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> produces a cheaper, more efficient service.

More profitable perhaps, but not cheaper. In fact, usually more expensive, because the PE firms buy up all the clinics in a city, eliminating competition, and then they can set the rates to whatever they want. Needless to say, any "savings" are passed along to the investors, not to the consumers.

> If the original small business owner sold, the money they got paid isn't gone - they could've used it to start another small business

They're usually selling because of retirement, so they're not going to start another business. The issue here is that the business is not passed along to another new small business owner, it's passed along to a giant PE firm.

> produce a more intensely competitive environment.

In reality, to reproduce an environment with less competition and more consolidation, as mentioned above.



Great, that "less competition" means higher prices... Which means someone setting up a new clinic can benefit from those higher prices - oh look, now you have competition again.




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