Rewind: How private equity kills companies and communities

Summary

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Episode Overview

Podcast: Decoder with Nilay Patel
Episode: Rewind: How private equity kills companies and communities
Date: January 15, 2026
Guest: Megan Greenwell, journalist and author of Bad Private Equity and the Death of the American Dream

This episode features a deep-dive conversation between Nilay Patel and Megan Greenwell about the wide-ranging impact of private equity (PE) on American business, communities, and the very fabric of the American Dream. Greenwell discusses her personal experiences, journalistic research, and stories from her book, which explores the often devastating effects PE has on media, retail, housing, and healthcare. The episode unpacks the history, mechanisms, and real-world consequences of financialization, with engaging discussion centered on the human cost and possible pathways forward.

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Key Discussion Points and Insights

1. Megan Greenwell’s Background and Deadspin’s PE Takeover

[05:24-12:13]

• Greenwell recounts taking her dream job as editor of Deadspin, describing it as “fun and weird,” a unique voice in sports, politics, and culture.
• Deadspin’s demise began when private equity owners (Great Hill Partners) dictated content and tried to morph it into ESPN, ignoring what made the site successful.
  • “We wanted to make more money... But instead it just like, was so nonsensical that we couldn’t even follow.” — Megan Greenwell [11:42]
• The disconnect between PE goals (maximize returns) and the company’s actual business model became glaringly obvious.
• Greenwell’s experience led her to realize PE’s incentives often run counter to sustaining and improving companies.

2. What Is Private Equity? Distinction from Venture Capital

[13:25-15:37]

• Nilay and Megan clarify the difference:
  • Venture capital is about investing in people making something new; the success of the venture is the source of returns.
  • Private equity often centers on ownership, cost-cutting, selling assets, extracting value through “financialization” rather than operational improvement or product innovation.
• “You’re making money not from making the thing, you’re making money from making money.” — Megan Greenwell [14:24]

3. The History of Private Equity’s Rise

[15:37-19:25]

• Originated in the 1960s with “bootstrap deals” taking over family-run companies to expand.
• Transformed in the 1980s with firms like KKR pioneering massive leveraged buyouts (e.g., RJR Nabisco), ushering in the age of the “corporate raider.”
• Cultural Impact: This milieu gave rise to the deal-making, zero-sum mentality epitomized by Donald Trump, Wall Street, and 1980s New York.
• “KKR... really doesn’t matter if the company is making money. They’ve cracked the code of just using money to make money.” — Megan Greenwell [16:41]

4. PE’s Expansion and Role in Current Economic Trends

[19:25-21:28]

• Post-2008, low interest rates fueled even more aggressive PE activity.
• PE now owns significant chunks of critical industries—e.g., 10% of all US apartments (25-30% in certain metros), facilitated by policies like cheap Fannie Mae/Freddie Mac funding.
• “Private equity has always gone where money is cheap and where industries show an opportunity for them to make money. Which... does not necessarily mean the industry is a growth industry.” — Megan Greenwell [19:53]

5. PE’s Impact on Communities: The Four Industry Stories

[24:51-27:32]

• Greenwell’s book uses four sectors—retail, healthcare, media, housing—to show how everyday experiences have been eroded by PE stewardship.
• Nilay explores the pro-PE argument: that they rescue and streamline failing businesses. Megan counters:
  • While there are successes, most money is tied up in large deals that often end disastrously.
  • “10 times as many businesses acquired by PE declare bankruptcy as other types of businesses.” — Megan Greenwell [27:14]

6. Healthcare: The Human Cost of PE

[27:32-37:43]

• Health care is uniquely vulnerable—everyone needs it, many can’t pay, the government under-reimburses, making it unsustainable even before PE.
• PE exploits policy changes (Medicare expansion, ACA) to extract value: selling real estate, cutting services—often at the expense of rural hospitals and patient care.
• Doctors’ autonomy and satisfaction have eroded; private equity has “made them workers.”
  • “It was just game over for doctors having any autonomy to themselves.” — Megan Greenwell [32:09]
• Even nonprofit and academic hospitals mimic PE tactics.

7. Why Market Forces Don’t “Correct” the Damage in Healthcare

[34:43-37:43]

• There are imposed limits (e.g., residency slots), regulatory quirks, and deep structural issues that break the normal feedback mechanisms of supply and demand—unlike, say, tech talent.
• “Healthcare is an industry that breaks what we think of as the rules of free market capitalism in so many ways.” — Megan Greenwell [35:48]

8. Violent Consequences, Public Awareness, and Anonymity of PE

[37:43-43:25]

• Recent real-world violence, like the shooting of a health insurance CEO, reveals how palpable public anger has become—yet PE still operates largely in the shadows.
• “Most people do not know if their local hospital is run by a private equity company... private equity loves to operate in the shadows.” — Megan Greenwell [38:36, 40:03]
• PE’s diffuse, complex ownership structures shield individuals from accountability and public backlash.

9. Stories of Resistance and Reform

[47:27-50:46]

• Each character in the book pushes back:
  • Former Toys R Us workers now campaign against pension fund investments in PE.
  • Journalists attempt to build nonprofit, locally-oriented news startups outside PE control.
  • Some states (Massachusetts, Pennsylvania) have rapidly advanced healthcare regulation after PE scandals.
• Greenwell underscores the need for multi-pronged, both grassroots and regulatory, responses.

