As a society we must ask ourselves what is the bottom- line consideration when it comes to health care?  Is it the numbers on a spreadsheet, the self-aggrandizement of the institution’s owners or the well- being of the patient?  The response should be obvious.  Yet, the insidious model of private equity, now the owner of 457 hospitals in America and countless medical practices, including every specialty, and even your pet’s good care, is turning the incentive structure on its head, focused only on self -enrichment at the expense of quality care. Such a case is going on as I write this in my own community and the hospital at which I was born.  It has been gutted financially by private equity plunderers and is on the verge of collapse.  James Kelly RN, our guest today, and the author of “Margin Over Mission: When Private Equity Owns Your Hospital” had seen enough at his own hospital in Albuquerque, taken over by private equity.  He schooled himself on the rapacious practices of this form of ownership which borrows heavily to purchase these facilities and lays the debt obligation on the care centers themselves, thus making patient care secondary to financial chicanery.  Regulators of any type are very late to the effort to halt these practices, often coming in only when a vital institution in the community is on the verge of collapse.  For a better understanding, please listen to this podcast.