What we fear from government-run healthcare is eerily similar to what private equity is creating.
Conservatives have always understood the virtue of free markets. Competition sharpens innovation, restrains costs, and rewards hard work. But we have also understood something else: that markets are not idols. They are tools, and when they are left unchecked in spheres where human lives are at stake, they can become instruments of ruin.
That is what we are now witnessing in the American medical field. Private equity firms, flush with capital and hungry for profit, are buying up practices, hospitals, and even hospices. At first glance, it may sound harmless enough—just another chapter in the story of consolidation, another industry being streamlined. But in reality, this financial takeover is quietly corroding the very foundations of medicine.
For generations, doctors owned their practices. That ownership carried with it responsibility, independence, and an incentive to serve. A physician who ran his own office would often stay late, squeeze in one more patient, or invest in expanding care, not because he was compelled, but because he knew both his livelihood and his community depended on it. When a physician owns his practice, his incentives align naturally with the patient’s wellbeing. His reputation is his lifeblood. If he cuts corners, rushes appointments, or treats patients like numbers, his phone stops ringing. Ownership forces excellence, rewarding doctors who build trust, provide personal care, and invest in long-term relationships with families who return year after year.
Once private equity steps in, however, everything changes. The doctors who once owned their practices become salaried employees. Their incentives flatten. Their autonomy vanishes. A calling becomes a job. What was once a vocation governed by duty and care and incentivized by self-retained profit for the doctor now begins to resemble a 9-to-5 shift managed by non-physician financiers.
Worse, the new owners do not measure success in healed patients or grateful families, but in quarterly earnings, cost reductions, and “throughput.” The question subtly changes from “How do we serve our patients best?” to “How do we move them through fastest?” The result is predictable: patient care becomes a cost center to be minimized rather than a mission to be upheld.
I see this dynamic in my own profession. In my law practice, on the rare occasion that I have even a few moments of empty time on my daily calendar, my mind immediately goes to the same questions: How do I fill this space? How can I grow the practice? What can we do better? How do we serve more clients? How do we improve their experience so they refer others? That is the mindset of an owner—someone whose name is on the door and whose livelihood depends on excellence. But when a doctor no longer owns his practice and instead becomes just another employee, those questions stop. The incentives disappear. He is no longer thinking about expanding care or elevating service; he is thinking about his lunch break, or when the clock strikes five, or how many more days he has to work for what used to be his practice until he can retire. Many still care deeply about their patients, but the system no longer rewards going the extra mile — it penalizes it. Ownership produces initiative; employment produces compliance. And patients can feel the difference.
There is also a profound difference in time horizon. When a doctor owns a practice, he builds it for the long haul. His goal is sustained success — a reputation that endures, a loyal patient base, a practice that he can one day pass to another caring physician who will preserve its standards. Even when he eventually sells, he typically sells to another doctor, someone who values the craft and intends to maintain or improve the quality of care. Private equity, by contrast, has no such commitment. Its model is not “build and steward,” but “buy low, extract value, sell high.” The only long-term plan is the exit — the moment the firm can flip the practice to the next buyer at a profit. That may be a smart investment strategy for Wall Street, but it is a disastrous business philosophy for medicine.
Movies like Wall Street and Pretty Woman portrayed this model well: it is often far easier to squeeze a company for short-term profit than to build one with long-term integrity. Private equity rarely buys a practice because it wants to strengthen medicine—it buys because healthcare is one of the few industries where the “product” (sick people) never stops arriving. It is not investing in the craft of healing, but in the reliable cash flow of human illness. That is not stewardship—it is extraction: get in, get out, pay back the investment bankers, and buy the Porsche.
Some physicians welcome this transition. Older doctors, especially, see it as an opportunity to cash out, to sell their practices for a handsome sum and retire comfortably. That may work well for them personally, but in the long term it hollows out the profession itself. It leaves behind a generation of doctors without ownership, without the old sense of investment, and without the freedom to shape their own practice of medicine. And worse, it leaves behind patients whose doctors are no longer incentivized to run a thriving practice.
