That said, Elon is one of the most obviously autistic people I've ever seen. He's not a great example of overdiagnosis. In fact, if autism hadn't already been discovered they'd have taken one look at him and invented Elontism.
Only about 15-20% have full time jobs. The suicide rate is incredibly, almost unbelievably, high. I think it was something like 80% have attempted suicide.
Personally I think we need more subtypes again. Its weird to lump high functioning aspergers folks like the richest man in the world into the same category as those who have to wear helmets and be physically prevented from harming themselves.
https://www.theguardian.com/society/2023/jul/31/autism-could...
Lots of unqualified people claim lots of things, that doesnt mean you ignore the actual doctors when it comes to medicine and ASD is literally defined as a disorder. You can not be diagnosed with it without some negative impact to your life.
They do also quote a few qualified doctors but the doctors use the word "disability" an awful lot and make no such claims.
Even then, the two folks that do argue for the "social model" of disability are still not arguing that it isnt a disability, they essentially just claim it would be nicer for people if we pretend it isn't - then they go on to to talk about how even among the autistic without learning disabilities the suicide rates are 9 times higher. They cite that as proof that its society making it worse, I see it as proof that autism isn't freaking good for you any more than depression is. Humans are social animals and social diseases are still diseases. More to the point, some of us wear helmets and spend 12 hours a day in a ball rocking back and forth. Thats not "societies problem".
The whole thing reminds me of when I was diagnosed and my neuropsych asked me if I wanted it to be included in my file. He explained that many/most of his very high functioning clients preferred it not be in their medical record, as they didn't want the stigma.
I honestly think we are still under-reporting the numbers for the high functioning, and its largely because some people are too scared to accept who/what they are. IMO those people need to face reality, not ask society to play pretend. The actual name of the diagnosis includes the word "disorder" and you literally cant have autism if you dont have problems.
Pretending that you are fine and it s just a personality trait is counterproductive, but if it helps you sleep at night go for it, I guess. Just be careful. Pretending like all your problems are societies fault won't actually change who you are or reduce your symptoms.
Also note that scientists and doctors are no longer on the frontlines of the change that's sweeping across society. It's activists who realize that identity and community is more important than cold logical arguments.
>Pretending like all your problems are societies fault won't actually change who you are or reduce your symptoms.
No, I don't pretend it's societies fault that I am who I am. It's societies fault for not being inclusive of who I am and not completely normalizing my condition so I feel included.
What I'm about to say is very negative, but please don't think it's directed at you. I'm just jaded and have seen some things.
I can respect that you see a problem and want to solve it, and I even agree that it's a problem. The suicide rate, for example, can at least partly be blamed on the way society (especially children) treat people who are different. That said, I can't help but feel that you are missing a few key things.
1) It's a medical condition. Better activism doesn't lead to better patient outcomes. It just puts conflicting pressures on already overtaxed doctors that make it hard for them to treat patients properly. See what's happening to trans folks for an example.
2) Forcing people to use different words to describe you doesn't make them respect you more, it just frustrates them that they can't speak plainly.
Take the medical term "Mongoloid" for example. It was used to describe the people we now call "Intellectually Disabled" until it became an insult. So doctors invented a new term: "Moron." Moron almost immediately became an insult, so they invented "Mentally Retarded." Mentally retarded became an insult, and was actually *outlawed* in 2010 (Literally outlawed, check out Rosa's law). A few weeks ago I heard my niece make fun of my nephew by calling him "mentally challenged" and doing a hand gesture. He was no less offended than he would have been if she'd used any of the other terms.
The history of that sickness is a history of euphemisms: Simpleteon, Cretin, Imbecile, Mongoloid, Retard, Idiot, Defective, etc... The've all been socially acceptable designations at one point, but each time a new one is created it also turns into an insult. It's not the phrasing that is the problem here, and it can't be fixed by adjusting the language we use (although I'm sure we'll keep inventing new euphemisms forever). There's a fundamental aspect of "not being smart" that people find insulting so whatever you call them BECOMES THE INSULT. We can't change that, it's just how humans are.
Similarly, autistic people are *Weird*. We just don't fit in well, and neither scolding the kids on the playground for using the wrong terms or blasting some Joe Six-Pack on twitter are going to change their minds.