10. Policy Solutions and the “Magic Wand”

[51:24-53:07]

• Megan highlights a key regulatory intervention: require PE firms to be responsible for the debts of their portfolio companies—as in Elizabeth Warren’s proposed “Stop Wall Street Looting Act.”
  • “You have to have skin in the game... if you’re a PE firm, you really don’t.” — Megan Greenwell [51:45]

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Notable Quotes & Memorable Moments

• “You’re making money not from making the thing, you’re making money from making money.”
  — Megan Greenwell [14:24]
• “10 times as many businesses acquired by PE declare bankruptcy as other types of businesses.”
  — Megan Greenwell [27:14]
• “It was just game over for doctors having any autonomy to themselves.”
  — Megan Greenwell [32:09]
• “Private equity loves to operate in the shadows.”
  — Megan Greenwell [40:03]
• “If you could wave a magic wand and just solve that problem, how would you do it?”
  — Nilay Patel [51:16]
• “You have to have skin in the game… if you’re a PE firm, you really don’t.”
  — Megan Greenwell [51:45]

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Timestamps for Key Segments

• [05:24] — Megan recounts Deadspin’s takeover by private equity.
• [13:25] — Explaining financialization and the PE/VC distinction.
• [15:37] — History of PE’s rise: from bootstrap deals to KKR and modern Wall Street.
• [19:25] — How policy and easy money accelerated PE’s influence in real estate and healthcare.
• [24:51] — Four industry case studies from the book and the evidence against PE “turnarounds.”
• [27:32] — In-depth on PE’s effect on healthcare and community hospitals.
• [32:09] — How PE made even doctors into “just” workers.
• [34:43] — Why market mechanisms don’t correct PE-driven dysfunction in healthcare.
• [37:43] — Public anger, violence, and why PE executives still remain anonymous and secure.
• [43:25] — Rising public knowledge about PE, from Red Lobster to Joanne Fabrics.
• [47:50] — Stories of pushback and the need for multifaceted reform efforts.
• [51:24] — The “magic wand”: how regulation could force PE to internalize risk.

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Tone and Language Notes

• The conversation is direct and at times wry, especially when describing the absurdities and harm unleashed by PE.
• Megan Greenwell brings a journalistic, clear-eyed sensibility, mixing indignation with careful explanations.
• Nilay is incisive and reflective, seeking structural explanations yet attentive to the on-the-ground lived experience.
• The overall tone is urgent but grounded—both analytical and human-centered.

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For Listeners Who Haven’t Tuned In

This episode provides a sobering but accessible look into how financial engineering by private equity fundamentally remakes—and often harms—industries, communities, and individuals’ lives. With compelling personal stories, sharp historical context, and actionable ideas, it’s essential listening for anyone interested in how money, power, and policy shape the world around us.

Transcript

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[Nilay Patel]

I the Decoder team and I are settling back in the podcast booth after the winter break in ces, and we're going to have new episodes for you starting on Monday. In the meantime, we wanted to highlight one of our favorites from last year, an interview with the journalist and author Megan Greenwell about her book Bad Private Equity and the Death of the American Dream. Private equity is one of those recurring themes of modern capitalism. You just plug the words private equity into Google and you will find scores of news stories about PE encroaching on everything from college sports in Utah to mobile home parks in the Adirondacks. It's everywhere, and my conversation with Megan last year was extremely illuminating as to why private equity does what it does to industries like health care, media and real estate, and just how deeply it's affecting the everyday lives of Americans everywhere. It's really great conversation that feels just as timely today as it did last summer. Enjoy, and we'll see you next week with more new episodes of Decoder. Hello and welcome to Decoder. I'm Nilai Patel, editor in chief of the Verge, and Decoder is my show about big ideas and other problems. Today I'm talking with Megan Greenwell a former top editor of both Wired and Deadspin, about her new book, Bad Private Equity and the Death of the American Dream. The book comes out on June 10th and it is a searing account of how private equity goes far beyond impacting failing businesses and deeply affects and transforms the lives of everyday Americans.

Now, Decoder is very much a show.

About the systems and frameworks that explain tech policy and business. And that means we've talked about private equity a number of times on the show because PE is everywhere across the business landscape, even though its massive influence on how so many companies operate is pretty hidden from view. But once you see it, you start to see it everywhere, and it is incredibly validating to hear that so many other people have had similar experiences with companies managed by private equity.

One of the reasons I know this.

Is because it's in our numbers and the feedback we get here on Decoder, our 2023 episode with Lawyer and author Brendan Ballew about his private equity book Plunder, is one of our most popular episodes. We'll link to that in the show Notes Megan's interest in private equity came from her experience as editor in chief of Deadspin, the famous and now defunct sports and culture website. Deadspin was part of Gawker, and Gawker was taken over by a private equity firm called Great Hill Partners, which began to immediately micromanage Deadspin's content. This was when Megan first began to realize that the goals and financial results of a private equity firm were very disconnected from the goals and financial results of the companies which they had taken over. In her book is a deep dive into how private equity works as expressed in four parts of the media, of course, retail housing, and maybe the most maddening of all, health care. My family has a lot of doctors in it and I have heard so much about how private equity has changed health care in America, and you'll hear Megan connect the dots between the financialization of the healthcare industry and the poor experiences many people have with healthcare today. Megan and I also spent some time talking about the history of private equity and the cultural through line from the New York City real estate world that gave rise to Donald Trump all the way to the private equity industry of today. There's a lot of history there that really does help explain how the incentives of finance have come to dominate the American way of life and now seeped into the highest levels of government. Perhaps most surprisingly, you'll hear Megan take great pains to differentiate private equity from venture capital, which is very different and comes with very different Problems. I always really enjoy talking to other editors, especially about something they're so obviously curious about. Let me know what you think about this one. I suspect you will have a lot to say. Okay, Megan Greenwell, author of Bad Private Equity and the Death of the American Dream. Here we go.

