent seeking than earning the same $250k on a $5m share purchase.
- nargella 5d agoI did a small research project based on medical billing challenge data (https://medgis.te0.io/ https://medgis.te0.io/). I tried to correlate the data to PE firms (best effort). As far as I could tell they were just a volume player but not the worst. After talking to people in the industry, theres some real sleezy doctors out there. Some do appointments at hospitals even if not required so they can charge more. There’s more anecdotes. All the incentives are messed up and I’m not sure how to fix without policy changes.
- rrrrrrrrrrrryan 5d agoIt's actually worse with veterinary practices. Younger veterinarians are drowning in school debt and can't buy the practices from the older folks that are retiring. So, private equity is basically snatching all of them up right now, betting that childless millennials are going to pay tons of money on veterinary care when their pandemic pups begin to reach end-of-life. They're going to cut wages for all the staff, and hike all the prices, because unlike with human medical care, there's hardly any regulation (yet).
- beloch 5d agoUp here in Canada, we've seen vet clinics rapidly go corporate in the last couple of decades. Even ignoring prices, the degradation in the quality of care offered is stark. Vets working for corporate clinics are heavily micromanaged. They get less time per animal, are pressured into certain diagnoses and prescriptions, etc.. A lot of us now refuse to take our pets to clinics that aren't owned by the vets working there. Unfortunately, in many places there aren't a lot of options. To put humans through this kind of misaligned system is the stuff of nightmares.
- limagnolia 5d agoWhat is so costly about a veterinary practice that new veterinarians can't just start their own? Why would they need to buy one? There is certainly some benefit to working for some one for a while, and maybe eventually buying out an established practice... but if they want too much for it, just start your own?
- selectodude 5d agoDogs use the same x-ray machines that people do.
- randerson 5d agoIf you start your own veterinary practice, and eventually build up a steady stream of happy customers, then sooner or later the PE firms will come knocking on your door, too. Imagine you're drowning in student debt and worrying about keeping your business afloat, when someone offers you $5M, and says you'll still get to work with animals, which you love, while they take care of the financial and business side, which you didn't enjoy. It's a no brainer for most people.
- s1artibartfast 5d agoHow does it define PE?
- burnt-resistor 5d agoPE buys up hospitals to gut them, make them less capable, and cheaper to run. Then, they buy up air ambulance services to unnecessarily fly patients to other hospitals they own because it's more profitable at the expense of care delays and worse outcomes. Meanwhile, patients and their families are stuck with exorbitant air ambulance bills $20k-60k.
- stephen_cagle 5d agoMy main problem with PE is that it is being invested in by things that I do not consider "investors" like retirement funds, teacher's pensions, annuities, etc. Many of these things have sort of implicit guarantees from the State or Federal government. These organizations should be completely banned from investing in PE. PE investments should only be invested in by "investors", and investors understand that their investment may go to zero.
- aitchnyu 5d agoDon't pensions have to take on riskier investments because of increased life expectancy?
- Gustomaximus 5d agoI feel it would be good to bring in (or back) compulsory partnership structures for key professional businesses like GPs, dentists, pharmacies, vets and accountants. The PE buy-up of these core local businesses isn't great for society generally, service delivery and the existence of a middle class. The other thing I feel gov should do is force a separation of distributors and point of sale, with rules that allow smaller business to buy at the same pricing as larger. People seem to forget a key requirement of capitalism is for government to create a level playing field for business. I cant see a better way to do this, and I suspect it would be very beneficial to the bulk of society if gov made some changes down this line.
- Zeetah 5d agoAnother area private equity is taking advantage of is college housing. They have driven tents through the roof (the pun is an unintended bonus).
- s0kr8s 5d agoIf you want to look at how similar laws have played out in practice recently at the state level, look up 2026 CPOM (Corporate Practice of Medicine) laws in Oregon, California, and Washington or Massachusetts in 2025. Nice summary of the legal landscape here: https://www.dlapiper.com/en/insights/publications/2026/07/corporate-practice-of-medicine-enforcement https://www.dlapiper.com/en/insights/publications/2026/07/co...
