We have given the power of life or death over more than half a million people to two dialysis monopolies, DaVita and Fresenius. A non-compete ban could change that.
A friend in the healthcare industry read the article. Loved it but had one point I wanted to share:
It’s misleading to imply getting dialysis through Medicare is free. It’s 80% coverage with 20 % falling to patients. Part A&B or/and co-insurance comes with deductible and copays, which can add up for lifetime of three/five days a week.
Medicare for All and regulations that compel insurance companies to pay for important services should be great - but as this shows, unless we can control for roll-ups and profit-hoarding, it hurts patients and medical professionals.
Non-competes for the doctors are important, tougher regulations and inspections would help, but honestly, greed and medical services are incompatible.
No one should be making Devita levels of profit until their dialysis innovations are keeping 100% of their patients alive and making them breakfast every day.
Parent groups worked tirelessly to get autism services covered by insurance - before this, it was school districts and parents funding privately for important services that could in some cases transform kids' lives. We - the parents - never imagined that reliable funding would attract greedy private equity, degrade services (this article doesn't fully explain how badly) and make them less available.
Well said, Nora. Here in the Province of Quebec (Canada), our provincial government has been experimented with private delivery.
Capture of service delivery by financiers and monopolists hasn't been discussed. An eye will have to kept out for that here.
That said, the spirit of how we do things in Quebec especially, and Canada in general, suggests that things won't be as bad as in America. One example: when pharmacists' chains started to grant rent-free space for clinics in buildings hosting pharmacies, the pharmacists' professional order banned the practice. (The idea being that patients who'd visit the clinics would go to the adjoining pharmacies to get their prescriptions filled).
Curious what the status or update on the non-compete ban is. It was really exciting to see that put forth, but how long are we realistically talking before that even has a chance to become reality?
Bless you, Matt; but you're somewhat off when you write "... it's important to recognize that the brutal acts ... represent not personal malevolence ...".
Au contraire, at some levels, there are acts of will by those who KNOW that their practices harm people grievously, if not kill them, when they don't "behave themselves".
At best, that's easy surrender to personal, corporate, and procedural, convenience.
It's all about for-profit medical care. Third party for-profit ownership of medical care facilities, doctors' practices, and the like should be prohibited, period. That would include both publicly-traded and private equity ownership. Medical care delivery should be nonprofit in all cases. There's plenty of opportunity in the rest of medicine for Wall Street.
Congratulations Mr. Stoller. I am now absolutely enraged this morning. Here, let me return the favor. Have you ever considered writing an article in UnHerd? I think the readers there could do with a little setting the record strait after this piece by Rindsberg.
Do European countries where Davita and Fresenius are two of several providers have the same problems? I’m American, living in Austria, where pretty much everyone gets basic care through the federal government. It is considered “insurance” like Medicare. I guess I’m puzzled by your remark about Medicare for All and what you think a system focused on *care* would look like. Health Care For All.
The answer is: Definitely not. National regulations in those countries do not allow the kind of practices that these same companies get away with in the Wild West of US healthcare.
Great piece of reporting. . . Until you used the Covid ‘vaccine’ reference near the end. Warp Speed was free for all of course except that the so-called vaccines were seriously flawed and have caused harm to millions.
OK, but I don’t really see the connection to M4A, other than *perhaps* increased disinterest of regulators since there’s no money problem. But you’ve well-shown that a lack of regulation—including market structure—and anti-trust enforcement has negatively affected all industries.
How does this market shape itself in a positive way without M4A?
Dialysis has a version of Medicare for All. That's the point. Medicare for All can be a nightmare, which is why the whole framing on the left is wrong. It's not about shoveling more public money for more access, it's about *care.* The M4A movement doesn't get that, they think that more access is more care. It's not.
So you say, but you don’t really make the case. You need heavy regulation and anti-trust enforcement to shape the market regardless of where the money comes from. Anti-M4A groups—including centrist Dems—fear monger successfully equating M4A as socialized, government-provided *care* vs funding. We’re no where near M4A, but there’s no chance in hell for government provided *care.*
My point is pretty clearly stated: you haven’t made a case that M4A is the cause of the issues. Like, nowhere have you. What’s the evidence that current market structure would be cool if public money weren’t involved. The rest of healthcare? Private insurance would lead to better care, except those needing insurance with pre-existing conditions.
Is, say, the market structure for cancer treatment far better. Is there a difference between cancer treatment for those on Medicare and those that aren’t? One can’t qualify for early Medicare until 2 years after being designated disabled—unless you have kidney disease. This is bad for kidney patients?
You know the market dynamics way better than I do, but that doesn’t mean you’ve supported your premise.
When I used to do personal injury work, we had a case come in where it seemed like clear medical malpractice because DaVita was so full they just rescheduled the guy's dialysis and he died. We couldn't get an expert who would testify that but for that, he would've lived, because he was so sick already. So they got away with it. And probably continued
A friend in the healthcare industry read the article. Loved it but had one point I wanted to share:
It’s misleading to imply getting dialysis through Medicare is free. It’s 80% coverage with 20 % falling to patients. Part A&B or/and co-insurance comes with deductible and copays, which can add up for lifetime of three/five days a week.
