[alwaysrunning]

"After a hospital was acquired by private equity, admitted Medicare patients had a 25% increase in hospital-acquired complications, compared with patients admitted before acquisition. Patients also had 27% more falls and 38% more bloodstream infections caused by central lines, which are temporary surgically inserted ports that allow easy intravenous access for patients receiving repeated drug infusions or other treatments.

The increase was seen despite private equity hospitals' placing 16% fewer central lines than before the buyout."

I am not sure who the private equity firms are, but I thought it was alarming when insurers started purchasing hospitals, urgent care facilities and even your standard family med doc, as they would be negotiating with themselves on how much profit they could make off each appointment. But I didn't consider lower standards when it comes to patient care, this adds a whole different dimension.

[Voultapher]

You know, it's maybe a bad idea to privatize some things https://www.economist.com/by-invitation/2023/07/10/mathew-la... water in the U.K got more expensive and the service worse. A terrible deal for everyone but a handful of private equity investors.

[giantrobot]

No one wants to learn the lesson that while government administration of some things might be "inefficient", any efficiencies brought about by privatization will be turned into margins by the private entity rather than savings to the end customers. Private entities need to maintain margins and will cut service to maintain them.

[Frost1x]

Yea the argument that efficiency gains are passed to consumers is a tired old and often false argument. The only time efficiencies are passed to consumers are when there is real healthy competition and consumers are supporting that diversity. That's when in order to remain competitive, efficiency needs to be passed to the consumer.

Even in those situations it's not guaranteed. Markets seem to arise at or duplicate similar solutions and even if it's inefficient it's not worth he risk to find better alternatives for consumers because the competitive edge vs risk vs reward just isn't a winning mix worth pursing.

I'm increasingly convinced that most forms of free market systems work best once we have commoditization of a solution and it's just a matter of reproducing that solution, and doing so isn't too capital intensive. As you start to move away from these parameters, markets get more and more consumer hostile and self focused making the argument for them increasingly weak.

[rqtwteye]

There needs to be a focus on competitive markets instead of free markets. Competition is mostly good for customers but competition needs to be created by regulating the market to some degree. Otherwise markets will almost always be taken over slowly by the biggest players that don’t like competition.

[brayhite]

It’ll never happen in the US. Neither political party with power will break away from the corporate interests that determine what laws and regulations will pass.

The last candidate who ran on small donors and wore a proud badge of being anti-corporate interests lost twice. Politicians are figuring out how much money can be made by both acquiring legislative influence and power and accepting donations to steer their platforms, as well as passing legislation and policy that helps siphon public funds into private companies that said politicians have a financial stake in.

Changing private equity power requires benevolence, and there’s very little of that left amongst those with political power in the US.

[lelandfe]

Not to mention that the private companies will work to avoid said competition. Little wonder why ISPs refer to creating networks where one already exists as “overbuilding”

[lotsofpulp]

When I look around, there are multiple businesses usually near each other that compete. Home Depot and Lowes, Walmart and Target, Burger King and McDonald’s. ATT/Verizon/Tmobile.

But it is possible that if you pay to build out an entirely new network to a place where Comcast has a monopoly, and the customers would rather pay Comcast $5 less than whatever the lowest price you can charge is, then you would see negative returns by paying to build that network (since the cost of building out a network like that is so astronomical, and Comcast obviously does not have to pay it so their COGS is much lower).

[JumpCrisscross]

> most forms of free market systems work best once we have commoditization

It’s almost the opposite. Free markets didn’t work in the pre-industrial era because everything was commoditised. That made returns on capital paltry, which in turn made it more “profitable” to conquer capital than build it.

After industrialisation, we repeatedly saw innovation—though not necessarily creativity—in market economies outperform that in centralised ones.

[JumpCrisscross]

> Private entities need to maintain margins and will cut service to maintain them

This is a false dichotomy. Public v private is so often framed as a political agency versus free-market bonanza. In reality, we have independent agencies and public-private partnerships. But on the private side, we also co-operatives, a model which seems well-suited for community hospitals.

