Pluralistic: Oregon bans the corporate practice of medicine (20 Jun 2025)


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A billionaire in a tuxedo with dollar-sign cufflinks, stands at a podium, yanking a lever shaped like a gilded dollar sign with one gloved hand. From the other hand, he contemptuously dangles a bloody corpse. His head has been replaced with the head of a doctor in a surgeon's blue cap, with red, glaring eyes. The background is the text of Oregon's new Corporate Practice of Medicine law, in blown-out, red type.

Oregon bans the corporate practice of medicine (permalink)

Private equity firms are the demon princes of the hellspace that is the imploding, life-destroying, plutocrat-generating American economy. Their favorite scam, the "leveraged buyout" is a mafia bustout dressed up in respectable clothes, and if you mourn a beloved, failed business, chances are that an LBO was the murder weapon, and PE was the killer:

https://pluralistic.net/2024/05/23/spineless/#invertebrates

(Despite simplistic explanations and bad-faith apologestics, a leveraged buyout is nothing like a mortgage – it is a sinister, complex, destructive form of financial fraud:)

https://pluralistic.net/2024/08/05/rugged-individuals/#misleading-by-analogy

As bad as this is, it's ten quintillion times worse when applied to healthcare. When PE buys your hospital, people die. A lot of people:

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

PE doesn't even have to buy the whole hospital – for a long time, PE groups bought out anesthetist practices affilated with hospitals and pulled them out of the hospital's insurance affiliation. Unsuspecting patients who went in for routine surgical care at a hospital that was in-network for their insurer would get a rude awakening from their sedation: "surprise bills" running to tens or hundred of thousands of dollars. PE groups did the same thing with emergency rooms, so that people experiencing serious medical emergencies who had the presence of mind to insist upon being brought to an in-network ER nevertheless got hit with life-ruining surprise bills:

https://pluralistic.net/2022/03/14/unhealthy-finances/#steins-law

Donald Trump sometimes panders to anti-elitist elements in his base by threatening the private equity racket. For example, Trump has frequently railed against the "carried interest" tax loophole that allows PE bosses to pay half as much tax as you or I would on their vast takings. "Carried interest" is a tax law that gave 16th century sea-captains a break on their "interest" in the cargo they "carried." It is both weird and fantastically unjust that richest, worst financiers in America are able to take advantage of this Moby Dick-ass-law:

https://pluralistic.net/2021/04/29/writers-must-be-paid/#carried-interest

But while Trump sometimes talks a good line about fighting private equity looters, he does not, has not, and will not lift a finger to them. He dares not. The carried interest tax scam is preserved in the Big Beautiful Bill, joined with many other giveaways the least productive, most guillotineable looters America has produced:

https://www.pillsburylaw.com/en/news-and-insights/no-changes-carried-interest-big-beautiful-bill-so-far.html

Working people cannot rely on Trump's federal government and the Republican Congress to protect us from these vampires. But this is America: when the feds fail, that creates an opportunity for state legislators to step in and act. And that's just what's happened in Oregon, where the state legislature has passed sweeping, bipartisan legislation that bans corporations from owning or operating a medical practice in the state:

https://prospect.org/health/2025-06-13-united-health-care-oregon-corporate-medicine/

This is called the "corporate practice of medicine" (CPOM) and it's already banned. The American Medical Association has a longstanding, absolute prohibition on medical practices that are run by anyone except a doctor. Oregon has had a CPOM ban on the law-books since 1947. Private equity meets this prohibition with a very transparent ruse indeed: they get a "rent a doc," often out of state, to serve as the nominal owner of their practices, and the doctor takes orders from the PE firm, and hires the PE firm's outsource agencies to actually operate the clinic or hospital, absorbing the entirety of the practice's profits.

The Oregon bill closes this loophole, and not a minute too soon. Giant healthcare monopolists – most notably groups associated with Unitedhealth, the largest health corporation in America – have embarked on a statewide buying spree, buying and shutting down rural hospitals and clinics, and transforming the remaining facilities into understaffed charnel houses that hemorrhage doctors.

