Thread

1. throwaway13337 · 1789952505 · focus · HN ↗

   There's a pattern to the kinds of companies PE buys and I think it points to the real problem.

   They like companies with some kind of moat that makes it hard to unseat them. Basically, companies where there is no alternative for the consumer. That way, they can inflict abuse but know there will be nowhere to run.

   There are two different ways to achieve this. Monopoly and regulation. Hospitals have both government granted locational monopoly and tons of regulations that make it impossible to compete.

   Private equity is the symptom, not the disease.

   Until we get at the disease, new monsters will be born with different name filling the same ecological niche. It's economic natural selection played out in the environment we created.

   1. Waterluvian · 1789953119 · focus · HN ↗

      The Americans simply will not reject their broken for-profit medical system wholesale. What I see is one more attempt at chipping away at it in hopes that maybe they can succeed piecemeal.

      1. claytongulick · 1789955671 · focus · HN ↗

         I'm not sure anyone has solved the problem, though.

         "For profit" isn't really the problem, fee for service is.

         Value based arrangements and capitated payment structures are real improvements.

         When you don't have any market forces constraining utilization, you get massive access problems.

         1. robmccoll · 1789957747 · focus · HN ↗

            The United States has both market forces and massive access problems. I'm not sure you can establish that causal relationship.

            1. georgemcbay · 1789959090 · focus · HN ↗

               > The United States has both market forces and massive access problems.

               It boggles my mind when I still occasionally hear people speaking out against all forms of single payer healthcare in the US saying they don't want to have to wait weeks/months to see a doctor like they do in Canada/UK/wherever.

               If I give them the benefit of the doubt of not being paid lobbyists for the medical insurance industry, I can only surmise these people haven't been to a non-emergency doctor since prior to 2020.

               Because even here in the US if you aren't fabulously wealthy with concierge medical you'll be waiting weeks/months to see a 'doctor'. And you'll almost certainly never actually see a doctor, you're going to see an overworked NP (no shade on NPs here, most of whom are great, just establishing how our medical system actually works in 2026).

               1. throwup238 · 1789961504 · focus · HN ↗

                  I don’t remember the last time I had to wait more than a few days to see a GP or more than a week for a specialist on an employer’s PPO insurance plan. I’ve had them at several employers ranging from university to FAANG so it’s not exactly something only fabulously wealthy people have access to.

                  The problem is there is a huge bathtub curve in insurance quality between employers and the public market. It’s a rude awakening when you can’t afford COBRA rates and have to fall back to a “bronze plan” or whatever is available on the exchanges.

                  1. anon291 · 1789962217 · focus · HN ↗

                     On the other hand, most states with significant tech workforces have Medicaid which most people will qualify for if they're laid off (I did!) and these are excellent. People pay for cobra despite a public option being available.
                  2. stephenhuey · 1789963232 · focus · HN ↗

                     FAANG employee health insurance? Something like 1% of American workers get that, if even that many. Then throw in my oil company friends here in Houston and a few other industries which give premium benefits and you still have a tiny subset of the American workforce getting exceptionally strong benefits. Not at all indicative of the experience of most Americans.

                     1. throwup238 · 1789963569 · focus · HN ↗

                        The universities I worked for (both public and private) provided the same level of PPO insurance, as did a random fitness startup, a clinical diagnostics company, and a construction company. I invite you to reread the part where I said “several employers [plural] ranging from university to FAANG”.

                        1. stephenhuey · 1789965421 · focus · HN ↗

                           Here in Houston, my friend who works at UH has excellent insurance. A quick search online confirms that it is much better than average. Different structure for employees at Rice, my alma mater, but still excellent. Gemini describes these employees being in a kind of "benefits bubble" here in Texas, and they're getting something way better from what most Texans get.

                           You said FAANG, so perhaps you're in California, a state that has laws regulating health insurance to an extent that make it unique in the USA?

                           1. throwup238 · 1789967010 · focus · HN ↗

                              > You said FAANG, so perhaps you're in California, a state that has laws regulating health insurance to an extent that make it unique in the USA

                              That is definitely a confounding factor, although I’m curious how much of that is the urban vs rural split in other states. (The construction company was not in California but oil boom-town adjacent in Texas)

                  3. Spooky23 · 1789965224 · focus · HN ↗

                     That’s not necessarily an insurance issue.

                     Part of ACA was the creation of regional health cartels. If you’re in a region with shitty networks, care may be hard to get. Where I live there’s a teaching hospital with a doctor focused medical network and a big Catholic hospital chain.

                     In my scenario, There is a good market for cardiac, OB, and some other specialties in each network. The rest is a monopoly— the catholic network doesn’t staff neuro for example, they just have consultants.

Unofficial Hacker News client; not affiliated with Y Combinator.