Even if we get them to change their words, the words will become insults by virtue of being tied to the "weird people". When you finally convince everyone to call us "neurodiverse" it will mean that neurodiverse has become an insult. When we convince them it's just a "personality type" it we be regarded as a bad personality type.
Changing other people just doesn't work. You have to change what you expect from them if you want to be happy. It's all your really in charge of.
What? Activism by trans people is directly responsible for the improvement of the lives of trans people (see informed consent for example).
You have to look at the real world, not the world that (presumably) we both wish we lived in. In real life, activism just leads to counter-activism.
I'm not saying that trans folks aren't better off now than they were a decade ago, but I am saying that for every action there is an equal and opposite reaction. If you have a medical condition that needs treatment you probably don't need a line of dummies lining up to block you as you walk in because you've turned your condition into "Activism."
Some things are made worse by turning it into politics.
[0] https://gender.stanford.edu/news/continuities-and-developmen...
Trans people are better off now specifically due to trans activism.
Every action having an "equal and opposite reaction" is a physics concept which doesn't apply here.
Not all of us are convinced that each and every component of human diversity needs to be treated as an ailment and medicated. Autism, as the name implies, is a spectrum. But we've widened the spectrum so far that its become meaningless. There are profoundly autistic people who can't speak who would not recognize my diagnosis of autism simply because I have trouble looking people in the eye.
You mention gender, and that's a perfect example: we've widened it to include every possible thing. And when it comes to the over-diagnosis/overmedication question: You can be just fine with the idea that gender is a spectrum, but also believe that giving hormones and surgery to teenagers is utterly insane.
I always knew much of my family, including me, had autism.
It reminds me of: "I used to do drugs... I still do, but also I used to." - Mitch Hedberg
Its funny because nobody expects you to use the language that way, but logically its still valid.
https://en.wikipedia.org/wiki/Empathising%E2%80%93systemisin...
Unironically trying to villify the "Atrazine is turning the frogs gay" guy is going to look really stupid to liberals very soon.
I'm very liberal and never made fun of the researcher who identified that atrazine makes frogs gay. It does objectively mess with amphibian development.
I did, and still do, mock Alex Jones for insisting that it was government conspiracy "chemical warfare operation" designed to do... something. That makes exactly as much sense as his Sandy Hook nonsense or pizzagate.
Maybe these private equity firms are trying to create incubators out of these autism centers for new startup ideas..
There should also be strict leverage, related-party transaction and dividend limits. In exchange, we might provide a public lender of last resort for healthcare providers who need a lifeline.
Banning private equity from healthcare is a good headline. And if I were a candidate, I’d probably run on it. But it’s a band-aid to a broader incentive problem.
Americans are deeply divided on the big bad guvmit
Administrative overhead. And some things resist it, e.g. ERs.
Fair point about emergency medicine. I meant healthcare (and also veterinary, dental, etc) in general. But I suppose there are some exceptions where the model doesn't fit so well.
Also, I am saddened by the shared anxiety of healthcare in US (availability while jobless, f*** by big bills, lack of care, etc). The raw amount of shared mental stress must contribute to lower lifespans :(
Also poor people who having serious health problems dont have time to be politically active.
But insurance companies are a-ok
Like bank bailouts and farm grants.
look at the F500 list and note how many healthcare companies are in the top 50 (even top 10), then ask yourself how much they could spend on marketing
As such, liberals and conservatives agree its a bad idea.
These companies, in finding essentially arbitrage opportunities, are, perversely, helping strengthen regulation, but only if regulators pay attention to what is going on and do something about it, instead of just watching it happen.
I think the place I take my kid to for therapy is likely private equity owned, but it's also about the only place available in my area.
I know they are charging around $80 per season, and I also know that the salaries for their therapists are around $25 to $30 per hour.
That leaves a very healthy margin for everything from employee benefits to building rental to admin (which I think is probably where the majority of margin goes).
I know of a childcare center that was acquired recently. Not sure if by PE or just another business, but the employees are less than thrilled with the changes.
A rule of thumb is that benefits cost an employer 25-30% of salary. So you're already pushing to 50% of revenue going to direct salary costs. Then there are employees in non-revenue roles (HR, legal, accounting, IT, etc...) and employees doing non-revenue work.
