US Men's Soccer: New World Cup, Same Result

 

July 22, 2026

Since FIFA announced 8 years ago that the United States, Mexico, and Canada would jointly host the 2026 World Cup, anticipation has grown that the world's most popular sport would make massive inroads into the nation's consciousness and grow the sport. With many of the national team players plying their trade at some of Europe's top clubs, there was hope that the men's team at the 2026 tournament would end the failures of previous teams.

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The first pillar of hope for the U.S. team was the selection of former Argentina national team player and prior club manager with Espanyol, Tottenham, Paris St. Germain, and Chelsea, Mauricio Pochettino.  For fans of the United States Men's National Team (USMNT), it was the first time they had confidence that the United States Soccer Federation (USSF) did their homework and "got their man."  Pochettino had an impressive pedigree, and he had dealt with high-pressure situations in some of the top leagues in Spain, England, and France. Optimism was in abundance about the potential of the men's program.

The World Cup Draw took place in Washington, D.C. at the Kennedy Center, and the USMNT was placed in Group D, along with Paraguay (1st game), Australia (2nd game), and Türkiye (final game).  Frankly, I thought the U.S. men had manageable and winnable games against Paraguay and Australia and was genuinely worried about the final game against the Turks. The games themselves were full of surprising results, including the opening American victory over Paraguay (4-1) and a drama-filled, war-of-words game against the Socceroos of Australia, but the U.S. triumphed 2-0. It was the first time that an American men's team won the first two games in its group, and it also locked up winning the group as well. Some fans wanted the USMNT to make the effort to win its last group game despite this, but Pochettino rested his starters. Türkiye's coach gave his team one final chance to redeem its failed World Cup (they lost both of their games against Paraguay and Australia) and beat Team USA, 3-2.  

As they say, the group games can be fun and entertaining, but real teams show their mettle by winning the knockout round games. The United States has always had a hard time moving past the Round of 16. Their best showing was a quarterfinal berth at the 2002 edition in Japan and South Korea, where they had an uncalled handball against Germany away from advancing to the semifinals.

With an expanded field of teams, there was an added round of 32 to the tournament, and the United States' first test was against Bosnia & Herzegovina, a solid but beatable team from Europe. It was an uneven first half, but it concluded with Folarin Balogun, the lone striker, scoring just before halftime. During the second half, the Americans began to assert their game plan and were controlling the ball with their movement, but the momentum shifted when Balogun was charged with an aggressive challenge on a Bosnian player.  The Video Assistant Referee (VAR) helped the field official determine that a red card was warranted.  So, in a knockout round game, the United States had to play a man down and somehow held on to survive.  It was a nerve-wracking 30 minutes until Malik Tillman was given the chance to take a free kick about 15 yards away after a foul on an American player.  His goal changed the game again, and a confident U.S. team prevented any chance for Bosnia & Herzegovina to get back into the game and moved on to the Round of 16.

The next test was a turning point for American soccer and the men's national team.  The team had advanced to play Belgium, a group of players with superior technical ability. Most importantly, the game was to be played on American soil, in Seattle. This progressive city has embraced soccer, with a stadium that is the loudest for its National Football League (NFL) team, the Seattle Seahawks. Everything was in place for this game to be one of the most important and memorable, with seismic effects on its historical timeline if a victory was attainable.

Unfortunately, from the opening whistle, the Americans seemed shell-shocked, with erratic passing, losing balls to the opponents all too quickly, very little control and possession, and were on their back heel for almost the entire match.  Malik Tillman was able to bring the game level (1-1) on a gorgeous free kick, but minutes after that elation, the USMNT were down again, 2-1. They never recovered, and Belgium added two more goals to drive the nail in the coffin of any chance of the team making history on home soil. One of which was an embarrassing goalkeeping error by Matt Freese, which will follow him throughout his life. He will have a hard time living it down, and I feel for him. Social media from Belgium was unforgiving, and in the United States, was equally unabashed to show their disappointment at the way the Americans bowed out of the tournament.

