In the US, where public health is not a political priority, the catalyst for policy change promoting healthier living will be fiscal. The government cannot afford the current trajectory of healthcare spending, which will eventually force changes in housing, food, and community planning.

At the J.P. Morgan conference, nonprofit hospitals abandoned talk of growth and expansion, focusing instead on "stability" and "consistency." This defensive pivot reflects deep concern over looming financial threats like federal Medicaid cuts and the loss of ACA subsidies, which could cripple their thin operating margins.

Unlike its reputation, the healthcare sector faces substantial challenges from regulation, pricing pressure, and difficulties in passing on costs. This makes it a deceptively risky area for credit investors who must perform careful selection rather than treating it as a defensive play.

By insuring millions more Americans, the ACA created a new, guaranteed government-backed revenue stream. This made healthcare an extremely attractive and low-risk target for private equity firms, accelerating the industry's financialization.

Contrary to popular belief, the U.S. has more mental health practitioners per capita than medical doctors. The crisis stems from a systemic distribution failure: therapists are concentrated in urban areas, many don't accept insurance due to low reimbursement rates, and high costs make access impossible for rural and low-income communities.

Regulatory capture is not an abstract problem. It has tangible negative consequences for everyday consumers, such as the elimination of free checking accounts after the Dodd-Frank Act was passed, or rules preventing physicians from opening new hospitals, which stifles competition and drives up costs.

Upcoming Medicaid cuts pose an "existential threat" to addiction treatment providers. Because their patient populations heavily rely on Medicaid expansion, new work requirements will disqualify many from coverage, effectively gutting the providers' revenue streams and potentially forcing closures.

PE acquisitions in healthcare impose rigid, cost-cutting operational models that strip physicians of their professional autonomy. This transforms them into cogs in a machine, driving burnout and fueling unionization efforts among doctors.

Government subsidies within healthcare systems like the ACA create a perverse incentive for providers and insurers to inflate prices. This triggers a toxic flywheel: higher costs demand more subsidies, which in turn fuel further price hikes, making the underlying problem of affordability worse over time.