Finally, you have rent, licensing, insurance, and all the other fixed costs.
So to your point, if we assume 4 appointments per season at one hour per, they are actually paying $100 in salary alone to only collect $80 season pass fee - a $20 loss! This business model is not sustainable
and then people complain why ther doctors burn out. what do you expect when you ingrained on them that every hour not booked is $80 lost, so we need to book them 24/7, cut their lunch break and squeeze every inch of life from them.
...may? How are they not already by gobbling them up in a calculated way. Targeting states with lax insurance claim scrutiny
[1] https://jamanetwork.com/journals/jama/fullarticle/2813379
They are much more likely to continue shoveling cash into private businesses through subsidies then to want to setup and/or run the same business for a fraction of the cost.
I hope they go after hospitals next.
We'll see. That was just an EO. That doesn't really have the force of law behind it. There's not a regulatory body (AFAIK) that would or could prevent PE from gobbling up a home.
But if there's a route to stop it then I'm not opposed to it. PE buying essential goods and industries is bad for everyone.
There is not an easy answer here, it basically a cost centre that whoever runs it, the welfare state is incentivized to spend as little as possible on it. PE is almost certainly a bad solution. If they can destroy a restaurant or other low impact business, I hate to think what they’d do to businesses that care for people. You’d get the healthcare equivalent of Burger King. But with government you get the equivalent of the DMV.
You don't have to do that, we have US government ran facilities. It's the VA.
And if you look at the costs associated with the VA, they are much much cheaper than almost any private care [1].
And if you know a few vets, you know they almost universally love the VA. It's one of the best perks of serving in the military.
[1] https://www.herc.research.va.gov/include/page.asp?ID=inpatie...
An ideal free market is a global minima (in theory). It's the best.
A non-ideal free market (heavily subsidised and regulated) might be close (in parameter space) to a global minima, but might be highly suboptimal compared to a local minima.
I have yet to see reasonable fix to the tragedy of the commons in a free market situation, and that's one of the most basic things one is fucking introduced to when studying economics and game theory.
Anybody who thinks health care is best served solely privately should have to pay to be diagnosed for something; either that or they've been failed in their privately funded education.
Historic explanations are even more problematic. How does libertarianism explain nomadic cultures or rice growing cultures (that tend to be highly collectivist)?
…or Nash equilibriums.
Are those your gut feelings, or do you have an argument to back it up?
In reality, the outcomes from Government operated hospitals in Scandinavian Countries do not need to hide behind those of other countries, especially not with the US
https://jamanetwork.com/journals/jamainternalmedicine/fullar...
"The government is the best entity to run healthcare, except, when the voters elect people who's motto is fuck you, I've got mine"
Not "Government is probably the worst actor to run healthcare facilities"
but:
"Americans are probably the worst actors to run healthcare facilities"
I hope it's not true.
Don't forget there are so many countries with government healthcare and their care is a lot more accessible than the US's. I've lived in many countries and a nationalised healthcare system is one of the things I select for.
Even a poor country like Cuba has one of the highest numbers of doctors per capita. Unfortunately a bit hamstrung by the US's illegal and needless sanctions so they can't get proper equipment but I've been told healthcare is still pretty excellent there.
On what planet does this not happen in America?
The challenge for citizens is active participation in oversight of management of the commons - rats will sneak into every granary otherwise.
so I agree with you in theory, but in practice, there was a whole host of other issues that would need to be dealt with somehow. I don’t know that more bureaucracy is the solution, but I would like to think it can be handled.
"Free" markets tend to have transparent pricing : US healthcare does not.
"Free" markets tend to have large numbers of independent players that compete with each other : This is disappearing in the US market.
We have the worst of both systems currently. It's not ran by the government to control costs to the end user. And it's ran by a few monopolistic insurance/medical companies to reap as much profit as possible.
[1] https://www.pgpf.org/article/how-does-the-us-healthcare-syst...
It's a line that tends to be mainly parroted by... the US. Quelle fucking surprise.
> Because we have governments anemic to running anything or regulating any business.
Since roughly Reagan, the US has been either fully dismantling, defunding, or privatizing these institutions.
We've seen the FAA start to rely too heavily on the likes of Boeing to set regulation standards. The FDA has relied heavily on fees from private institutions to function and it's weakening due to that improper mixing has resulted in the likes of the Vioxx scandal.