For USMNT fans such as myself, I was hoping that with the improved quality of play of our players, many of whom are in Europe, and the World Cup on home soil, I felt things would be different. I had hoped that crowd support from their countrymen would push the men into uncharted territory, perhaps the semifinals, but it was not in the cards.  Being a fan of the U.S. men is like being a diehard fan of the Dallas Cowboys, Cleveland Browns, or New York Jets. For those fans, before each season begins, hope springs eternal, and optimism has a chance, but as the season progresses, you come to realize that it is not going to happen, and joy leaves your body. Despite this, believing one day things will be different is what keeps us fans going, persisting with our fandom until we see that dreamed-of success.

And as President Kennedy once said, "Success has many fathers, but failure is an orphan." Everyone wants to take credit when things go well, but no one claims responsibility when things do not go as planned. With the failure of the USMNT to make it to a respectable level in the tournament, pundits, former players, and others all point the finger at various areas that were blamed. The LA Times's Kevin Baxter laid out some of the problems and issues, but I appended my opinions.

1) Youth Development and "Pay to Play:"  The United States has the largest number of participants playing soccer in the world (14 million), but it does not produce the type of players that France, Spain or Germany does because our system of development is run like a business, which relies on parents who can afford expensive travel soccer, rather than being heavily subsidized by wealthy clubs, local communities and other affluent benefactors. I have mentioned this problem before, and until the United States becomes more ambitious in making the sport accessible to all socio-economic backgrounds, the U.S. men will run into this problem.  It is a reason why the American men have not produced an elite-level player that is considered "world class." 

2) Tactical Identity: Most countries have a set of tactics and playing style that endures despite coaches and players being interchangeable.  Take Spain for example. All of their players, regardless of which club they play for, know their roles on the national team, their formation style, and what the general game plan is. game plan.  They keep their shape and discipline, wear down teams with pinpoint passing and excellent pressing when they lose the ball, and get it back quickly.  These tactics and roles are bred from an early age, and players, as they progress, never lose the ethos of those tactical beliefs.  It doesn't vary or is drastically reimagined. The U.S. men always change their tactics every four-year cycle, depending on the player pool and the preferences of the coach. That instability doesn't allow for players to understand what is expected if they get called up as-needed throughout their careers.

3) Competition from other sports: This is a serious problem, especially with lucrative options in the National Football League (NFL), National Basketball Association (NBA), Major League Baseball (MLB) and the National Hockey League (NHL).  Even if a talented athlete loves soccer (like former NFL player Chad "OchoCinco), he pursued a pro football career because it allowed him to achieve generational wealth; most will go where the money is. Major League Soccer (MLS) doesn't have that yet, so it is hard to mold and groom elite soccer players in the American domestic league, unlike top-flight options in England, Spain, Germany, France or Italy.

4) Confidence on the ball and acute tactical vision: If you watch Spain and the Japanese women's team, two groups that have mastered tactical vision and superb passing ability, you notice that the U.S. men don't seem to possess those qualities. Not to mention "first touch," the ability to quickly control the ball and a confidence in how each individual player deals with nerves and big moments. The Belgium game was a quick reminder of these deficiencies.

5) Lack of serious competition:  The United States over the last 20 years has, off and on, mastered regional supremacy in its region, the Confederation of North, Central America & Caribbean Football (CONCACAF).  It shares regional titles with Mexico, but has seen other nations improve their soccer and provide an upset or two, like Panama, Canada, Jamaica, or Costa Rica. However, it does not allow the American men to challenge themselves against better nations, unlike teams in Europe and South America.  Geography is not something the USSF can really change or improve.  There have been rumors that due to more teams being included in the 2030 FIFA World Cup (64 teams), there may be some cooperation and joint qualification with the South American Football Confederation (CONMEBOL). That should give the USMNT better competition to determine its strength as a team.

6) Confidence or Nerves:  This reared its head when the USMNT performed one of their worst games against the Belgians in the Round of 32.  Before that, in the group stage and against Bosnia & Herzegovina, the Americans showed cohesion, flair in passing, and some panache in their confidence in moving the ball.  All that disappeared against Belgium.  Was it President Trump meddling in a red card against Folarin Balogun, and having his good friend, FIFA President Gianni Infantino, "suspend" the infraction so that the USMNT's star player would be available?  Could that have affected US team morale if favoritism played a part? It was motivation for the Belgians, of that I am certain.

