Your Money and Your Life: Private Equity Blasts Ethical Boundaries of American Medicine

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Yves here. We’ve covered the pathbreaking work of Eileen Appelbaum and Rosemary Batt on how private equity acquisitions of outsourced hospital and outpatient center staffing, along with buyups in related areas like ambulance services, veterinary products and pet supplies, have led to price increases and deterioration of care. Political scientist Laura Katz Olson builds on and extends their work in her recent book, Ethically Challenged: Private Equity Storms US Health Care. The article below makes for a good introduction for friends and family members who may be new to this topic.

By Lynn Parramore, Senior Research Analyst at the Institute for New Economic Thinking. Originally published at the Institute for New Economic Thinking website

Newsflash: Private equity firms– the most rapacious entities ever spawned by Wall Street — want your body.

They’re already in your urinary tract and your fallopian tubes. In your dentist’s chair and your dermatologist’s office. Unbeknownst to you, these financiers track you from cradle to grave, lining their pockets through everything from fertility treatments to hospice care, all the while decimating the quality of services you receive and jacking up prices.

Kids, the elderly, and the poor are especially tasty targets in their break-neck hunt for profits. They’re even coming for your pets.

In her harrowing new book, Ethically Challenged: Private Equity Storms US Health Care, political scientist Laura Katz Olson documents how private equity firms are reshaping health care in the U.S., circling in to buy dentist offices, mental health facilities, autism treatment centers, rehab facilities, physician staffing services, and myriad other providers, forcing them into bare-bones, bottom-lined focused “care”.

Once upon a time, it was stores like Toys ‘R Us that learned what happens when billionaire-run PE firms fix companies in their sights. Now, the harm they do is about more than bankruptcies and lost jobs. It’s a matter of life and death.

In a nutshell, PE seeks to invest or acquire equity ownership in companies and flip them fast for a higher price. They’ll get that higher price by any means necessary – chopping staff, cutting corners, and loading the company with debt along the way. The idea is to buy, squeeze, dump, repeat. Private equity is now a major player in the health care sector, with investments accelerated in recent years at a mind-blowing pace ($100 billion in capital invested in 2018 alone).

So how do these motives and operations line up with health care? Let’s see … how would you like to send your loved one to a rehab facility where successful treatment would be considered a failure because they want the patient to come back?

As Olson documents, that’s how perverse things get. She notes that in order to gin up business, PE firms taking over rehab centers will resort to a tactic known as “body brokering” – having companies pay intermediaries to lure patients in by trolling on social media, hanging out at 12-step meetings, and spinning fancy marketing campaigns. If the (often unscientific) treatments don’t work, score one for private equity! Owners aren’t liable for ineffective treatments, Olson points out, “so when patients relapse they can charge them another round.” Meanwhile, they abuse eligibility for federal payments, soaking up taxpayer funds meant to fight human tragedies like the opioid scourge.

Some of the worst players in this frightening game of human health roulette have likely already set up shop in your town. Bain Capital (hi, Mitt Romney!) swoops in on renal care, home health care, substance abuse, emergency medical transport, and hospitals. The Carlyle Group goes for dentistry, home health care, hospice, and eating disorders. KKR, one of the biggest players in the health care industry, targets physician staffing, emergency medical transport, dentistry, home health care, substance abuse, autism disorders, health information, and hospitals.

As usual, it all goes back to the 1980s, when financialization took hold of the American economy. Olson observes that private equity has been growing ever since, boosted by lax regulation and preferential tax treatment. Politicians and regulators grease the wheels of the gravy train in hopes of hopping aboard the minute they leave office. Private equity often gushes campaign contributions, and both parties enjoy the largesse. Never mind that PE bilks taxpayers through Medicare and Medicaid, making medical bills more burdensome and patients sicker.

“PE firms take over businesses using other people’s money; plunder what they can, and spit out the remains,” writes Olson. And sadly, it’s public pensions that feed the hungry beast. She notes that pension funds, along with endowments and wealthy individuals, finance the largest percentage of PE deals. This means that workers are invested in the very business model that wrecks their jobs – and now, their health.

“Private equity’s business model is neoliberalism on steroids,” declares Olson. It’s the profit motive over everything – most assuredly over human life. And there’s hardly a whiff of accountability: “private equity lives in a darkly curtained world, protected from external scrutiny,” she writes.

It’s like the black hole of capitalism, into which every positive human value vanishes into oblivion.

This is real. This is happening. And as Olson warns, it’s just getting started.

