[Plura-list] Private equity finally delivered Sarah Palin's death panels

Wed Apr 26 16:11:12 EDT 2023

Read today's issue online at: https://pluralistic.net/2023/04/26/death-panels/

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,

Tonight (Apr 26), I'll be in Burbank at Dark Delicacies at 6PM with my new book, *Red Team Blues*:

https://www.darkdel.com/store/p2873/Wed%2C_Apr_26th_6pm%3A_Red_Team_Blues%3A_A_Martin_Hench_Novel_HB.html#

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,

 From Apr 26-28, Barnes and Noble is offering a 25% discount on preorders for my upcoming novels (use discount code PREORDER25):

The Lost Cause (Nov 2023)

https://www.barnesandnoble.com/w/the-lost-cause-cory-doctorow/1142827022

The Bezzle (Red Team Blues #2) (Feb 2024)

https://www.barnesandnoble.com/w/the-bezzle-cory-doctorow/1143329885

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,_

Today's links

* Private equity finally delivered Sarah Palin's death panels: Hospices are unregulated, heavily subsidized charnel houses.

* Hey look at this: Delights to delectate.

* This day in history: 2013, 2018, 2022

* Colophon: Recent publications, upcoming/recent appearances, current writing projects, current reading

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,_

🕵🏿‍♂️ Private equity finally delivered Sarah Palin's death panels

Remember "death panels"? Sarah Palin promised us that universal healthcare was a prelude to a Stalinist nightmare in which unaccountable bureaucrats decided who lived or died based on a cost-benefit analysis of what it would cost to keep you alive versus how much your life was worth.

Palin was right that any kind of healthcare rationing runs the risk of this kind of calculus, where we weight spending $10,000 to extend a young, healthy person's life by 40 years against $1,000 to extend an elderly, disabled person's life by a mere two years.

It's a ghastly, nightmarish prospect - as anyone who uses the private healthcare system knows very well. More than 27m Americans have no health insurance, and millions more have been tricked into buying scam "cost-sharing" systems run by evangelical grifters:

https://www.nytimes.com/2020/01/02/health/christian-health-care-insurance.html

But for the millions of Americans *with* insurance, death panels are an everyday occurrence, or at least a lurking concern. Anyone who pays attention knows that insurers have entire departments designed to mass-reject legitimate claims and stall patients who demand that the insurer lives up to its claim:

https://kffhealthnews.org/news/article/khn-podcast-an-arm-and-a-leg-how-to-shop-for-health-insurance-november-24-2021/

The private healthcare sector is designed to deny care. Its first duty is to its shareholders, not its patients, and every dollar spent on care is a dollar not available for dividends. The ideal insurance customer pays their premiums without complaint, and then pays cash for all their care on top of it.

All that was true even before private equity started buying up and merging whole swathes of the US healthcare system (or "healthcare" "system"). The PE playbook - slash wages, sell off physical plant, slash wages, reduce quality and raise prices - works in part because of its *scale*. These aren't the usual economies of scale. Rather the PE strategy is to buy and merge *all* the similar businesses in a region, so customers, suppliers and workers have nowhere else to turn.

That's bad enough when it's aimed at funeral homes, pet groomers or any of the other sectors that have been bigfooted by PE:

https://pluralistic.net/2022/12/16/schumpeterian-terrorism/#deliberately-broken

But it's especially grave when applied to hospitals:

https://pluralistic.net/2020/05/21/profitable-butchers/#looted

Or emergency room physicians:

https://pluralistic.net/2022/03/14/unhealthy-finances/#steins-law

And if you think that's a capitalist hellscape nightmare, just imagine how PE deals with dying, elderly people. Yes, PE has transformed the hospice industry, and it's even worse than you imagine.

Yesterday, the Center for Economic and Policy Research published "Preying on the Dying: Private Equity Gets Rich in Hospice Care," written by some of the nation's most valiant PE slayers: Eileen Appelbaum, Rosemary Batt and Emma Curchin:

https://cepr.net/report/preying-on-the-dying-private-equity-gets-rich-in-hospice-care/

Medicare pays private hospices $203-$1,462 per day to take care of dying old people - seniors that a doctor has certified to have less than six months left. That comes to $22.4b/year in public transfers to private hospices. If hospices that $1,462 day-rate, they have lots of duties, like providing eight hours' worth of home care. But if the hospice is content to take the $203/day rate, they are not required to do *anything*. Literally. It's just free money for whatever the operator feels like doing for a dying elderly person, including doing nothing at all.

