Zack is on mastodon.cloudNov 16, 2022
Cory Doctorow

It's not just you. US healthcare, already a bureaucratic nightmare of buck-passing and price-gouging, has gotten *far* worse. Private equity firms have created regional health-care monopolies that don't just rip patients off - they're *killing* us.

Private equity is a scam. Fund managers raise gigantic sums by claiming to be able to "beat the market." In reality, they do worse for their investors than a boring old index fund:

https://pluralistic.net/2020/02/25/pluralistic-your-daily-link-dose-25-feb-2020/#extraordinaryclaims

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Pluralistic, your daily link-dose: 25 Feb 2020 – Pluralistic: Daily links from Cory Doctorow

Nov 16, 2022 at 8:11pmWeb
Show threadCory DoctorowNov 16, 2022

The fund managers don't have to beat the market in order to make bank. They can take advantage of the "carried interest" loophole, which has nothing to do with interest rates - it's a tax system that was invented for 16th century sea-captains (no, really):

https://pluralistic.net/2021/04/29/writers-must-be-paid/#carried-interest

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Pluralistic: 29 Apr 2021 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

PE dresses up its playbook in all kinds of bullshit, but it's a smokescreen. At core, PE funds buy companies, merge them to monopoly, slash wages, fire staff, load up their businesses with debt, and then skedaddle before the businesses collapse. They call this "creating value":

https://pluralistic.net/2020/07/24/software-is-cake-too/#looters

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Pluralistic: 24 Jul 2020 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

This playbook guarantees that everything PE touches will turn to shit. PE is a parasite that preys on weak industries and makes them even more dysfunctional. Think of how PE has cornered regional rental housing markets and then turned every rental in town into a slum:

https://pluralistic.net/2022/02/08/wall-street-landlords/#the-new-slumlords

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Pluralistic: 08 Feb 2022 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

Most of us didn't really think about rail-freight until last winter, when the whole system nearly collapsed. Again, the bloody handprints of PE are all over that crisis:

https://pluralistic.net/2022/02/04/up-your-nose/#rail-barons

The pandemic put a lot of businesses into a precarious state, and PE swooped in, buying up distressed businesses at scale and putting them into a death-spiral:

https://pluralistic.net/2020/03/30/medtronic-stole-your-ventilator/#blackstone-kkr

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Pluralistic: 04 Feb 2022 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

This acquisition was fueled by Trump's corporate covid bailout and the trillions in public money that the GOP made available to corporate borrowers (remember, PE thrives on debt):

https://pluralistic.net/2020/09/17/divi-recaps/#graebers-ghost

Of all the sick industries in America, healthcare is the sickest, and it's the domain where PE has done the most damage. PE stripped healthcare systems to the bone, removing all excess capacity and exhausting and demoralizing healthcare workers:

https://pluralistic.net/2020/05/21/profitable-butchers/#looted

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Pluralistic: 17 Sep 2020 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

They bought up emergency rooms, turned them into scam factories that hit every unfortunate person who stepped foot in them with thousands in "surprise billing" fees. Then they cut doctors' pay and spent millions on ads to block anti-surprise billing legislation:

https://pluralistic.net/2020/04/21/all-in-it-together/#doctor-patient-unity

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Pluralistic: 21 Apr 2020 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

The ER scam was and is wild. Some hospitals lock all their doors except for the ER doors, and then they'd hit you for "emergency care" when you went through the ER on your way to receiving normal, non-emergency procedures:

https://pluralistic.net/2022/03/14/unhealthy-finances/#steins-law

The damage wasn't limited to emergency rooms. Whole hospitals - whole hospital *systems* - were crashed by PE looters, and many of these got emergency government bailouts, because...free market?

https://pluralistic.net/2020/10/01/the-years-of-repair/#mass-murder

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Pluralistic: 14 Mar 2022 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

PE has bought its way into every corner of the health-care system, and made every bad thing, much, much worse. You know how "bad nursing home" are three of the scariest words in the English language? Try on "bad private equity owned nursing home" for size. The death toll is *massive*:

https://pluralistic.net/2021/02/23/acceptable-losses/#disposable-olds

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Pluralistic: 23 Feb 2021 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

Biden's SEC chair Gary Gensler has made the most decisive anti-PE moves in decades, requiring disclosures that will help investors (especially union pension funds) pierce the veil of bullshit that brings in the billions that PE fashions into weapons of financial mass destruction:

https://pluralistic.net/2022/02/10/monopoly-begets-monopoly/#gary-gensler

But the wheels of justice grind slow, and PE has trillions to fuel its race to suck every bit of value out of the health-care system before the party comes to an end.