The Institute for New Economic Thinking (INET) has focused on the alarming trend of private equity buying health care providers and taking them private through research by Eileen Appelbaum and Rosemary Batt, and detailed the encroachment of private equity into emergency rooms in a series of articles over the pandemic. INET’s Thomas Ferguson and colleagues Paul Jorgensen and Jie Chen have also focused attention on private equity’s political contributions. Now, Laura Katz Olson shares her perspective with INET on how we got to this dangerous place and what we can do to get out of it.

Lynn Parramore: We all remember Mitt Romney telling us during his presidential campaign that private equity firms like Bain Capital are good for society, saving failing companies and creating jobs. What didn’t Mitt tell us? How is the public perception skewed?

Laura Katz Olson: There are a few private equity firms that specialize in buying distressed firms — sometimes they buy businesses decimated by other PE firms just to milk what’s left. But in reality, most of them buy up flourishing companies. The results usually aren’t very good for society.

LP: How do they make money buying well-functioning companies?

LKO: The first way is to put high debt on the company and have the company pay it off. PE firms generally aren’t putting in more than 2% in equity themselves. Maybe 28% or so comes from their limited partners, like public pension funds. When the PE firm sells the company, the debt has been paid off by the company but the PE firm gets 20% of the money, having put very little in.

The second way is to charge the company all kinds of enormous fees – transaction fees, monitoring fees, annual management fees, consulting fees, advisory fees, servicing fees. The PE firms siphon a great deal of money in fees both from the company and from their limited partners, like the pensions.

The third way, becoming more popular recently, is to take special dividends called “dividend recaps.” The company has to take on even more debt to pay these dividend recaps. The PE firms share a little bit of the money with limited partners but they pocket most of it. And it’s a lot of money – PE took in $58 billion this way in 2021.

Just think about all this debt and all this money going into the PE firm’s pockets! The company is stuck paying off the debt, so it has to increase the cash flow any way it can. It all makes me think of that old medical practice of bloodletting. PE just drains the company and weakens it, at times driving it into bankruptcy.

Private equity firms used to take huge conglomerates and tear them apart to sell off the parts because the parts were worth far more than the whole. Today what they do is the opposite – they take a small piece that’s well-functioning, like a flourishing dental practice, and they add more and more dental practices to it — consolidating. They’re especially interested in niches that are not consolidated. After they consolidate for three or four years, they sell it in a secondary LBO [leveraged buyout], and after that, they’re selling it to a third, on and on.

LP: It seems like a neat trick to extract so much money from a company and at the same time build its market worth for resale. How do they manage it?

LKO: Consolidating is one of the main ways they do it now. Instead of the parts being worth more than the whole, the sum is worth more than the parts. They put all this debt on the company and then squeeze it. When you’re talking about services like home care or hospice care, it’s the front-line staff that will get squeezed. They cut the workforce, so you have fewer workers per patient. You lower the qualifications for the staff so you can get cheaper labor. You have fewer physicians because they’re expensive. You have less training and supervision. You overbook – you get a kind of production line going. For products, you use cheaper materials. You skimp on medical supplies, etc.

In the case of dermatology, we’ve seen unnecessary treatments being pushed, as well as untrained people who may not know, for example, how to spot cancer. Dentistry has had an especially egregious history — and some companies known for abuses, like the chain Aspen Dental, are still around. It’s incredible.

LP: Private equity firms like to claim that they are maximizing efficiency and controlling costs, but it looks like what they’re really doing is pushing shoddy services and products at higher prices.

LKO: That’s right.

LP: What happens to patients when they get into the hands of a health care provider under pressure from private equity? What else can go wrong beyond getting poorly trained staff?

LKO: Well, you have to worry about getting lured into procedures you don’t need. I’ve heard of dental offices where children were put in straight jackets and teeth were pulled that didn’t need to be pulled. Elderly people have been given unnecessary dental work. I’m particularly offended by what goes on in hospice care. You have people dying and Medicare is paying for them to have a dignified, quiet death. Instead, they are neglected as these PE firms are profiteering. Children with autism are being harmed, too. Autism is an easy target for profiteering because there’s a shortage of practitioners and you’re free to do whatever treatment you want and call it standard treatment. There’s so much that goes wrong. These are just a few examples.

LP: As you’re pointing out, children and the elderly are especially vulnerable to the harm done by the intrusion of private equity into medicine. How are the poor affected?