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[Nilay Patel]

Megan Greenwell, your journalist. You're the author of Bad Company, Private Equity, and the Death of the American Dream. Welcome to Decoder.

[Megan Greenwell]

Thank you for having me.

[Nilay Patel]

I feel like the. The book is really important. It's really good.

It's.

It's fun to read in a, like, infuriating way, but I should say journalist is important. You were the editor of Deadspin. You were wired for a minute. You have a long history as a journalist.

[Megan Greenwell]

Yeah, been around the block a few times.

[Nilay Patel]

We've talked about private equity a bunch on the show. It's a force in American business. It's a rising force in technology, which is often the focus of this show. We've talked about it in the context of media a lot. And you had a very direct private equity in media experience at Deadspin. I came up as a blogger on the other side of the Gawker equation. We were ferocious competitors to Gizmodo, and I ran in gadgets. And we would always look at Deadspin as this amazing, vibrant force, not only in American sports media, but in political media and cultural media. Just for our audience. Who doesn't remember what Deadspin was like in that moment, just give a sense of what it was.

[Megan Greenwell]

I mean, Deadspin was like so many things because it was so fun and so weird. As the 2010s went on, there were fewer and fewer publications that were doing fun and weird, but Deadspin just never lost that ethos. But it added on all of this other stuff, right? So it added on serious investigative work and big, beautiful features, pretty ambitious videos and all of that stuff. We had a nice events business going. When I got there in 2018, it was absolutely my dream job. Like, that was the job I wanted, was editor of Deadspin. And I was sort of like, great, I'll stay here until they kick me out. And them kicking me out came a lot sooner than I expected it to because of private equity. But, yeah, it was just, I think, one of the most distinctive sites on the Internet in a way that really made it the place I wanted to work.

[Nilay Patel]

And I feel like the rise and fall of Deadspin encapsulates a lot of things, right? There was a set of upstart blogs, and we were all there for the moment when the traditional newspapers would be furious at the bloggers in a way that the tiktokers now refer to me as the mainstream media, which is like, very funny. And I'm like, no, I lived the first version of this fight, actually.

Hold on.

But then there was a displacement, right? That. That did become a huge force in American sports and culture. And then the business model fell out for a huge variety of reasons that we've talked about a lot on Dakota over the years. And then private equity rolls in. And the thing that grabs me about that, and I'm confident led you to write this book, is the PE company tried to operationalize Deadspin.

[Megan Greenwell]

Yes, right.

[Nilay Patel]

It tried to get more value out of whatever commodity it perceived Deadspin to be. And you lived it. So I'm just curious. That's how I saw it from the outside. Is that actually what happened?

[Megan Greenwell]

Yeah, I think that's basically right. I mean, we had been run by Univision. We were so far outside the core of what Univision did that they couldn't figure out what to do with us. And we were definitely under monetized, right? Like, we had failed to develop a subscription product because we on the editorial side would say, hey, we should think about subscription products. It's 2018 and this is the time to do it. They would say, yeah, yeah, yeah, totally. But we don't have the business staff to do that. And so when Univision finally cut us loose, it wasn't that I thought that private equity buying media was a good thing, but it honestly didn't seem like the worst case scenario because they were telling us, yeah, we're going to properly monetize you. Right. And we all wanted that. We wanted to be successful. Deadspin was profitable. You can define profitable any number of ways. And we were part of a network of other sites, not all of which were profitable. Right. But by any metric I ever saw, you know, Deadspin alone was profitable. And so we were sort of like, this is an opportunity moment. This isn't a, like, slice moment. They talked a big game about how we were going to develop a subscription product and go hard on all of these other things that would make us more profitable. And none of us objected to that at all. It just turned out that what they actually wanted to do was dictate what we could cover and try to make us espn, which was so far away from the functional business model that it was just going to destroy the whole thing.

[Nilay Patel]

Where did that disconnect come from? That micromanaging of the newsroom. Like, did they actually want to dictate what you could cover or was that a function of this widget? Appears to be the most popular widget. Make more of that widget and less.

Of this other widget.

[Megan Greenwell]

No, I would have been much happier if it was going on any metric at all. But on literally on day one, you know, we knew they hadn't seen many of the numbers except sort of top numbers and diligence. And they came in and said, well, you guys need to stop covering everything that's not sports. And my first reaction was sort of. I was trying to be generous and I said, oh, yeah, you know, it's so funny you would think that. But actually, non sports content, which was about 10% of what we did, outperforms sports content by 2 to 1, expecting that that would shut down the conversation. Because why wouldn't you want to do the thing that does better on the metrics? Right? They said, we don't care. You're getting rid of the non sports content. And I think really their goal was to be espn. You know, one of the other immediate things they said was they wanted us to run score bugs along the top of the website. And I was trying to explain, Nobody comes to Deadspin.com to check who won the baseball games last night. That is just so far from what we do. And they said, right, but we want more readers. I was like, great, I can think of all sorts of ways to get more readers, but the way to get more readers is not to try to compete with espn. And they would say things like, well, why can't we compete with espn? And I was trying to explain the very basics of media business models to them and literally saying things like, so, for example, ESPN has rights to NBA games, which we do not have.

