Today's links For-profit healthcare is the problem, not (just) private equity: Competition can't solve the hospice problem. Hey look at this: Delights to delectate. Object permanence: Inner-tube laces; NZ MPs ejected for talking about sexual assault; Snowden's opsec advice; Xi on interop. Upcoming appearances: Where to find me. Recent appearances: Where I've been. Latest books: You keep readin' em, I'll keep writin' 'em. Upcoming books: Like I said, I'll keep writin' 'em. Colophon: All the rest. For-profit healthcare is the problem, not (just) private equity (permalink) When you are at 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 healthcare. 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. So all of this is obviously very bad, a stark example of what happens when you mix the most rapacious form of capitalist plunder with the most vulnerable kind of patient. But, as Elle Rothermich writes for LPE Journal, the PE model of hospice is merely a more extreme and visible version of the ghastly outcomes that arise out of all for-profit hospice care: https://lpeproject.org/blog/hospice-commodification-and-the-limits-of-antitrust/ The problems of PE-owned hospices are not merely a problem of the lack of competition, and applying antitrust to PE rollups of hospices won't stop the carnage, though it would certainly improve things somewhat. While once American hospices were run by nonprofits and charities, that changed in 1983 with the introduction of Medicare's hospice benefit. Today, three quarters of US hospices are private. It's not just PE-backed hospices; the entire for-profit hospice sector is worse than the nonprofit alternative. For-profit hospices deliver worse care and worse outcomes at higher prices. They are the worst-performing hospices in the country. This is because (as Rothermich writes) "The actual provision of care—the act of healing or attempting to heal—is broadly understood to be something more than a purely economic transaction." In other words, patients are not customers. In the hierarchy of institutional obligations, "patients" rank higher than customers. To be transformed from a "patient" into a "customer" is to be severely demoted. Hospice care is a complex, multidisciplinary, highly individualized practice, and pain treatment spans many dimensions: "psychological, social, emotional, and spiritual as well as physical." A cash-for-service model inevitably flattens this into "a standardized list of discrete services that can each be given a monetary value: pain medication, durable medical equipment, skilled nursing visits, access to a chaplain." As Rothermich writes, while there are benefits to blocking PE rollups and monopolization of hospices, to do so at all tacitly concedes that health care should be treated as a business, that "corporate involvement in care delivery is an inevitable, irreversible development." Rothermich's point is that health care isn't a commodity, and to treat it as such always worsens care. It dooms patients to choosing between different kinds of horrors, and subjects health care workers to the moral injury of failing their duty to their patients in order to serve them as customers. Hey look at this (permalink) Enshittification short-listed for Goodreads Readers' Favorite Nonfiction https://www.goodreads.com/choiceawards/readers-favorite-nonfiction-books-2025 Enshittification https://www.youtube.com/watch?v=CcceOOPdKZY James Watson, dead at 97, was a scientific legend and a pariah among his peers https://www.statnews.com/2025/11/07/james-watson-remembrance-from-dna-pioneer-to-pariah/ Exclusive: Here's How Much OpenAI Spends On Inference and Its Revenue Share With Microsoft https://www.wheresyoured.at/oai_docs/ Not So Wonderful Things https://stage-write.ghost.io/not-so-wonderful-things/ Object permanence (permalink) #20yrsago New Sony lockware prevents selling or loaning of games https://memex.craphound.com/2005/11/12/new-sony-lockware-prevents-selling-or-loaning-of-games/ #20yrsago Dr Seuss meets Star Trek https://web.archive.org/web/20051126025052/http://www.seuss.org/seuss/seuss.sttng.html #20yrsago Sony’s other malicious audio CD trojan https://memex.craphound.com/2005/11/12/sonys-other-malicious-audio-cd-trojan/ #15yrsago Will TSA genital grope/full frontal nudity “security” make you fly less? https://web.archive.org/web/20101115011017/https://blogs.reuters.com/ask/2010/11/12/are-new-security-screenings-affecting-your-decision-to-fly/ #15yrsago Make inner-tube laces, turn your shoes into slip-ons https://www.instructables.com/Make-normal-shoes-into-slip-ons-with-inner-tubes/ #15yrsago Tractor sale gone bad ends with man eating own beard https://web.archive.org/web/20101113200759/http://www.msnbc.msn.com/id/40136299 #10yrsago San Francisco Airport security screeners charged with complicity in drug-smuggling https://www.justice.gov/usao-ndca/pr/three-san-francisco-international-airport-security-screeners-charged-fraud-and #10yrsago Female New Zealand MPs ejected from Parliament for talking about their sexual assault https://www.theguardian.com/world/2015/nov/11/new-zealand-female-mps-mass-walkout-pm-rapists-comment #10yrsago Councillor who voted to close all public toilets gets a ticket for public urination https://uk.news.yahoo.com/councillor-cut-public-toilets-fined-094432429.html#1snIQOG #10yrsago Edward Snowden’s operational security advice for normal humans https://theintercept.com/2015/11/12/edward-snowden-explains-how-to-reclaim-your-privacy/ #10yrsago Not (just) the War on Drugs: the difficult, complicated truth about American prisons https://jacobin.com/2015/03/mass-incarceration-war-on-drugs/ #10yrsago Britons’ Internet access bills will soar to pay for Snoopers Charter https://www.theguardian.com/technology/2015/nov/11/broadband-bills-increase-snoopers-charter-investigatory-powers-bill-mps-warned #10yrsago How big offshoring companies pwned the H-1B process, screwing workers and businesses https://www.nytimes.com/2015/11/11/us/large-companies-game-h-1b-visa-program-leaving-smaller-ones-in-the-cold.html?