As Appelbaum told Maureen Tkacik for her excellent writeup in *The American Prospect*: "Why anybody commits fraud is a mystery to me, because you can make so much money playing within the guidelines the way the payment scheme operates."

https://prospect.org/health/2023-04-26-born-to-die-hospice-care/

In California, it's very, very easy to set up a hospice. Pay $3,000, fill in some paperwork (or don't - no one checks it, ever), and you're ready to start caring for beloved parents, grandparents, sisters, brothers, aunts and uncles as they depart this world. You *do* get a site inspection, but don't worry - you aren't required to bring your site up to code until *after* you're licensed, and again, they never check  - not even if there are multiple complaints. After all, no one at the Centers for Medicare & Medicaid Services (CMS) has the job of tracking complaints.

This is absolute catnip for private equity - free government money, no obligations, no enforcement, and the people you harm are literally dying and can't complain. What's not to like? No wonder PE companies have spent billions "rolling up" hospices across the country. There are 591 hospices in Van Nuys, CA alone - but at least 30 of them share a single medical director:

https://auditor.ca.gov/reports/2021-123/index.html#pg34A

Medicare caps per-patient dispersals at $32,000, which presents an interesting commercial question for remorseless, paperclip-maximizing, grandparent-devouring private equity ghouls: do you take in sick patients (who cost more, but die sooner) or healthy patients (cost less, potentially live longer)?

In Van Nuys, the strategy is to bring in healthy patients and do nothing. 51% of Van Nuys hospice patients are "live discharged" - that is, they don't die. This figure - triple the national average - is "a reliable sign of fraud."

There are so many hospice scams and most of them are so stupid that it takes a monumental failure of oversight not to catch and prevent them. Here's a goodun: hospices bribe doctors to "admit" patients to a hospice without their knowledge. The hospice bills for the patient, but otherwise has no contact with them. This can go on for a long time, until the patient tries to visit the doctor and discovers that their Medicare has been canceled (you lose your Medicare once you go into hospice).

Another scam: offer patients the loosest narcotics policy in town, promising all the opioids they want. Then, once their benefits expire, let them die of an overdose (don't worry, people who die in hospice don't get autopsies):

https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle

You can hire con artists to serve as your sales-force, and have them talk vulnerable, elderly people into enrolling in hospice care by convincing them they have nothing to live for and should just die already and not burden their loved ones any longer.

Hospitals and hospices also collude: hospitals can revive dying patients, ignoring their Do Not Resuscitate orders, so they can be transfered to a hospice and die there, saving the hospital from adding another dead patient to their stats.

CMS's solution is perverse: they're working with Humana to expand Medicare Advantage (a scam that convinces patients to give up Medicare and enrol in a private insurance program, whose private-sector death panel rejects 13% of claims that Medicare would have paid for). The program will pay private companies $32,000 for every patient who agrees to cease care and die. As our friends on the right like to say, "incentives matter."

Appelbaum and co have a better idea:

I. Do more enforcement: increase inspections and audits.

II. Block mergers and rollups of hospices that make them too big to fail and too big to jail.

III. Close existing loopholes.

They should know. Appelbaum and her co-authors write the best, most incisive analysis of private equity around. For more of their work, check out their proposal for ending pension-plan ripoffs by Wall Street firms:

https://pluralistic.net/2022/05/05/mego/#A09948

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,_

🕵🏿‍♂️ Hey look at this

* Eminent cryptographer Matthew Green on Red Team Blues https://blog.cryptographyengineering.com/2023/04/24/book-review-red-team-blues/

* An Economic Model Of Intermediary Liability https://james.grimmelmann.net/files/articles/economic-model-of-intermediary-liability.pdf

* Center for the Study of Political Graphics https://www.politicalgraphics.org

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,_

🕵🏿‍♂️ This day in history

#10yrsago HOWTO die at Burning Man https://burners.me/2013/04/25/9-ways-to-die-at-burning-man/

#10yrsago Fair use decision: remixing is legal even when there is no intent to comment or parody original work https://www.artnews.com/art-in-america/features/richard-prince-wins-major-victory-in-landmark-copyright-suit-59404/

#10yrsago Debunking the HTML5 DRM myths https://web.archive.org/web/20130427210336/http://freeculture.org/blog/2013/04/23/dont-let-the-myths-fool-you-the-w3cs-plan-for-drm-in-html5-is-a-betrayal-to-all-web-users/

#10yrsago Akissi: kids’ comic about a mischievous girl in Cote D’Ivoire https://memex.craphound.com/2013/04/26/akissi-kids-comic-about-a-mischievous-girl-in-cote-divoire/

#10yrsago Publishing should fight ebook retailers for more data https://web.archive.org/web/20130428235824/http://www.thebookseller.com/blogs/tangible-assets.html

#10yrsago Jello Biafra talks Occupy, music, and Obama https://www.theguardian.com/music/2013/apr/25/jello-biafra-obama-occupy

