Thread

1. frisco · 1789948788 · focus · HN ↗

   Medicine is extremely capex intensive and only become more so. Sucking private capital out of healthcare is going to make it vastly worse for everyone; higher prices and less innovation. I think we can criticize the often ruthlessness of PE while realizing that limiting medicine's ability to invest would be a huge self-own and only force further centralization into the biggest non-profit centers.

   Medicine is already held back enough by the lack of ability to use debt to finance its sales, unlike almost every other industry; you can repossess a car but you can't repo an implant or administered drug, forcing everything to be paid for in cash upfront. Medicine needs as much access to capital as it can get.

   1. BugsJustFindMe · 1789948856 · focus · HN ↗

      > Sucking private capital out of healthcare is going to make it vastly worse for everyone; higher prices and less innovation.

      Injecting PE into healthcare is what made it vastly worse for everyone in the first place. You can't have it both ways.

      1. frisco · 1789949118 · focus · HN ↗

         I'm sorry, compared to what? We're not talking about a routine doctor's office for healthy people. Advanced care is extremely technologically intensive and your local surgeon is not personally buying the $20M in infrastructure required for many modern advanced treatments. Venture capital has been essential for progress in medicine, and many advanced therapies are going to be increasingly delivered vertically integrated for the widest accessibility and best outcomes.

         1. bonsai_spool · 1789950159 · focus · HN ↗

            > Venture capital has been essential for progress in medicine

            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

            1. frisco · 1789954720 · focus · HN ↗

               agreed but that is not what they are talking about banning -- "PE" is expansive and includes all those other things. If they narrowed this proposal to just what people are thinking of as "PE" here rolling up clinics and gaining local pricing power that would be different and I'd agree with you

               1. bonsai_spool · 1789960422 · focus · HN ↗

                  > agreed but that is not what they are talking about banning

                  I think you misunderstand me. I think what is proposed to be banned (employers of doctors who are PE firms) should not exist. It is strictly not necessary, and there's an excellent example of the consequences playing out across Massachusetts right now (which explains the bill's introduction by Warren)..

                  I'm not sure how we decided only lawyers can run law firms but that anybody can operate a hospital...

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