See page 3 below.
https://www.medicare.gov/Pubs/pdf/11360-Medicare-Dialysis-Kidney-Transplant.pdf
Is there not a role here for private antitrust lawsuits, such as the recent huge verdict in the class action on monopolized real estate fees?
This is one of your best posts so far.
Medicare for All and regulations that compel insurance companies to pay for important services should be great - but as this shows, unless we can control for roll-ups and profit-hoarding, it hurts patients and medical professionals.
Non-competes for the doctors are important, tougher regulations and inspections would help, but honestly, greed and medical services are incompatible.
No one should be making Devita levels of profit until their dialysis innovations are keeping 100% of their patients alive and making them breakfast every day.
Here's another awful story:
https://cepr.net/report/pocketing-money-meant-for-kids-private-equity-in-autism-services/
Parent groups worked tirelessly to get autism services covered by insurance - before this, it was school districts and parents funding privately for important services that could in some cases transform kids' lives. We - the parents - never imagined that reliable funding would attract greedy private equity, degrade services (this article doesn't fully explain how badly) and make them less available.
Well said, Nora. Here in the Province of Quebec (Canada), our provincial government has been experimented with private delivery.
Capture of service delivery by financiers and monopolists hasn't been discussed. An eye will have to kept out for that here.
That said, the spirit of how we do things in Quebec especially, and Canada in general, suggests that things won't be as bad as in America. One example: when pharmacists' chains started to grant rent-free space for clinics in buildings hosting pharmacies, the pharmacists' professional order banned the practice. (The idea being that patients who'd visit the clinics would go to the adjoining pharmacies to get their prescriptions filled).
Curious what the status or update on the non-compete ban is. It was really exciting to see that put forth, but how long are we realistically talking before that even has a chance to become reality?
Bless you, Matt; but you're somewhat off when you write "... it's important to recognize that the brutal acts ... represent not personal malevolence ...".
Au contraire, at some levels, there are acts of will by those who KNOW that their practices harm people grievously, if not kill them, when they don't "behave themselves".
At best, that's easy surrender to personal, corporate, and procedural, convenience.
Agreed, kind of seems like Kent enjoys his role and is having a good time.
10/10 title Matt, well done
It's all about for-profit medical care. Third party for-profit ownership of medical care facilities, doctors' practices, and the like should be prohibited, period. That would include both publicly-traded and private equity ownership. Medical care delivery should be nonprofit in all cases. There's plenty of opportunity in the rest of medicine for Wall Street.
Congratulations Mr. Stoller. I am now absolutely enraged this morning. Here, let me return the favor. Have you ever considered writing an article in UnHerd? I think the readers there could do with a little setting the record strait after this piece by Rindsberg.
https://unherd.com/2024/01/the-democrat-extortion-racket-will-backfire/
Do European countries where Davita and Fresenius are two of several providers have the same problems? I’m American, living in Austria, where pretty much everyone gets basic care through the federal government. It is considered “insurance” like Medicare. I guess I’m puzzled by your remark about Medicare for All and what you think a system focused on *care* would look like. Health Care For All.
The answer is: Definitely not. National regulations in those countries do not allow the kind of practices that these same companies get away with in the Wild West of US healthcare.
Great piece of reporting. . . Until you used the Covid ‘vaccine’ reference near the end. Warp Speed was free for all of course except that the so-called vaccines were seriously flawed and have caused harm to millions.
LOL
OK, but I don’t really see the connection to M4A, other than *perhaps* increased disinterest of regulators since there’s no money problem. But you’ve well-shown that a lack of regulation—including market structure—and anti-trust enforcement has negatively affected all industries.
How does this market shape itself in a positive way without M4A?
Dialysis has a version of Medicare for All. That's the point. Medicare for All can be a nightmare, which is why the whole framing on the left is wrong. It's not about shoveling more public money for more access, it's about *care.* The M4A movement doesn't get that, they think that more access is more care. It's not.
So you say, but you don’t really make the case. You need heavy regulation and anti-trust enforcement to shape the market regardless of where the money comes from. Anti-M4A groups—including centrist Dems—fear monger successfully equating M4A as socialized, government-provided *care* vs funding. We’re no where near M4A, but there’s no chance in hell for government provided *care.*
"We’re no where near M4A, but there’s no chance in hell for government provided *care.*"
I'm not totally sure what your point is. Dialysis *is* Medicare for All. We're not 'nowhere near M4A,' we are there.
My point is pretty clearly stated: you haven’t made a case that M4A is the cause of the issues. Like, nowhere have you. What’s the evidence that current market structure would be cool if public money weren’t involved. The rest of healthcare? Private insurance would lead to better care, except those needing insurance with pre-existing conditions.
Is, say, the market structure for cancer treatment far better. Is there a difference between cancer treatment for those on Medicare and those that aren’t? One can’t qualify for early Medicare until 2 years after being designated disabled—unless you have kidney disease. This is bad for kidney patients?
You know the market dynamics way better than I do, but that doesn’t mean you’ve supported your premise.
When I used to do personal injury work, we had a case come in where it seemed like clear medical malpractice because DaVita was so full they just rescheduled the guy's dialysis and he died. We couldn't get an expert who would testify that but for that, he would've lived, because he was so sick already. So they got away with it. And probably continued
I think it's a little disingenuous of you to refer to doctors and scientists as ingenuous.
Sorry, I couldn't resist.