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pluralistic

@pluralistic@mamot.fr

By Cory Doctorow (GPG 0xBF3D9110957E5F4C)
@doctorow.

Archived at pluralistic.net

I post long threads. If you don't like these in your timeline but want to read them, I suggest unfollowing me here and subscribing to my RSS, or my newsletter, or any of my various long-form feeds. Links at https://pluralistic.net.

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pluralistic, to random
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Remember ""? promised us that was a prelude to a Stalinist nightmare in which unaccountable bureaucrats decided who lived or died based on a cost-benefit analysis of what it would cost to keep you alive versus how much your life was worth.

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If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/04/26/death-panels/#what-the-heck-is-going-on-with-CMS

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pluralistic,
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Palin was right that any kind of healthcare rationing runs the risk of this kind of calculus, where we weight spending $10,000 to extend a young, healthy person's life by 40 years against $1,000 to extend an elderly, disabled person's life by a mere two years.

It's a ghastly, nightmarish prospect - as anyone who uses the private healthcare system knows very well.

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pluralistic,
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More than 27m Americans have no health insurance, and millions more have been tricked into buying scam "cost-sharing" systems run by evangelical grifters:

https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html

But for the millions of Americans with insurance, death panels are an everyday occurrence, or at least a lurking concern.

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pluralistic,
@pluralistic@mamot.fr avatar

Anyone who pays attention knows that insurers have entire departments designed to mass-reject legitimate claims and stall patients who demand that the insurer lives up to its claim:

https://kffhealthnews.org/news/article/khn-podcast-an-arm-and-a-leg-how-to-shop-for-health-insurance-november-24-2021/

The private healthcare sector is designed to deny care. Its first duty is to its shareholders, not its patients, and every dollar spent on care is a dollar not available for dividends.

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pluralistic,
@pluralistic@mamot.fr avatar

The ideal insurance customer pays their premiums without complaint, and then pays cash for all their care on top of it.

All that was true even before started buying up and merging whole swathes of the US healthcare system (or "healthcare" "system"). The PE playbook - slash wages, sell off physical plant, slash wages, reduce quality and raise prices - works in part because of its scale.

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pluralistic,
@pluralistic@mamot.fr avatar

These aren't the usual economies of scale. Rather the PE strategy is to buy and merge all the similar businesses in a region, so customers, suppliers and workers have nowhere else to turn.

That's bad enough when it's aimed at funeral homes, pet groomers or any of the other sectors that have been bigfooted by PE:

https://pluralistic.net/2022/12/16/schumpeterian-terrorism/#deliberately-broken

But it's especially grave when applied to hospitals:

https://pluralistic.net/2020/05/21/profitable-butchers/#looted

Or emergency room physicians:

https://pluralistic.net/2022/03/14/unhealthy-finances/#steins-law

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pluralistic,
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And if you think that's a capitalist hellscape nightmare, just imagine how PE deals with dying, elderly people. Yes, PE has transformed the hospice industry, and it's even worse than you imagine.

Yesterday, the Center for Economic and Policy Research published "Preying on the Dying: Private Equity Gets Rich in Hospice Care," written by some of the nation's most valiant PE slayers: Eileen Appelbaum, Rosemary Batt and Emma Curchin:

https://cepr.net/report/preying-on-the-dying-private-equity-gets-rich-in-hospice-care/

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pluralistic,
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Medicare pays private hospices $203-$1,462 per day to take care of dying old people - seniors that a doctor has certified to have less than six months left. That comes to $22.4b/year in public transfers to private hospices. If hospices that $1,462 day-rate, they have lots of duties, like providing eight hours' worth of home care.

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pluralistic,
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But if the hospice is content to take $203/day, they aren't required to do anything. It's just free money for whatever the operator feels like doing for a dying elderly person, including doing nothing at all.

As Appelbaum told Maureen Tkacik for her excellent writeup in The American Prospect: "Why anybody commits fraud is a mystery to me, because you can make so much money playing within the guidelines the way the payment scheme operates."

https://prospect.org/health/2023-04-26-born-to-die-hospice-care/

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pluralistic,
@pluralistic@mamot.fr avatar

In California, it's very, very easy to set up a hospice. Pay $3,000, fill in some paperwork (or don't - no one checks it, ever), and you're ready to start caring for beloved parents, grandparents, sisters, brothers, aunts and uncles as they depart this world. You do get a site inspection, but don't worry - you aren't required to bring your site up to code until after you're licensed, and again, they never check - not even if there are multiple complaints.

