6 ms·

While that sounds concerning, I have to question the underlying thesis: Does private ownership always short-change customers, like the subtitle insinuates? "hos

While that sounds concerning, I have to question the underlying thesis: Does private ownership always short-change customers, like the subtitle insinuates? "hospice agencies are now for-profit, putting profit maximization over patient well-being." Do hotels or restaurants put profit maximization over customer well-being? If they do, they will be out of business rather soon. If the hospices have competition and comparability (for patients or their loved ones) then the same mechanism should work over time.

efields 3y ago
Hotels do this, and it’s a race to the bottom. The hotel experience has gotten so bad people accept going days without turndown service now.
- throwaway5959 3y ago
  That’s thankfully turning around. We were just in a hotel for a few days and they offered to turndown our room each night which we declined as we don’t really make a mess and it was only two nights.
- version_five 3y ago
  Would you like to "make a green choice" and have our staff ignore your dying loved one for the day in exchange for a $5 Starbucks gift card?
- mym1990 3y ago
  Or maybe people want to be left alone in the evening?
  - sarchertech 3y ago
    My guess is that don’t actually mean turndown service, but just general housekeeping.
    - efields 3y ago
      Yes.
- quesera 3y ago
  FWIW, the first thing I do when I arrive at a hotel room is to put the Do Not Disturb sign on the door handle, where it stays for my entire trip. I have zero desire to have anyone enter my room at any time, for any reason, while I am paying for it. In some longer stays (4-7+ days), hotel management will actually require housekeeping to enter. Fine, OK, I get it. But I do not wish it. I don't claim to know how common my preferences are, but it seems likely to me that most guests don't care a super lot about maid service, so it's a natural thing to dial down.
chasing 3y ago
> Do hotels or restaurants put profit maximization over customer well-being? If they do, they will be out of business rather soon. If the hospices have competition and comparability (for patients or their loved ones) then the same mechanism should work over time. This is not how it works and is why the government sometimes needs to step in with regulations. As a founder in the healthcare space once said to me: “I like regulations because it means I can do the right thing for my customers and not have to worry about competing with people who are willing to do harm because it’s more profitable.” Companies need to be able to compete. Some will do better. Some worse. But the government needs to establish the baseline rules so society as a whole isn’t harmed.
- 93po 3y ago
  Let's be honest in that regulations are often made due to benefit of companies and detriment to people, too.
ska 3y ago
"private equity" is not the same as "private ownership", no?
omginternets 3y ago
>I have to question the underlying thesis: Does private ownership always short-change customers, like the subtitle insinuates? What a bizarre misrendering of the actual question, which is "does private equity systematically undermine the quality of healthcare?"
RobotToaster 3y ago
>Does private ownership always short-change customers, like the subtitle insinuates? Corporations literally only have one goal, to generate the maximum profit for shareholders. By definition profit is money not spent on making services better.
- skinnymuch 3y ago
  I don’t think that’s true of all corps like cooperatives. That’s not all profit is. How would labor theory, surplus value, and so on, be explained?
- dghlsakjg 3y ago
  Please don't spread this meme about corporations being required to maximize profits/shareholder value. There isn't a requirement or law that says corporations to maximize profits. The legal obligation is to act in the best interest of the corporation on behalf of the shareholders. There are limited situations where the only goal is to get a higher stock price, like in a buyout, but in general business there is no legal obligation to chase profits over other values. Corporations can do things that actively remove value from shareholders, and they do it all the time. Donating to charitable causes, benefits packages that are incredibly generous, sending employees home early on the day before a holiday, providing discounts to employees, etc. All of these things would be illegal if profit-maximizing was law, but it isn't. Instead corporate officers can say that the long-term benefits of acting as a responsible corporation is in the best interest of the company. Anyone saying that screwing people over for the benefit of the corporation is a requirement of corporate governance is full of it. See here for more: https://insight.kellogg.northwestern.edu/article/shareholder-value-purpose-corporation#:~:text=There%20are%20a%20lot%20of,obliged%20to%20maximize%20shareholder%20value https://insight.kellogg.northwestern.edu/article/shareholder....
  - RobotToaster 3y ago
    Isn't that just buying "goodwill"? Which is a form of long term profit maximisation.
    - 3y ago
nologic01 3y ago
Profit maximization is the overarching objective. Customer dissatisfaction, complaints, fines etc is only a problem if it starts eroding profits. Businesses have developed countless mechanisms to be able to survive client backlash. Oligopolies and cartels is a major trick. Competition highlights poor performers. Not good for business. Uninformed customers is another biggie. Hence, fight consumer protection mechanisms, limit disclosure etc. Finally, regulatory capture, eg fixing the rules of the game so that legally there is no recourse. So, yeah, in some ideal world in which economists win Nobel prizes arguing the optimality of the corporate structure you'd be right. We dont live in that ideal world. That sad thing is that, obviously, profit maximizing private enterprize, just like the public sector itself, are indispensable organizational units. Until we learn to tame them we will be paying the price.
skitout 3y ago
One big difference is : the one that is experiencing the hotel is choosing it and paying for it, have different experiences with hotel before and after... In hospice it is generally the kids choosing and paying the hospice for their dad or mom who will live there... and when they say the food is bad you often assume they ham it up... And you tend to chose the place based on beautiful brochure, as you have no experience in this area... it is easy to move to another hotel, not so much to move your dad to another hospice In France we recently had a huge scandal about for profit expensive nursing home (Orpea). Many old people were undernourished to save on food cost for example...
Spooky23 3y ago
Have you stayed in a hotel before? Because of favorable tax rules, hotels have turned into a cartel business. Every aspect of the hotel experience is worse than it was 10, 15 or 20 years ago. Because the top 5 hotel chains control more rooms than the rest of the industry, they are able to segment and spare every expense. Jumping brands doesn’t help because they ape each other. The default experience is no housekeeping, two towels, a price 30-50% more on an inflation adjusted basis, prepaid at checkin. Since the 1970s, when modern conservative legal theory started to take root, the playbook for American business is tumor growth followed by cost cutting, even at expense of the business itself. Medical networks and sub-entities are no different. Nursing homes are a preview of the future - they provide an operational money losing minimum viable service, but the owners are able to walk away with substantial returns on the real estate and overheads. In 10 years the default will be chat with ChatGPY, followed by a video call with a NP in India or the Philippines and wait 4 months to see a provider in person.
- Aeolun 3y ago
  > two towels Why is everyone obsessed with towels? This is not the first time I’ve seen this indicated as a standard for quality, but I don’t understand. Do you _need_ more than two towels?
  - emodendroket 3y ago
    Depends on how many people are staying and for how long... Though you can just request more.
  - missedthecue 3y ago
    To add, I have never been to a place that wouldn't give you another towel if you gave a 10 second call to the front desk
  - Spooky23 3y ago
    I typically travel with my family of 3-4 people. I also prefer to use a fresh towel if I shower after a workout or some other interval that doesn’t align with housekeeping. And honestly, what’s the bfd? The marginal cost of washing a towel should easily be supported by my $350/night expense to stay at Hampton Inn or whatever. The cheapness has moved beyond that now. I’ve encountered properties who refuse to refresh sheets now, or require a request to be made at a time like 3pm, when you arrive at 8pm.
Aeolun 3y ago
> If the hospices have competition and comparability (for patients or their loved ones) People in end-of-life care are kind of a locked in market. Nobody is going to a better hospice that might be an hour further away from all their family.
emodendroket 3y ago
I don't think a restaurant is really comparable to hospice care. There's not much a long-term commitment involved, the pricing is more transparent, it is easier to judge the quality of what you are getting, and the service is not exactly essential.

