The fund managers don't have to beat the market in order to make bank. They can take advantage of the "carried interest" loophole, which has nothing to do with interest rates - it's a tax system that was invented for 16th century sea-captains (no, really):

https://pluralistic.net/2021/04/29/writers-must-be-paid/#carried-interest

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PE dresses up its playbook in all kinds of bullshit, but it's a smokescreen. At core, PE funds buy companies, merge them to monopoly, slash wages, fire staff, load up their businesses with debt, and then skedaddle before the businesses collapse. They call this "creating value":

https://pluralistic.net/2020/07/24/software-is-cake-too/#looters

3/

This playbook guarantees that everything PE touches will turn to shit. PE is a parasite that preys on weak industries and makes them even more dysfunctional. Think of how PE has cornered regional rental housing markets and then turned every rental in town into a slum:

https://pluralistic.net/2022/02/08/wall-street-landlords/#the-new-slumlords

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Most of us didn't really think about rail-freight until last winter, when the whole system nearly collapsed. Again, the bloody handprints of PE are all over that crisis:

https://pluralistic.net/2022/02/04/up-your-nose/#rail-barons

The pandemic put a lot of businesses into a precarious state, and PE swooped in, buying up distressed businesses at scale and putting them into a death-spiral:

https://pluralistic.net/2020/03/30/medtronic-stole-your-ventilator/#blackstone-kkr

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This acquisition was fueled by Trump's corporate covid bailout and the trillions in public money that the GOP made available to corporate borrowers (remember, PE thrives on debt):

https://pluralistic.net/2020/09/17/divi-recaps/#graebers-ghost

Of all the sick industries in America, healthcare is the sickest, and it's the domain where PE has done the most damage. PE stripped healthcare systems to the bone, removing all excess capacity and exhausting and demoralizing healthcare workers:

https://pluralistic.net/2020/05/21/profitable-butchers/#looted

6/

They bought up emergency rooms, turned them into scam factories that hit every unfortunate person who stepped foot in them with thousands in "surprise billing" fees. Then they cut doctors' pay and spent millions on ads to block anti-surprise billing legislation:

https://pluralistic.net/2020/04/21/all-in-it-together/#doctor-patient-unity

7/

The ER scam was and is wild. Some hospitals lock all their doors except for the ER doors, and then they'd hit you for "emergency care" when you went through the ER on your way to receiving normal, non-emergency procedures:

https://pluralistic.net/2022/03/14/unhealthy-finances/#steins-law

The damage wasn't limited to emergency rooms. Whole hospitals - whole hospital *systems* - were crashed by PE looters, and many of these got emergency government bailouts, because...free market?

https://pluralistic.net/2020/10/01/the-years-of-repair/#mass-murder

8/

PE has bought its way into every corner of the health-care system, and made every bad thing, much, much worse. You know how "bad nursing home" are three of the scariest words in the English language? Try on "bad private equity owned nursing home" for size. The death toll is *massive*:

https://pluralistic.net/2021/02/23/acceptable-losses/#disposable-olds

9/

Biden's SEC chair Gary Gensler has made the most decisive anti-PE moves in decades, requiring disclosures that will help investors (especially union pension funds) pierce the veil of bullshit that brings in the billions that PE fashions into weapons of financial mass destruction:

https://pluralistic.net/2022/02/10/monopoly-begets-monopoly/#gary-gensler

But the wheels of justice grind slow, and PE has trillions to fuel its race to suck every bit of value out of the health-care system before the party comes to an end.

10/

In "Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties," *Kaiser Health News*'s Fred Schulte reveals the plan of attack:

https://khn.org/news/article/private-equity-takeover-health-care-cities-specialties/

In 2021, PE firms bought 1,400 health care companies, spending $206b (the total since 2012 is more than $1t). They've cornered regional markets for eye care, dental care, family practices, hospices, and pet care. We've had a year to see how that played out, and it's not pretty.

11/

Since 2014, PE have paid out $500m in fines for falsifying billings to the US government, but a fine is a price, and the fines have been absorbed into PE's business plans as part of the cost of operations.

Once a PE firm buys up all the specialists in a region, things get very bad. Take San Antonio, where nearly all the gastroenterology clinics have been bought up by PE firms, and where routine colonoscopies now cost patients thousands more than they paid before:

https://khn.org/news/article/private-equity-gastroenterologist-colonoscopy/

12/

While there are plenty of illegal ways that PE companies extract value from their acquisitions, the legal tactics are pretty ugly all on their own, like cutting staff and replacing them with less skilled, less trained, cheaper workers, putting patients at risk.

13/

This is particularly worrying when you consider how heavily PE companies invest in practices to treat people who are vulnerable and struggle to advocate for themselves, such as behavioral health specialists who treat autism, addiction and mental illness.

Whether or not you can escape PE depends a lot on where you live. PE only owns 12% of the nation's anesthesiology practices, but those practices are concentrated in five states, where more than two thirds of anesthesiologists are PE owned.

14/

When PE takes over your care, billings go way up. The average PE-treated patient generates $71 more per claim, and is 9% more likely to experience "lengthy, more costly" care:

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2795946

Doctors who sell their practices to PE companies are lured in with promises of administrative relief from experts who'll handle billing, scheduling and compliance. But PE firms exercise fine-grained control over these doctors, violating rules that say medical practices must be run by MDs.

15/

Take National Spine, a PE-backed chain owned by Sentinel Capital Partners that bought up 40+ pain-management clinics across the country. Doctors saw their caseload explode from 16 patients/day to 25. Medicare billings also exploded, with "unnecessary and often worthless" back braces being charged at up to $1,100 each. Patients were given $1,800 "medically unnecessary and often worthless" urine tests. National settled these claims for $3.3m in April 2019, without admitting guilt.

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