Antitrust, Vampires and Bloody Acquisitions

Authors

Theodosia Stavroulaki, Saint Louis University School of Law

Keywords

Private equity; healthcare; COVID-19; hospitals; medical practices; healthcare workers; physician markets; short-term profit; leveraged buyouts; healthcare providers; economies of scale; operational efficiency; empirical research; shareholder returns; healthcare system; social determinants of health; health inequities; health of democracy; structural inequities; mergers and acquisitions; Hart-Scott-Rodino Antitrust Improvements Act; antitrust; antitrust scrutiny; regulatory review; antitrust enforcers; merger review; competition; provider shortages; health outcomes; economic inequality; platform and add on model; roll-up model; health insurers; insurance premiums; health insurance networks; reimbursement rates; healthcare costs; market bargaining power; Medicare; marginalized communities; staffing ratios; patient satisfaction; access to care; public health; Merger Guidelines; Clayton Act; market power; anticompetitive effects; Federal Trade Commission; Department of Justice; private equity buyout; labor markets; Herfindahl-Hirschmann Index; market concentration

Abstract

Private equity has rapidly seized control of large swaths of the U.S. healthcare system. This Essay argues that its takeover is not a story of efficiency or innovation but one of extraction. Drawing on a substantial body of research, it shows that private equity acquisitions are associated with rising healthcare costs, inferior care, reduced access to essential services, and deteriorating working conditions for physicians and nurses—harms that fall most heavily on marginalized communities.

These outcomes are not accidental. They stem from the private equity business model, which relies on leveraged buyouts, aggressive cost cutting, and roll-up strategies designed to generate short-term profits. In healthcare, these incentives manifest as staff reductions, service line closures, physician burnout, and the erosion of population health. As access to care shrinks and health outcomes worsen, civic participation declines, deepening inequality and undermining democratic inclusion.

Despite these predictable harms, antitrust enforcers have largely failed to confront the harm private equity’s expansion in healthcare poses to Americans. Many acquisitions evade review under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, and enforcers have, thus far, not considered how private equity buyouts in healthcare harm labor. This Essay argues that existing antitrust law—particularly section 7 of the Clayton Act—already provides the tools to act. It calls on enforcers and courts to block private equity buyouts that are likely to increase prices, harm quality, or reduce access to care and to treat labor harms as central anticompetitive effects. Antitrust law cannot cure every ill, but it can stop the bleeding.

Recommended Citation

Theodosia Stavroulaki, Antitrust, Vampires and Bloody Acquisitions, 94 Fordham L. Rev. 1649 (2026).
Available at: https://ir.lawnet.fordham.edu/flr/vol94/iss5/3