While MLS has made progress in being a competitive and secure option for aspiring American players, it is not at the level of those leagues in Europe. Our best players want to play at the highest level, and will seek out options abroad instead. The other issues mentioned need to be addressed, or the USMNT will remain unable to advance past the Round of  16 at every future tournament. The World Cup on home soil was the best chance to advance farther than ever before, since host nations tend to get favorable draws. That is probably the biggest missed opportunity in this World Cup's post-mortem, after being bounced out of the tournament.  I hope the USSF can be aggressive in the development of younger players, improve American coaching, and recruit European coaches for their tactical knowledge (the Netherlands had its fingerprints on the success and vast improvement of the technical abilities of many teams, including the Japanese men's team) to expedite and improve our soccer IQ.

I dread to think that whenever the US men compete in the World Cup, it is going to be Groundhog Day every time. If that is the case, then USMNT fans should organize therapy and coping sessions with Cowboys, Browns, and Jets fans.  We can share in our misery together.

The "Election Season" Circus is in Town till November.

June 15, 2026

Election season is upon us, with the early-round primary voting taking place on Tuesday, June 2nd. Anti-Trump fever is still going strong in California, but several interesting races and ballot initiatives have remained in the news for the past few months. The campaign to replace outgoing Governor Gavin Newsom has many suitors.  Additionally, Los Angeles Mayor Karen Bass faced a surprising challenge from former reality TV star Spencer Pratt, who was making waves.  What does the future hold for the legendary city of Los Angeles and the state of California?

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Several candidates ran for the open governor's position in California (61, to be exact). Still, the candidates that have received the lion's share of media coverage were Katie Porter (current member of Congress), Xavier Becerra (former member of Congress and Biden Administration Cabinet official), and Tom Steyer (hedge fund billionaire and environmentalist), Chad Bianco (San Bernardino County Sheriff), Steve Hilton (advisor to former British Prime Minister David Cameron and Fox News personality), Matt Mahan (San Jose Mayor), Antonio Villaraigosa (former Los Angeles Mayor) and Betty Yee (former State Controller of California).

Of those, the main frontrunners are Xavier Becerra, Steve Hilton, and Tom Steyer, according to recent polling, with Becerra leading in a few of them.  Eric Swallwell, a member of Congress, was doing well in early polling, but he had to drop out of the race to deal with a flood of negative stories of infidelity and inappropriate behavior with female staffers. It was convenient for his opponents, especially fellow Democrat Xavier Becerra, who moved up in polling with Tom Steyer to potentially leave out the leading Republican candidate, Steve Hilton, in the state's "jungle primary." It means that only the top two in votes advance if no candidate receives 51% advance to the general election. Nothing to see here, of course.

California leans heavily Democratic, including voter registration, so the fact that two Republicans (Steve Hilton and Chad Bianco) are in the Top 6 of polling shows voter fatigue and disappointment with the party to some extent.

According to calmatters.org:

Xavier Becerra is critical of the Trump Administration's treatment of undocumented immigrants, specifically those within Los Angeles County, and is open to revising the state's climate change goals for fuel affordability and looking into freezing utility and insurance rates. His endorsements include the California Faculty Association, Equality California, and Planned Parenthood of California.  He has been involved in politics at various levels at the state and congressional levels, including a stint as the Secretary of Health and Human Services under President Biden.  He is connected to the Democratic machine and Establishment, and it might be hard for him to shake off being part of the "club" for younger voters.  Mr. Becerra would have to show that he can improve the lives of Californians despite being a political insider.

Steve Hilton is a business-friendly conservative who would like to cut taxes for all Californians, primarily middle-class and wealthier residents.  In addition, he would like to cut the state's fuel and gas regulations and open more land use for building more suburban, single-use homes. He is endorsed by President Trump, the Nisei Farmers League, and the Israeli-American Civic Action Network. What is interesting is that Mr. Hilton only became a U.S. citizen 5 years ago, having had a successful political career in England, culminating in an advisory role to British Prime Minister David Cameron, and later as a Fox News analyst. What is the driving factor for his elevation to prominence and sudden rise to challenge for the governorship of the state with the 4th largest economy in the world?