[Arn_Thor]

PPPs are often a mirage. As long as there's a private actor involved, some of the input (money) will be siphoned off as profits. That's the height of inefficiency. Where the alternative is a competent, responsive and accountable government, the government will allocate the resources more effectively, and all "inefficiency" goes into working people's pockets. This is not always practical, for example in situations where only private businesses have highly specialized knowledge, but for basic infrastructure the private sector offers nothing the government couldn't do just as well.

[phkahler]

Or how about just non-profit? Regardless of the options, private equity seems like the worst one and should probably be illegal.

Taking "profit" from keeping people "not dead" seems as close to extortion as you can get without actually being so.

[JumpCrisscross]

> how about just non-profit?

“If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction” [1].

> Taking "profit" from keeping people "not dead" seems as close to extortion

Modern medicine is expensive. For profit or not, expenses must be covered.

We’re better off incentivising people to become doctors and nurses and pharmaceutical researchers. The problem is all the nonsense being eaten up in administration, administration largely paid for by price obfuscation.

[1] https://www.hsph.harvard.edu/news/press-releases/hospitals-c...

[phkahler]

>> “If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction”

Fair enough. So let's just ban for-profit healthcare so we can stop being distracted by that whole thing.

[albert180]

Still you manage to waste 10% on Administrative Expenses and have the worst health outcomes in G7 but the highest expenses. Maybe learn a thing or two from northern Europe which has 100% public healthcare delivery

[giantrobot]

> Modern medicine is expensive. For profit or not, expenses must be covered.

There's a ton of bullshit that goes into "medical expenses" in the US. Not the least of which is the inability for people to pay for care and end up in the ER for urgent non-emergency services because ER services are required to be provided. Hospitals need to foot the costs of those people that literally can't pay. Those costs get amortized over every other service (plus plain old margin and gauging) increasing the overall costs.

Besides eliminating unpaid emergency service public health coverage would let people get regular medical care without plunging into debt so they'd go sooner before conditions become acute. Private insurance could even still exist, but as a premium add-on to statutory coverage.

More doctors and nurses is just supply side economics applied to healthcare. Those jobs will appear naturally with the entire population completely covered. Rural hospitals could even open back up since they'd be serving people with actual coverage.

[klipt]

Water is a monopoly right? Seems obvious that privatizing a monopoly doesn't help, because there's no competition incentive to keep prices down and service up.

[albert180]

Hospitals are a monopoly too, when you have an emergency and need care now, you can't compare prices or get quotes for the care, as you don't know even what you will need

[aeternum]

This is not well-known but the vast majority of hospital visits are non-emergency.

People used to have choice but now due to 1950s tax code, your employer chooses a health conglomerate which chooses an insurance company which influences the billing allowances which influences the hospital profitability which is now so complicated that often only PE firms are willing to take the investment risk.

The incentives and market feedback is now so distorted that there is little to no signal. Healthcare in the US is often used as an example of failed free markets, but it is very far from a free market.

[albert180]

It's still one of the most deregulated, most bloated and inefficient systems in the whole world, delivering the worst health outcomes across the G7-States. Everywhere else in the world tight-controlled and regulated Healthcaresystems deliver far better quality. It's one of the cases where you need a regulated market, not a free one

[aeternum]

Does it actually provide worse health outcomes?

American lifestyles especially in certain states are generally not conducive to good outcomes but the US healthcare system itself is still generally world-renowned for cutting edge procedures.

Analyzing from a cost POV it's quite bad, but in many ways healthcare is the ultimate marginal good so people are willing to spend what they have.

[AnotherGoodName]

I sometimes think the "anti-government run anything" mantra is just people who are easily swayed by propaganda reciting a line. It's easy to take singular examples of government failure and write articles claiming that everything must be owned by private equity because government is dysfunctional.