Medicare is a good example of this. Under Clinton, rather than expanding or reforming medicare he introduced a plan to allow private insurance companies to get government dollars (medicare part c).
> These are institutions that have mostly been created during the progressive era of the US. The EPA (I believe) is the latest of these organizations.
> Since roughly Reagan, the US has been either fully dismantling, defunding, or privatizing these institutions.
Yup. Primarily on the 3rd prong but, especially under Clinton, there was also significant defunding that went one. "The era of big government is over".
Clinton did welfare reform, which added much stricter means testing and work requirements to welfare. The "reinventing government" program was literally a hack and slash on government agencies not unlike DOGE. The student loan reform reduced subsidies for students. He signed in the crime bill which enabled the building of private prisons and ramped up the US incarceration rates. And he created Medicare part C which created a route to send government funds to private insurers.
Obama's signature bill, the ACA, was a giant handout to insurance companies in pretty much every way. By trying to force people into buying insurance and also subsidizing insurance purchases, it was a major gift to health insurers. Even the Medicaid expansion mostly resulted in private insurers getting more wealthy as most states implement Medicaid via a private insurance contractor. After the first midterm Obama got very little done mainly due to the republican's continuing the Newt Gingrich "we oppose everything you support" strategy and the filibuster.
Biden was mostly business as usual, however both the infrastructure bill and the chips act can't be seen as anything other than just massive giveaways to private industry. The build back better act would have been the same had it passed.
In many countries, essential services like hospitals, drinking water supply, airport security, schools, even prisons are now partially or fully privatized. It seems insane when you think about it, but that’s what your grandparents voted for.
This article only refers to the US. This is the second time I've brought it up over the last week, but it'd be nice if the US and "the west" weren't constantly conflated.
Not all of us have fucked over their citizens and spiraled into borderline dictatorships that are well on their way to becoming international pariahs as much as the US have.
It's the only developing country that is also "first-world" or "western", and unfortunately, also the most powerful of those.
Government runs anything that regulation alone cant make safe.
Once the incetives got changed, a lot of doctors opened up their own practices as PE. The government still foots the bill, but the corrupt middleman of the local variety got cut from the flow
Could you expand on this?
The hospital has 100 beds, 30 in personnel and some amount of equipment to maintain, repairs to make, etc. They get funding from the ministry based on that. Then the head of the hospital pockets some of the allocated money on repairs and gets some percentage off bribes that doctors get from patients. If nobody ever visits the hospital, no surgeries are performed and no x-rays are done, they still have the same funding. People mostly can only go the hospital in the locality where they have their registered address (which you don't get if you live in the privat rental, but it's a different problem), unless they pay a bribe (see above).
After: the hospital is still government (or city) owned, but it has to generate revenue by proding actual services. Since health is a basic constitional right, the government still pays for most of the stuff, but only after they get the itemized bill of services and materials provided. Itimized services and materials have fixed prices set by the government too. Government or a city can still give the hospital a subsidy if they want for some capital heavy stuff, but they then see how good it's utilized.
Now the best part -- if you are a doctor and head of your hospital is a cunt, who still does the habitual stuff, you can get from your ass and open your own one-person practice, sign a contract with the government and they will pay the same amount to your directly. The patients can choose freely where they get the service and will not pay for it anyway. In practice it also means not having to pay bribes to actually have it provided.
You can think of it as a government operating an insurance company that is funded directly by the taxpayers and then dealing with health providers on a regulated, but open, market.
Our grandparents wanted a nice hospital and that's what they voted for. The people they elected needed funds to build the hospital, so they sought funding. The IMF and World Bank said "sure, we'll help you fund it. But in order to do so, you need to privatize your healthcare industry."
Our grandparents got a nice hospital for a while, the politicians got another 4 years in power, and a few years later we noticed that our free healthcare was gone.
This, multiplied across the entire developing world.
This seems like a pretty weird perspective to have?
We don’t want to pay for them. When private equity is forced to sell, someone has to buy or the providers get shuttered.
On the other hand, we’re clearly willing to blow the money and deficit on stupid stuff. But only if it goes boom, apparently.
The only possible entities who could buy a company are either a bigger company, or private equity.