Tom Steyer wants to challenge the monopoly of the state's publicly traded utility companies, raise property taxes on business-owned properties, and explore collecting fees on AI use to help support workers displaced by new technologies. He has collected support and is endorsed by the California Nurses Association, California Environmental Voters, and California Teachers Association.  He founded a successful hedge fund, Farallon Capital, was its co-senior managing partner, and left the firm in 2012 as a billionaire.  He is passionate about protecting the environment and founded NextGen America to educate and advocate for environmental protections and legislative action on behalf of those causes.  I thought he might have a chance, even as a billionaire, to convince young people and middle-class residents that he would be able to improve their lives with lower insurance premiums and gas prices.  It doesn't appear to be the case that he was able to convince those target groups.  Perhaps people were tired of seeing too many of his campaign commercials.  Or did opposition from the utility companies play a part?

In the Los Angeles mayoral race, incumbent Karen Bass is fighting to lead the second-largest city again despite strong challenges from Spencer Pratt and nouveau-socialist Nithya Raman, a graduate of Harvard and MIT.

Mayor Karen Bass declared a State of Emergency after the damaging fires in January 2025. She introduced the Inside Safe program to remove the homeless throughout the city, fast-tracked new public affordable housing, and worked to improve tax incentives for film and television production companies. However, her primary negativity falls under her absence and perceived lack of leadership during the damaging wildfires that destroyed large sections of the Pacific Palisades, Altadena, and part of Los Angeles.

Nithya Raman is a current member of the Los Angeles City Council and a member of the Democratic Socialists of America (DSA). In addition to financial recovery from the wildfires, she wants to focus her campaign on housing affordability, reviewing homeless policy failures (returning to the streets, high costs with little return for specific programs), protecting jobs for the entertainment industry, transportation efficiency, and street safety, along with protections for renters throughout the city, and increasing housing affordability. Initially, she had thrown her support behind Ms. Bass and then changed course and entered her candidacy right before the filing deadline.   

Spencer Pratt is known primarily for being on a reality TV show ("The Hills"), making videos detailing his family's struggles after their home in the Palisades burned down, and his fight to rebuild that home despite the city's red tape, bureaucratic opposition, lack of support from insurance companies, and other challenges.  He has gained traction through high visibility on various, mostly conservative podcasts, shows, and platforms.  Mr. Pratt planned on being aggressive in tackling the city's homeless proliferation, saying it's primarily drug-related, and having a strong skepticism of the numerous non-profits making money from it. He also supports fiscal audits and government accountability.

Polls before June 2nd showed Karen Bass leading Nithya Raman and Spencer Pratt, 26%, to 25%, and 22%, respectively, and essentially within the 3% margin of error.  Only the top two candidates in any race in the state can advance to a runoff for the general election, unless one of them gets at least 50+1% of the vote outright.

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Primary Election Night Early Results:

Mayor of Los Angeles 

 Source:  https://www.nbcnews.com/politics/2026-primary-elections/los-angeles-mayor-results

Karen Bass was expected to make the general election, since Los Angeles County and the city itself skew leftward politically.  Los Angeles has not had a Republican mayor since Richard Riordan (1993-2001). I thought Spencer Pratt would make the runoff and qualify for the general election ballot.  I didn't foresee the momentum that Nithya Raman had shown with the large surge of mail-in ballots breaking for her campaign. As he is known to do, President Trump seems to imply that there are major questions of fraud, specifically, why ballots counted after Election Day seemed to have been broken in larger numbers for Mr. Pratt.  If late ballots show support only for certain candidates, it does not give confidence in the process overall.  It also lends support to conspiracy theorists.

Governor of California

           

source: https://www.nbcnews.com/politics/2026-primary-elections/california-governor-results

Before June 2nd, Xavier Becerra was leading in most polls, with Steve Hilton and Tom Steyer remaining constant in second and third position, respectively.  California is notorious for taking its time to count ballots, which doesn't endear it to those in the state seeking efficiency and impartiality. If dramatic surges push candidates who were losing before mail-in and late ballots are counted into the runoff, it will undermine the perception of a fair election. Steve Hilton has only been an American citizen for 5 years, so it is quite shocking to see that, for a brief period, he was leading the state's campaign to replace the outgoing governor. Mail-in ballots did not benefit Mr. Steyer like they did for Nithya Raman, and so Mr. Becerra and Mr. Hilton are left to battle it out in the general election in November.  