LKO: If you go through all of these areas of health care, Medicaid is paying a significant percentage. The poor are very vulnerable. Minorities are also vulnerable.

LP: And the taxpayers?

LKO: Taxpayers get hit hard by the Medicare and Medicaid costs. Medicaid is the second-largest item on every state budget and around the fifth largest item on the federal budget. Medicare, for example, is the major payer for hospice services.

LP: How is this allowed to go on? Why isn’t anybody in government doing anything about it?

LKO: I would have to argue – I’m trying to think how to put it – this is not a partisan issue. The Democrats and the Republicans both take advantage of it. They go back and forth between private equity and top government positions, like secretaries of defense and secretaries of state. It’s so lucrative. Even presidents. George H.W. Bush was involved—he went to a private equity firm.

LP: We’re talking about big money here, as you say. In your book, you mention that the heads of the six main listed PE firms are among the topmost earners in the U.S. right now.

LKO. It’s very big money. A significant percentage of our billionaires now come from private equity. They make far more money than investment bankers.

LP: Let’s talk about how this money is working its way through the political system. What most concerns you?

LKO: You have the lobbying and the campaign donations, of course. But the larger issue in my view is the revolving door. If government officials come down hard on private equity, that would preclude them from joining the PE firms when they leave the Biden administration, for example. It just keeps anybody from being interested in this, with a few exceptions like Elizabeth Warren. Such a lack of interest!

One thing that has to be looked at is how the public pension funds are invested in private equity. That is steadily increasing, and it means that PE is getting more and more money. They are now going to appeal to retail so that the general public can put in money. And the more money they get, the more they have to spend, and the more health care facilities and practices they buy.

LP: So this problem is metastasizing as we speak, to use a term from medicine.

LKO: Yes. That’s a good word.

LP: How does a regular person know if private equity has gotten involved in their health care? Are there any telltale signs?

LKO: You have to ask. It’s difficult to know. Many of these chains have separate names for each of their businesses so they are hard to identify. Often I’ve noticed that the facilities have nice, shiny nice buildings, like the rehab centers, for example. They’re gorgeous.

LP: Let’s talk about this involvement of private equity in rehab and mental health facilities. It seems that PE contributes to the distress in our society – and then turns right around and profits from that distress. How are patients faring in these facilities?

LKO: Not very well. Look at the rehab facilities – one thing they tend to have in common is that people who have alcohol or drug problems usually have other issues, too. But the facilities taken over by PE tend not to have other kinds of specialists. They focus on one thing and don’t look at the co-existing issues. The staff tends to be less trained. It’s all the things we’ve talked about. They use techniques and treatments without scientific backing. One of the techniques is using horses. Look, horses are wonderful. I love horses. But there’s no proof that horse therapy can treat drug or alcohol abuse!

LP: Sounds like there’s not much oversight on the efficacy of treatments.

LKO: It’s a problem with private equity in general. They tend to pick areas that have very little oversight.

LP: Private equity is even getting into pet care, as I understand it.

LKO: I haven’t studied it specifically, but I belong to groups and I see things coming in about pet facilities that are very concerning. PetSmart, for example, is reported to have some serious issues. Animals are reportedly being killed and abused.

LP: Is there any case that you’ve seen in which private equity makes medicine better?

LKO: No, I haven’t. Private equity argues that one of the best things they do is make more services available in scarce markets. Well, certainly they do make more services available, as in the case of autism services. But is it better to have more low-quality services than none at all? Experts will tell you that low-quality autism services are pretty damaging to the child.

LP: Does private equity belong in medicine at all? Should it be banned?

LKO: This is something I didn’t put in my book, but the conclusion I have come to is yes, we have to ban it. We really need to prohibit, I think, the corporate practice of medicine, period. If you look at the private equity playbook, its only goal is to make outsized profits – they can’t make ordinary profits. If they make ordinary, respectable profits, their investors will go somewhere else because of the risk.

Private equity doesn’t care whether the product is Roto-Rooter or hospice. That’s one of the major differences between PE and a regular company, which may care about the community, the reputation of the company, and the quality of the product. They want to keep their customers. They care about the future. But private equity doesn’t work like that. Because private equity often aims to sell a company after four or five months, they don’t care about the future. They don’t care about the product at all. Private equity is antithetical to our health care system.

