> Ultimately, capitalism is not necessarily at odds with providing efficient high quality healthcare.

Um, yes it is?

First off, there is tension between "efficient" and "high quality". High quality in an environment with peaky demand requires over-resourcing during periods of lower demand, which is inefficient. The best way to resource for peaky demand curves is to run at 60-80% usage (i.e. 20-40% idle).

Health care has peaky demand curves. PE is going to optimize on efficiency therefore degrading peak demand performance, which is when quality matters the most.

Second, capitalism optimizes resources to maximize value capture. That's great when value capture is tied closely to value delivery, like you want a hamburger and you get a hamburger.

Not when value capture is diffusely tied to value delivery. You want a stable market economy with rule of law to protect your property and your contracts. While without this, nothing you own has any worth (making it the most valuable thing possible), the value of this is rarely delivered to you in discrete chunks.

How can capitalism create things like my macbook m3 that are very high quality, but you don't think it can create a very high quality healthcare business?

Why doesn't everyone have a macbook like mine? Because society hasn't decided to subsidize them. But that doesn't mean the macbook isn't high quality.

Capitalism's incentives alone are not sufficient to provide healthcare in a way that most people think is reasonable and fair for all members of society. But that doesn't mean that it can't be useful in allocating capital in ways that are very beneficial to society.

The purpose of regulation can be to create incentives where capitalist participants profit goals align with society's notion of what is best for everyone.

The problem as usual is that some people think that researchers who create new medicines should not be motivated by profits, or that doctors are taking too much money, etc. Any dimension that we regulate will result in pressures on other parts of the system. In my view, government is often not good at creating socially optimal regulations because interest groups get involved and create regulatory capture.

Should surgeons really earn $900K and the top student in a top med school class has a 50% chance of even getting the chance to train in that subspecialty? Do the outcomes really justify such an excessive focus on quality? Should we all expect our insurance to cover 2025 pharma options when 2010 options might cost half as much?

The "optimizations" we have at this point are far from optimal, and any serious analysis needs to look at many different measures of quality or it doesn't make sense. Much medical care has virtually no impact on longevity, does that mean it is useless? I'm not advocating for private equity at all, just saying that it is the regulatory environment that creates those "market opportunities" for PE firms, not something about capitalism. As we've seen with Trump and the support his base has for his whimsical tariffs, people put way too much faith in government's ability to optimize things.