Death rates rose in hospital ERs after private equity firms took over

Private equity and ER outcomes

• Commenters largely see higher ER death rates after PE takeovers as unsurprising, tying them to aggressive cost-cutting (especially staffing) and shorter time horizons.
• Prior work on PE-owned nursing homes and high-markup hospitals is cited: worse outcomes, fewer staff, more violations, much higher prices.
• A minority notes PE often buys distressed hospitals; without the acquisition some might close, so the true counterfactual is unclear. Others respond that “rescuing” them by degrading care is not an acceptable tradeoff.

Regulation, competition, and Certificates of Need (CON)

• One camp argues “overregulation plus profit-seeking” creates local monopolies that PE exploits. Examples:
  • Certificate of Need laws restricting new hospitals and some clinics.
  • Caps on residency funding and med-school bottlenecks.
  • Licensing and scope-of-practice limits on NPs/PAs/other clinicians.
• Critics push back that PE-owned hospitals underperform even in states without CON, so deregulating construction doesn’t explain the mortality gap.
• There are conflicting anecdotes: CON blocking needed rural facilities vs preventing oversupply that destabilizes existing hospitals.

Is healthcare amenable to free-market dynamics?

• Pro-market side: for most non-emergency care, competition and price transparency (e.g., cash surgery centers, CT scan shopping) can sharply lower prices and improve access.
• Skeptical side: healthcare is inelastic and information-poor—patients often can’t shop, predict needed services, or judge quality, especially in emergencies; this undermines standard market discipline.

Workforce, staffing, and skill mix

• The study itself blames reduced ER staffing post-acquisition; several physicians say this matches what they see.
• There’s debate over expanding supply: some want more residencies and immigration; others worry that wage suppression or overuse of less-trained NPs/PAs can harm quality. One physician emphasizes the large training gap between MDs and mid-levels.

Costs, billing, and insurance structure

• Many point to opaque, wildly variable pricing, insurance–provider negotiations, and “cost shifting” to uninsured patients as central distortions.
• Others argue the biggest cost drivers are high US wages for clinicians/admins, high drug/device prices, and obesity/chronic disease; administrative overhead is seen as significant but not the whole story.

System design and moral framing

• Strong current against for‑profit and PE ownership of hospitals and prisons; some want outright bans or public/nonprofit-only provision.
• Proposals span: single payer, public emergency care only, mixed public–private models, aggressive antitrust, standardized contracts, and equal pricing for insured vs cash patients.
• Several frame PE-driven excess deaths as “social murder” or structural violence; others caution against overstretching that term but still see the outcomes as morally intolerable.