But here’s where it gets really diabolical: the problem does not end with primary care. Specialists—kidney doctors, cardiologists, oncologists—depend on referrals from general practitioners. Private equity understands this perfectly. Once they acquire the primary care networks, they can use referrals as leverage. Specialists who resist the buyout find themselves cornered: either sell their practices or watch their patient pipeline dry up. What begins as a few acquisitions quickly snowballs into near-total consolidation. Independence becomes nearly impossible, and what was once a diverse ecosystem of practices is reduced to a funnel controlled by corporate hands.
And here is the great irony: private equity succeeds by dismantling the very competitive marketplace that conservatives champion. This is not free-market capitalism—it is the slow suffocation of it. Capitalism depends on competition. It thrives when multiple independent actors innovate, improve, and earn business by serving people better. But private equity’s model does the opposite: it buys up practices, eliminates competition, corners referral networks, and absorbs specialists under one corporate umbrella until meaningful choice disappears. And when competition dies, the outcome is always the same: prices rise, service declines, and innovation stalls. What remains is not a market, but a captive audience—patients who must accept whatever care the consolidated system offers, at whatever price it demands.
This is not hyperbole. Studies already show that after private equity takes over hospitals, rates of complications rise, infections increase, and mortality creeps upward. A 2023 JAMA study found that hospital-acquired adverse events increased after private equity acquisition. A 2023 BMJ systematic review concluded that private equity ownership in healthcare is linked to higher costs and worse patient outcomes. A 2025 Annals of Internal Medicine study found significantly higher emergency department mortality following hospital buyouts. And research from Harvard Medical School reported similar findings, documenting increased deaths in emergency rooms after private equity takeovers. The math is easy to understand: when efficiency is defined as reducing staff and cutting corners, the “savings” are paid for in suffering.
At the same time, costs go up. Billing systems are optimized for revenue rather than fairness. Networks close off, leaving patients with fewer options and less continuity of care. Visits get shorter, waiting rooms more crowded, staff more stretched. The personal touch—the human bond between patient and physician—dissolves under the pressure of spreadsheets and quarterly reports.
Is this not exactly what we conservatives fear government healthcare would be: an unaccountable monopoly that spreads resources thin and puts patient care last? If we oppose it coming from Washington, we should be equally wary of it coming from Wall Street.
Some defenders of this model insist that there are benefits, and to be fair, they are not entirely wrong. Private equity can bring capital and administrative support. It can help struggling practices stay afloat. In some cases, it can expand services or improve efficiency. But to mistake these limited advantages for a net positive is to ignore the larger, darker trend. Medicine is not a retail chain or a real estate portfolio. It is not an “asset class.” It is the arena where life and death are decided, where trust between human beings is paramount. A system that undermines care, strips autonomy from physicians, and inflates costs for families is not a free market worth celebrating. It is, rather, the logical outcome of short-term profit-seeking at the expense of long-term stability.
This presents conservatives with a dilemma. We are instinctively wary of regulation. We believe in free trade and free markets, not central planning. But even Adam Smith warned against monopolies, and Edmund Burke reminded us that liberty without virtue collapses into ruin. To defend free markets blindly, even when they corrode the very fabric of medicine, is not conservative at all. It is reckless.
The truth is that some guardrails are necessary. Regulators should ensure that acquisitions do not coerce specialists into selling under threat of lost referrals. Standards of care must be enforced so that “efficiency” does not become a euphemism for patient harm. Ownership structures and outcomes must be made transparent so that families can know whether the hospital they trust is being run for medicine or for investors. These are not radical interventions; they are modest rules of the road to keep medicine from being strip-mined like a coal seam.
Because in the end, medicine is not just another industry. It belongs in the same protected category as the family, the church, and the community—institutions that conservatives understand must be preserved, not plundered. If we allow private equity to hollow it out, we will not only degrade the quality of care, we will degrade trust in one of the last noble professions. Doctors will become corporate cogs, patients will become commodities, and the bond between them will be severed.
Private equity has its place in the American economy. But the operating room should not be its next boardroom, and the patient should never become the product.