[Nilay Patel]

And.

[Megan Greenwell]

And it was like they had never thought of that before. So that was what was really maddening about it was there was not like a journalistic purity thing where I was like, you just can't touch this precious thing we've created. We wanted to make more money and we felt like we knew some ways to make more money and that smart business guys would bring better ideas than what we had. But instead it just like, was so nonsensical that we couldn't even follow.

[Nilay Patel]

It does feel like, why did the sports journalist write a book about private equity comes from that moment, right? Because the private equity company just wants to increase returns and they have a lot of moves to increase returns that have nothing to do with the businesses themselves being More profitable.

[Megan Greenwell]

Yes.

[Nilay Patel]

Feels like that disconnect became really apparent to you during this time.

[Megan Greenwell]

Really apparent to me. And I knew nothing about how private equity worked other than a vague kind of it can be bad sort of thing, you know. Alden Global Capital in media had already become a boogeyman by then, but I had covered a lot of things in my career by then, but I had never covered business. Didn't know how this worked. And it was just very confusing to me that their incentives would be different than the incentives of the company they were running. And as I started reading more about it, I began to understand. Yeah. That because of financialization tactics, they are just different incentives. Right. And so they can make a lot of money off of a company they acquire without making the company itself successful.

[Nilay Patel]

Talk about financialization for a minute. This show is, I would say, broadly sympathetic to people who are trying to do stuff. It's kind of what we do here. We talk to people about the decisions they make and why they make them. And, you know, there is an underlying assumption in that, that what they're trying to do is make good products or run good companies. The producers and I are always joking that the founders are the most interesting people we have on the show.

[Megan Greenwell]

Yeah.

[Nilay Patel]

Because they seem to care. You know, like right there. There's something else happening with. With those folks versus the sort of McKinsey robots that we sometimes get as the CEOs.

[Megan Greenwell]

Totally.

[Nilay Patel]

But the assumption is they're actually trying to run their companies. And that's a pretty base assumption that this show is founded on. And then there's this other thing you're describing, financialization, where the. The point is not to run the company. And that is a system that is everywhere. It's like an invisible cloud for the American economy. And you ran right into it. Talk about that a little bit.

[Megan Greenwell]

One frequent confusion that people have is that they mix up venture capital and private equity, and to me, they are so diametrically opposed because venture capital faults, though, it has. The point is to invest in people who are making something. Right. The point is give the founders the money. Private equity is sort of the opposite because A, you're not investing, you're buying companies outright, typically. But B, the ways you make money just don't have anything to do with making the product in a lot of cases. So financialization can mean any number of things, but. But at its core, what it means is you're making money not from making the thing, you're making money from making money. You're investing the money. You're selling off the real estate, which is a big thing in private equity. You're collecting your management fees, you're making strategic investments and selling things from one of your funds to another one of your funds to collect the dividends. It's really the game is simply making money. The game is not making money off of a product or a service or whatever.

[Nilay Patel]

There's a moment, or maybe several moments for the last 30 to 50 years where the American economy shifted from industrialists and people who are known for their products to billionaires who are, who make money by having a lot of money. What would you describe those moments as?

[Megan Greenwell]

So the rise of private equity started in the 60s, but in the 60s it was sort of taking over companies, a lot of family run companies, they called them bootstrap deals, where you would take over a family run company that showed the potential to expand but didn't have the capital to expand. And so it did start almost from what we now think of as a VC type of ethos. And then in the 70s and 80s, private equity turned into this different beast. The rise of kkr, Kohlberg, Kravis and Roberts was a big moment for this wave of financialization and for the rise of private equity. So essentially they said, great, let's take these little bootstrap deals and let's take them to massive, massive companies, right? And so barbarians at the gate, to my mind, maybe the best business book ever written chronicles the RJR Nabisco deal, which was a KKR deal deal and which was the largest leveraged buyout ever completed. And I think that was a huge moment where all of these other folks looked at what KKR was doing and said, oh, we can do that and that will make us a ton of money. And it, you know, again, it really doesn't matter if the company is making money. They've sort of cracked the code of just using money to make money. And so I think that that rise of KKR was probably the most important moment in private equity history, but also in sort of setting the tone for everything is financialization. Kohlberg, Kravis and Roberts was three guys, one of whom was a generation older than the other two. And he ended up leaving the company he co founded because he found that his other two co founders were far too ruthless in terms of the types of hostile takeovers and other deals that they would do, you know, just to make money for themselves, often at the expense of the company they were buying.

[Nilay Patel]

Just to put this in context, this is the go go 80s, right?

[Megan Greenwell]

Yeah. Corporate Raiders.

[Nilay Patel]

Yeah. This is corporate raiders. This is big limousines in New York City. The whole thing. Not for nothing, this is the movie Wall Street. Greed is good. Wall street is about a leveraged buyout of an airline that's very incidental to the plot, but that is the business deal at the heart of that movie. This is where Donald Trump comes from. Right. This is the milieu that produces Donald Trump in his worldview, where everything is a transaction and everything is zero sum. Can you connect those dots as clearly as I'm connecting them? Because this Trump administration in many way feels like the 80s again. There's, there's a modern gloss on it, but that worldview seems to persist.

