禁止私募股权持有医疗机构的法案
Bill to Ban Private Equity from Owning Medical Practices

原始链接: https://truthout.org/articles/warren-introduces-bill-to-ban-private-equity-from-owning-medical-practices/

参议员伊丽莎白·沃伦(Elizabeth Warren)与一组民主党议员共同提出了一项两院立法,旨在遏制企业对美国医疗体系的收购。该法案寻求禁止私募股权公司和保险公司拥有医疗机构。这一趋势近年来显著加剧,目前有超过 80% 的医生受雇于企业实体,而 2019 年这一比例为 62%。 支持者认为,将利润置于患者护理之上导致了医疗成本上升和健康成果下降。该法案以俄勒冈州成功的立法为蓝本,包含了强有力的执行机制——包括联邦贸易委员会、州总检察长的监管,以及医生享有的私人诉讼权——以确保强制剥离资产。支持者认为,这种“分层执行”对于恢复医生的自主权并确保医疗决策掌握在医生而非华尔街投资者手中至关重要。随着医疗成本持续攀升,此次立法推动旨在解决因私募股权迅速扩张进入医疗领域而引发的结构性问题。

这篇 Hacker News 的讨论聚焦于一项拟议中的法案,该法案旨在禁止私募股权(PE)机构持有医疗机构。这场辩论凸显了经济效率与医疗质量之间的矛盾。 支持禁令的人士认为,私募股权的介入会导致以利润为导向的激励机制,从而损害患者护理,优先考虑行业整合而非本地所有权,并对劳动条件产生负面影响。一些参与者建议,基础医疗服务应以非营利实体的形式运作,以减轻这些扭曲的激励机制。 相反,私募股权的支持者认为,这些公司往往能为无法获得传统银行贷款的濒临倒闭的医疗机构提供必要的财务生命线。他们主张,这种模式对寻求出售医疗机构的企业主有利,并认为批评者往往误解了杠杆融资的复杂性。 该讨论串强调了一个深刻的分歧:投资者关注的是财务可行性和市场动态,而患者和员工主要担心的是成本上升、服务质量下降以及工作条件的恶化。讨论最后以关于游说和政治献金对立法进程影响的愤世嫉俗的评论告终。
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原文

More than 80 percent of doctors are employed by corporate entities — a massive increase from 62 percent seven years ago.

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A group of Democrats has introduced bicameral legislation to ban private equity from owning medical practices as increasingly widespread corporate ownership continues driving up health care costs each year.

The bill was introduced Wednesday by Sen. Elizabeth Warren (D-Massachusetts) with the support of 12 other members of the Senate and House. The legislation was based on a law in Oregon aimed at beating back the corporate takeover of health care providers that took effect this year. The law has already been successfully used by physicians in Eugene to prevent a corporate takeover.

Warren’s bill would ban for-profit corporations like private equity funds and insurance companies from owning medical practices, while also prohibiting entities known as management services organizations, which conduct business operations for practices, from controlling such offices.

Such a prohibition could help stanch the rapid rise in health care costs. Between 2000 and 2004, KFF found, costs for medical care far outpaced costs for goods and services at large, increasing by 121 percent compared to 86 percent for the rest of the consumer price index.

The growing grip of private equity on health care, like in other sectors, has played a major role in this rise in costs. In 2000, private equity invested $5 billion in health care; by 2024, this had risen to $104 billion. Since private equity firms are focused not on patient care, but on maximizing profits, research has found that private equity ownership is associated with worse outcomes for patients as well as higher costs, particularly in nursing homes.

In large part due to rising costs for care, health coverage costs are slated to rise precipitously next year. A recent survey found that employers expect health care plan costs to rise by an average of 11 percent per worker in 2027, unless benefits are cut. This could translate to higher costs for workers and patients on job-based insurance if employers shift the burden onto them; costs for plans through the Affordable Care Act are also expected to rise significantly due to Republicans’ massive slashes via the One Big Beautiful Bill.

“Patients want to know that decisions about their health are being made by their doctors, not by Wall Street investors,” said Warren. “If we’re going to lower costs and un-rig the health care system, we need to stop the corporate takeover of medicine.”

The passage of the bill could also help allow physicians to retain control in their practices, including in their medical decisionmaking, at a time when private equity and other corporate actors are close to gobbling up almost the entire field of medical providers.

As the lawmakers point out, research has found that, as of this year, 82 percent of physicians are employed by hospitals or other corporate entities as the industry shifts away from private practices. This is a 20-point increase from 2019, when 62 percent of physicians were employed this way.

The legislation has been backed by numerous health and advocacy groups, who say that private equity must be barred from standing between patients and receiving good health care.

“A prohibition is only as strong as its enforcement, and this bill backs its corporate practice of medicine prohibition with three enforcement paths: the FTC, state attorneys general suing on behalf of residents, and physicians themselves through a private right of action with treble damages,” said Marco Fernandez, president of the Association for Independent Medicine. “That layered enforcement, paired with mandatory divestment, is what gives this bill teeth that earlier [Corporate Practice of Medicine] laws have often lacked.”

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