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Comment by Rinzler89 | Hacker News Reader

How did the government allow for healthcare to merge into a monopoly? They didn't allow Nvidia to buy ARM but they allow this?

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The line we (Johnson City) were sold is that these hospitals would have gone out of business if they didn't consolidate.

I think part of it is that insurance companies gouge hospitals too. They are an even bigger monopoly with a lot of leverage against any ordinary city hospital.

I (Bristol) know a couple Ballad doctors and admins, and that was absolutely the case.

>Hospital

>Business

We're supposed to be a developed country.

Hospitals are businesses in developed countries too. Here in Japan, the hospitals and clinics are all private businesses, but the prices are very low, ambulance rides are free, etc. The keys, as far as I can tell, are 1) no consolidation/monopolization and 2) lots of regulation.

Hospitals are also businesses too in Europe. It's the regulations around the system that make the difference.

We were. Then a few decades of legislative capture, private equity, and neoliberal gibberish about "service economies" drained all of the opportunity out of rural and semi-rural America, consolidating what was left in major metro areas.

It's very hard to make money as a small, independent hospital with all the healthcare bureaucracy and other requirements. The only way to turn a profit is to merge with other hospital systems and get bigger.

This trend applies to many industries in the US besides healthcare. Agriculture and education, for example.

Thanks for doing what you do, and for your simultaneously grounded and innovative perspective.

Because these are very localized to a certain geographic area?

No, because they were permitted to violate the law by legislators.

> In the six years since lawmakers in both states waived anti-monopoly laws...

> Ballad Health was formed in 2018 after state officials approved the nation’s biggest hospital merger based on a so-called Certificate of Public Advantage, or COPA, agreement. COPAs have been used in about 10 hospital mergers over the past three decades, but none has involved as many hospitals as Ballad’s.

> State lawmakers in Tennessee and Virginia waived federal anti-monopoly laws so rival hospital systems — Mountain States Health Alliance and Wellmont Health System — could merge into a single company with no competition. Ballad is now the only option for hospital care for most of about 1.1 million residents in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina.

I'm sure it'll be different this time, though

The government even enforces a monopoly or duopoly in hospital healthcare:

https://www.investopedia.com/terms/c/certificate-of-need.asp

The government treats them sort of like a utility.

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