That the leavings of a PE business are unattractive to either of them is not a surprise.
That has nothing to do with what society at large (a better definition of "we") actually wants or needs.
Voters, broadly and monolithically.
> only possible entities who could buy a company are either a bigger company, or private equity
Communities. Forcing PE to divest from healthcare would require setting up a lending facility communities can borrow from to buy back their healthcare infrastructure. (Or have the government just buy it outright.)
I guess you could make it work as a window-dressing bill. Force PE to divest. Leave unsaid that you’re letting billionaires and family offices buy it up to continue the same shit. But actually solving the problem means ponying up cash to buy this stuff back. Even if it’s out of bankruptcy. (I’m not even touching the politics of paying PE and its lenders with public money.)
I’m imagining harder. Forced divestiture. Good amount of the hospitals and nursing homes would be bought of out bankruptcy.
But they still need to be bought and funded. And I think nobody wants to have a conversation about how much that costs and who winds up paying for it, particularly with many of PE’s hospitals being in rural America.
The American mind virus at work.
My (non-US) state government literally purchased a private hospital late last year. Now it’s public.
Keep telling yourself that corporations are going to save you. Maybe it’ll happen eventually.
Unfortunately that is virtually impossible in the current political climate, so I didn't include it.
What I was trying to say is that, as it stands, PE is the end of an entity's life. Once it's been strip-mined for all value, of course nobody wants it.
We probably need a Constitutional amendment codifying independent agencies before it can happen. We don’t need the President denying protesters medical treatment because he needs to distract from his pediphilia.
https://www.cms.gov/medicare/regulations-guidance/physician-...
Perhaps we should have kept taxing the rich the we did during WW2 and the few decades following it? No, clearly that would never work!
Genuine question: source for any of the rich having paid more in the 50s than they did in the 90s? My understanding is that while published rates were high, effective rates were roughly flat until the Bush and Trump tax cuts.
https://taxpolicycenter.org/taxvox/effective-income-tax-rate...
Now the 1% is paying more of the overall taxes, about 40%, but that number is also skewed (and can be misleading) by the absolute massive disparity between what the top and bottom make now. Plus of course reporting and tax compliance has changed a bit, plus a whole host of other confounding factors that this 40% statistic subsumes, but it's worth mentioning because it's always brought up in these discussions.
So the article has no source for the data? Only two years of data comes from the IRS, where does the rest come from? Why should we trust this?
To quote the article: "Debates over measuring effective tax rates have been lively because measuring taxes and incomes is complex and involves judgement calls (and the political stakes are high.) We applied a simple and replicable method to a single, publicly available source of data to estimate the effective tax rates of high-income taxpayers that avoids making assumptions about grey areas like unrealized capital gains and corporate tax burdens."
We don’t want to pay for them. When private equity is forced to sell, someone has to buy or the providers get shuttered.
Sell? The point is that PE should never have purchased these things in the first place.
You can change the present. Not the past. Private equity owns these things. If you want them to not own it, you have to buy it back. Even if out of bankruptcy. Even if via eminent domain. Then you have to run it. All of that costs money.
In theory state or federal governments could seize ownership of those healthcare provider organizations. But then legally the government would be forced to compensate the current owners at fair market value.
When you review the findings on the standard behavioral intervention, autism, on average requires 2.5 years of 40hr/week.
Thats basically one persons job.
It shows a -0.2pp DECREASE in in-hospital mortality, with no significant change on 7 or 30 day mortality. The authors suggest this could be due to:
* selecting for healthier patients - the paper shows an average change of 0.1 years younger for patients. this is not significant!
* transferring out sicker patients - 30 day mortality would show this (it doesn't), and the transfer rate does not change meaningfully
So based on the evidence you have provided, private equity purchasing hospitals saves lives. Maybe that is wrong, but it is the conclusion of that evidence.
They also don't claim PE is killing people in the conclusion; did you read the paper?
They've had more bloodstream infections, surgical infections, and falls. Everything which traces back to staff cuts and lack of hygiene.
Also they dumped the complicated, and probably expensive cases to real hospitals In contrast, transfers to other acute care hospitals increased 12.2% at private equity hospitals compared with control hospitals
They had more bloodstream infections yep. Surgical infections was NOT statistically significant. And again, mortality went down!!
