When private practices merge with hospital systems, costs go up

Profit Motive, Nonprofits, and Consolidation

• Commenters say it’s unsurprising that hospital acquisition of practices raises prices: consolidation reduces competition and enables higher billing and upcoding.
• Many argue that “nonprofit” hospitals behave like for-profit firms, funneling surplus to executives and affiliated businesses instead of shareholders.
• Some see this as a natural outcome of a system where the real goal is profit, not efficient or equitable care.

“Statistical Murder” and Responsibility for Harm

• A heated subthread debates whether policy- and profit-driven increases in mortality (e.g., private equity in hospitals, insurer denials) should be labeled “murder” or “manslaughter.”
• Critics of the term argue that all health systems ration finite resources and that calling this “murder” is legally wrong and analytically useless.
• Supporters counter that knowingly accepting preventable deaths for profit is morally akin to homicide, citing analogies like tobacco, the Pinto case, and abortion bans.
• Others stress the difficulty of defining when prioritizing cost or convenience over life crosses a legal or moral line.

Insurance, Single Payer, and Alternative Models

• Many blame the US insurance layer for massive waste, denial-driven profits, and forcing practices into hospital systems just to handle billing.
• Single payer is proposed as a way to remove the middleman and realign incentives, though some note that single-payer systems (e.g., Canada) can still ration and limit supply.
• Others argue effective multi-payer systems exist; the US problem is weak regulation and political resistance, not just lack of single payer.
• Side debate extends the logic to food: if healthcare is a right, should government also guarantee basic nutrition?

Billing Complexity and EHR Interoperability

• A key operational reason for mergers: private practices can’t afford complex billing, revenue cycle, and EHR systems, so they sell to hospitals that already run Epic or similar.
• Some see startups trying to be “Stripe for clinics” as a counterforce that might let practices stay independent.
• On data sharing, national networks exist, but participation and implementation vary; standards are messy, and connectivity costs money, so cross-system coordination is uneven.

Private Equity, Air Ambulances, and Service Cuts

• Commenters link private equity ownership of regional hospitals and air ambulances to service cuts, more transfers, huge surprise bills, and likely higher mortality.
• “Membership” programs that waive balance bills are noted as partial mitigation but also evidence of a distorted market.

International Comparisons and Local Anecdotes

• Several note the US already spends more public money per capita on healthcare than some universal systems, yet gets worse value.
• Explanations offered include profit extraction, racism, and protecting existing privileges.
• Anecdotes describe towns where rising overhead forces practices to sell to hospitals, which can then bill 2–10× more for identical visits, further entrenching consolidation.