Emergency doctors’ group goes bankrupt, and blooms that smell of peaches

Stop and smell the plumeria.  ͏  ͏  ͏ [San Antonio Express-News - Header Logo]( [View in browser]( Only 25¢ Get Access to Your Trusted Source for Local News. [Subscribe Today.]( [Private equity gambles and loses on health care]( Seven years ago, one of the nation’s largest private equity firms acquired a doctors’ group it expected to become a cash cow. KKR and its partners expected a $10 billion investment in physician-staffing company Envision Healthcare to grow into a $100 billion health care behemoth. This week, though, [Envision declared bankruptcy](, wiping out KKR’s investment and causing one of the largest PE losses in recent years. To understand why KKR thought Envision was a good bet, check out a [Hearst newspapers investigation]( and [my column](. Envision’s game plan was to contract with hospitals to staff their emergency departments and other high-revenue businesses. Envision would then refuse to join any insurance network, even if the hospital accepted them. This way, Envision could send enormous bills to the insurance companies, and whatever balance the insurer refused to pay, Envision would collect from the patient. The term of art for this practice is “balance billing.” Envision bankrupted thousands of families this way, and KKR planned to expand the business plan into more hospitals nationwide. After all, in our free-market health care system, providers are encouraged to charge as much as they can get away with. A bonus was America’s aging population, which meant more patients to bill. Envision and KKR were not alone in pursuing balance billing. Radiologists and anesthesiologists also avoid insurance networks, bankrupting many middle-class families. Angry patients started complaining to state and local officials, and soon lawmakers began questioning whether [there should be limits on doctors taking advantage of patients desperate to save life and limb](. Congress, the Texas Legislature and other bodies passed laws cracking down on balance billing, especially for emergency department bills. In 2021, the Biden administration promulgated a rule [banning balance billing for emergency medical care](, requiring providers and insurers to work out disputes between themselves. Envision started negotiating contracts with insurers, but surprise, they could no longer generate the 10X returns that private equity expects. KKR had to write off the company, and Envision met its demise this week. Most people agree that society should not allow doctors and hospitals to charge whatever the market will bear because all of us would pay any price to live. Envisions’ bankruptcy does not solve our overpriced and under-performing health care system, but it’s a sign we are moving in the right direction. [Chris Tomlinson Headshot] Chris Tomlinson Business Columnist What Else I'm Writing [Story photo for Abbott, Patrick hold bills hostage]( Photo: Elizabeth Conley, Staff Photographer [Abbott, Patrick hold bills hostage]( Texas leaders pushing unpopular bills hold must-pass measures hostage. [Story photo for Texas grid more reliable with clean energy]( Photo: Jon Shapley, Houston Chronicle / Staff Photographer [Texas grid more reliable with clean energy]( For our health, climate and pocketbooks, there are better ways to stabilize the grid than building natural gas plants. What I'm Reading Must Read: [Texas 'Death Star' bill to block an array of local regulations on verge of passing Legislature]( Local officials know best unless they are Democrats. (Houston Chronicle and San Antonio Express-News) Should Read: [Amor Eterno]( Before the school shooting in Uvalde, Kimberly Mata-Rubio had never been on a plane or given a public speech or scolded a U.S. senator right there in his office. A year in the life of a grieving mother. (Texas Monthly) Interesting Read: [Lincoln spoke Spanish? UTSA professors explore benefits, dangers of deepfakes, AI-generated content]( Also, see a realistic video of Lincoln giving the Gettysburg Address. (San Antonio Express-News and Houston Chronicle) Technical Read: [Machines of mind: The case for an AI-powered productivity boom]( Programs like ChatGPT will help more than hinder. (Brookings) Fun Read: [Annie Ernaux Has Broken Every Taboo of What Women Are Allowed to Write]( How, through the simple story of her origins, did Ernaux lay her hand so surely on the human tragedy of our ability to make ourselves unfree? (New York Time Magazine) Question of the Week What is the biggest problem with the U.S. health care system? Reply directly to this email and tell me your thoughts. Mailbag Last Week’s Question: What will it take to change Texas’s gun laws? “I do not know what can be done about gun laws in Texas, but I know it will take a combination of things - more red flag laws, some serious emphasis on mental help and more Texans speaking up against what is now happening. I come from a family of gun owners, and I do not want to take their guns away, but I do think responsible gun owners should start stepping up and trying to find solutions instead of buying more assault rifles and screaming about constitutional rights. … Those spewing out hateful comments (both sides) are just adding fuel to the fire.” –Linda Winder, Angleton “Because the deaths of Texas children have not moved the legislature, voting them out is the answer.” –John Callaghan, San Antonio “Abbott is very comfortable surrounded by armed guards paid by all of us. He has been corrupted by power, and so have his Republican friends, but they will cause the dismantling of society as we know it. One of the most striking contradictions is that most of these people are strongly anti-abortion because of the right to life, yet they don’t care about the right to life of those of us who are already alive.” –Luis Mesa, Missouri City “When Ted Cruz, Greg Abbott and John Cornyn came to Uvalde and (talked about) mental health care instead of some sort of gun regulation, I thought then, ‘Yes, let’s begin with you and your ilk.’” –Bert Clayton, San Antonio “We actually have a good benchmark for that, and it’s more than 4,000 dead daily nationwide. That was the peak COVID death rate, and Republicans didn’t give a damn then.” –Phil Kerig, Conroe The Takeaway [Story photo for The Takeaway]( Photo: Shalini Ramanathan/STR That's me in [my best American Gothic pose](, but instead of a pitchfork, I'm holding a stalk of my favorite flowering shrub. Last month, Jane Thompson thoughtfully answered my question of the week about philandering politicians, so I asked where she lived so I could share her comment. That's when I noticed her handle: janeplumeria. My wife will tell you I love flowers far more than her or most people. When I lived in Africa, I always employed a gardener to ensure my home was surrounded by tropical blooms. [Frangipani trees](, AKA plumerias, were my favorite. Jane told me she acquired her first cutting at the Hilo, Hawaii airport in 1978. Her collection has grown dramatically since then, and she offered to give me a cutting or two. I was embarrassed to confess I’d never grown one myself. My wife is the gardener in the family, and she’d only managed to find a single six-inch plumeria that would need years to bloom. Luckily, Shalini was excited by Jane's offer, explaining that nothing beats cuttings from an avid enthusiast. So we drove out to meet Jane, whose collection has grown into hundreds of beautiful tropical plants. I felt like I was back in Nairobi. She graciously gave us seven cuttings and priceless advice. Shalini spent Saturday teaching me how to pot the cuttings and care for them. We marveled over one plant’s yellow blooms that smelled of peaches. Jane’s gift reminded me to stop and smell the flowers, something a columnist trying to hold powerful people accountable rarely does. In Hawaiian culture, [plumeria flowers represent birth and love; spring and new beginnings](. These are things we all need right now. Do yourself a favor, and buy yourself some flowers. Share With Your Friends Do you know someone who would like Tomlinson's Take? For the Houston edition, [send them here to sign up](; for the San Antonio edition, [send them here](. More Newsletters 6@6 Your evening recap of the day’s biggest stories. 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