September 22, 2023

Any time someone starts lecturing me about how Joe Biden is a corporatist who is only concerned about protecting big business, I ask, "Then why did he make Lina Khan the head of the Federal Trade Commission?"

I mean, come on, she's going after Google. And Amazon. And now she's going after private equity for their role in medical monopolies. I f*cking LOVE Lina Khan.

Private equity guys don't:

I started to notice about a year ago that my local mega hospital, Penn Health, has divvied up its practices into their own separate entities -- with their own budgets. "Huh. That's weird," I thought, but put it out of my mind. Now, after reading this very lengthy and detailed piece from Matt Stoller's BIG newsletter, which specializes in the politics of monopoly power (you can subscribe here), I suspect this has something to do with private equity -- that the long-common practice of contracting out emergency rooms has spread to all the other departments, and is why our costs keep going up.

At this point, despite her rational approach to policy, or rather because of it, Khan is absolutely loathed on Wall Street. And actions like this - systemic work to change market-shaping incentives instead of performative talk tough but act weak bullshit - are why. For instance, earlier this week, the FTC unveiled charges against specific Amazon executives - Neil Lindsay, Russell Grandinetti, and Jamil Ghani - who orchestrated deceptive practices surrounding Amazon Prime. The penalties against individuals can be significant; these men can be fined, or thrown out of the industry, if they are found guilty of willfully making decisions to deceive customers.

Going after large firms is unusual, but going after the actual decision-makers is, well, simply not done. The FTC has, or I should say had, an unwritten rule not to enforce laws against individuals unless they are powerless diet supplement scammers. Big powerful Amazon executives, they must be treated with respect, especially since they are often represented by former FTC officials now in private practice. Khan broke the unwritten rule, in which enforcers are not supposed to go after the powerful by name for breaking the law.

The same dynamic is at work in this private equity case. If this suit is successful, it means the party is over for doing roll-ups and raising prices, which is easy money for a lot of Yale graduates like Brian Regan. And so the response - the FTC are a bunch of losers and radicals - isn’t a surprise. Indeed, given the whole ecosystem of deal-makers that thrive on these kinds of deals, it would be weird if Khan were anything but despised.

But this rage is the price of lowering health care costs and restoring some sense of sanity to health care, and frankly, business, in America. Because another way of asking the question, “Why is health care so expensive in America?” is to ask Brian Regan how many Teslas he truly needs.

Personnel is policy. This is why I'm ride or die for Joe Biden.

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