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Pluralistic: 10 Feb 2022 – Pluralistic: Daily links from Cory Doctorow

Show threadCory DoctorowNov 16, 2022

In "Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties," *Kaiser Health News*'s Fred Schulte reveals the plan of attack:

https://khn.org/news/article/private-equity-takeover-health-care-cities-specialties/

In 2021, PE firms bought 1,400 health care companies, spending $206b (the total since 2012 is more than $1t). They've cornered regional markets for eye care, dental care, family practices, hospices, and pet care. We've had a year to see how that played out, and it's not pretty.

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Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties

Private equity firms have shelled out almost $1 trillion to acquire nearly 8,000 health care businesses, in deals almost always hidden from federal regulators. The result: higher prices, lawsuits, …

Kaiser Health News
Show threadCory DoctorowNov 16, 2022

Since 2014, PE have paid out $500m in fines for falsifying billings to the US government, but a fine is a price, and the fines have been absorbed into PE's business plans as part of the cost of operations.

Once a PE firm buys up all the specialists in a region, things get very bad. Take San Antonio, where nearly all the gastroenterology clinics have been bought up by PE firms, and where routine colonoscopies now cost patients thousands more than they paid before:

https://khn.org/news/article/private-equity-gastroenterologist-colonoscopy/

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Betting on ‘Golden Age’ of Colonoscopies, Private Equity Invests in Gastro Docs

An aging population in need of regular cancer screenings has driven private equity companies, seeking profits, to invest in many gastroenterology practices and set up aggressive billing practices. …

Kaiser Health News
Show threadCory DoctorowNov 16, 2022

While there are plenty of illegal ways that PE companies extract value from their acquisitions, the legal tactics are pretty ugly all on their own, like cutting staff and replacing them with less skilled, less trained, cheaper workers, putting patients at risk.

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Show threadCory DoctorowNov 16, 2022

This is particularly worrying when you consider how heavily PE companies invest in practices to treat people who are vulnerable and struggle to advocate for themselves, such as behavioral health specialists who treat autism, addiction and mental illness.

Whether or not you can escape PE depends a lot on where you live. PE only owns 12% of the nation's anesthesiology practices, but those practices are concentrated in five states, where more than two thirds of anesthesiologists are PE owned.

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Show threadCory DoctorowNov 16, 2022

When PE takes over your care, billings go way up. The average PE-treated patient generates $71 more per claim, and is 9% more likely to experience "lengthy, more costly" care:

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2795946

Doctors who sell their practices to PE companies are lured in with promises of administrative relief from experts who'll handle billing, scheduling and compliance. But PE firms exercise fine-grained control over these doctors, violating rules that say medical practices must be run by MDs.

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Private Equity Acquisition of Physician Practices and Health Care Spending and Utilization

This difference-in-differences study of private equity acquisition of physician practices examines changes in prices and utilization associated with acquisition.

Show threadCory DoctorowNov 16, 2022

Take National Spine, a PE-backed chain owned by Sentinel Capital Partners that bought up 40+ pain-management clinics across the country. Doctors saw their caseload explode from 16 patients/day to 25. Medicare billings also exploded, with "unnecessary and often worthless" back braces being charged at up to $1,100 each. Patients were given $1,800 "medically unnecessary and often worthless" urine tests. National settled these claims for $3.3m in April 2019, without admitting guilt.

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Show threadCory DoctorowNov 16, 2022

RLH Equity Partners's pharmacies bilked the military health insurer Tricare out of $68m through a system of kickbacks and telemarketer sales. RLH settled the case for $21m and blamed it on a few corrupt "individuals."

Most of the time, fraud claims are settled by the companies that the PE funds owe, while the PE funds themselves get off scot-free. That leaves the funds free to re-offend, and to further push the limits on patient endangerment.

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Show threadCory DoctorowNov 16, 2022

One of the grisliest parts of this tale is in the realm of children's dentistry. PE firms have bought up these practices and turned them into high-volume Medicare-fraud assembly lines that perform rushed, unnecessary major procedures on poor kids and bill the government a fortune for them.