The “dumping cases” thing is incredibly suspicious. So they’re so motivated by money that they … don’t keep patients who would spend a lot? On top of that, the 30 day mortality doesn’t show an increase, which is what you’d see if they dumped deaths onto other hospitals.
Usually those hospitals send the patients they expect to become to cost more than the DRG Reimbursement (Complications, too old, too many comorbidities) off to public hospitals. At least that's how it works in Germany. At the same time, they are very aggressive with upcoding their diagnoses to get more reimbursement.
Moderate and below that I think you can live a pretty free life. Its not like down-syndrome. Autism is surprisingly normalized.
It's easy to scam the government out of money for this because a bunch of well-meaning "useful idiots" will say "pay whatever it takes; give them as much money as they need; it's for human lives!" and none of that is true. It's all about using different battalions to rent-seek on normal tax-paying Americans.
Tim Walz lost his hope for re-election over this but he's not the only one. In time we will discover a large array of healthcare scams and home-care and autism/child mental health are going to be near the top.
And usually it's not a problem, of "Throwing more money at it", but lack of regulations and enforcing them.
That said, Physician Owned Clinics have better outcomes, there is no reason why that shouldn't be the standard model of operating them. Usually they have more moral scruples about worsening care for profit.
Also there is naturally more competition, if there are multiple small operators instead of only Fresenius Nephrocare or DaVita
https://www.cbsnews.com/texas/news/death-rates-at-u-s-dialys...
The data [https://www.transonic.com/renal-disease-in-us] says that kidney transplants for dialysis patients happen LESS frequently in the USA than in Europe, yet the survival rate is very close - 39% USA vs 41% Europe. This implies that dialysis in the USA is very close or _better_ quality than in Europe - as there is a large difference in transplant rates but only a small difference in survival rates.
Maybe the above data is wrong, but CBS don't seem to provide any better data
Survival rates for ESRD are higher in Europe than the U.S. This could be explained by the inferiority of national standards of care, a higher prevalence of patients with diabetes and differences in practice patterns.
Let's look at actual journals
For those with ESKD onset from 2004 to 2008, unadjusted 5-year survival of all patients with ESKD (treated with dialysis or transplantation) was 41% in the USA, 48% in Europe, and 60% in Japan, despite patients being 2–3 years older on average in Europe and Japan than in the USA, and Japan having very few transplant patients.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
The US had a much higher KRT incidence, prevalence, and mortality compared to Europe, and despite a higher kidney transplantation rate, a lower proportion of prevalent patients with a functioning graft.
The NDIS is our disability welfare scheme, and it's costs have exploded as oversight has failed to keep pace with exploitative actors. Few questions asked welfare for our vulnerable would be nice, but sadly it doesn't look sustainable in most places.
fortunately the UK doesn't have this problem for people as the state run healthcare system has set the price floor at zero
it hasn't stopped the private equity scum completely though, instead they have bought up most of the country's formerly independent vets
> From only 10% in 2013, almost 60% of veterinary practices are now owned by large companies
they then immediately "optimise the demand curve", doubling/tripling their prices, meaning there are now people that can no longer afford to treat their pets
Who gets to say what "a little bit of money" is here?
Social programs have been funded, show poor results, then seem like dead ends because of fraud.
Stealing money put aside to help the less fortunate is far more heinous imo.
If we wanted to worry about the bigges source of theft though it is wage theft by a large margin over all other forms of threat combined. And the healthcare industry is ripe with labor abuses.
Or do you mean like Republican Senator from Florida Rick Scott who was elected AFTER he was involve in $1.7 billion dollars in Medicaid fraud (largest in history) and whom the Republican party embraces and endorses and has in a position of power today? https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386....
Can we join together and agree fraud should be stopped rather than protecting people based on which team they are on? It's fine to question whether something is fraud or not, but once it's clear, let's shut it down and punish those responsible.
The Republican party EMBRACED the head man involved in the largest theft in Medicare history, and he is a powerful Senator for them.
This is very much political, as I highlighted. One party acts with responsibility, the other doesn't care except for soundbites and wielding accusations as a weapon and abuse as a boogie man to say 'we can't have government, because people like our Senator steal from it' (it happens to also be the part that hates government, shockingly).