#10yrsago Too-big-to-fail banks implicated in $500 trillion fraud: biggest price-rigging scandal in history https://www.rollingstone.com/politics/politics-news/everything-is-rigged-the-biggest-price-fixing-scandal-ever-82255/

#5yrsago A who’s-who of tech manufacturers sent scaremongering letters to the Illinois legislature to kill Right to Repair https://www.vice.com/en/article/vbxk3b/appliance-companies-are-lobbying-against-right-to-repair

#5yrsago Security researchers can turn Alexa into a transcribing, always-on listening device https://threatpost.com/researchers-hacked-amazons-alexa-to-spy-on-users-again/131401/

#5yrsago Microsoft sends recycler to jail for reinstalling obsolete, licensed copies of Windows on refurbished PCs https://www.washingtonpost.com/news/true-crime/wp/2018/04/24/recycling-innovator-eric-lundgren-loses-appeal-on-computer-restore-discs-must-serve-15-month-prison-term/

#5yrsago Trump’s finance watchdog wants to make the taxpayer-funded database of crooked banks go dark https://www.npr.org/2018/04/25/605835307/the-consumer-complaints-database-that-could-disappear-from-view

#5yrsago Little Brother is 10 years old today: I reveal the secret of writing future-proof science fiction https://www.tor.com/2018/04/26/ten-years-of-cory-doctorows-little-brother/

#1yrago Bottled water monopolist admits recycling is bullshit https://pluralistic.net/2022/04/26/plastic-fatalistic/#recycled-lies

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,_

🕵🏿‍♂️ Colophon

Today's top sources:

Currently writing:

* A Little Brother short story about DIY insulin PLANNING

* Picks and Shovels, a Martin Hench noir thriller about the heroic era of the PC. FIRST DRAFT COMPLETE, WAITING FOR EDITORIAL REVIEW

* The Bezzle, a Martin Hench noir thriller novel about the prison-tech industry. FIRST DRAFT COMPLETE, WAITING FOR EDITORIAL REVIEW

* Vigilant, Little Brother short story about remote invigilation. ON SUBMISSION

* Moral Hazard, a short story for MIT Tech Review's 12 Tomorrows. FIRST DRAFT COMPLETE, ACCEPTED FOR PUBLICATION

* Spill, a Little Brother short story about pipeline protests. ON SUBMISSION

Latest podcast: How To Make a Child-Safe TikTok https://craphound.com/news/2023/04/17/how-to-make-a-child-safe-tiktok/

Upcoming appearances:

* Red Team Blues at Dark Delicacies (Burbank), Apr 26
https://www.darkdel.com/store/p2873/Wed%2C_Apr_26th_6pm%3A_Red_Team_Blues%3A_A_Martin_Hench_Novel_HB.html#

* Red Team Blues at SFPL with Annalee Newitz (San Francisco), Apr 30
https://sfpl.org/events/2023/04/30/author-cory-doctorow-red-team-blues

* Red Team Blues at Powell's with Andy Baio (PDX/Cedar Hills Crossing), May 2
https://www.powells.com/book/red-team-blues-martin-hench-1-9781250865847/2-1

* Red Team Blues at Books, Inc with Mitch Kapor (Mountain View), May 5
https://www.booksinc.net/event/cory-doctorow-books-inc-mountain-view

* Bay Area Bookfest (Berkeley), May 6/7
https://www.baybookfest.org/session/cory-doctorow/

* Open Source Summit (Vancouver), May 10
https://events.linuxfoundation.org/open-source-summit-north-america/

* Massy Books Red Team Blues event with Sean Cranbury (Vancouver), May 10
https://www.eventbrite.ca/e/red-team-blues-cory-doctorow-in-conversation-with-sean-cranbury-tickets-608877016547

* Wordfest (Calgary), May 11
https://wordfest.com/2023/event/wordfest-presents-cory-doctorow/

* Gaithersburg Book Festival, May 20
https://www.gaithersburgbookfestival.org/featured_author/cory-doctorow/

* Public Knowledge Emerging Tech keynote (DC), May 22
https://www.eventbrite.com/e/emerging-tech-tickets-600582126307

* WEPFest with Ron Diebert, Dave Bidini and Nancy Olivieri (Toronto), May 23
https://www.westendphoenix.com/shop/wepfest-spring-fundraiser

* HowTheLightGetsIn (Hay), May 28
https://howthelightgetsin.org/events/the-ai-enigma-12147

* HowTheLightGetsIn (Hay), May 29
https://howthelightgetsin.org/events/the-danger-and-desire-of-the-frontier-12246

* Red Team Blues event with Tim Harford (Oxford), May 29
https://www.eventbrite.co.uk/e/cory-doctorow-red-team-blues-with-tim-harford-tickets-574673793787

* Red Team Blues event with Christian Reilly (Nottingham), May 30
https://www.waterstones.com/events/an-evening-with-cory-doctorow/nottingham

