Bill to Ban Private Equity from Owning Medical Practices (truthout.org)

I can tell you I am infinitely more happy living with the Australian medical system than what the US has even if it isn’t flawless with zero issues left to deal with.

How much would you want to sacrifice your 20s and early 30s? How much would you need to work in the middle of nowhere where your kids won’t have the best opportunities?

Why stop at healthcare? Why not other essentials of life, like food or toilet paper?

Do you realize that when Walmart moves into a community, prices charged for everyday things overall drop significantly, both at Walmart and their competition, which means that poor families are able to buy more with every dollar.

What do you have against poor people?

You don't need to disallow them for necessary care to be provided. You can just have public healthcare programs. That can look like publicly-owned hospitals or regulation that private hospitals must provide certain services under certain conditions if they want to keep operating. Private healthcare then works to provide more than that basic service that fulfills necessary care, to the benefit of the public that can afford more.

Unpopular knowledge is that these businesses are generally illegal in their current forms under existing US law. The relevant laws are still in effect, they are just rarely enforced. The scale of the lawbreaking runs to the trillions of dollars annually, and it directly harms every US consumer.

The illegal conduct is so pervasive that even explaining the existing federal law makes one sound ridiculous, because companies have been explicitly advertising illegal behavior for decades. Because there is no sanction.

One of my faves is the notion that $BIG_RETAILER can buy in bulk and get better pricing, which they pass on to the consumer. You may have seen a company advertise something like this. It sounds like smart business! There is an active federal law[1] that explicitly prohibits this arrangement.

Lack of enforcement of that law is a factor in the disappearance of the American "high street" and the demise of many small retailers.

My #1 call for reform in the US is to simply start enforcing laws, even if doing so makes rich people/companies uncomfortable.

1 - https://en.wikipedia.org/wiki/Robinson–Patman_Act

I'd expand that to any type of business that has effectively inelastic demand through the ability to hold people emotionally hostage.

So, for example, in addition to hospitals also include veterinarians, funeral services, family planning, etc.

Soulless PE vultures should be barred from all of this.

Streamlining everything. Sometimes this is done in a bad faith way, but it’s often not difficult to do it in a good faith way.

Some simple examples:

- right-sizing staff (can be reducing, increasing, or changing roles)

- improving marketing (e.g., simple things like customer reactivation, packaging the product/service better, or just plain, ol’ getting the word out better via stuff like before/after pics or success stories)

- improving operations (e.g., better organization, better processes, better communication, better training, better logistics, etc.)

> Delivering better profit margins?

Improved profit margins are a byproduct of the things listed above.

It's a steelman argument to be clear I'm not entirely convinced by it.

Contrary to popular belief, being intelligent in one thing does correlate with being intelligent at other things[1]. For doctors, the comparison with private equity (MBAs?) might be close, but it's not hard to imagine the targets of other PE rollups have owners that are more average in intelligence, think plumbing or roofing.

[1] https://en.wikipedia.org/wiki/G_factor_(psychometrics)

Seems like you could build a hallway around the trailer; if you do it right, nobody knows it's a trailer in the middle of the building. If you do it really well, you can still pull the trailer out.

Most private practices are small groups, not individuals. It absolutely sucks to have to find a new doctor who’s a good fit for you, when you’ve been seeing the same person for years or even decades. Usually when your doctor retires you rely on them to make a recommendation for a replacement. Usually that’s another partner in their same practice. At the very least, you (historically) expect them to sell the practice to someone they think is a worthy successor. Patients are fairly sticky.

And many of these PE sales require the selling partner to stay on for at least a year or two to ease the patients through the transition and so the patients get used to the changes before the doctor actually retires. That way, sticking around after the doctor retires doesn’t feel like such an upheaval.

One is ambitious, the other is a nepo baby.

Disallow eyeglasses. Abolish money.

Any other good ideas?

In your model, the only possible business owners would be those with major capital resources to begin with, encouraging the spread of existing businesses into a sprawl: Walmart is now your doctor, pharmacist, and pharma manufacturer. Nobody would start a small business because they'd have to carry all liability, any new ideas are limited to spread at a glacially slow pace, because companies can't be aquired or acqui-hired, but can instead only scale on their own revenues.

Sure, you are allowed to start a new business. But where would you get money? You can't sell your dung transport business, and you don't have enough money of your own to just start a new business from scratch.

You wouldn't have any business if all, or many, of your patients die.

The west has been an oligarchy for several decades at least, so it's not that people in the west don't believe in social stability, it's that they are living in the hollowed out shell of the former "company" where that doesn't exist. We need to optimize for the people's prosperity and well being.

> The steelman argument is that private equity is just property rights. If I build a business I get to decide what to do with it.

A) can probably only be fixed with regulation. Why would hospitals and insurance otherwise make prices transparent? The current state serves them really well.

You think the government tells hospitals to lie to you? The hospitals lie because the government doesn't force them not to. Laissez-faire capitalism causes that. Regulation is needed to fix it.

VC's can still fund companies that are making expensive new products.

Banks (and PE...) can still underwrite loans for these things.

We have many solutions for capex-intensive businesses and have had these for over four hundred years. LBO-type PE is not even fifty years old yet