They already got audited by DOGE, now we move on to PE
It's hard to argue against those who say private equity ruins everything. It's astonishing. And massively depressing.
You can download for free when you search the 'net for Founderstowne.
Massive respects to your journalism, I have a lot of questions regarding this tho, namely how long did it take you to build this expose and where are you gonna drop it because I searched net for Founderstowne but I didn't find anything special, are they the VC fund you are gonna expose?
I expose just about everyone as a "roman a clef" (a work of "fiction":>).
I'm 58 years old. Entrepreneurial builder. Disgusted by VC/PE. Been writing this book since 1987.
Also, the two links in your profile do not work
I see a post with 13 points (upvotes / positive reactions) and [flagged] (meaning the title alone upset a few people given there's been no time to read the content yet).
As with all HN submissions, YMMV - Your Mileage May Vary
During my journey I took a beat and pointed my new skills at VCs. I interviewed a few dozen VCs trying to understand what they were trying to get done and what mattered to them, but with a bit of a bias trying to gauge whether they wanted to better predict market demand of their portfolio or prospective investments' products.
What I learned shocked me a bit. The sense I got was that they didn't really care about market demand or building a strong business, they mostly cared if the founder could sell the company up to food chain (series a, b, c etc).
Roughly speaking: "I don't care what value my portfolio companies create, I care about marking up my book so I can increase my take".
I don't know how much this had to do with ZIRP, but it really soured me to the VC industry. I've been committed to bootstrapping my companies ever since.
Pages in my book related to how private-equity screwed over the vet industry: 250. 442. 1001.
I think people will be blown away that the company that makes M&Ms owns a ton of vets.
When I get sued (and I will), I'll employ "roman a clef" and slightly fictionalize the names.
By the way, VCs are not exactly any better than PE firms.
I've tried to reach out Marc Andreesen to see if he can 100% pivot to building instead of extracting. I'm encouraged by his latest fund.
And even if you know for a fact that you aren't at fault, an ounce of prevention is worth a pound of cure and all that. The legal process isn't exactly cheap.
There might have been a time where PE bought up mismanaged companies, and turned them around - but the PE acquisition spree we've seen for the past 10 years or so...it seems exclusively to cause enshitification. And it is happening everywhere. There will always exist some niche PE firms for every sector out there, nothing is safe.
- Veterinary services
- Dental services
- Optometry services
- Urgent care services
I had a storage unit for a while until I realized that the monthly bill was more than the value of the contents.
For every one of you there's a few people using it as business storage and dozens of people who are dealing with living situation stuff (college housing vs apartment, house closing timing, job relocation, house renovation, etc, etc, etc) that trade in and out of units on like a 1-2mo timeline.
Source: Almost bought one.
I’ve even offered to pay for several years in advance at their “current” rate, and they won’t accept it.
A few months ago i got an email saying that PE had acquired it.
I was paying between ~$25/month before. Today i got the first bill from new management for $89.
Same volume/usage, nothing significantly different.
Sigh.
sears had a ceo who was obsessed with competition and pitted his units against each other. they could have created an online portal and then crushed amazon in the crib -- but didn't.
toys r us had a cto who pushed for internet stuff... and said no.
So politicians pretend to care by throwing more money at their cronies and get away with it because won't someone PLEASE think of the children. And then people pat them on back and vote for them in the next election, and blame "capitalism" while the people they've just voted back in make millions.
They even say "We're also dealing with children who are largely insured by Medicaid programs" and yet still people are failing to join the dots...
Where is this 'join' translated from ?
Like those centers are going to be owned by someone one way or another - what is so special or bad about equity firms vs alternatives?
Genuine question. Because I don’t have a clue how this works in US.
Individuals or family holdings are more likely to have concern for their reputations in addition to finances, public companies are more likely to scrutinized offsetting what would be their much lower reputational concerns. But PE is diffuse and often distant enough to eliminate human reputational concerns while being held to far lower stadards than public companies.
A family introduces some perverse financial incentives but you also get long term (ie multi generation) planning and reputation concerns.
A group of practicing professionals who own the operation will hopefully exhibit some shared pride and professionalism.
A co-op or similar arrangement ties the interests directly to the local community.
The larger the public company the less overlap there will be with the customer's interests. At least they might worry about reputation and stock price though.