efields 3y ago

Hotels do this, and it’s a race to the bottom. The hotel experience has gotten so bad people accept going days without turndown service now.

throwaway5959 3y ago
That’s thankfully turning around. We were just in a hotel for a few days and they offered to turndown our room each night which we declined as we don’t really make a mess and it was only two nights.
version_five 3y ago
Would you like to "make a green choice" and have our staff ignore your dying loved one for the day in exchange for a $5 Starbucks gift card?
mym1990 3y ago
Or maybe people want to be left alone in the evening?
- sarchertech 3y ago
  My guess is that don’t actually mean turndown service, but just general housekeeping.
  - efields 3y ago
    Yes.
quesera 3y ago
FWIW, the first thing I do when I arrive at a hotel room is to put the Do Not Disturb sign on the door handle, where it stays for my entire trip. I have zero desire to have anyone enter my room at any time, for any reason, while I am paying for it. In some longer stays (4-7+ days), hotel management will actually require housekeeping to enter. Fine, OK, I get it. But I do not wish it. I don't claim to know how common my preferences are, but it seems likely to me that most guests don't care a super lot about maid service, so it's a natural thing to dial down.

chasing 3y ago

> Do hotels or restaurants put profit maximization over customer well-being? If they do, they will be out of business rather soon. If the hospices have competition and comparability (for patients or their loved ones) then the same mechanism should work over time. This is not how it works and is why the government sometimes needs to step in with regulations. As a founder in the healthcare space once said to me: “I like regulations because it means I can do the right thing for my customers and not have to worry about competing with people who are willing to do harm because it’s more profitable.” Companies need to be able to compete. Some will do better. Some worse. But the government needs to establish the baseline rules so society as a whole isn’t harmed.

93po 3y ago
Let's be honest in that regulations are often made due to benefit of companies and detriment to people, too.

ska 3y ago

"private equity" is not the same as "private ownership", no?

omginternets 3y ago

>I have to question the underlying thesis: Does private ownership always short-change customers, like the subtitle insinuates? What a bizarre misrendering of the actual question, which is "does private equity systematically undermine the quality of healthcare?"

