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Comment by klyrs | Hacker News Reader

> Private equity companies pool money from wealthy investors to buy their way into various industries, often slashing spending and seeking to flip businesses in three to seven years.

The focus of the article is on physicians vs. NPs and PAs, but the real driver of the enshittification is, yet again, private equity firms extracting short-term profits, to hell with long-term outcomes.

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We need to outlaw for profit anything with healthcare. The incentives are misaligned with society’s needs.

Why only healthcare specifically?

We’ve seen that having a profit motive is, to a point, generally good in many areas of commercial life.

Healthcare is not one of these areas.

Let's do the same for housing

I'm asking why the difference? Why is it good for society sometimes, and sometimes terribly wrong, in your view?

Inelastic demand is one oft cited trait.

Externalities of the absence of something can be small, large, positive or negative.

What do you think are the externalities of _not_ having healthcare available to majority of your population ?

You rephrased the question

Because there shouldn't be a variety of price points, and innovation should not be hoarded. Healthcare should be uniformly the best it can be.

Agree but the question is why specifically only healthcare

A lot of people are perfectly happy with private healthcare. I happen to be one of them. But I'm also not opposed to my tax money funding the county hospital either. We can have both.

Private is not the same thing as for profit. A non-profit is a private entity. They are not part of the public sector.

In fact, much healthcare was delivered like so pre-WW2. Still today, Kaiser and Cleveland Clinic are non-profit.

I'm happy with my private, for-profit healthcare. But I'm also glad to support public healthcare services with taxes. It's not just one or the other, we can have both of them.

Probably because you are generally healthy...

I will mention again for the fun of it, that private healthcare for profit works very fine in other places, like Switzerland for which I can vouch. There might be a lesson somewhere, maybe?

Sadly this probably means no covid vaccine and few advancements. It's easy to spread out what we have; it's hard to run an engine of care and innovation at the same time. Choose hard.

I appreciate that R&D funding requires investment, but that doesn't have much to do with hospital reimbursement rates -- especially when the alternative of a more European-style healthcare system comes along with a German company inventing one of the two Covid vaccines (https://en.wikipedia.org/wiki/BioNTech)..

"European-style" isn't so much of a thing. There are all sorts of models. BioNTech is a public listed for-profit company that partnered with Pfizer, a public listed for-profit company, to develop that vaccine.

There needs to be lots of profit in healthcare for anyone to do anything, or even to be in a position to do anything.

Of course there's a European style in contrast to the American style.. Single payer coverage governed by a government/quasi-government body with no profit taking and rates for drugs and care negotiated by the payer. Some have free point-of-service care, some have copayments, some have private insurance or supplemental insurance but the contours are the same.

There are dozens of huge pharma companies in Europe inventing life-saving drugs with plenty of profits to go around, this conceit that we need to price gouge Americans to pay for Research while the same firms spend more on marketing than R&D is just the dumbest thing.

European drugs are often funded by their profits from America.

Just a completely evidence-free claim that's repeated ad nauseam. The big European pharmas (along with the big US ones) are repurchasing shares on the order of tens of billions of dollars per year. If they're so reliant on excess profits to fund R&D, maybe they should have held onto those funds?

Go look at Pfizer revenue from US vs Europe. Europe has more people, but less than half the revenue in a typical year.

Americans are indeed subsidizing new drugs for the entire world.

Presenting Pfizer as if it's primarily serving the German market is silly. Pfizer by revenue is primarily in the US market.

https://www.statista.com/statistics/267877/revenues-of-pfize...

It's not evidence free. One of the things single payer does is negotiate discounts based on their whole country's population. That's going to fund ops and a bit of profit, not R&D.

> If they're so reliant on excess profits to fund R&D

R&D money comes from profits. It's not specific to the pharma industry. They just have particularly enormous R&D costs.

mRNA vaccine research was funded in large part by DARPA grants in the USA.

The overwhelming majority of hospitals are nonprofit.

The overwhelming majority of prisons are run by the state.

The overwhelming majority of higher education is nonprofit.

The Catcholic church circa 1500 was nominally nonprofit.

PE probably does turn everything to shit but acting like not having shareholders or owners who are looking to wring every cent out so they can get the fattest check will solve the problem seems naive at best.

I think the problem here is that "profit motive" is reduced to capitalism. For politicians profit is votes so under funding hospitals and prisons to spend in high profile pork projects (can even be tax cuts) is still profit motive. It's a rational choice if they think they can get more votes, more bang for their buck, by spending it elsewhere. This isn't traditionally seen as "profit motive", but really it is because it was done for the private benefit instead of over arching ethical deliberations or calculations for net good etc.

Non profit is a tax designation and that's it. Non profits, especially healthcare, still pay their execs and c suite multiple times *more* than physicians and staff, and cut corners and costs in many areas. Non profit status doesn't mean shit.

Having a non-majority of something doesn't make it "not true" or "not matter".

Why in the world would you include a statistic about the Catholic church in this conversation? Are you insinuating something? You can do better.

You really need to put more context around your last comment. It's confusing at best.

I'm not sure about that. Private health care is largely beneficial in countries with strong socialized health care. I'm definitely no expert on financial regulation, but I see the practice of "flipping" businesses as the real problem. Where I live, we've recently introduced a "house flipping tax" (which doesn't go far enough, in my opinion, but that's another conversation). A similar approach could be taken to private sales of businesses: if you buy and sell a company in a relatively short period of time, the gains (from the sale, from income, etc) should be taxed at a steeply elevated rate.

Yeah, private healthcare can always be a valid addition, but access to "strong socialized healthcare" should be a relatively good minimum floor — something many countries do not have.

All humans need health maintenance, it doesn't need to be a "can I afford it" value proposition. I know friends currently living without it because they can't, even with subsidized social options... this is endemic to the problem of "socializing" a private healthcare system, where $ comes first.

Absolutely. The US creates particularly perverse incentives. In countries with strong socialized healthcare, private offerings must be better than the public service to be worthwhile. In the US, private healthcare needs to be better than literally nothing when a big player buys up the competition.

Boy you people really love banning things don't you. Why on earth would you _outlaw_ people from being able to see their private, for-profit family doctor.

I’m not sure who “you people” are. Doesn’t feel like that’s adding much to the conversation, nor does it incline me to participate.

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