[Megan Greenwell]

Yes, absolutely. And you know, Donald Trump himself, obviously not a private equity guy, but what he is is a real estate gu. And the marriage between big corporate real estate and private equity has always been extremely tight knit. Right. A lot of the people in Donald Trump's close orbit have always been private equity guys. I think you're right that. That ethos of just don't worry about anything else, don't worry about any downstream effects, just do what we want to do in this exact moment without ever thinking about ramifications. Yeah, it very much unites them. And that really was all the same world in New York in the 80s, for sure.

[Nilay Patel]

Many things have happened since New York in the 80s and now, among them, the rise of the tech companies. Among them the 2008 financial crisis. There was a lot of free money floating around in a zero interest rate environment that created companies like Uber and Airbnb. It seems like that also accelerated and made private equity more aggressive. And that maybe is underrated compared to, well, a bunch of tech companies exist.

[Megan Greenwell]

I do think that's right. I think private equity has always gone where money is cheap and where industries show an opportunity for them to make money. Which again, does not necessarily mean the industry is a growth industry. Right. And so you think about industries like housing and healthcare, both of which I cover in my book, and those were industries where it was just like policy changes of various types led to a lot of cheap money. And for private equity, that just looked like gold. Right. And so that world that created Uber, Airbnb, et cetera, very much is the same conditions that caused this huge growth in private equity throughout the 2000 and tens and has culminated for the moment in where we are now, which is just, you know, private equity devouring everything in a certain set of industries. There was a study last month that said private equity firms now own about 10% of all apartments in the US and in several metropolitan areas, it's over 25 or even over 30%. And that is a result of you can get cheap money from Fannie Mae and Freddie Mac. And that was a deliberate policy decision, right? That was intended to benefit low and middle income home buyers and did benefit many of those people and also meant that there was just this fountain of money for private equity firms.

[Nilay Patel]

We have to take a short break.

We'll be right back.

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[Nilay Patel]

Welcome back. I'm talking with journalist and author Megan Greenwell right before the break. We are speaking about private equity broadly and her interest in it after her parent company got bought by a firm that was less than interested in the success of the websites it owned. And that led us directly into talking about her book.

That brings us, I think, directly into the book. You have structured the book in a series of four stories, four characters in retail and healthcare and media and housing. Those are all industries that have been just completely upended by private equity in ways that I think normal people can just feel. Right. Your experience as a consumer at a retail store is shaped by private equity in ways you can just feel. Certainly in healthcare, which I want to talk about at length, lots of people have talked about in housing. We can just see the wreckage of the media economy around us, particularly newspapers. The pro case for private equity that I've heard on the show is these industries were failing or would have failed on their own. The PE companies come in, they apply a ruthless operations model to some businesses that we're going to go under. They extract the profits. Sure, maybe they cut some, some deals on the side to improve their own financial welfare. But then you have these like lean, mean operating companies that can go off and do things. Has that played out? Do you, do you see those success stories? I can think of one. I don't want to give it away, but have you seen other success stories?

[Megan Greenwell]

Sure, there are certainly success stories. I do not want to say that private equity deals always end badly. That is certainly not the case. The private equity's main lobbying group loves to cite the statistic. I forget the exact number, but the majority of private equity deals are actually for small family run companies. And that is A true as best I can tell and B, it is also true that more of those deals are successful than is true for the biggest companies. Right. And I do focus on the more disastrous stories in my book. While it is true that most deals are for small companies, the most of the money is for the big Companies, right? And so the larger leverage buyouts just have much greater effects on the number of workers our society at large, all of those things. And those deals tend to have the worst outcomes, right? So 10 times as many businesses acquired by private equity declare bankruptcy as other types of businesses. So that is just a statistic that is hard to argue with. It's not that private equity never works. It's that when the ethos is you get bigger and bigger and bigger at all costs and you devour bigger and bigger and bigger things, then you start to end up with a problem where more people are negatively affected and the results tend to be a lot worse.

[Nilay Patel]

Let's talk about healthcare in that context. You have a line in the book that has really stuck with me that communities need businesses. Right? There's some enormous value that just having commerce in your community provides. Right. It makes the community vibrant. It makes people feel like they belong together. There's a relationship people might have between the businesses in their community and themselves, the people who run those businesses. Healthcare is part of that community in like a huge way, commodifying that and making that an industrial product. That's a systematic change that private equity scale has brought to America. Right? And that, that's the money you're talking about. You need a lot of money to just wholesale change the nature of healthcare in America. That money arrived. We can feel it. I think people can really feel it right now. But there's no market pressure to make it better. But that's the thing that like kills me about it, is everyone knows it's bad. And the idea that you could provide a better service in ultra capitalist America and make more money by providing the better service is just short circuited. Why do you think that is?

