The other fundamental problem is the demographic profile in most developed countries. We have aging populations, and proportionally fewer young people to care for them. I'll bet most HN users wouldn't want to work at a retirement home or assisted living facility even if it paid well. My father spent his final years in such a facility and dealing with him was quite difficult for the staff there. This will inevitably cause higher costs and lower quality.

> There’s lots of markets that are okay-ish notwithstanding scummy people.

It is not at all clear to me that there are "lots" of such markets, but that is neither here nor there. A prerequisite for an okay-ish market is that buyers need to be able to choose not to buy, and when you have literal limited mobility it becomes very difficult to walk away from your housing and care provider, either literally or figuratively.

> housing and healthcare (the third is education.) For the first one we know roughly what we need to do but won’t. For the second we don’t even have that.

Healthcare costs increasing is of very little concern to nursing facility ownership. Almost none of that is borne by the facility itself. They'll often hire skeletal crews of CNAs and LPNs (I was a paramedic, rare was it to see a facility in our area that even had an RN, and if they were, they were the DON, Director of Nursing, and had no direct hand in patient care). The facilities would contract with a physician service who oftentimes would not even speak to the patient, let alone -see- them.

And every, every single interaction with actual care provision was fully billed to the patient/resident's insurance. Anything that is not a profit making center for facility ownership is ruthlessly subcontracted out. A solid portion of the SNFs in my county will openly call 911 for anything beyond the most absolute basic first aid, even when their employees are ostensibly better educated/trained than the EMTs who might be responding.

Healthcare costs in the US are an abomination, but that's not the issue here, or not directly.

Scummy people are like flies to shit - they thrive in the chaos.

People buying up nursing homes are using tactics like what you’d see in the movie Goodfellas. They’ll structure the buy so that they are assuming the license to operate while “renting” the facility from an affiliated entity, cut opex, fraudulently bill Medicare and Medicaid for rehab, and exit through bankruptcy of the operating entity.

That's not the fundamental problem.

The fundamental problem is that we have ceased demanding that our government produce reasonable outcomes.

The reasons for that are many, but it's a core sign of how far we've fallen that there's even a discussion or argument about this obvious fact. We are in charge. We can just ban private equity companies from doing this you know.

There didn't used to be ambiguity about the point of having a society and having that society governed by the people and having those people's representatives solve problems like this.

That ambiguity was created on purpose, for money, by specific people. Not coincidentally, they're the same people making the profits in this story.