[tptacek]

This is what I'm getting at in the sibling comment. Most people make decisions that in the aggregate cost lives. The causal connection and moral weight of taking a life through speeding (or, more likely, by helping create the permission structure for everybody else to speed by speeding yourself) is pretty clear. And I'm saying this as someone who drives at the prevailing rate, rather than the posted limit.

None of this is to say that PE firms squeezing vital hospitals aren't morally culpable. Just that there's a meaningful distinction between immoral decisionmaking and violence.

[potato3732842]

That's the "magic" that underpins all the perverse things modern western societies engage in.

Life is considered valuable in integer quantities but fractional life is considered value-less.

People are free to do, endorse, concoct and peddle all sorts of things that waste people's time (life) or waste people's money on the basis that it "saves lives" because it prevents lives from being lost in whole numbers but the sum total of the little fractions ad up to more.

[tptacek]

I just think we can express the idea that things are very bad without doing violence to the word violence.

[lkey]

Intentionally and artificially reducing the quality or quantity of life-saving resources to the point of excess death is, in fact, violence. I think you wouldn't have trouble recognizing the starvation campaign is Gaza as intentional violence.

Thus, I have no trouble asserting that PE firms commit intentional violence against patients.

Indirection allows you diffuse the responsibility into the anodyne 'immoral decisionmaking' while social murder remains as it ever was.

[tptacek]

Hurtling down the road in excess of the speed limit is also dangerous. Both actions have some probability of killing someone over a long enough time horizon. What's the threshold? Or are most people in cars also essentially murderers as well?

[lkey]

You misunderstand.

It isn't 'all the drivers' fractionally at fault (others can quibble about that), it's the people who create the moral hazard. The car industry and politicians that decided that the ungoverned car, the road, and the parking lot will be the only way to traverse Dallas or LA lo those many years ago, the ones that affirm that system with 'one more road' using tax dollars year after year, knowing that more people will die as a result. https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in... <- the line goes up.

They have a duty of care as representatives that they are failing to meet. Compare that to cities in Europe or the North East. When you make policies that serve the few and sacrifice the bodies of the many, that act is violence.

Likewise, with PE. When they intentionally understaff a hospital, no single doctor is responsible for killing the patient that died bleeding in the waiting room. It is the choice that we allowed that PE firm to make. Are you comfortable with a fresh MBA using excel to ensure that your local hospital should have four less doctors than strictly necessary to treat you in a timely manner? Society doesn't need to be organized this way, we can and should demand better.

Imagine the reverse, a municipality decides to privatize their water and sewage treatment, but puts no restrictions on the results as long at those wealthy enough are not inconvenienced. This is precisely how you get Flint. Or redlined cities that put the 'undesirables' in industrial waste parks. These acts are violence.

[tptacek]

This seems like a worldview calculated so that individuals almost never have any culpability --- even when speeding down the road, the responsibility for that harm is more properly attributed to corporations and politicians. From that vantage point, it's clear to me why one would see the decisions of a hospital-owning PE firm as "violent", while not seeing the decisions of a reckless driver that way.

[NoGravitas]

The term "social murder" has a long pedigree, and is really the term of art for this kind of concealed/indirect "violence". Mark Twain's quote about the two Reigns of Terror also applies, and is perhaps a little older.

[tptacek]

Right, and if you go from the actual definition of social murder, basically everybody in the G8 is a murderer, unless you artificially confine the analysis to your own county.

I'm sure the concept has a lot of utility philosophically, but when you try to distill it down to "PE firm owners are murderers" you wind up in pretty crazy places unless you supply a lot of motivated reasoning and special pleading.

[array_key_first]

There's infinite levels of badness and eventually it does reach a point, be it in risk, probability, magnitude, or impact, in which it is super bad, and we may consider it violence, or murder, or crimes against humanity, or what have you.

Everything is not everything else. Scale not only matters, it's almost the only thing that matters.

[tptacek]

If you can define that threshold, you don't need terms like "social murder" anymore.

[array_key_first]

Nobody can really because it's complicated. Or, at least, nobody can agree, which is why we have the terms. However, I think the terms have some validity, because the broader concept does.

I mean, is Hitler a murderer? Is your run of the mill burglary gone wrong worse than the Holocaust? Obviously not. So there has to be some kind of understanding of organized death.

[tptacek]

I'm not sure "at least it wasn't the Holocaust" is, in practice, quite the defense legal argument it's being made out to be here.

[rybosome]

I see your point, but I’m not sure that I agree.

Consider that when speeding, you might cause an accident. Such an accident would most likely impact a small number of people other than yourself.

When a PE firm engages in extractive hospital management, it provably increases mortality rate, and it does so at scale.

The first choice carries possible risks of lower magnitude, the second choice carries guaranteed risk of higher magnitude.

“Risky behavior” vs “ruthless greed”, the latter feels much closer to violence.