Pretty much the only concern PE has is avoiding litigation. Their primary motivation is maximizing value extraction over the short or medium term.
However AFAIK most government solutions in the west involve public "insurance" as opposed to the direct operation of health care facilities themselves.
The government has to answer to the people. PE firms do not: they answer only to money.
1. PE aren't investors like you and me. We can go to our brokerage and buy shares of a public company, hold those shares, vote on directors and proposals, etc... Or we can buy and sell ETF/mutual fund shares that own companies. Then, we (or fund managers) can sell those shares after any period of time we want. Could be years, decades, or minutes. Whatever meets our investing goals. The same is actually true for hedge funds. We buy a a piece of a company, hold it as long as we want, then sell to take profit/loss. When PE buys a company though, they buy the whole company AND they have a specific timeline in mind. This is because PE firms are actually temporary private "investment funds": partners put in money and expect a certain return on investment after a certain period of time. At the end, that's when the fund needs to wind down and return capital + returns. So, there's already a ticking clock on anything a PE firm buys, and pressure to generate return before time runs out. They typically do this by taking a company public on the stock market (maybe again) or selling it to someone else. (This doesn't always succeed, but there are other options then, like continuation funds.)
2. PE funds also take on a lot of debt. They can't afford to buy whole companies or roll up entire industries just with their investors' funds, so they borrow a lot. Now, the companies they buy for their portfolios not only need to generate returns for their investors, they also need to do that AFTER making payments on that debt. It multiplies the pressure.
There are a lot of cases where PE bought struggling companies, and with discipline and incentives turned things around on a timeline. But there are also a lot of cases where PE bought stable but boring companies, used debt and pressure to force them to raise prices, cut services, lay off workers, and lower quality in order to generate returns at the pace required.
(Most of this I learned from reading Matt Levine columns, I'm not an expert and don't work in this industry at all, so I may have some details wrong.)
But also by the system that disconnects end user’s satisfaction (families with kids on spectrum in this case) from the profit.
In other words if users of those centers were part of the profit equation - PE would not be a problem at all. Am I right?
If so then the real evil are people who created and support such a system I guess.
The real question to ask is why can they take on so much debt? And for that, one needs to acknowledge the fact that, particularly for the well-connected, debt is easy to obtain as banks essentially create money for loans. There are constraints (otherwise the banks would make themselves trillionaires), but the constraint is not the quantity of money. This creation of money through lending leads to inflation which further supports operating via debt as those who take out loans see the real value of the loans decrease. The banks just made up the money so there isn't a direct loser from the inflation other than everyone who has to deal with increased prices. You can think of it as a broad, regressive tax on the population to fund these firms doing far more than they should.
With an actual constrained money supply tied to real wealth in the economy, the PE firms would have to focus on the best deals which means the businesses that are truly dying and their role is to turn the nonproductive assets into something productive.
---
I asked ChatGPT to critique my answer (which is unaltered above) and it said to tone down the lending being propped up by inflation and instead emphasized the following:
>Inflation can help leveraged borrowers, but in PE the bigger structural advantages are: • Interest deductibility (a massive tax subsidy to debt) • Limited liability (upside captured, downside partially socialized) • Fee extraction independent of performance • Ability to load debt onto the acquired company, not the PE fund
I then asked it to answer the question without regards to my context and it basically said PE is different because of
> • short ownership horizons • high leverage • strong control • financial returns as the primary goal
Here is the link to the short conversation if interested: https://chatgpt.com/share/6963a0de-7a04-8012-8c36-afef5dd74f...
At this point, my son had done 18 months of ABA and was being used to train new RBT's (high turnover field of course). The prescribed hitting was creating behavioral problems at home, but was being used to justify extensive hours of ABA.
I dont think a profit driven model is great for these kids.
Krasnol•3w ago
mapontosevenths•3w ago
hermanzegerman•3w ago
accrual•3w ago
Krasnol•3w ago
Why can't we just leave some things out of the whole madness?
It's not like we don't have enough stuff that can be made profitable already.
Just let your customers be healthy, have a roof over their head, water, electricity, internet. They'll have more time and money to spend on all the other profitable stuff.
It doesn't have to be EVERYTHING!
Panzer04•3w ago
Krasnol•3w ago
mapontosevenths•3w ago
Krasnol•3w ago