There's a pattern to the kinds of companies PE buys and I think it points to the real problem.

They like companies with some kind of moat that makes it hard to unseat them. Basically, companies where there is no alternative for the consumer. That way, they can inflict abuse but know there will be nowhere to run.

There are two different ways to achieve this. Monopoly and regulation. Hospitals have both government granted locational monopoly and tons of regulations that make it impossible to compete.

Private equity is the symptom, not the disease.

Until we get at the disease, new monsters will be born with different name filling the same ecological niche. It's economic natural selection played out in the environment we created.

It's actually worse with veterinary practices.

Younger veterinarians are drowning in school debt and can't buy the practices from the older folks that are retiring. So, private equity is basically snatching all of them up right now, betting that childless millennials are going to pay tons of money on veterinary care when their pandemic pups begin to reach end-of-life.

They're going to cut wages for all the staff, and hike all the prices, because unlike with human medical care, there's hardly any regulation (yet).

Australia is on its way down this path after Brookfield / Healthscope was holding a private hospital hostage against the government and had performance so degraded a child died. Hopefully we (aus) continue down this path of burning off the rot.

https://www.abc.net.au/news/2025-03-27/nsw-government-joes-l...

Can someone steelman private equity, please? I'm honestly looking for the upsides (for non-investors) of when PE moves into an industry like medicine and begins buying up businesses that traditionally aren't already large chains.

I already hear the downsides frequently from someone whose work is directly affected.

Remember that when private equity buys out a business, there is at least one major winner in that moment: the current owners who have been building up that business over years.

One foreseeable consequence of this bill is that it reduces the ultimate value of starting and building your own practice, leading to more consolidation among existing large operators. As this is foreseeable, I also imagine that it's an unstated goal.

My main problem with PE is that it is being invested in by things that I do not consider "investors" like retirement funds, teacher's pensions, annuities, etc. Many of these things have sort of implicit guarantees from the State or Federal government. These organizations should be completely banned from investing in PE. PE investments should only be invested in by "investors", and investors understand that their investment may go to zero.

I did a small research project based on medical billing challenge data (https://medgis.te0.io/). I tried to correlate the data to PE firms (best effort). As far as I could tell they were just a volume player but not the worst. After talking to people in the industry, theres some real sleezy doctors out there. Some do appointments at hospitals even if not required so they can charge more. There’s more anecdotes. All the incentives are messed up and I’m not sure how to fix without policy changes.

They'll still manage to figure out some loophole to do it anyway. PE really is cancer to most industries.

PE has bought most of hvac, electrical, plumbing, daycare, dentist. They keep the same local well established name, but is run centrally by the PE firm. They employ smooth talking salesmen to convince homeowners to pay tens of thousands of dollars for simple things. The salesmen makes 150K+ commissions. The actual plumbers/hvac people make $20/hour. The HVAC salesmen convince unsuspecting homeowners to spend 30K - 70K on upgrades and warranties. They also get a percentage from the manufacturer, usually some shitty brand. They sell warranty/services package which is questionable.

If you want to look at how similar laws have played out in practice recently at the state level, look up 2026 CPOM (Corporate Practice of Medicine) laws in Oregon, California, and Washington or Massachusetts in 2025.

Nice summary of the legal landscape here:

https://www.dlapiper.com/en/insights/publications/2026/07/co...

I feel like medical practices should be like law firms where effectively non-lawyers can’t own equity and equity owners have to comply with ethics and code of conduct rules…

How do you even define PE?

Because there’s many shades of gray here, no?

Warren was a 1980s Republican who did legal work on behalf of major corporations including Big Oil vultures.

She stayed in the race for Super Tuesday in 2020 rather than consolidating the progressive vote for Sanders.

Right before, her campaign accepted millions in funding from billionaires after promising not to. Her comment was roughly, as soon as others stop taking billionaire money, I will stop.

Make it a leverage limit. Otherwise you’ll have other players come in and replicate the playbook.

The short-term fix is banning PE. The long-term one is restricting the leverage these groups can take. Then put limits on upstream leverage. We have these across our economy. We just don’t apply them to this sector.

How does it define PE?

Most importantly to fight it as Private Equity is creeping like a cancer into good health systems globally, even in Europe, to slowly but surely siphon away all that is good.

It's important to fight it now before it is too late and other places also fall apart into a degraded, predatory, dystopian US system !