The bill took several tries to get through the legislature. As Oregon House Majority Leader Representative Ben Bowman told Matt Stoller and David Dayen on their Organized Money podcast, the statehouse was crawling with lobbyists hired by out of state private health-care firms who were worried about "contagion" if Oregon's bill passed and spread to other states:

https://www.organizedmoney.fm/p/how-oregon-is-ending-corporate-run

But the bill passed anyway, thanks to a combination of two factors. First, during the bill's legislative adventure, Unitedhealth's Optum bought out the Oregon Medical Group and made working conditions so terrible that dozens of doctors quit, leaving thousands of rural patients (from predominantly Republican districts) without medical care. Optum "fired" thousands of patients, including some who were undergoing cancer treatment, on the basis that they weren't profitable enough to care for:

https://www.thebignewsletter.com/p/private-equity-unitedhealth-take

In the midst of all this, another Unitedhealth monopolist, Change Health, got hacked and virtually no one in America could get a prescription filled – worse, the hack exposed the health records of almost everyone in America, the largest health-related breach in US history:

https://pluralistic.net/2024/06/28/dealer-management-software/#antonin-scalia-stole-your-car

Then, as icing on the cake, Unitedhealth's Oregon operation screwed over multiple, cancer-fighting lawmakers who were serving in the state-house as the bill was under debate. Combine this with testimony from doctors who described how they were unable to practice medicine after leaving Unitedhealth's terrible facilities because they had been trapped with noncompete clauses in their contracts, nor could they warn other doctors away from falling prey to this trap because they were also bound by nondisparagement clauses.

The new bill, SB 951, passed out of the legislature and was signed by the governor earlier this month. It is now good law in Oregon, which means that corporations can't operate medical practices, and that medical personnel can't be subjected to noncompete clauses (fun fact: every noncompete clause is written by a lawyer, but the American Bar Association prohibits noncompetes for lawyers).

Now it's time for those out-of-state healthcare looters' worst fears to be realized. It's time for the contagion to spread to other states.

The US federal system is a big, gnarly mess, but by design, it leaves a lot of power in local hands. That's bad news when local power is being used to ban trans people from peeing, or to attack school librarians, or to ban masking. But it's good news when states and cities can use the American system to create sanctuary systems that welcome asylum seekers and treat them with dignity (which is why the American right, the standard bearer for "states' rights" when it came to school segregation and voter suppression, is now all-in on sending armed soldiers to terrorize their fellow Americans with assault rifles).

Another reason to like state and local politics: local Democrats often suck way less than the necrotic federal Dem establishment. Some of them are even good! In Philly, Mayor Cherelle Parker just signed the Protect Our Workers, Enforce Rights (POWER) Act, which protects 750,000 workers from wage theft:

https://prospect.org/labor/2025-06-18-how-philadelphia-secured-basic-rights-for-750-000-workers/

The POWER Act shifts the burden of proof for wage theft allegations from workers to their bosses and allows them to recover their stolen wages plus $2,000 in statutory damages per violation; it sets up a new fund (replenished with employer fines) that gives money to victims of retaliation, and it creates a public "bad boss" database of repeat offenders.

As Brock Hrehor writes for The American Prospect, the POWER Act was passed after Trump gutted the National Labor Relations Board and left it unable to protect American workers. The POWER Act tackles one of the most pernicious forms of crime in America: wage theft, which accounts for more losses than all property crime in America combined, with losses overwhelming borne by Black and brown workers, especially women. Wage theft is notoriously hard to police, thanks to fear of retaliation and the precarity of victims of this crime.

The POWER Act passed as a result of the combined efforts of unions (SEIU, AFL-CIO) and the Working Families Party. Along with the Oregon Corporate Practice of Medicine ban, it shows how local, grassroots activism can protect everyday, working people from even the worst corporate criminals, even in Donald Trump's America.

Hey look at this (permalink)


A shelf of leatherbound history books with a gilt-stamped series title, 'The World's Famous Events.'

Object permanence (permalink)

#10yrsago What’s in the Pope’s barn-storming environmental message? https://www.wired.com/2015/06/popes-memo-climate-change-mind-blower/

#5yrsago Microsoft criticizes Apple's monopolism https://pluralistic.net/2020/06/19/art-of-the-deal/#honi-soit-qui-mal-y-pense

#5yrsago Austerity in disrepute https://pluralistic.net/2020/06/19/art-of-the-deal/#breadlines-r-us

#5yrsago Avia, c'est mort https://pluralistic.net/2020/06/19/art-of-the-deal/#avia

#5yrsago Trump's covid "test-tubes" are contaminated miniature soda bottles https://pluralistic.net/2020/06/19/art-of-the-deal/#art-of-the-deal

#5yrsago Trump wants to dismantle the OTF https://pluralistic.net/2020/06/19/art-of-the-deal/#save-otf

Upcoming appearances (permalink)

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Recent appearances (permalink)


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Latest books (permalink)


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Upcoming books (permalink)

  • 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/

  • 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


Colophon (permalink)

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Currently writing:

  • Enshittification: a nonfiction book about platform decay for Farrar, Straus, Giroux. Status: second pass edit underway (readaloud)

  • A Little Brother short story about DIY insulin PLANNING

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