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Show threadCory DoctorowNov 16, 2022

These include baby root canals and crowns, and the PE-backed dental chains set quotas for their staff, requiring them to perform a certain number of major procedures on each patient. One particularly horrifying case recounted by the KHN article is that of two-year old Zion Gastelum, who died following major dental surgery.

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Show threadCory DoctorowNov 16, 2022

Gastelum received six root canals and crowns on his baby teeth at a PE-owned Kool Smiles clinic in Yuma, AZ. The oxygen bottle used during his surgery "was empty or not operating properly" and the staff who oversaw the procedure were undertrained and didn't notice. He never regained consciousness, and died of brain injuries days later.

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Show threadCory DoctorowNov 16, 2022

Kool Smiles's owners paid $24m to settle a DoJ overbilling claim less than a month later. The settlement alleged that Kool Smiles performed unnecessary procedures, including baby root canals. Kool Smiles denied that they were responsible for Gastelum's death.

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Show threadLewis EdwardsNov 16, 2022
@pluralistic My parents took me to a civilian dentist with our military insurance. Next thing I knew, I had fillings in all of my molars. Didn't go to a dentist for over ten years after that.
Show threadmharrNov 16, 2022
@pluralistic Could this sort of thing maybe be a single thread? :/
Show threadCory DoctorowNov 16, 2022
@mharr it is. See my bio.
Show threadmharrNov 16, 2022
@pluralistic Hmm. There's gotta be a way to have Mastodon just show page one on the timeline. Looking into that.
Show threadStuart BrozNov 16, 2022
@mharr @pluralistic
I believe you can set the first post to a global audience and make the rest unlisted. Anyone can see unlisted posts as comments (or if linked directly), but they don't display in the timeline.
Show threadmharrNov 16, 2022
@zorbtrauts @pluralistic That would be something the original poster needs to do, aye? By all accounts this is a general problem on timelines with science & tech news feeds, so I think it needs a universal fix that subscribers can apply. As-is this can't be great for audience numbers.
Show threadCory DoctorowNov 17, 2022
@zorbtrauts @mharr you have misunderstood how hidden posts work. Posts are only hidden for non followers on the same instance. If you don't like my posting style, my bio explains how to get my essays elsewhere and you can unfollow me here.
Show threadmharrNov 16, 2022

@pluralistic Well, I found a stupid brute force option that works for now: Set individual filters for 2/ 3/ 4/ etc.

Quite amused that searching for generalized solutions to this immediately brings up your name in various forums :P

Show threadKevin DalleyNov 16, 2022
@pluralistic
I think of rail freight when I'm on a passenger train, delayed for hours by freight trains, in violation of the law guaranteeing priority to passenger trains
Show threadTioNov 16, 2022
@pluralistic Cory I wish you moved from Mastodon to Friendica and make long nice posts rather than so many little ones 😀 - you are always welcomed to our instance at social.trom.tf . For me it is so difficult to read the so many posts. I know I can go on your website, and I do, but just saying, could be far better for all on the fediverse. Inline media, stylize text, long posts, add to categories, etc..
TROM Social | Home

Show threadCory DoctorowNov 17, 2022
@tio please see my bio for ways to read my daily essays off mastodon if you don't like my posting style here
Show threadTioNov 17, 2022
@pluralistic Yes thanks Cory, I know.

But I was suggesting an alternative that could be a lot better for the fediverse overall.
Show threadCory DoctorowNov 17, 2022
@tio I use this instance because it is run by a well regarded digital human rights group with a history of resisting surveillance and censorship demands. That is far more important than character limits to me.
Show threadTioNov 17, 2022
@pluralistic I understand. Fair enough. I would say our project and our instance is "resisting surveillance and censorship demands" as well, quite to the extreme perhaps because I want for people to have a voice and I would not easily accept the removal of accounts if asked by 3rd parties.
Show threadEleanor SaittaNov 16, 2022
@pluralistic
Hey, you should update your syndication feed so you're posting this on mastodon-sized chunks instead of twitter-sized ones, at least
Show threadEleanor SaittaNov 16, 2022
@pluralistic
Show threadCory DoctorowNov 17, 2022
@dymaxion I edit and post every stanza by hand for masto.
Show threadEleanor SaittaNov 17, 2022
@pluralistic
Oh, huh — they seemed short. Carry on then! :-)