This has infested veterinary practices. Vet costs have increased 8-12% annually for 4-5 years now. The process approaches the vet saying their integrated back office system will save you local personnel and allow the vet to increase client service hours by wasting less on admin. Their system fractures a vet visit into service actions - each of which has a fee. They create a medication factory where a bottle of 100 tablets that cost $1 each becomes $5 a tablet, plus a dispensing fee. Over the past 6 years this has increased vet bills by 50-80%. Sadly, this brings people to abandon pets because they can not afford vet bills = death for the pet or a hard/short life as a stray. This private equity has also infested dentistry, which shows up as more dental bankruptcies as more people choose extraction over implants/root canals.

I'm surprised that medical practices can be owned by anybody other than licensed physicians.

In most states a law firm's owners must all be individuals licensed to practice law (i.e. lawyers).

Why not the same thing for medicine?

I'm not so sure limiting competition is the way to go here. One thing I hate about US healthcare is the lack of price transparency. They would rather shut an entire hospital down before giving you a price sheet. So when outfits like Walmart were looking to get into healthcare and offer basic services like blood tests, checkups, xrays, and common procedures available for flat fees and published prices, the reaction of the US healthcare community was that of a primal scream of terror, and they - specifically hospital groups -- have mobilized an army of lobbyists to try to prevent anyone else from competing.

Hospitals are massive byzantine organizations with so many management layers and so many shady billing techniques, from charging for procedures not performed, to changing what they charge you based on when they find out how much you can pay, it's crazy. What other business forces you to sign a waiver agreeing to pay whatever they decide to charge you, without them telling you what that is, or they will refuse to serve you?

PE buys up hospitals to gut them, make them less capable, and cheaper to run.

Then, they buy up air ambulance services to unnecessarily fly patients to other hospitals they own because it's more profitable at the expense of care delays and worse outcomes. Meanwhile, patients and their families are stuck with exorbitant air ambulance bills $20k-60k.

Another area private equity is taking advantage of is college housing. They have driven tents through the roof (the pun is an unintended bonus).

If for-profit healthcare is allowed then it could be regulated like banking, with requirements to prevent failure (including requirements for financial health), and if there is failure, to ensure customers are protected and provide for continuity.

Like banks, failure of a healthcare institution can be destructive for its customers and the community. If a bank goes under, especially a significant one for the community, regulators see that it's acquired by a surviving institution - often with only a weekend of downtime.

Nothing a few bills slipped to republican and "moderate" democratic senators won't fix!

Bi…cameral legislation?

This is dumb. Just enforce the existing antitrust laws. Yeah sorry Apple Google, this is going to hurt

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How about just “cannot sell for 20 years”?

The usual complaint is going full extractive mode, desperately squeezing profit and selling inside 3-7 years.

So, yeah, we can keep private investment. But they're fucking stuck with it, trying to maintain a healthy business for 20 years.

You know what american healthcare really needs is more regulation!

I feel it would be good to bring in (or back) compulsory partnership structures for key professional businesses like GPs, dentists, pharmacies, vets and accountants.

The PE buy-up of these core local businesses isn't great for society generally, service delivery and the existence of a middle class.

The other thing I feel gov should do is force a separation of distributors and point of sale, with rules that allow smaller business to buy at the same pricing as larger.

People seem to forget a key requirement of capitalism is for government to create a level playing field for business. I cant see a better way to do this, and I suspect it would be very beneficial to the bulk of society if gov made some changes down this line.

I wonder if ai can help doctors reclaim their practices, as the bureaucracy of dealing with insurance may become easier. Administrative overhead must be cheaper with ai. It was the main reason for consolidation and giving up management to hospitals and private equity.

> employers expect health care plan costs to rise by an average of 11 percent per worker in 2027, unless benefits are cut

I am sure most workers would prefer to get that extra 11% as a cash raise, but because healthcare costs are out of control the same care costs 11% more.

Certainly some companies will throw up their arms and hire someone overseas instead.

Medicine is extremely capex intensive and only become more so. Sucking private capital out of healthcare is going to make it vastly worse for everyone; higher prices and less innovation. I think we can criticize the often ruthlessness of PE while realizing that limiting medicine's ability to invest would be a huge self-own and only force further centralization into the biggest non-profit centers.

Medicine is already held back enough by the lack of ability to use debt to finance its sales, unlike almost every other industry; you can repossess a car but you can't repo an implant or administered drug, forcing everything to be paid for in cash upfront. Medicine needs as much access to capital as it can get.