[Megan Greenwell]

Part of the reason that a ton of private equity money flowed into health care in particular was the Affordable Care Act. The Affordable Care act obviously had all sorts of positive benefits for society, especially for people who couldn't get insurance otherwise. It also meant again that there was a new source of guaranteed money for private equity firms. Because all of a sudden, you know, worst case scenario, like the government's going to pay a lot more people are insured than previously were. And so the problem of health care, which is not a problem that private equity created, is that everybody needs it. Many people can't pay for it, the government reimburses terribly for it. And so it really is a broken business model in a way that will require, you know, if anybody ever gets serious about fixing it, will require tearing it down to the studs and starting over. And that's a very difficult thing to do. And so private equity, you know, understandably, to some extent, kind of came in and said, well, you know, this is real broken, but we see a way for it to work for us. And working for them generally did mean kind of the stripping it for parts model. You sell off the real estate, you cut back the services. And so all of a sudden, you know, I focus on rural hospitals in the book where people genuinely don't have other options. And that when you take away more and more and more of the services they do have at their local hospital. Yeah, that's great for the private equity firm. Right. That's just cutting costs and then you kind of ruthlessly consolidate to cut more costs. And then, you know, if people don't have a place to deliver their baby anymore, okay, that's unfortunate. But here we are. Did that actually answer your question?

[Nilay Patel]

It did.

You know, my parents were small town doctors in Wisconsin in the 80s. My sister's a doctor now. The, the reason that I focused on communities and businesses is the hospitals they worked at in small town Wisconsin in the 80s were just part of the community. Yeah, right. Everyone was born in my town at one of the two hospitals, St. Mary's or St. Luke's and people talked about it and I don't know why that was a rivalry, but it was a rivalry like in the way that small towns just create rivalries and then all of those things are merged into giant corporate entities now. And that has been the experience of my parents career. My sister, her practice was bought by a PE company. Every time we do an episode about pe, we get emails from doctors saying, you don't understand how bad it is. Yeah, right. We have operationalized and added efficiency to medicine in a way that has actually made the practice of medicine almost untenable. Like people do not like doing it. And you, you describe it very clearly in the book in a way that I don't think I've seen anybody just straight up describe it. You say people don't think of doctors as workers and private equity has made them workers. They still have the status and they're still doctors, but PE has made them workers. Talk about that a little bit. Does that seem tent? Because it's really hard to be a doctor and then to be a doctor and then to feel like an employee of a machine. It's destabilizing. Just from the experiences I've had with my own family and from the people that write in, every time we do.

[Megan Greenwell]

A PE Episode the doctor I focus on in the book who is in small town Wyoming, he wanted to go into community medicine because his beloved uncle, who was his role model, was a community doctor and his uncle was a community doctor in like, you know, the 30s, 40s, 50s, at a time when being a community doctor meant you just worked for yourself, right? You could set whatever prices you wanted if the market would bear them, the market would bear them. If not, deal with it. You could barter, you know, you could treat people who couldn't afford to pay whatever choices you wanted to make. And then as medicine in the US professionalized, everybody got pulled into the kind of hospital and clinic system. And then when private equity came in, you know, it was just game over for doctors having any autonomy to themselves. And one thing that I think is really interesting is that it's not actually just private equity, right? So academic medicine, my husband works in academic medicine, uses that same philosophy of ruthless consolidation as well. There's a story in the book about Yale, which just bought up everything across Connecticut. And what you saw was patient satisfaction went way down and the costs patients paid went way up. And that's Yale, right? That's in some sense the opposite of a private equity run hospital. But it's all the same problems. The doctors at Harvard's hospitals, the internists, are unionizing right now because they're so overworked. They don't have any autonomy and they're just sick of it. And so though private equity didn't create these problems, it certainly took advantage and made doctors into a cog in the machine in the same way that they had for years treated retail workers, for example, as cogs in the machine. And so, yeah, doctors are furious. They're the most common group of people I hear from too. There are all these groups of doctors wanting to organize against private equity. And what's interesting to me is like, these are not all leftist doctors. These are a lot of folks who think that, you know, unions are exactly the wrong answer for doctors, for example. But there is this current of we may not all agree on the solutions, but we are completely unanimous that private equity is the enemy. Whatever our individual politics.

[Nilay Patel]

That dynamic is super interesting to me that you have this class of ultra educated, pretty wealthy people, wildly divergent political views, and they can see the problem. And the thing that gets me is there are supposed to be systemic and market correctives to the problem. Like there aren't enough doctors that alone should solve the problem. Right? Like the market should be receptive to the needs of the Scarce labor. And that is short circuited. And I, I kind of don't know why. Like, I can see it in tech, if you're an AI engineer, like, you get a boat, you know, like, yeah, the market is ultra receptive to recruiting and retaining that talent because it's scarce. And in the healthcare market, it, it's, it feels almost as though it's the opposite. And there's not some big supply of new doctors that's going to show up. We're certainly not going to immigrate them like they did with my parents in the 70s and 80s. Why do you think that's been so short circuited in health care?

[Megan Greenwell]

Yeah, I mean, there are a couple of reasons. One is that there's an imposed limit on how many doctors there can be because there is an imposed limit, literally imposed by the federal government on the number of residency slots. Right. So there is a shortage of doctors. But it is also true that, like, you have everybody fighting for this number of residency slots. But the other thing is, like, healthcare is an industry that, that breaks what we think of as the rules of free market capitalism in so many ways because of there's more government involvement than in a lot of industries. But also because there's this book that is like the definitive history of American medicine as a business. It's called the Social Transformation of American Medicine. It's by this Princeton professor named Paul Starr. And it came out in the 80s. I picked it up in like 2022, expecting it to feel incredibly dated. And in fact, it felt so prescient because it traced exactly, step by step how we went from this system of doctors treating their own communities to, okay, now we're starting to get professional hospitals. That's great, we're able to save more lives. But also now we're putting doctors into this system without really thinking about how do we design a system that makes sense. And so from the very beginning, it was super broken. Right. There was never a time where this system worked well. And we could just say, like, let's go back to that. It's a tricky one to me because I don't think private equity is a good system for American medicine. And also, I truly don't know what the solve is without, like I say, ripping it down to the studs and starting over.