RobotToaster 3y ago

>Does private ownership always short-change customers, like the subtitle insinuates? Corporations literally only have one goal, to generate the maximum profit for shareholders. By definition profit is money not spent on making services better.

skinnymuch 3y ago
I don’t think that’s true of all corps like cooperatives. That’s not all profit is. How would labor theory, surplus value, and so on, be explained?
dghlsakjg 3y ago
Please don't spread this meme about corporations being required to maximize profits/shareholder value. There isn't a requirement or law that says corporations to maximize profits. The legal obligation is to act in the best interest of the corporation on behalf of the shareholders. There are limited situations where the only goal is to get a higher stock price, like in a buyout, but in general business there is no legal obligation to chase profits over other values. Corporations can do things that actively remove value from shareholders, and they do it all the time. Donating to charitable causes, benefits packages that are incredibly generous, sending employees home early on the day before a holiday, providing discounts to employees, etc. All of these things would be illegal if profit-maximizing was law, but it isn't. Instead corporate officers can say that the long-term benefits of acting as a responsible corporation is in the best interest of the company. Anyone saying that screwing people over for the benefit of the corporation is a requirement of corporate governance is full of it. See here for more: https://insight.kellogg.northwestern.edu/article/shareholder-value-purpose-corporation#:~:text=There%20are%20a%20lot%20of,obliged%20to%20maximize%20shareholder%20value https://insight.kellogg.northwestern.edu/article/shareholder....
- RobotToaster 3y ago
  Isn't that just buying "goodwill"? Which is a form of long term profit maximisation.
  - 3y ago

nologic01 3y ago

Profit maximization is the overarching objective. Customer dissatisfaction, complaints, fines etc is only a problem if it starts eroding profits. Businesses have developed countless mechanisms to be able to survive client backlash. Oligopolies and cartels is a major trick. Competition highlights poor performers. Not good for business. Uninformed customers is another biggie. Hence, fight consumer protection mechanisms, limit disclosure etc. Finally, regulatory capture, eg fixing the rules of the game so that legally there is no recourse. So, yeah, in some ideal world in which economists win Nobel prizes arguing the optimality of the corporate structure you'd be right. We dont live in that ideal world. That sad thing is that, obviously, profit maximizing private enterprize, just like the public sector itself, are indispensable organizational units. Until we learn to tame them we will be paying the price.

skitout 3y ago

One big difference is : the one that is experiencing the hotel is choosing it and paying for it, have different experiences with hotel before and after... In hospice it is generally the kids choosing and paying the hospice for their dad or mom who will live there... and when they say the food is bad you often assume they ham it up... And you tend to chose the place based on beautiful brochure, as you have no experience in this area... it is easy to move to another hotel, not so much to move your dad to another hospice In France we recently had a huge scandal about for profit expensive nursing home (Orpea). Many old people were undernourished to save on food cost for example...

Spooky23 3y ago

Have you stayed in a hotel before? Because of favorable tax rules, hotels have turned into a cartel business. Every aspect of the hotel experience is worse than it was 10, 15 or 20 years ago. Because the top 5 hotel chains control more rooms than the rest of the industry, they are able to segment and spare every expense. Jumping brands doesn’t help because they ape each other. The default experience is no housekeeping, two towels, a price 30-50% more on an inflation adjusted basis, prepaid at checkin. Since the 1970s, when modern conservative legal theory started to take root, the playbook for American business is tumor growth followed by cost cutting, even at expense of the business itself. Medical networks and sub-entities are no different. Nursing homes are a preview of the future - they provide an operational money losing minimum viable service, but the owners are able to walk away with substantial returns on the real estate and overheads. In 10 years the default will be chat with ChatGPY, followed by a video call with a NP in India or the Philippines and wait 4 months to see a provider in person.

Aeolun 3y ago
> two towels Why is everyone obsessed with towels? This is not the first time I’ve seen this indicated as a standard for quality, but I don’t understand. Do you _need_ more than two towels?
- emodendroket 3y ago
  Depends on how many people are staying and for how long... Though you can just request more.
- missedthecue 3y ago
  To add, I have never been to a place that wouldn't give you another towel if you gave a 10 second call to the front desk
- Spooky23 3y ago
  I typically travel with my family of 3-4 people. I also prefer to use a fresh towel if I shower after a workout or some other interval that doesn’t align with housekeeping. And honestly, what’s the bfd? The marginal cost of washing a towel should easily be supported by my $350/night expense to stay at Hampton Inn or whatever. The cheapness has moved beyond that now. I’ve encountered properties who refuse to refresh sheets now, or require a request to be made at a time like 3pm, when you arrive at 8pm.

Aeolun 3y ago

> If the hospices have competition and comparability (for patients or their loved ones) People in end-of-life care are kind of a locked in market. Nobody is going to a better hospice that might be an hour further away from all their family.

emodendroket 3y ago

I don't think a restaurant is really comparable to hospice care. There's not much a long-term commitment involved, the pricing is more transparent, it is easier to judge the quality of what you are getting, and the service is not exactly essential.