Screenshot: Envision

Private equity—in which hugely wealthy people take a public company private and invest huge amounts in it (often taking on large amounts of debt in the process, which the company and not the investors are responsible for)—is everywhere. Its vulture claws have sunk into many industries in America. It took away Toys R Us and is threatening to take down some of your favorite news destinations. And, as Axios reported today, private equity has found another industry to worsen while turning a profit: healthcare.

KKR, a global investment firm, is set to pay $10 billion (nearly half of which consists of debt) to take a company called Envision Healthcare private. As Axios notes, Sen. Claire McCaskill asked Envision last year about its billing practices, a few months after the New York Times reported on how Envision’s subsidiary, EmCare, took over the management of emergency rooms and didn’t enter into contracts with insurance companies, meaning all patients were deemed to be out-of-network and charged thousands more for ER visits.

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Axios reported that Envision has said it will “move almost all of its out-of-network contracts to in-network contracts by the end of this year,” but it also noted that “[g]oing private means healthcare groups don’t have to disclose a whole lot about their finances or strategy.” Meaning, if KKR decides the best way to recoup that $10 billion investment is to keep billing patients thousands of dollars for trying to stay alive, it’s going to be a lot harder to stop them—and as Axios pointed out, private equity doesn’t really have an incentive to do that anyway.

Axios also pointed to a Bloomberg report published yesterday on air ambulances, another area where patients have almost no choice but to use incredibly expensive services. Air ambulances “have few restrictions on what they can charge for their services,” Bloomberg wrote, with one major company’s average charge growing to $49,800 in 2016, because they’re considered air carriers and not healthcare services. And Bloomberg reports that consumer groups say “air-ambulance companies strategically stay out of health-plan networks to maximize revenue”—just like Envision. Air ambulances charging desperate people thousands of dollars, by the way, are also similarly very attractive to private equity companies:

Wealthy investors lured by the industry’s rapid growth have acquired many of the biggest air-ambulance operators, leaving control of the business in the hands of private-equity groups. American Securities LLC bought Air Methods for $2.5 billion in March 2017. Rival Air Medical Group Holdings, which includes Air Evac and several other brands, has been owned by New York private-equity firm KKR & Co. LP since 2015. Two-thirds of medical helicopters operating in 2015 belonged to three for-profit providers, the GAO said in its report.

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Hey look, it’s KKR again! They must be a real swell bunch of guys.

And, to complete our trio of stories that illustrate how terrifying the world of finance is: Bloomberg also reports that private equity in general is being taken over by the richest of the rich, a “List of 55" who are “reshaping global business, if not capitalism itself”:

Around the globe, bankers are vying for the world’s hyper-wealthy as never before. And they are holding out investments that are tantalizingly off-limits to the rest of us, behind a velvet rope of bespoke investment banking.

This is how the super-rich keep getting super-richer. Anyone can buy stocks. Only a privileged few can bankroll multimillion-dollar ventures or buy entire companies. Private equity—that lucrative and, at times, controversial force of modern finance—has become a playground of the new aristocracy.

It was bound to happen. Like so many things, investing is becoming increasingly stratified. Private bankers now say that entry-class “rich” starts at about $25 million. But you need more than that—typically at least 40 times more, or about $1 billion—if you want a ticket into serious deal-making.

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So not only is private equity cannibalizing industries and turning a profit on over-charging regular Americans for healthcare, it’s also becoming increasingly restricted to the very wealthiest, whose vast empires only grow. Pretty soon, everything will be owned by either Jeff Bezos, Warren Buffet, or the animated ghost of John D. Rockefeller, sitting atop a literal mountain of dollar bills that reaches almost to space and is guarded by dragons and dudes with Elon Musk’s pathetic flamethrowers.

But hey, single payer would cost too much, right?