_r=0 #5yrsago Anti-bear robo-wolves https://pluralistic.net/2020/11/12/thats-what-xi-said/#robo-lobo #5yrsago Xi on interop and lock-in https://pluralistic.net/2020/11/12/thats-what-xi-said/#with-chinese-characteristics #5yrsago Constantly Wrong https://pluralistic.net/2020/11/12/thats-what-xi-said/#conspiratorialism Upcoming appearances (permalink) Cardiff: Hay Festival After Hours, Nov 13 https://www.hayfestival.com/c-203-hay-festival-after-hours.aspx Oxford: Enshittification and Extraction: The Internet Sucks Now with Tim Wu (Oxford Internet Institute), Nov 14 https://www.oii.ox.ac.uk/news-events/events/enshittification-and-extraction-the-internet-sucks-now/ London: Enshittification with Sarah Wynn-Williams and Chris Morris, Nov 15 https://www.barbican.org.uk/whats-on/2025/event/cory-doctorow-with-sarah-wynn-williams London: Downstream IRL with Zack Polanski, Ash Sarkar, and Aaron Bastani (Novara Media), Nov 17 https://dice.fm/partner/tickets/event/oen5rr-downstream-irl-aaron-bastani-in-conversation-with-cory-doctorow-17th-nov-earth-london-tickets London: Enshittification with Carole Cadwalladr (Frontline Club), Nov 18 https://www.eventbrite.co.uk/e/in-conversation-enshittification-tickets-1785553983029 Virtual: Enshittification at the Internet Archive, Nov 21 https://www.eventbrite.com/e/book-talk-enshittification-tickets-1839608451399 Virtual: Enshittification with Vass Bednar (Vancouver Public Library), Nov 21 https://www.crowdcast.io/@bclibraries-present Toronto: Jailbreaking Canada (OCAD U), Nov 27 https://www.ocadu.ca/events-and-exhibitions/jailbreaking-canada San Diego: Enshittification at the Mission Hills Branch Library, Dec 1 https://libraryfoundationsd.org/events/doctorow Seattle: Neuroscience, AI and Society (University of Washington), Dec 4 https://www.eventbrite.com/e/neuroscience-ai-and-society-cory-doctorow-tickets-1735371255139 Madison, CT: Enshittification at RJ Julia, Dec 8 https://rjjulia.com/event/2025-12-08/cory-doctorow-enshittification Recent appearances (permalink) How to dis-Enshittify the world (Blood In the Machine) https://www.bloodinthemachine.com/p/how-to-dis-enshittify-the-world-with Reimagining Digital Public Infrastructure (Attention: Govern Or Be Governed) https://www.youtube.com/watch?v=F8JuXDfDtBY Enshittification and How To Fight It (ILSR) https://www.whoshallrule.com/p/enshittification-and-how-to-fight Big Tech’s “Enshittification” & Bill McKibben on Solar Hope for the Planet https://www.writersvoice.net/2025/11/cory-doctorow-on-big-techs-enshittification-bill-mckibben-on-solar-hope-for-the-planet/ Enshittification and the Rot Economy with Ed Zitron (Clarion West) https://www.youtube.com/watch?v=Tz71pIWbFyc Latest books (permalink) "Canny Valley": A limited edition collection of the collages I create for Pluralistic, self-published, September 2025 "Enshittification: Why Everything Suddenly Got Worse and What to Do About It," Farrar, Straus, Giroux, October 7 2025 https://us.macmillan.com/books/9780374619329/enshittification/ "Picks and Shovels": a sequel to "Red Team Blues," about the heroic era of the PC, Tor Books (US), Head of Zeus (UK), February 2025 (https://us.macmillan.com/books/9781250865908/picksandshovels). "The Bezzle": a sequel to "Red Team Blues," about prison-tech and other grifts, Tor Books (US), Head of Zeus (UK), February 2024 (the-bezzle.org). "The Lost Cause:" a solarpunk novel of hope in the climate emergency, Tor Books (US), Head of Zeus (UK), November 2023 (http://lost-cause.org). "The Internet Con": A nonfiction book about interoperability and Big Tech (Verso) September 2023 (http://seizethemeansofcomputation.org). Signed copies at Book Soup (https://www.booksoup.com/book/9781804291245). "Red Team Blues": "A grabby, compulsive thriller that will leave you knowing more about how the world works than you did before." Tor Books http://redteamblues.com. "Chokepoint Capitalism: How to Beat Big Tech, Tame Big Content, and Get Artists Paid, with Rebecca Giblin", on how to unrig the markets for creative labor, Beacon Press/Scribe 2022 https://chokepointcapitalism.com Upcoming books (permalink) "Unauthorized Bread": a middle-grades graphic novel adapted from my novella about refugees, toasters and DRM, FirstSecond, 2026 "Enshittification, Why Everything Suddenly Got Worse and What to Do About It" (the graphic novel), Firstsecond, 2026 "The Memex Method," Farrar, Straus, Giroux, 2026 "The Reverse-Centaur's Guide to AI," a short book about being a better AI critic, Farrar, Straus and Giroux, 2026 Colophon (permalink) Today's top sources: Currently writing: "The Reverse Centaur's Guide to AI," a short book for Farrar, Straus and Giroux about being an effective AI critic. FIRST DRAFT COMPLETE AND SUBMITTED. 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