Conclusion:

As of June 9, 2026

Source: https://www.nbcnews.com/politics/2026-primary-elections/los-angeles-mayor-results

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With mail-in ballots being counted a week after Election Day, Nithya Raman surged past Spencer Pratt and is now qualified for the general election, thereby knocking him out of the top two.  He was in a healthy spot behind Ms. Bass on election night,  but now he has been removed from the picture entirely.  The Democrats' large voter registration advantage (55% to 15% approximately) in the city shows it was not a total surprise that any Republican in the field would eventually fall below two Democratic women of color in a very diverse metropolis. Republicans have won citywide before, but there is a negative perception nationwide that after-the-fact mail-in ballots shifted the winds decisively and were one-sided.  Moreover, the fact that a distant third-place finisher on election night would make it into the final two spots for November, a week later, gave fuel to skeptics and cast doubt in conservative circles about its legitimacy. I doubt Mayor Bass wanted to campaign against an intelligent and educated Indian woman from Kerala.  She would have preferred that her campaign focus on contrasts between her and Mr. Pratt that would have worked in her favor.  Now she must figure out a way to beat another woman of color.  It is a much more difficult challenge.

Source: https://www.nbcnews.com/politics/2026-primary-elections/california-governor-results

With 84% of the ballots counted as of today, the governor's race has not seen too much change or volatility since Xavier Becerra moved past Republican Steve Hilton into first place.  The campaign for California's next chief executive will be fought between a Democratic Party insider and a conservative who has no leadership record to run on, whose rapid rise seems mysterious.  While I think Mr. Hilton will get support from President Trump and other Republican party heavyweights, his lack of any legislative record and no prior experience in leadership will cast doubt on his ability to deal with powerful, monied interests in Sacramento, such as labor unions, utility companies, well-funded non-profits, and wealthy activist groups.  While Xavier Becerra won't be a popular or consensus choice amongst voters in the state, I think he will be able to use his decades of experience as a state legislator and member of Congress to deal with those special interests in the state capital in a pragmatic way, which allows him to protect his ambitions for the White House as well.  That will be the deciding factor against the upstart conservative Steve Hilton.

The Inevitability of Death & Taxes in California: But First, More Taxes.

 

May 9, 2026

As the state of California finds new ways to generate tax revenue after running budget deficits for the past few years, one new 2026 statewide ballot proposal is the so-called "Billionaires' Tax." It is now generally referred to as the "wealth" tax. It is billed as a method to extract 5% of tax revenue from billionaire residents' assets to support the state's executive and legislative agendas.  The ballot measure is being pushed by the United Healthcare Workers West (UHW), part of a powerful national union that represents many healthcare workers in California.  

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Californians have likely heard of the new "Billionaire's Tax" that was introduced into public consciousness a few months ago.  It was selectively labeled a tax on the state of California's billionaire class so they would pay their "fair share." So far, it has collected 1.5 million signatures and has qualified for a vote this November. One should note that the vast majority of federal taxes are indeed paid by the affluent.  According to the CATO Institute, at the federal level, the top 10 percent of income earners pay more than 60 percent of all taxes, and 72 percent of income taxes.

The measure was written by four university professors, Emmanuel Saez (UC Berkeley), Brian Galle (UC Berkeley), David Gamage (Missouri), and Darian Shanske (UC Davis), and promoted in California by UHW, a subsidiary union affiliated with the powerful Service Employees International Union (SEIU) umbrella.  Most of the authors are academics who focus on economics and income inequality, such as Emmanuel Saez, who researches incomes of the poor, middle class, and the wealthy, and David Gamage, who focuses on tax policy.

UHW union members are nurses, techs, and service staff who work in hospitals, physician practices, nursing homes, and assisted living facilities.  These union members belong to larger state healthcare organizations, including Kaiser Permanente and Dignity Health.  These measures are not always about the common good, but rather suggest a hidden agenda or to devise creative methods for generating more revenue for local and state governments. In fact, the temporary organization created to promote this wealth tax is called "Save California Healthcare and Education," with SEIU as the top funder of this initiative.  The name is intended to appeal to voters' desire for good intentions and benevolence in areas that benefit the common good, including healthcare and public education.  