So yes, we need to ban private equity from health care. But given that it’s not going to happen, I would say that we need to prohibit the corporate practice of medicine – anybody can make a case for that. You can eliminate their tax advantages. You can limit the debt imposed on companies, especially in the health sector. You could easily control consolidation and monopolies in the health sector. You could use specific anti-trust laws. I would definitely forbid investment by retail customers such as their 401(k)s. I would forbid non-disclosure and non-disparagement agreements, which make it so difficult to obtain information. I had such a hard time interviewing people. When I could get people to talk to me – and that was really hard — they were extraordinarily careful. I would also prohibit “stealth branding” – where the PE firm buys a chain, like a dental chain, but gives each office its own name, like Marilyn’s Happy Dental Care. It’s very deceptive.

LP: It’s interesting that PE players and firms don’t tend to be household names. They’ve really managed to fly under the radar. Can you mention a few that came up a lot in your research? Folks to look out for?

LKO: Bain Capital, the PE company that Mitt Romney still profits from, is one. The Carlyle Group has really been involved in recruiting high-ranking people from the government – one of its co-founders, David Rubenstein, served as Deputy Assistant to the President for Domestic Policy during the Carter administration. George H.W. Bush became a senior member of its Asia advisory, and so on. KKR, of course, is one of the biggest. They control a lot in health care.

I’m concerned that as PE gets more and more money – with these pension funds, and especially if they get their hands into the 401(k)s – they’re just going to keep buying up anything and everything. And it’s not just health care. More and more of these firms are appearing and getting into more and more industries. As young people, or even older people involved in the well-established financial firms, realize how much money is involved, they just start a PE firm. Look at Jared Kushner [Affinity Partners]. It’s a very worrisome situation.

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22 comments

  1. shinola

    Econ. prof. 1974: “If you want a guaranteed high income, get a medical degree; people will pay anything if their life or health depend on it.”

    (Said prof. was an unapologetic plutocrat)

    1. Paul Kleinman

      The fact that MDs in the US easily make twice as much as Western European MDs of equal or greater competence is something to take a long hard stare at and find a solution-one of them being the qualification of experienced nurse practitioners to practice a wider scope of primary care medicine. But this is not quite the same problem as KRK and the Carlyle Group mega PE predators turning medicine into a mass assembly line- 10 patients per hour -“have any questions? Use our patient portal where a nurse/physician’s associate will answer them “under the supervision of a doctor” which justifies additional charges at $8 a minute. But it’s also true that many physicians like the cut that PEs given them in increased patient volume at the expense of patient well being.

  2. ANTIDLC

    https://www.motherjones.com/politics/2022/05/private-equity-city-pensions-burger-king-roark-liverpool-yale/

    Everything Everywhere All at Once: How Private Equity Rules Your World
    From your favorite burger joint to your local dentist, PE titans are invested in almost everything you do.

    Hannah Levintova and Tim MurphyMay+June 2022 Issue

    Over the past four decades, private equity has become a powerful, and malignant, force in our daily lives. In our May/June 2022 issue, Mother Jones investigates the vulture capitalists chewing up and spitting out American businesses, the politicians enabling them, and the everyday people fighting back. Find the full package here.

    Lots more: https://www.motherjones.com/politics/2022/05/private-equity-apollo-blackstone-kkr-carlyle-carried-interest-loophole/

    How Private Equity Looted America

    Read more from our May/June 2022 issue on vulture capitalists, their political enablers, and the working people fighting back:

    The Smash-and-Grab Economy
    Real Estate Predators Tried to Cash In on the Pandemic. Then Tenants Fought Back.
    Everything Everywhere All at Once: How Private Equity Rules Your World
    These Are Congress’ Biggest Private Equity Investors
    The Fight to Keep Their “Poor People’s Paradise” out of Private Equity’s Hands
    My Newspaper Was Gutted by Journalism’s Biggest Bogeyman
    I Started a Facebook Group for People Cut by PetSmart During Covid. It Didn’t End Well.

  3. Telee

    I myself have had a difficult time finding doctors that you can trust. Cardiologists calling me at home ( 5 times ) after undergoing cryogenic ablation for A-Fib, and telling me that I need another operation to put an implant in my heart. Sending me for tests to establish risk factors so Medicare would pay. After the ablation, during a follow up appointment, the doctor doesn’t have time to tell me how I should adjust my medication, saying we’ll get to that later because he is focused on getting me to agree to the next operation. Months later when I have an appointment with the above mentioned cardiologist partner ( who I trust ) and ask him if I need the implant the his answer is NO! I go to a different practice and the cardiologist is scheduling tests without my approval telling me that we need to check all the boxes. So I left that practice too.
    Or after major abdominal surgery I become extremely ill with severe round the clock nausea and vomiting. The surgeon tells me to call the other doctors. But they won’t talk to me! So after 2 months of suffering with no medical care my ex ( I don’t talk to her after divorce ) who is a doctor breaks the log jam and I find out that the reason the doctors won’t talk to me is the surgeon didn’t bother calling the other doctors to see me because until he does I am still thought to be under his care! When I tell the gastroenterologist who diagnosed my condition that I was in limbo for months he tells me that he will no longer allow me to be in his practice!
    I could go on with other examples but you can see why I am suspicious of modern medicine all the time. Many are only in it for the money.