[Nilay Patel]

That's a political solution, a regulatory solution. There are many podcasts about healthcare policy that people can go listen to, but it feels like for this show, in this context, in 2025, we have to talk about the other relief valve that appears to exist, which is. Brian Thompson, the CEO of UnitedHealthcare, was shot on the street in New York City. Luigi Mangion is in prison awaiting his trial for. For what appears to be that murder, that is a very bad outcome. You don't want what feels like political violence to correct the. The excesses of the private equity market in health care or really anywhere else. Has the industry seen, oh, this is. We've squeezed it so hard that there are shootings in the street. That feels like, okay, like it's time to pull the rip cord and maybe actually think about the outcomes here.

[Megan Greenwell]

It's such an interesting question. What I understand to have been the main reaction in health care circles to that shooting was, you know, let's get more security, let's make sure these people are better protected, not maybe we need to change the system so the anger isn't so palpable. I also think talking about private equity specifically, and, you know, Brian Thompson, not a private equity guy, health insurance guy, those folks get to feel a little safer because of the knowledge that few people understand their influence. Right. So most people do not know if their local hospital is run by a private equity company. Most of the workers I talked to, you know, a couple hundred people didn't know that their company was owned by private equity, even if they had worked there for years. And so private equity loves to operate in the shadows. And when you start to think about, like, yeah, is the anger so intense that it's going to result in political violence? Maybe until December, health insurance executives felt like they were in that group. But I. I think that private equity executives probably still feel like they're in that group even after the Brian Thompson shooting. Because, like, you know, who can name a private equity executive? Right.

[Nilay Patel]

Well, anyone.

You just walk around New York, their names are on all the buildings.

[Megan Greenwell]

That's true. I mean, yes, if you're paying enough attention to who's on the board of any art museum or who the children's hospital is named after or whatever. Yes. But, you know, I don't think most people, if told, you know, see, the Kravis Children's Hospital over there, could tell you who Henry Kravis is and why he matters. Right. There's, like, this interesting divide between, like, our perception of private equity guys as philanthropists, benefactors of cultural institutions, all of that, and private equity guys as private equity guys. And so if you don't know, I think this is a real fundamental problem with private equity is that nobody understands who they are or how they work. And that probably does give them a little bit of a better sense of security in the age of Luigi Mangioni. But also, you know, it's. It's the negative outcomes there are pretty bad too.

[Nilay Patel]

I will say that the CEOs who show up on decoder increasing amounts of security when they show up in person. It is. Oh, yeah, that is very much a trend that we have seen. But I just feel like our customers hate us so much that some of them have started shooting us. Is the last market corrective, Right. Like something has to happen there that at least changes the valence of the conversation. And you're saying for PE that pressure still isn't felt?

[Megan Greenwell]

I don't think it's felt, no. Because I just don't think. I think private equity guys know that they are not yet being super closely looked at. And even if you know that American health care is super broken, you just have to kind of understand a lot to understand which part of that you can attribute to private equity people. A health insurance CEO. Everybody hates their health insurance, Right? So I'm trying to think of how to say this without sounding terrible, but like, it is less surprising on some level to me that somebody would go after a health insurance executive, as terrible as that is. Then if somebody were to look up, okay, so this fund owns my local hospital. This fund is run by Xpe company. This PE company is run by X people. This is exactly what decisions they took. There is a level of shell companies and funds and all of this stuff that ends up disguising it a little bit from people who don't put in the work to, you know, really dig. And who would, you know, unless they're crazy nosy journalists like us. This is not to say, like there have been doctor shootings too, right? Because somebody's surgery gets messed up and somebody goes and shoots their doctor. But that feels so much more visceral, I think, as does a health insurance CEO, than like this fund three levels above even the parent company of your hospital does.

[Nilay Patel]

To me, what's really interesting is that the conditions that create the health insurance market that we have today are three levels above. It is consolidation, it is cost control, it is profit extraction. And that seems to becoming more apparent it. Right. I. I think more and more people are aware that PE shows up and then these effects follow. I think more and more people are aware that Toys R Us was a company that existed and no longer exists. Or like Red Lobster, they're trying to blame a very obvious thing on Endless Shrimp. And actually it's the PE company showed up.

[Megan Greenwell]

Yeah, the crafters man. Mad about Joanne Fabrics. I hear from the crafters so often.

[Nilay Patel]

Doctors and crafters.

[Megan Greenwell]

Yeah, exactly. Those folks are mad.

[Nilay Patel]

Let's take another quick break. We'll be back in just a minute.

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[Nilay Patel]

Welcome back.

I'm talking with Megan Greenwell about her book Bad Company, Private Equity and the Death of the American Dream. Before the break, we were talking about what happened to the industries and companies and people she followed in her book before enduring Private Equity takeover. But the stories don't just stop there. Every person in Megan's book pushes back on the influence of PE in some way. So I wanted to ask how.