The discussion ultimately comes back to the main question: why now? Professor Galle believes that, due to the recent tax cuts that Congress gave the wealthy, including in California, there is a $100 billion revenue loss projection, some of which will go toward healthcare, in particular MediCal.  He feels taxing billionaires in the state would generate funds to cover that shortfall, so that healthcare costs, which are currently increasing, are not passed down to patients. Emmanuel Saez is another economist at UC Berkeley who studies income inequality, and both join the other authors of this bill as an attempt to alleviate that inequality through additional taxation of those with means. Will it, though?

There is another hidden agenda within this ballot measure. Tech entrepreneur Chamath Palihapitiya, who opposes the measure, points to a clause in the ballot measure (page 26) that allows the state legislature to convert the original intent of a one-time tax on assets over $1 billion into a tax on the aggregate assets (home, financial investments) of almost everyone, including the middle class. This seems to be the endgame or another wealth transfer to the elites at the expense of the welfare of the public.  France had a similar wealth tax for decades and generated a few billion dollars a year. However, during that time, the economy saw nearly 50 times that amount of capital leave the country.  President Macron repealed it in 2018. 

Google co-founder Sergey Brin is part of the state's wealthy residents who are funding opposition to the wealth tax. Take the two competing ballot measures through an opposition organization, Building a Better California. The first measure would prohibit new taxes on personal property, including retirement accounts, intellectual property, and financial assets, and none of these assets could be taxed retroactively. The second would audit new taxpayer-funded programs and includes a special provision that would invalidate the proposed "billionaire tax." This seems appropriate.

The SEIU-UHW frames the issue, like Professor Galle, as a way to offset reductions in force (RIF) for hospitals and other organizations that employ many of their union members due to loss of state and federal funds. Their press release even refers to this measure as a way to stave off "collapse" of the state's healthcare system when costs are passed on to patients. It is very telling that the union also added that this ballot initiative would help K-12 education and food stamp assistance programs.  A Holy Trinity of empathic good intentions. While those issues are serious and important, using them to trigger support for billions in taxpayer money, of which the union itself will benefit indirectly (through dues from members), comes across as less than noble.  

Some of my concerns about the wealth tax passing are as follows:

• 1) If the clause on page 26 is enacted, I fear that many middle-class Californians will not be able to pay the increased taxes on assets (homes, stock portfolios), and many will be forced to sell off those assets and declare bankruptcy.  Why would legislators want this as a side effect?
• 2) The sheer volume of wealth flight leaving the state if the wealth tax passes may see a short-term gain in terms of tax revenue, but in the long-term, I think the financial health of the state will be horrific.  
• 3) California generates so much revenue for its annual budget, yet no one seems to want to track how money is spent, or adjustments that can be made for future budgets. For example, a lot of money was designated for the mitigation of chronic homelessness, but despite the money spent on it, the issue has not improved. The solution is always to seek more money, rather than to control and reduce what is being spent improperly.

If two competing ballot measures pass (the wealth tax and one of Sergey Brin's initiatives), then whichever one receives the most overall votes supersedes any other and becomes law. I hope the wealth tax does not pass, although polls show many in the state want to see the wealthy pay more. 

People tend to get energized by any sort of pushback or taxation of elites, and the "taxation" of the billionaire is really a Trojan Horse to tax the assets of a much larger group: the middle class within the state. Calling it the 'Billionaire Tax' is intended to hide its true purpose.  If the presumed effect was to tax billionaires at 5% of net assets, why the need for a special clause that allows legislators to lower the threshold without voter approval?  That appears to be the real goal. The middle class, as a group, lacks the organizational, financial, or legal resources to challenge the law, and capitulation and relinquishing assets will come about sooner or later without the protracted court fights.  

I believe that the catastrophic financial disaster will affect middle-class residents.  Politicians within the state don't seem to care too much for middle and lower-income Americans who will suffer.  Special interest groups, well-funded political action committees (PACs), and specially created political organizations have too much influence, and voters in the state continue to bear the brunt of those failed policies. People who require local, county, and state benefits will suffer from decreased funding. I sincerely hope voters in this state see through the false narratives and reject this dreadful ballot initiative.

 

 

Private Equity and Healthcare: A Bad Prescription.

 

January 6, 2026

Over the last few years, the healthcare industry has witnessed significant acquisitions and investments by large private equity (PE) firms. What is the primary reason that healthcare and private equity became intertwined? Will this business relationship benefit healthcare in the United States, or will the industry fall prey to the financial interests that have taken over other sectors on Wall Street?