But do you know what? I used to pay 1/4 the price for electricity when i lived in an area with a local county run power company compared to my new nearby location that has PG&E as the only option. As in government run utilities were literally 1/4 the price per kwh and yet i'm supposed to buy into this "GOVERNMENT IS INEFFICIENT LOL COMMUNISM" propaganda that just doesn't appear true in the slightest. I mean this is consistent across the board.

I know the baby boomer generation were vulnerable to this anti-socialism propaganda but can we please start looking at things objectively and push back against this privatization that is almost always a way for politicians to enrich themselves. Sigh.

[jaybrendansmith]

My township recently sold my local sewer line to a private company, after privatizing my water line to the same company. Interestingly, there was a major scandal a few years ago where the private company had allowed grey water to mix with the fresh water running to everybody's tap, and a few people got sick. There seemed to be a major public outcry but the company did not pay a price for the error, and were rewarded with the sewer business. As someone who maintains a SaaS business, this seemed unforgivable to me, the equivalent of my company failing in their one job, to keep the servers online. At the same time, my water bill has just about doubled, and my sewer bill has now gone to be around three times. I now pay 4.5 times what I did at my old residence with public utilities, for the exact same service. Is everybody on the take?

[Gibbon1]

I think the anti-government everything must be privatized thing is pushed because it's an opportunity to divert large flows of money into wealthy peoples pockets. The head of a publicly run company might make as much as a sr tech bro. The head of a privatized one can divert tens of millions a year.

Same as attempts to privatize social security. You got a cash flow of $1.4T/year and it drives the lords of capital bonkers they can't get their hands on it.

[kriops]

Game show idea: Is it a malfunctioning market, or just regulatory capture?

[skfingngihg]

The government is less efficient at serving its stake holders than for-profit corporations.

The government creates the conditions for PGE to be so bad. I’m defecting from the grid this year, PGE’s high prices mean my s system will pay for itself in less than a year and will likely be more reliable.

battery and solar companies saved me from PGE and they can save you. The government perhaps can but likely won’t. Extrapolate for yourself what this means about the world and what organizations should command the most resources.

[cool_dude85]

The government told PG&E not to fix its broken ass infrastructure and cause a catastrophic fire? I think if you examine the historical record, you will find that the opposite occurred. The government told PG&E not to have 100-year-old infrastructure in fire prone areas, and PG&E decided to send dividends to its hedge fund owners instead of doing so.

[figassis]

Seems a bit passive no? The government has a job, but your way of handling it is the opposite of holding it accountable. Government is made of people and they will be as inefficient as allowed to be.

[rqtwteye]

Seems it’s the perfect target for investors. Competition is for suckers.

[Sharlin]

Oh, but it does help. Just not the general population.

[Fomite]

One of the big problems is that infection control and antibiotic stewardship don't have billable procedures most of the time, and are thus viewed as cost centers by hospital leadership.

[ublomate]

And therein lies the most significant problem with unbounded capitalism. Capitalism is a very, very powerful tool, because it redefines everything in terms of money. This enables the magic of specialization and trade, but it also causes situations like this where greedy and/or thoughtless people chip away at the margins of things like safety and let other people suffer the consequences.

[JumpCrisscross]

> Capitalism is a very, very powerful tool, because it redefines everything in terms of money

Well, in terms of capital. For the segments of the economy we put into the market. Also, this is more a feature of industrialisation than capitalism—socialist economies still consider resource allocation in generalisable terms.

[amelius]

> Capitalism is a very, very powerful tool, because it redefines everything in terms of money.

But only when it is convenient. For example school teachers or police officers can work their brains out but cannot profit from it like entrepreneurs do. For many people unbounded capitalism is a very shitty proposition.

[saulpw]

Teachers and police officers don't benefit by definition because they do not have capital. Capitalism benefits the people who start private schools and private jails. Capitalists take advantage of labor in order to increase their own profits.