That's the last bit of the book. It's the after section. You talk about ways forward, the vignettes in your book, the main characters have all fought against P.E. in some way. How do you see that playing out?

[Megan Greenwell]

So I felt strongly that I didn't want to end the book on like, well, this system sucks. I'm out. You know, and the most natural way to do that in that I also didn't want to do something prescriptive because I'm not an activist. The most natural way to do that felt like it was to look at people who were doing something after the fact. Where I ultimately came to is if we are serious about changing this system, it's going to have to be so multifaceted an approach. So the four characters in my book are, you know, quote, unquote, fighting back in several ways. The woman who worked at Toys R Us, like, flew around the entire country for the first time in her life speaking in front of these pension boards, trying to convince pension funds no longer to invest in private equity or at least to exert more pressure on the private equity funds they do invest in. The media example in the book to me is really interesting because that's not something we're like. Like there's no regulatory situation that is going to get private equity out of local newspapers. That's just that you have to rebuild the business model from scratch. And so the person I focus on works for a local nonprofit startup of which there is, you know, a big wave right now. And that is not itself a silver bullet to anything, but is like an interesting experiment. And the fact that there are people making these experiments is, I think, a useful thing to shine some light on. There are also court cases and there are proposed bills. You know, I don't think in our current political climate there's going to be a lot of regulation of private equity on the federal level, but there are lots of interesting things happening in Various states right now, especially in healthcare, because after big private equity disasters in Massachusetts and Pennsylvania, those states, you know, both blue states, real quick got very serious about doing some regulation. And so I didn't come away from the book feeling totally hopeless about the chances of clawing a little bit back from private equity. I don't think the system is going to disappear anytime soon, nor do I feel particularly strongly that it needs to. But I think after several years of reporting, I certainly came away thinking this system is very broken and that here are some people doing some interesting things that seem to be gaining some momentum to do something about.

[Nilay Patel]

Feels to me like the big solve is somehow connecting the inputs and the outputs once again. Right. We talked to billionaires on the show. There's a part of me that says, you know, fair play. If. If you actually run Google and Google exists and your goal is to operate Google and win in a market where Google has competitors like, fine, right? Like, at least I can connect the input and the output there. A lot of people like Google. You're motivated to make Google pretty good.

Great.

PE is all about disconnecting the inputs and the outputs. If you could wave a magic wand and just solve that problem, how would you do it?

[Megan Greenwell]

I mean, I'm just going to essentially plagiarize Elizabeth Warren here. She, for several years now has introduced this Stop Wall Street Looting act, which would regulate pe, all told, would probably regulate PE basically out of existence. But the part of it that I.

[Nilay Patel]

Find the magic wand is making it go away just to.

[Megan Greenwell]

I mean, yes, but. But the single part of that bill that I find the most. I find the case for it the most compelling is actually pretty simple. So the basis of leveraged buyouts is you borrow all this money and you, as a private equity firm are not responsible for paying the money back, only the portfolio company itself is. And so what ends up happening is you bury your own portfolio company under this mountain of debt. And one component of her bill is you can't do that anymore. You have to have skin in the game. And again, you know, going back to my distinction between private equity and venture capital, nobody would ever think that if you're a VC and you invest money in a company that you don't have something on the line there. But if you're a PE firm, you really don't. You don't have much on the line. There's a limit to how much you will make if you drive the company out of business. But it's also pretty hard to lose money because you're just not responsible for those loans. And so I think if there were one policy change I would make, I would just say, great, okay, you are legally responsible for the loans that your portfolio company takes out.

[Nilay Patel]

I feel like you definitely have to write your next book on the venture capital industry in the. The market conditions it has created. That is a really interesting contrast that you're making there.

[Megan Greenwell]

Yeah, no, I. VC is fascinating to me and it's like now I'm probably too rosy on VC because I just see such a distinction and because I have such a knee jerk reaction to people conflating the two. So if there's like a negative story that happens in VC world, all of these people will tag me in it and be like, cc, that's private equity. And I'm like, no, okay, different thing. But I am very interested in the VC system because I don't, you know, I don't know enough about it.

[Nilay Patel]

Yeah, well, Megan, you have to come back when you write your VC book. For now, perfect. The book is Bad Company, Private Equity and the Death of American Dream. I highly recommend it. It is, like I said, it's a. It's a fun read. It will make you very mad, but it's a fun read and I really enjoyed it. Thanks for being on Megan.

[Megan Greenwell]

Thank you, Neel.

[Nilay Patel]

The book is Bad Company, Private Equity and the Death of the American Dream and It's out on June 10th to order from wherever you like to buy your books. I'd like to thank Megan for taking time to join me on Decoder site and thank you for listening. I hope you enjoyed it. If you'd like to let us know what you thought about this episode or really anything else at all, drop us a line. You can email us atdecoder the verge.com we really do read all the emails. Or you can hit me up directly on threads or bluesky. We also have a TikTok and an Instagram. Check them out. They're at Decoder Pod.

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With your friends and subscribe wherever you hear podcasts. Decoder is a production of the Verge and part of the Vox Media Podcast network. Our producers are Kate Cox and Nick Statt. Our editor is Ursa Wright. The Decoder music is by Breakmaster Cylinder. We'll see you next time.