    1. PHLDenizen

      I’ve noticed (and doctor dad has, too) is that the bifurcation between good care and substandard, trusted and untrusted is the presence of EBM. With few exceptions, there seems to be a pretty strong dividing line based on age that sorts the paint-by-numbers docs from those who assess patients as individuals, not binning them by test results.

      EBM sucks. It creates clinically WORSE outcomes on average. It supposes a decision tree, much loved by MBAs and insurance companies for diametrically opposed rationales. Hospital execs bias them toward revenue as needless quantities of lucrative interventions. Insurers bias the tree toward minimizing payouts by constraining the number of choices as tightly as possible. Medicine is often more art than science and applying Taylorism is demoralizing for physicians and kills patients.

      By way of example, my dad and his partners have consolidated into a large, independent group precisely BECAUSE they want to force as much autonomy as possible. Dad — an invasive cardiologist — shies away from expensive diagnostics and testing in the absence of clear clinical indications they’re necessary. I’m sure if he wanted to, he could find any number of reasons to cath or stent a larger number of patients, but he’s far more interested in his patients’ well being than lining his pockets. He leaves money on the table to be a good doctor. I think he’s on his 3rd generation of patients. It’ll be a shame when he retires.

      EBM turns doctors and patients into hostages. It needs to be euthanized. And based on what I’ve read about the WHO’s pandemic treaty, medicine is going full authoritarian.

  4. Questa Nota

    Body brokering mash-up with real estate investing, SoCal style.

    Residential treatment facilities for alcohol, drug and other rehabs are typically regulated for low capacities. Say that you are an entrepreneurial type with a yen toward generating some cash while avoiding taxes and seeking capital gains.

    Here is your business model:

    Buy a securable multi-bedroom house in a desirable area with reasonable airport and pharmacy access.
    1. Troll for Find high income cash clients with bad tendencies. Brokering can be fun.
    2. Limit insurance clients as those low reimbursement caps are drags on profit.
    3. Reward your key staff for meeting income targets, with bonuses for repeat visitors.
    4. Don’t forget the chef, pool, spa and other amenities.
    5. Churn daily staff as a cost of doing business.
    6. Keep control over the meds as controlled substances are tightly regulated.
    7. No paparazzi, ever.

  5. Telee

    I should add that Biden is hell bent on privatizing Medicare by allowing private equity to come between Medicare and elderly patients for 40% of the Medicare budget. What a crime!

  6. Alice X

    Golly gee willikers, Batman – those PE people are gonna give Capitalism a bad name!

    ————–

    An informative and thus distressing article, thank you Yves.

  7. Susan the other

    The reason this will collapse of its own weight, but maybe not soon enough, is because it is a big “Little Shop of Horrors” – the beast of private equity devours even itself. Unless somebody ruthlessly chops it down. The only way to prevent the destruction of everything is to socialize medicine. Top to bottom and all across the board. Government’s dime the whole way. That will, theoretically, eliminate the “private” in private equity. Because it would be a contradiction to allow such massive and destructive parasitical profits to go to privateers that the government supports, both passively (allowing it) and actively (paying the bills). The USA cannot survive this contradiction in our constitutional assumptions much longer. We will either fail completely as a sovereign country or we will write medical human rights into both the Constitution and specific laws. With no loopholes. So what do we want? A completely failed and destroyed country, or good, strict socialized medicine? The only unanswered question here is, Will PE give up its profits?

  8. Felix_47

    Until we get rid of fee for service and develop a model based on the British system which they have had for 90 years expect no better. Doctors should be on government salary just like firemen paramedics.

    1. PHLDenizen

      More effective solution is hospital admins, insurance companies, and any non-physicians making decisions about patient care jointly and and inescapably liable for malpractice, with company stock as collateral.

