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。

这场关于黑客新闻(Hacker News)上拟议法案的讨论,探讨了是否应禁止私募股权(PE)持有医疗机构。讨论的核心在于:私募股权究竟是医疗体系失灵的“症状”,还是“病灶”本身。 许多评论者认为,私募股权公司利用“护城河”——例如政府授予的垄断权、需求证明法(certificate-of-need laws)以及监管俘获——来牺牲患者和医护人员的利益以获取利润。私募股权的批评者指出,在兽医和医疗等行业,服务正经历“平庸化”(enshittification):地方诊所被收购、整合并背负债务,导致价格上涨、工资降低以及医疗质量下降。 相反,一些人认为,私募股权为退休的企业所有者提供了必要的流动性,并带来了独立经营机构所缺乏的运营效率。他们认为,真正的问题不在于私募股权,而在于按服务付费模式以及过度依赖雇主提供的保险等系统性弊病。 这场辩论凸显了双方的严重分歧:一方认为私募股权是一种掠夺性力量,将基本服务视为待剥离的“资产”;另一方则认为,在受到低效、既得利益者监管以及高资本要求制约的市场中,私募股权是合乎逻辑的产物。
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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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