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pluralistic,
@pluralistic@mamot.fr avatar

After all, no one at the Centers for Medicare & Medicaid Services () has the job of tracking complaints.

This is absolute catnip for private equity - free government money, no obligations, no enforcement, and the people you harm are literally dying and can't complain. What's not to like? No wonder PE companies have spent billions "rolling up" hospices across the country.

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pluralistic,
@pluralistic@mamot.fr avatar

There are 591 hospices in , CA alone - but at least 30 of them share a single medical director:

https://auditor.ca.gov/reports/2021-123/index.html#pg34A

Medicare caps per-patient dispersals at $32,000, which presents an interesting commercial question for remorseless, paperclip-maximizing, grandparent-devouring private equity ghouls: do you take in sick patients (who cost more, but die sooner) or healthy patients (cost less, potentially live longer)?

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Viss, to random
@Viss@mastodon.social avatar

well that was fun!
went to see @pluralistic at his book signing!

pluralistic,
@pluralistic@mamot.fr avatar

@Viss @gaileyfrey SO GREAT TO SEE YOU AGAIN, Viss!

pluralistic,
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@bishop6 @Viss Thank you for coming!

pluralistic, to random
@pluralistic@mamot.fr avatar

Today's threads (a thread)

Inside: How Amazon makes everything you buy more expensive, no matter where you buy it; and more!

Archived at: https://pluralistic.net/2023/04/26/greedflation/

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pluralistic,
@pluralistic@mamot.fr avatar

Tonight (Apr 25) at 7PM I'll be in for the launch of my new novel, Red Team Blues, at Books, hosted by . Please come and say hi!

https://www.mystgalaxy.com/event/42523Doctorow

Tomorrow (Apr 26), you can catch me in at Dark Delicacies at 6PM:

https://www.darkdel.com/store/p2873/Wed%2C_Apr_26th_6pm%3A_Red_Team_Blues%3A_A_Martin_Hench_Novel_HB.html#

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pluralistic,
@pluralistic@mamot.fr avatar

How Amazon makes everything you buy more expensive, no matter where you buy it: Most Favored Nation is my least favorite scam.

https://mamot.fr/@pluralistic/110260912605591851

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pluralistic,
@pluralistic@mamot.fr avatar

Hey look at this

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pluralistic, to random
@pluralistic@mamot.fr avatar

Amazon is very proud of its : at first, the company offered subsidies to customers, which lured in sellers. Then, it demanded that those sellers lower their prices, which lured in more customers. With more customers, more sellers piled in. Faster and faster, the flywheel spins, creating the :

https://fourweekmba.com/amazon-flywheel/

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pluralistic, to random
@pluralistic@mamot.fr avatar

Today's threads (a thread)

Inside: How Goldman Sachs's "tax-loss harvesting" lets the ultra-rich rake in billions tax-free; Happy Independent Bookstore Day; and more!

Archived at: https://pluralistic.net/2023/04/24/tax-loss-harvesting/

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pluralistic, to random
@pluralistic@mamot.fr avatar

A Collective Bargain: Workplace democracy is a training ground for true national democracy

https://doctorow.medium.com/a-collective-bargain-a48925f944fe

pluralistic, to random
@pluralistic@mamot.fr avatar

Competition is just a click (and $45b) away
https://www.justice.gov/opa/press-release/file/1328941/download

> pays $45 billion a year for contracts to lock out rivals, signing deals with “Apple, LG, Motorola, and Samsung; major U.S. wireless carriers such as AT&T, T-Mobile, and Verizon; and browser developers such as Mozilla, Opera, and UCWeb— to secure default status for its general search engine and, in many cases, to specifically prohibit Google’s counterparties from dealing with Google’s competitors.”

pluralistic,
@pluralistic@mamot.fr avatar

buys an entire EVERY SINGLE YEAR to make sure we don't ever use its competitors' products.

pluralistic, to random
@pluralistic@mamot.fr avatar

Does anyone have a recommendation for a tool or web app that can ingest a @Kickstarter survey results spreadsheet and then spit out custom reports, e.g. "Email addresses for everyone whose reward or add-on includes a specific item, who completed a survey since my last d/l"?

pluralistic, to random
@pluralistic@mamot.fr avatar

My next novel is Red Team Blues, a grabby thriller about how finance curdled the dream of tech as a force for human thriving. It comes out in a matter of days, and to get you ready for that release, I've been serializing the first chapter all week - and today, I wrap up the series.

--

If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/04/21/bondage-fees/#henched

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