by Paul Waldman - Washington Post
When You Dial 911 and Wall Street Answers
by The NYT
A Tennessee woman slipped into a coma and died after an ambulance company took so long to assemble a crew that one worker had time for a cigarette break.
Paramedics in New York had to covertly swipe medical supplies from a hospital to restock their depleted ambulances after emergency runs.
A man in the suburban South watched a chimney fire burn his house to the ground as he waited for the fire department, which billed him anyway and then sued him for $15,000 when he did not pay.
In each of these cases, someone dialed 911 and Wall Street answered.
The business of driving ambulances and operating fire brigades represents just one facet of a profound shift on Wall Street and Main Street alike, a New York Times investigation has found. Since the 2008 financial crisis, private equity firms, the “corporate raiders” of an earlier era, have increasingly taken over a wide array of civic and financial services that are central to American life.
Today, people interact with private equity when they dial 911, pay their mortgage, play a round of golf or turn on the kitchen tap for a glass of water.
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Private equity put a unique stamp on these businesses. Unlike other for-profit companies, which often have years of experience making a product or offering a service, private equity is primarily skilled in making money. And in many of these businesses, The Times found, private equity firms applied a sophisticated moneymaking playbook: a mix of cost cuts, price increases, lobbying and litigation.
In emergency care and firefighting, this approach creates a fundamental tension: the push to turn a profit while caring for people in their most vulnerable moments.
For governments and their citizens, the effects have often been dire. Under private equity ownership, some ambulance response times worsened, heart monitors failed and companies slid into bankruptcy, according to a Times examination of thousands of pages of internal documents and government records, as well as interviews with dozens of former employees. In at least two cases, lawsuits contend, poor service led to patient deaths.
Private equity gained new power and responsibility as a direct result of the 2008 crisis. As cities and towns nationwide struggled to pay for basics like public infrastructure and ambulance services, private equity stepped in. At the same time, as banks scaled back their mortgage operations after the crisis, private equity firms — which face lighter regulation than banks, and none of their rainy-day capital requirements — moved in there as well.
The power shift has happened with relatively little scrutiny, even as federal authorities have tightened rules for banks. Unlike banks, which take deposits and borrow from the government, private equity firms invest money from wealthy individuals and pension funds desperate for returns at a time of historically low interest rates.
Since the 2008 financial crisis, private equity firms have gone from managing $1 trillion to managing $4.3 trillion — more than the value of Germany’s gross domestic product — according to the advisory firm Triago. Retirement nest eggs are fueling the growth and sharing in private equity’s risks and returns: Nearly half of private equity’s invested assets come from pensions.
“There is private equity — a lot of it — and it’s happening everywhere,” said Vikram Pandit, a former Citigroup chief executive who is now head of the Orogen Group, which invests in financial businesses. Across the financial landscape, he said, “New champions will emerge.”
Tense talks led to Brigham, nurses deal
Late Saturday, after months of tense negotiations and with a strike looming, it wasn’t disagreement on wages or benefits that kept Brigham and Women’s Hospital and its nurses union from nailing down a new contract. The final sticking point was a new patient-monitoring device that the Boston hospital wanted to deploy, and nurses wanted a say in how it would be used.
With help from Mayor Martin J. Walsh, who played the role of unofficial mediator throughout the weekend even though he was out of town, Brigham and the Massachusetts Nurses Association found a late-night compromise that averted what would have been the largest nurses strike ever in the state on Monday.
“I am certain that the mayor’s intervention turned the tide of this negotiation,” said Dr. Ron M. Walls, the Brigham’s chief operating officer. “He helped both sides understand how important reaching an agreement was, how important it was to the city.”
At 12:30 a.m. Sunday, the hospital and the union representing 3,300 nurses announced they had arrived at contract terms they each could live with. The hospital will get three years of labor peace, which officials said would provide needed stability. Nurses won wage concessions that were less than what they initially sought, but more than the Brigham had previously offered.
It was the culmination of almost 10 months of often contentious talks, including some 27 hours over Friday and Saturday, when Governor Charlie Baker, Senator Elizabeth Warren, state Attorney General Maura Healey, and businessman Jack Connors also worked to help prevent a potentially disruptive job action.
“We’re very relieved,” said Kelly Morgan, a nurse and vice chairwoman of the bargaining committee. “We’re feeling very satisfied with the agreement we reached. It benefits our patients tremendously. It benefits our nurses tremendously.”
The contract talks — with many highs and lows that had officials from both sides thinking they were close to a deal, only to see it fall apart — had grown more acrimonious in recent weeks. The union authorized a 24-hour strike, accusing the Brigham and Partners of disrespecting nurses. The hospital said it would lock out the union nurses for an additional four days.
Medicare, an effective program that needs expansion
by Jack Bernard
I have been amazed at the number of negative Medicare-for-all attack pieces printed in various respected papers over the last few months, making me wonder why primarily liberal economists would be attacking a program that progressives have been trying to enact since Truman.
The underlying implication is that the current private system is more effective than a federal government run single-payer model. As a Republican former elected official with a very conservative spending record, I too believe in eliminating governmental waste and in utilizing the private sector when it is more effective.
Therefore, my record makes some citizens surprised when I advocate for Medicare for all. Objectively, the U.S. healthcare system is and has been severely broken. Despite our spending far more per capita, our country is far behind all developed democracies, which scoff when our politicians make the false claim that we have the best healthcare in the world.
For example, the National Research Council and Institute of Medicine recently commissioned a panel of experts to compare our health with that of 16 other developed nations. We ranked poorly, on the bottom in several key areas! The NRC/IM report stated that our health care is “inaccessible or unaffordable” with “lapses in the quality and safety of care”.
The nations with the lowest cost and best outcomes have comprehensive universal health insurance, either: A.) the government provides direct care (like England or the “socialist” VA here); B.) there is a public utility model (like Denmark and France); or C.) there is single-payer (like Canada, with Medicare covering everyone).
Despite the demagoguery, options “B” and “C” do not represent a government takeover of health care delivery. These options eliminate private-sector insurance company marketing and administrative costs, and big pharma price gouging, directing that money into patient care rather than paying for bureaucracy and multimillion-dollar CEO salaries.
Medicare, the U.S.’s national health care insurance for the disabled and those over 65, has under 3 percent overhead costs (Canada is under 2 percent). Private insurance companies complained because the Affordable Care Act (ACA) required them to get down to 20 percent, or pay a fine.
You will notice that the list of options used by other nations does not include an “Obamacare” model, with dozens of private insurance companies offering a multitude of confusing, expensive plans. In fact, the ACA is a direct descendant of the private insurance plan model derived by the conservative Heritage Foundation as an alternative to “Clinton Care” in the 1990s. That overly complex model became “Dolecare,” which then became “Romneycare.” Oddly, the ACA was then passed by Democrats.