* Red Team Blues event with Ian Forrester (Manchester), May 31
https://www.waterstones.com/events/in-conversation-with-cory-doctorow/manchester-deansgate

* UCL Peter Kirstein Lecture, Jun 1 (London):
https://www.eventbrite.co.uk/e/peter-kirstein-lecture-2023-featuring-cory-doctorow-registration-539205788027

* Cymera Festival, Jun 3 (Edinburgh)
https://www.cymerafestival.co.uk/cymera23-events/2023/4/4/connection-interrupted-with-nina-allan-cory-doctorow-and-ian-mcdonald

* Red Team Blues with Martha Lane Fox at the British Library, Jun 5 (London):
https://www.bl.uk/events/an-evening-with-cory-doctorow-techno-thriller

* Re:publica keynote, Jun 7 (Berlin)
https://re-publica.com/de/news/rp23-keynote-von-cory-doctorow-rebecca-giblin-kreative-arbeitsmaerkte-und-monopole

Recent appearances:

* Media Death Cult
https://www.youtube.com/watch?v=24k8r-p6ibQ

* IFTF Future Now
https://soundcloud.com/institute-for-the-future/future-now-003-chokepoint-capitalism-with-cory-doctorow?si=b46c7320d8bd48789fa2783ff52975d8

* Examining capitalism's chokepoints (Changelog)
https://changelog.com/podcast/535

Latest books:

* "Chokepoint Capitalism: How to Beat Big Tech, Tame Big Content, and Get Artists Paid, with Rebecca Giblin", on how to unrig the markets for creative labor, Beacon Press/Scribe 2022 https://chokepointcapitalism.com

* "Attack Surface": The third Little Brother novel, a standalone technothriller for adults. The *Washington Post* called it "a political cyberthriller, vigorous, bold and savvy about the limits of revolution and resistance." Order signed, personalized copies from Dark Delicacies https://www.darkdel.com/store/p1840/Available_Now%3A_Attack_Surface.html

* "How to Destroy Surveillance Capitalism": an anti-monopoly pamphlet analyzing the true harms of surveillance capitalism and proposing a solution. https://onezero.medium.com/how-to-destroy-surveillance-capitalism-8135e6744d59 (print edition: https://bookshop.org/books/how-to-destroy-surveillance-capitalism/9781736205907) (signed copies: https://www.darkdel.com/store/p2024/Available_Now%3A__How_to_Destroy_Surveillance_Capitalism.html)

* "Little Brother/Homeland": A reissue omnibus edition with a new introduction by Edward Snowden: https://us.macmillan.com/books/9781250774583; personalized/signed copies here: https://www.darkdel.com/store/p1750/July%3A__Little_Brother_%26_Homeland.html

* "Poesy the Monster Slayer" a picture book about monsters, bedtime, gender, and kicking ass. Order here: https://us.macmillan.com/books/9781626723627. Get a personalized, signed copy here: https://www.darkdel.com/store/p2682/Corey_Doctorow%3A_Poesy_the_Monster_Slayer_HB.html#/.

Upcoming books:

* Red Team Blues: "A grabby, compulsive thriller that will leave you knowing more about how the world works than you did before." Tor Books, April 2023

* The Internet Con: A nonfiction book about interoperability and Big Tech, Verso, September 2023

* The Lost Cause: a post-Green New Deal eco-topian novel about truth and reconciliation with white nationalist militias, Tor Books, November 2023

This work - excluding any serialized fiction - is licensed under a Creative Commons Attribution 4.0 license. That means you can use it any way you like, including commercially, provided that you attribute it to me, Cory Doctorow, and include a link to pluralistic.net.

https://creativecommons.org/licenses/by/4.0/

Quotations and images are not included in this license; they are included either under a limitation or exception to copyright, or on the basis of a separate license. Please exercise caution.

_,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,__,.-'~'-.,_

🕵🏿‍♂️ How to get Pluralistic:

Blog (no ads, tracking, or data-collection):

Pluralistic.net

Newsletter (no ads, tracking, or data-collection):

https://pluralistic.net/plura-list

Mastodon (no ads, tracking, or data-collection):

https://mamot.fr/@pluralistic

Medium (no ads, paywalled):

https://doctorow.medium.com/

(Latest Medium column: "A Collective Bargain: Workplace democracy is a training ground for true national democracy https://doctorow.medium.com/a-collective-bargain-a48925f944fe)

Twitter (mass-scale, unrestricted, third-party surveillance and advertising):

https://twitter.com/doctorow

Tumblr (mass-scale, unrestricted, third-party surveillance and advertising):

https://mostlysignssomeportents.tumblr.com/tagged/pluralistic

"*When life gives you SARS, you make sarsaparilla*" -Joey "Accordion Guy" DeVilla