#markets

It for damn sure wasn't avocado toast.

I'm on a tour with my new book, the international bestseller Enshittification: catch me next in Cardiff (TONIGHT!), London and Oxford! Full schedule here.

When are at to the library, you are a patron, not a customer. When you are at school, you're a student, not a customer. When you get health care, you are a patient, not a customer.

Property rights are America's state religion, and so market-oriented language is the holy catechism. But the things we value most highly aren't property, they cannot be bought or sold in markets, and describing them as property grossly devalues them. Think of human beings: murder isn't "theft of life" and kidnapping isn't "theft of children":

https://www.theguardian.com/technology/2008/feb/21/intellectual.property

When we use markets and property relations to organize these non-market matters, horrors abound. Just look at the private equity takeover of American health-care. PE bosses have spent more than a trillion dollars cornering regional markets on various parts of the health system:

https://pluralistic.net/2024/02/28/5000-bats/#charnel-house

The PE playbook is plunder. After PE buys a business, it borrows heavily against it (with the loan going straight into the PE investors' pockets), and then, to service that debt, the new owners cut, and cut, and cut. PE-owned hospitals are literally filled with bats because the owners stiff the exterminators:

https://prospect.org/health/2024-02-27-scenes-from-bat-cave-steward-health-florida/

Needless to say, a hospital that is full of bats has other problems. All of the high-tech medical devices are broken and no one will fix them because the PE bosses have stiffed all the repair companies and contractors. There are blood shortages, saline shortages, PPE shortages. Doctors and nurses go weeks or months without pay. The elevators don't work. Black mold climbs the walls.

When PE rolls up all the dialysis clinics in your neighborhood, the new owners fire all the skilled staff and hire untrained replacements. They dispense with expensive fripperies like sterilizing their needles:

https://www.thebignewsletter.com/p/the-dirty-business-of-clean-blood

When PE rolls up your regional nursing homes, they turn into slaughterhouses. To date, PE-owned nursing homes have stolen at least 160,000 lost life years:

https://pluralistic.net/2021/02/23/acceptable-losses/#disposable-olds

Then there's hospices, the last medical care you will ever receive. Once your doctor declares that you have less than six months or less to live, Medicare will pay a hospice $243-$1,462/day to take care of you as you die. At the top end of that rate, hospices have to satisfy a lot of conditions, but if the hospice is willing to take $243/day, they effectively have no duties to you – they don't even have to continue providing you with your regular medication or painkillers for your final days:

https://prospect.org/health/2023-04-26-born-to-die-hospice-care/

Setting up a hospice is cheap as hell. Pay a $3,000 filing fee, fill in some paperwork (which no one ever checks) and hang out a shingle. Nominally, a doctor has to oversee the operation, but PE-backed hospices save money here by having a single doctor "oversee" dozens of hospices:

https://auditor.ca.gov/reports/2021-123/index.html#pg34A

Once you rope a patient into this system, you can keep billing the government for them up to a total of $32,000, then you have to kick them out. Why would a patient with only six months to live survive to be kicked out? Because PE companies pay bounties to doctors to refer patients who aren't dying to hospices. 51% of patients in the PE-cornered hospices of Van Nuys are "live discharged":

https://pluralistic.net/2023/04/26/death-panels/#what-the-heck-is-going-on-with-CMS

However, once you're admitted to a hospice, Medicare expects you to die – so "live discharged" patients face a thick bureaucratic process to get back into the system so they can start seeing a doctor again.

Shaxi 沙溪 is a historic market town in Jianchuan county, Yunnan province, southwest China.

Shaxi started as a horse caravan town for tea and horses along the ancient Tea Horse Road (also known as the South Silk Road) leading from Yunnan into Burma and Tibet during the Tang dynasty (618–907).

Nearby Shibao mountain contains Buddhist rock carvings and temples of over 1300 years old and is a UNESCO World Heritage Site.