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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.

• A Little Brother short story about DIY insulin PLANNING

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"When life gives you SARS, you make sarsaparilla" -Joey "Accordion Guy" DeVilla

READ CAREFULLY: By reading this, you agree, on behalf of your employer, to release me from all obligations and waivers arising from any and all NON-NEGOTIATED agreements, licenses, terms-of-service, shrinkwrap, clickwrap, browsewrap, confidentiality, non-disclosure, non-compete and acceptable use policies ("BOGUS AGREEMENTS") that I have entered into with your employer, its partners, licensors, agents and assigns, in perpetuity, without prejudice to my ongoing rights and privileges. You further represent that you have the authority to release me from any BOGUS AGREEMENTS on behalf of your employer.

ISSN: 3066-764X

Google is hosting a Customs and Border Protection (CBP) app that uses facial recognition to identify immigrants, and tell local cops whether to contact ICE about the person, while simultaneously removing apps designed to warn local communities about the presence of ICE officials. ICE-spotting app developers tell 404 Media the decision to host CBP’s new app, and Google’s description of ICE officials as a vulnerable group in need of protection, shows that Google has made a choice on which side to support during the Trump administration’s violent mass deportation effort.

Google removed certain apps used to report sightings of ICE officials, and “then they immediately turned around and approved an app that helps the government unconstitutionally target an actual vulnerable group. That's inexcusable,” Mark, the creator of Eyes Up, an app that aims to preserve and map evidence of ICE abuses, said. 404 Media only used the creator’s first name to protect them from retaliation. Their app is currently available on the Google Play Store, but Apple removed it from the App Store.

“Google wanted to ‘not be evil’ back in the day. Well, they're evil now,” Mark added.

The CBP app, called Mobile Identify and launched last week, is for local and state law enforcement agencies that are part of an ICE program that grants them certain immigration-related powers. The 287(g) Task Force Model (TFM) program allows those local officers to make immigration arrests during routine police enforcement, and “essentially turns police officers into ICE agents,” according to the New York Civil Liberties Union (NYCLU). At the time of writing, ICE has TFM agreements with 596 agencies in 34 states, according to ICE’s website.

GEMA is the official music publishing collections organisation in Germany. They’re big, they’re powerful, they throw their weight around, and a lot of people think they’re dicks. Large swathes of YouTube are still blocked in Germany because they might contain music that GEMA hasn’t been paid for.

So GEMA decided it was going to take on the AI guys.  In September 2024 GEMA put together a licence scheme for AI vendors — with ongoing licensing fees, not just a one-off payment. [MBW, 2024]

GEMA’s proposed license fee would be — get this — “a 30% share of all net income generated by the generative AI model or system of the provider.” 30% of all the profit OpenAI makes. If they ever make a profit. It’s not clear why GEMA is going for a share of net, rather than a share of revenue. GEMA also want ongoing payments for secondary usage of AI-generated music. [GEMA, 2024]

In November 2024, GEMA sued OpenAI because ChatGPT would happily spit out lyrics by German songwriters on request. [press release, 2024]

Yesterday, GEMA won big in the Munich Regional Court against OpenAI. [Bavarian State Ministry of Justice, in German]

OpenAI had argued that their large language models did not store copies of the lyrics — just whatever the model had been trained on by the whole training set.

This is the sort of argument that Stability AI successfully used against Getty Images — that the models aren’t literally a copy. Even though they are actually a compressed copy of their training data!

The Munich court did not buy OpenAI’s argument. Language models can absolutely just reproduce their training data, and GPT very obviously did that precise thing.

The court said that training was fine. It was spitting out copies that constituted spitting out copies.

OpenAI argued that if the chatbot just happened to spit out a copy of the lyrics, that was the user’s fault for asking for them. The court didn’t buy that either — it was OpenAI that put the lyrics into the training data and made them available.

The court has prohibited OpenAI from reproducing the lyrics. If you ask ChatGPT for song lyrics, it will now block the output on copyright grounds. It will still produce a translation of the lyrics into another language, though. [Heise, in German]

The Munich judgement can be appealed. OpenAI says “we disagree with the ruling and are considering next steps,” but they would say that. [Reuters]

GEMA also sued the AI music generator Suno in January for allegedly spitting out recognisable copies of licensed German songs. There isn’t a court date as yet. [GEMA; GEMA]

OpenAI has already threatened to leave Europe if it gets regulated too hard. Imagine GEMA being the ones to drive the chatbots out of Germany.

• Video — Podcast

Great things often begin as outlines. Whether you’re a writer or a student, an attorney or a software developer, outlines can help clarify and develop ideas and concepts. Screenplays and books flow better. Speeches, dissertations, and essays make all the points you want to make. Class notes, meeting notes, and agendas have structure that makes them easier to understand. Projects and budgets are easier to visualize and plan.

We’re thrilled to share that the next version of OmniOutliner is nearly ready as a universal app for Mac, iPad, iPhone, and Apple Vision Pro, and that we’re making test builds available to anyone who wants to help make sure we haven’t overlooked anything.

Want to give it a try? Head on over to our test page, and check out the release notes. We look forward to your feedback!

(And we look forward to sharing more news with the rest of you soon!)

(At the Omni Group, we make powerful productivity apps which help you accomplish more every day. Feedback? I’d love to hear from you! You can find me in the Mastodon corner of the Fediverse at @kcase@mastodon.social, or send me email at kc@omnigroup.com.)

“Watch your step sir, keep moving,” a police officer with a vest that reads ICE and a patch that reads “POICE” says to a Latino-appearing man wearing a Walmart employee vest. He leads him toward a bus that reads “IMMIGRATION AND CERS.” Next to him, one of his colleagues begins walking unnaturally sideways, one leg impossibly darting through another as he heads to the back of a line of other Latino Walmart employees who are apparently being detained by ICE. Two American flag emojis are superimposed on the video, as is the text “Deportation.”

The video has 4 million views, 16,600 likes, 1,900 comments, and 2,200 shares on Facebook. It is, obviously, AI generated.

Some of the comments seem to understand this: “Why is he walking like that?” one says. “AI the guys foot goes through his leg,” another says. Many of the comments clearly do not: “Oh, you’ll find lots of them at Walmart,” another top comment reads. “Walmart doesn’t do paperwork before they hire you?” another says. “They removing zombies from Walmart before Halloween?” 

The latest trend in Facebook’s ever downward spiral down the AI slop toilet are AI deportation videos. These are posted by an account called “USA Journey 897” and have the general vibe of actual propaganda videos posted by ICE and the Department of Homeland Security’s social media accounts. Many of the AI videos focus on workplace deportations, but some are similar to horrifying, real videos we have seen from ICE raids in Chicago and Los Angeles. The account was initially flagged to 404 Media by Chad Loder, an independent researcher.

“PLEASE THAT’S MY BABY,” a dark-skinned woman screams while being restrained by an ICE officer in another video. “Ma’am stop resisting, keep moving,” an officer says back. The camera switches to an image of the baby: “YOU CAN’T TAKE ME FROM HER, PLEASE SHE’S RIGHT THERE. DON’T DO THIS, SHE’S JUST A BABY. I LOVE YOU, MAMA LOVES YOU,” the woman says. The video switches to a scene of the woman in the back of an ICE van. The video has 1,400 likes and 407 comments, which include “ Don’t separate them….take them ALL!,” “Take the baby too,” and “I think the days of use those child anchors are about over with.”