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Bill to Ban Private Equity from Owning Medical Practices

509 points · 384 comments · paimapi

  1. NegativeK · · focus · HN ↗
    Can someone steelman private equity, please? I'm honestly looking for the upsides (for non-investors) of when PE moves into an industry like medicine and begins buying up businesses that traditionally aren't already large chains.

    I already hear the downsides frequently from someone whose work is directly affected.

    1. tbrownaw · · focus · HN ↗
      > Can someone steelman private equity, please?

      Step back and look at what it fundamentally is.

      Person A has a business they want to sell.

      Person B has a pile of money and thinks that that business is (or can be) a good investment.

      That's it.

      So, what happens if person A is prohibited from selling their business? Are they forced to keep working because they don't have enough other savings to retire on? Do they shut the business down in order to retire? Something else?

      .

      Calls to ban private equity are attempts to play "shoot the messenger".

      1. Xirdus · · focus · HN ↗
        > So, what happens if person A is prohibited from selling their business?

        I actually made that thought experiment. Disallow selling businesses. Disallow selling shares. Disallow stock market. Disallow mergers. The only way to acquire a business is to found it or to inherit it. The only way to quit a business is to shut it all down, with all assets liquidated, all liabilities settled, and all contracts terminated.

        The main downside is that it's harder for to make money. Otherwise... I only see positives. And no, it wouldn't kill innovation. The investors would just have to invest the old fashioned way - by founding companies or expanding their existing businesses. As for job security, we already don't have it in the current system.

        1. tacostakohashi · · focus · HN ↗
          Private property is theft!

          Disallow eyeglasses. Abolish money.

          Any other good ideas?

          1. Xirdus · · focus · HN ↗
            You can sell all your offices, desks, printers, laptops, machinery, land, inventory, intellectual property, and anything else you want to your heart's content, to anyone you want, for any price you want. The only thing you can't sell is the legal entity itself.
          2. NegativeK · · focus · HN ↗
            I don't agree with the parent of your comment, but saying they're a Maoist is way too far from my request of steelmanning.
        2. alex43578 · · focus · HN ↗
          That's such an incredibly shortsighted view of the downsides.

          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.

          1. bruce511 · · focus · HN ↗
            It's worse than that. When the owner retires, all staff lose their jobs. That's a fairly big bummer.

            I'm currently part of a "small" business/factory (around 50 employees). The owner is nearing retirement. Are all 50 of us gonna hit the streets tomorrow? Should our customers, many longstanding over 20 years get their contracts terminated? Do they get any warning? Can they easily switch to other suppliers? Is our offering somewhat unique?

            Frankly, I think the thought-experiment is very incomplete if you can't see major downsides.

            1. Xirdus · · focus · HN ↗
              Recently, the owner of the factory my grandfather worked for the last 30 years has retired and sold their business, as a single package, fully operational, with employees and pending orders. It was still shut down and all employees were let go without any severance. From what I know, this is the norm for retirement sales, not the exception.

              In this thought experiment, the result would be very similar to what happened, except with less wealth concentration, and with fewer Boeing-McDonnell Douglas mergers that ruin good companies in pursuit of short term profits (because short term profits are harder to realize by design).

              Lost jobs are also a lot less of a problem in countries with functioning safety net.

          2. Xirdus · · focus · HN ↗
            > In your model, the only possible business owners would be those with major capital resources to begin with

            Or you get a loan. Or you get an investor on board. How is that different from the current situation?

            > encouraging the spread of existing businesses into a sprawl: Walmart is now your doctor, pharmacist, and pharma manufacturer.

            It's happening anyway. My last vaccination was done 100% at Walmart.

            > Nobody would start a small business because they'd have to carry all liability

            How is that different from the current situation?

            > any new ideas are limited to spread at a glacially slow pace, because companies can't be aquired or acqui-hired

            Acquisitions are a relatively recent inventions, acqui-hires even more so. People have been doing massive inventions at rapid pace for like 200 years before being bought out by FAANG was a viable business strategy.

            > but can instead only scale on their own revenues.

            And loans. Don't forget loans.

        3. cyberax · · focus · HN ↗
          OK. Your job is from now is dung transport. Because you inherited it, whether you like it or not.

          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.

          1. AngryData · · focus · HN ↗
            They can't sell "Xirdus's Dung Service", but they can still sell their assets like the dung cart, shovel, dung pit, etc.
            1. cyberax · · focus · HN ↗
              Sell it to whom? Who is going to be buying the assets? And what about employees?

              (never mind that "selling assets" is just a workaround for "selling business")

              1. Xirdus · · focus · HN ↗
                It makes it impossible to share part of a business, including stocks. It also massively increases the friction of takeover by killing all employee, vendor, and client contracts, so the buyer cannot benefit from any of these without arranging for it separately. It also invalidates the strategy of leveraged buyout. But yes, it can be done in principle. Which is especially important in the "who will take over the local dentist's office" scenario - this system would heavily favor small business owners who want to do the business personally over holding corporations and PE funds.
                1. cyberax · · focus · HN ↗
                  Nope. It will result in a large company moving in and buying all the assets (still allowed), and forcing the employees to work for less money. Because why not?
                  1. Xirdus · · focus · HN ↗
                    It already does literally just that. You're basically saying nothing would change.
                    1. cyberax · · focus · HN ↗
                      Yes. So your system not only fails to solve the issue in question, but also makes everything worse.
          2. Xirdus · · focus · HN ↗
            It's crazy what some people will come up with just to have something to criticize instead of the actual contents of the thing they're replying to. Nobody said continuing an inherited business is mandatory, least of all me.

            I am all for serious discussion about shortcomings of my idea. But this isn't it.

            1. cyberax · · focus · HN ↗
              No, I'm just describing the dystopia that will be the result of your idea.

              You basically want to reinvent the feudalism with its nobility and peasants.

              1. Xirdus · · focus · HN ↗
                The dystopia you're describing has nothing in common whatsoever with my idea. Now please stop misrepresenting my words.
                1. cyberax · · focus · HN ↗
                  Yes. It absolutely does, because your system heavily favors inherited capital that HAS to stay within the family. It also heavily discourages capital mobility, risk-taking, and entrepreneurship.

                  Say "hello" to dynastic marriages, noble lineages, etc. The _best_ case is the system of medieval guilds.

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