[rootusrootus]

> I thought it was alarming when insurers started purchasing hospitals, urgent care facilities and even your standard family med doc

I am skeptical of that conclusion. Kaiser Permanente gets good results, and they are an HMO: the very definition of an insurer owning the hospital/urgent care/family doc.

[chiefalchemist]

> After a hospital

*A* hospital. Single. I'm certainly not going to defend private equity. But if we're going to do a takedown, let's do it correctly. Cherry picking what is likely an outlier is not doing it correctly.

[arcaen]

Not sure where you got the idea that the study was only of a singular hospital, seeing as the study outline details claims for 600k hospitalizations in 51 private-equity hospitals are compared to 4m comparable hospitalizations in 259 non-private-equity hospitals.

[chiefalchemist]

Where? I'm talking directly about the paragraph sighted. FFS I even quoted it. Those stats are for A hospital. It says it right there...A.

Y'all read those stats to be for all. Instead it was one extreme outlier and y'all's biases fell for it.

This is why we can't have nice things. Too much assuming, not enough intentional "listening".

[arcaen]

Why are you trying to suggest that the 25% increase in hospital acquired complications are limited to a single outlier? The conclusion of the study states that the outcomes across those 51 private-equity acquired hospitals result in a 25.4% increase in hospital acquired complications.

So if the generalized hospital is an outlier, then why are the stats quoted matching the overall average results from the study?

Based on the context of the linked study, it's quite clear that the above quoted paragraph has the following meaning:

"After a [randomly selected] hospital [of the 51 sampled private equity acquired hospitals] was acquired by private equity, admitted Medicare patients had [on average, based on evalutation of those 51 PE acquired hospitals against 259 non PE aquired hospitals,] a 25% increase in hospital-acquired complications, compared with patients admitted before acquisition..."

The purpose of the article is to summarize the study findings. If they were talking about an outlier, they would mention that and use phrasing like "After THE hospital..." where "the" reiterates that it's a specific singular, and not a generalized sample.

Here's the direct text from the linked study as well that medicalxpress paraphrased/reworded: "After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004)."

It seems like you're hung up on medicalxpress's choice of wording for their paraphrasing, which is fine, but 25.4% increase in hospital acquired conditions is NOT an outlier amongst the 51 sampled PE acquired hospitals.

[chiefalchemist]

I'm not trying to say anything. I'm simply reading the article and stating the obvious: a cherry picking tactic that sensationalizes an important issue is bull shit.

- It has not place in journalism.

- It has no place on HN.

It's a distraction. We're wasting time debating the merits of a turd, and it is a turd. If we're going to do better than we need to expect better. The study might be sound. The article as present is shite.

[ecounysis]

The writing of the article was not as precise as it needed to be (I assume for the sake of saving space and words). It was a summary given in lay terms to an audience that could dig deeper into the source research results if they needed further clarification.

"After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals. ... This increase in hospital-acquired conditions was driven by a 27.3% increase in falls and a 37.7% increase in central line–associated bloodstream infections at private equity hospitals, despite placing 16.2% fewer central lines."

https://jamanetwork.com/journals/jama/fullarticle/2813379

[chiefalchemist]

Some things never change. So typical of HN. A comment lacking in critical thinking is added. The punters jump on to further the false narrative. And...the correction to that misguided affair is down voted. Y'all are funny. Ignorant, but funny.

[orwin]

Sorry, I avoid saying that on HN, but if you read the article and not just skimmed through it, you could have clicked on the link to the study here:

https://jamanetwork.com/journals/jama/fullarticle/2813379?gu...

And discover why your comment was downvoted. I apologize I did not leave a comment to explain why I was down voting, I just did not want to say 'look, this person can't read', it's tacky (sorry for still doing it btw)

[chiefalchemist]

The *pulled quote* says "A hospital" (read: cherry picked) and then uses that outlier to sway the assuming and the naive.

If I wanted to speak to the whole study I would have. However, the paragraph pulled specifically says "*a* hospital*.

Now who did the skimming?? FFS