  9. Arizona Slim

    In my neck of the woods, I’m getting pummeled by Aspen Dental ads. I can hardly watch a single YouTube video without seeing at least one.

  10. flora

    Thanks for this post.

    An aside: Mitt Romney is a Davos WEF-man. Bain Capitol has been a Strategic Partner of the WEF for 18 years.

  11. Rod

    I can’t help but noticing how Pension Funds, with a dry well of Bond and Holdings Interest and Low Stock Dividends keep getting ‘Co Opted’ into participation.
    Mortgage Tranches and CDOs also come to mind from an earlier Good Time.
    And Oil—lots of Oil—a long time Steady Freddy.
    Everybody—and every PensionFund—has a Name (ie: Mitt Romney or NCSERS) and those need Publicized far, wide, and often, when uncovered.

    Nobody gets a free lunch.

  12. IM Doc

    It is not just doctor groups and hospitals playing the game.

    Today, I am taking care of a young woman who is a waitress in the local restaurant. She has iron deficiency anemia. We have isolated the cause, but her Hemoglobin level is right at 7 (normal is 15) and her ferritin level is 0.1 ( normal 20). It will take us weeks of oral iron supplementation with her suffering the cramps and diarrhea that come with this for us to make an impact.

    Another option which has been widely available for decades is to give her a boost of iron IV. This is about the same to produce as rusty nails dissolved in water in an IV bag. Until about 5 years or so ago, this therapy literally cost maybe 20 dollars. It is now 15,000 dollars. You heard that right.

    This patient is on Obamacare and will be needing to come up with the 10,000 deductible for this treatment. These high deductibles were considered immoral until Obamacare made them commonplace.

    She cannot afford it – and therefore will be working hard with profound anemia for the next several months. A few days ago, there was a link and comments about doctor’s having moral injury. These kinds of things which happen multiple times daily are why.

    I cannot believe this country. Nor can I believe that everyone is OK that these old generic drugs like IV iron are being allowed to be reformulated and rebranded and being sold for this kind of mark up. It is constant and all the time as one by one they fall. It is as immoral a thing as I have ever been involved with. And yet – it is just blown off by our politicians as no big deal. I feel like I am part of it. There are days I just want to take a long shower after work to clean off all the sleaze.

    1. Questa Nota

      Gotta hand it to the pols, their lobbyists and pharma constituency. They managed to gin up huge cash flow, many more potential donors, means-testing slow patient death, extra layers of bureaucracy and a star turn for Chief Justice Roberts all without breaking much of a sweat.

      Well played, sirs, and madams. Can’t leave out Nancy and others who wanted to pass the ACA bill to see what was in it. Bitter, party of one? Take a number and rent a seat in the waiting room annex.

    2. flora

      EpiPen, insulin, and now this. It looks to me like extortion under color of ‘medicine’. (But what do I know?) This is unconscionable. Medicare Part D and Obamacare have made things steadily worse, imo. Thanks for your comment.

      “Unconscionability (sometimes known as unconscionable dealing/conduct in Australia) is a doctrine in contract law that describes terms that are so extremely unjust, or overwhelmingly one-sided in favor of the party who has the superior bargaining power, that they are contrary to good conscience.” – Wiki

  13. Hayek's Heelbiter

    I well might have missed it inn the articles or comments..
    How back office bureaucrats, with zero medical training, make life or death decisions on whether someone is allowed to have medical care or not (apparently 30% of the money spent on Murican health care).
    Wasn’t illegal at some time in the distant past to practice medicine without a license?

  14. KLG

    Traveling yesterday and late to the party…

    Another book for my 4th-year reading elective for medical students…the list grows. Some of them no longer wonder where I get my politics. A few of them think I am a communist who wants them to starve, while driving a Range Rover and Panamera as the two family cars, until the kids start to turn 16 and a Z4 is added to the list.

    The iron supplementation story from IM Doc is particularly appalling. Iron salts are abundant and cheap. Preparing the solution for IV use might cost $10, hence the former price of $20. The “Market” rules!

  15. orlbucfan

    Man, I could tell a few horror stories about the U.S. Deathcare System that would curl a few hairs. They go back years. Private Equity is just another name for medical malpractice. And quit calling bribes “lobbying” and “campaign contributions,” too.

  16. Tim

    A movie still worth watching all these years later: “Other People’s Money” starring Danny DeVito. It was a pretty big movie, in every theater.

    We thought it would be a passing thing that regulation and the population wouldn’t put up with. We were wrong.

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