American health care's life-destroying "surprise bills" are the fault of local, private-equity monopolies

Surprise billing -- when your urgent or emergency medical care results in massive bills that your insurer won't cover -- are a life-destroying phenomenon for an increasing number of Americans, who not only can't shop around for an emergency room from the back of an ambulance, but who also have no way to learn in advance whether their visit will generate five- or even six-figure bills.

Here's how that happened: private equity funds have been on a purchasing spree, buying up the private doctor's groups that ERs, hospitals and urgent care centers contract with (part of the MBA-driven mania for hollowing out all social institutions into procurement systems that buy everything from outside contractors).

Once a private equity "roll up" strategy has cornered the urgent/emergency medical care providers in a city or region, they just...raise prices. Seriously, it's that simple: corner the market, raise prices.

This is happening up and down the health-care stack: two thirds of air ambulances are now owned by three private-equity-backed funds, and while the number of air ambulances has gone up, while demand has remained flat, the price of an air ambulance has doubled in a decade. The helicopter that takes you to a hospital today might cost $56k, of which your insurer will expect you to pay $44k.

In 2018, private equity did about 800 health-care acquisitions, totalling more than $100b, leaving 22% of US physician markets in a "highly concentrated" state.

But just because the deals totaled to more than $100b, that doesn't mean that PE firms spent that much. Read the rest