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What is private equity? It is a type of investment where a central investor raises capital for a specific fund, which then invests in private companies. Capital is generally provided by investment funds, hedge funds, and wealthy individuals, who then manage and utilize the money to invest in companies, reduce costs and expenses, restructure operations, and subsequently increase revenue. These companies are then sold to other private equity firms after profits are distributed to investors. In some other cases, once revenue is maximized, the company is then listed for bankruptcy.

There are three main components of private equity: "Investment," "Value Creation," and "Exit."  

1) The funds are generated to take over or acquire underperforming public companies and, in some cases, convert them into private ones. Most of these companies have been around for quite some time, rather than start-ups, which get funding from venture capital.

2) PE firms then move towards value creation, to raise the valuations for acquired companies through various measures and operational improvements, which include cost-cutting of staff or ending underperforming divisions or departments, restructuring, and moving the company in an entirely different business direction. In some cases, the equity fund brings in new leadership and attempts to expand into new markets.

3) Once a market cap has stabilized, or the PE fund has achieved maximum utilization, typically between 3-7 years, the fund looks to exit the investment and realize profit margin. This process involves selling the canabalized company to another firm (known in the industry as a "trade sale,") taking the company public (or again after privatization, after initial acquisition) with an IPO, or selling to another PE firm (known as a "secondary buyout"). Profits are then distributed to limited partners and investors, as well as management fees (2% of overall assets) and performance fees (20% of improved performance).

Why is private equity more prevalent in finance and capitalism today? What is the allure? From what I have gathered, some of the key features include a "high risk/high reward" ethos.  Private equity can potentially provide higher returns than the market, but it also has its challenges, as the acquired assets are often illiquid and carry significant risk. There is also a more active investor management spirit, rather than the traditional passive investor model that is commonly known.  

So why do private equity companies want to get involved with the healthcare industry?  

1) Investment: The industry has stable revenue streams and, like going to the movies, was "recession resistant" due to consistent demand for services, benefits of profits from pharmaceutical drug sales or technology, regardless of economic conditions.

2) Potential for High Growth:  The United States has an aging population and has seen an increase in chronic diseases, with new technological advancements in those fields.

3) Industry Fragmentation: In healthcare, there are varied specialties such as dentistry, oncology, liver disease, heart disease, diabetes, and kidney disease care (dialysis), with many independent health providers. Private equity acquisition requires or encourages consolidation within independently owned, but competing providers, to centralize revenue streams to create profits.

4) Operational Improvements: PE firms tend to seek out or target underperforming or inefficient healthcare companies, to implement their own management, and try to streamline operations for intended profit.

5) Regulatory Rules and Reimbursement Procedures: An appealing aspect of the healthcare industry for PE firms is the intensive, rigid, and regulatory policies (regarding Medicare, private health insurance) in place. It is a benefit for these PE firms to design business practices that maximize profit and investor utilization due to these rules.

6) Exit Opportunities: Private Equity firms look to acquire healthcare companies, improve their value, and sell them within a short time period for a solid profit. There is a consistent demand for healthcare, and the trend of consolidation provides opportunities for PE firms to sell to bigger firms, which in turn brings in more equity firms or funds to buy healthcare companies.

There are several great articles online that highlight the problems that many see with PE firms acquiring struggling healthcare companies. David Blumenthal, with the Commonwealth Fund, explained how, in addition to acquiring healthcare companies, they are also buying specialized physician practices with high margins for profit in the fields of gastroenterology, dermatology, urology, and cardiology. In his opinion study provided data showed that in nearly 13 percent of metropolitan areas, private equity firms account for more than half of the physician market for specialists. The author points out that PE investors have spent $200 billion on acquisitions in 2021 and over $1 trillion over the past decade in the healthcare field.   

In the past, physicians and their investors would raise capital to own hospitals and support offices, but now PE firms and fund managers oversee funds that invest in healthcare, despite having no knowledge of the field or understanding which practices would benefit patients. What is damaging is when PE firms or funds use leveraged loans to acquire healthcare companies and use them as collateral, with the loan proceeds being used to pay dividends to investors. The debt is then transferred to the healthcare company. A consequence of this business model, in my opinion, is that the increased costs will most likely be passed to patients.  The acquired health provider is under enormous pressure to repay that new debt.  Health insurance is already cost-prohibitive for many Americans, so any increases in monthly premiums will result in a drop in those who can afford it without their employer health plans providing coverage.