- y-curious 5d agoKey word is “recently”: seems like every law from states outside of CA were enacted in 2026. It seems too early to tell if they’re successful
- carefree-bob 5d agoI'm not so sure limiting competition is the way to go here. One thing I hate about US healthcare is the lack of price transparency. They would rather shut an entire hospital down before giving you a price sheet. So when outfits like Walmart were looking to get into healthcare and offer basic services like blood tests, checkups, xrays, and common procedures available for flat fees and published prices, the reaction of the US healthcare community was that of a primal scream of terror, and they - specifically hospital groups -- have mobilized an army of lobbyists to try to prevent anyone else from competing. Hospitals are massive byzantine organizations with so many management layers and so many shady billing techniques, from charging for procedures not performed, to changing what they charge you based on when they find out how much you can pay, it's crazy. What other business forces you to sign a waiver agreeing to pay whatever they decide to charge you, without them telling you what that is, or they will refuse to serve you?
- octoberfranklin 5d agoI'm surprised that medical practices can be owned by anybody other than licensed physicians. In most states a law firm's owners must all be individuals licensed to practice law (i.e. lawyers). Why not the same thing for medicine?
- aurizon 5d agoThis has infested veterinary practices. Vet costs have increased 8-12% annually for 4-5 years now. The process approaches the vet saying their integrated back office system will save you local personnel and allow the vet to increase client service hours by wasting less on admin. Their system fractures a vet visit into service actions - each of which has a fee. They create a medication factory where a bottle of 100 tablets that cost $1 each becomes $5 a tablet, plus a dispensing fee. Over the past 6 years this has increased vet bills by 50-80%. Sadly, this brings people to abandon pets because they can not afford vet bills = death for the pet or a hard/short life as a stray. This private equity has also infested dentistry, which shows up as more dental bankruptcies as more people choose extraction over implants/root canals.
- tiffanyh 5d agoHow do you even define PE? Because there’s many shades of gray here, no?
- jchook 5d agoWarren was a 1980s Republican who did legal work on behalf of major corporations including Big Oil vultures. She stayed in the race for Super Tuesday in 2020 rather than consolidating the progressive vote for Sanders. Right before, her campaign accepted millions in funding from billionaires after promising not to. Her comment was roughly, as soon as others stop taking billionaire money, I will stop.
- deleted 5d ago[deleted]
- thelastgallon 5d agoPE has bought most of hvac, electrical, plumbing, daycare, dentist. They keep the same local well established name, but is run centrally by the PE firm. They employ smooth talking salesmen to convince homeowners to pay tens of thousands of dollars for simple things. The salesmen makes 150K+ commissions. The actual plumbers/hvac people make $20/hour. The HVAC salesmen convince unsuspecting homeowners to spend 30K - 70K on upgrades and warranties. They also get a percentage from the manufacturer, usually some shitty brand. They sell warranty/services package which is questionable.
- exabrial 5d agoThis is dumb. Just enforce the existing antitrust laws. Yeah sorry Apple Google, this is going to hurt
- marsven_422 5d ago[dead]
- Nifty3929 5d agoRemember that when private equity buys out a business, there is at least one major winner in that moment: the current owners who have been building up that business over years. One foreseeable consequence of this bill is that it reduces the ultimate value of starting and building your own practice, leading to more consolidation among existing large operators. As this is foreseeable, I also imagine that it's an unstated goal.
- basch 5d agoa business can be sold to a younger generation.
- deleted 5d ago[deleted]
- zephyrthenoble 5d agoI ask this honestly, do you work in private equity? I ask because, no one else would believe that private equity is anything other than a middle man to the exact outcome you are describing, with the detour of cutting jobs and benefits from the remaining employees while simultaneously trying to buy the company for we cheaply as possible from the owner, and selling it at as a price as possible. PE steals value from both ends.
- mahboi 5d agoYeah I saw this and thought, this is oddly specific, is there some publicly-traded company trying to buy up medical care for cheap?