Private equity firms claim that their goal is to make healthcare more efficient and cost-effective while improving patient care, but a recent Harvard Medical School report suggests the opposite.  The article referenced a study in the September 23, 2025, edition of Annals of Medicine (AoM), which presented its data, suggesting that emergency room deaths are higher than at hospital emergency rooms not owned by those funds. These researchers, from Harvard Medical School, the  University of Pittsburgh, and the University of Chicago, found that private equity-owned hospitals saw large reductions in staff and salaries. They surmised that those cuts were directly tied to an increase in patient deaths. Emergency rooms are where human-to-human interaction meets life and death, and reduced staffing leads to substandard care.

Chris Hedges, a prominent progressive journalist, provided additional perspective on the merging of healthcare and private equity on The Real News Network, highlighting the negative effects on people's lives. He provided an example with nursing homes that are owned by PE have 10% more deaths due to staffing shortages, similar to hospitals, based on reduced staffing and minimal compliance standards of care. He points out that in 1975, with a population of 216 million people, the United States had approximately 1.5 million hospital beds. As of 2024, with a population of 340 million, the country now only has 925,000 beds. Finally, he points out that even though most Americans have some form of insurance, 56% still have medical debt.   

PE firms tout better financial returns when expenses, including personnel cutbacks, are streamlined. One of the researchers in the AoM study, Zirui Song, provided data suggesting that, among Medicare patients, older and the more vulnerable individuals, a desire for returns can lead to "potentially dangerous, even deadly consequences."  Additionally, he described how patient transfers from the newly acquired PE hospitals increased, and intensive care stays were shortened as well.

What are other motivations for private equity to target healthcare? David Blumenthal pointed out that there are a few reasons for this. First, the low cost of capital with low interest rates began the acquisition boom in the healthcare industry. This, in turn, brought in a new wave of aggressive investors who wanted immediate returns. Second, the increased commercialization of healthcare, which was traditionally a non-profit industry, allowed investors to treat it like any other market. Lastly, because healthcare doesn't provide value to Americans, keeping them healthy has been a losing battle.  Although I would add that we, as citizens of this country, need to do our part, striving to be healthier.

I am concerned that the predatory methods of PE are to seek out distressed companies that are ripe for exploitation for sheer profit, which is wrong in the context of healthcare. Healthcare companies deal with an unhealthy and costly consumer base. Americans are the unhealthiest people among first-world nations.  According to the University of North Carolina (UNC) at Chapel Hill's Gillings School of Global Public Health, only 1 in 8 Americans meets the metabolic criteria for optimal health.  In the US, nearly 1 in 3 adults is overweight, while 2 in 5 are considered obese. Part of the high cost of healthcare in the United States is the poor state of the average American citizen's health, and additionally affected by the profit motive of the healthcare system.

How can we see improvement in healthcare costs? There are several ideas.  Mr. Blumenthal points out that with interest rates rising and all the "low-hanging fruit" already acquired, PE's involvement in the industry may start to wane.  Public scrutiny regarding PE ownership of healthcare companies (cost, quality of care, access, and equity) should encourage Congress to require the disclosure of who owns private, for-profit healthcare companies and their goals.  PE was simply taking advantage of an industry that failed to deliver and establish quality care, and investors exploited profit from that malady.

In my opinion, PE needs to exit the healthcare sector to return it to a non-profit model, leaving medical decisions to physicians and related providers for patient care, rather than administrators.  What the PE oversight for healthcare has shown is that quality of care generally does not improve, and that the cost-benefit medical decisions for patients should surmount quarterly profits and dividends for investors.  The current healthcare crisis caused by private equity has violated the Hippocratic tenet of "do no harm." Healthcare must not be for-profit, and PE must divest from this industry.  

Finally, Americans need to become healthier, and there are innumerable ways to achieve this, with the primary initiative to be taken by Americans who should invest in their health and participate in activities that work best for them.

We need to mandate better healthcare for American citizens in creative ways to reduce chronic diseases with lifestyle changes earlier in life, nutritional, and safe physical activities that will unequivocally lead to increased longevity and productivity, which will also improve the economy of this country.

That should be the better prescription for America.