The Carlyle Group plans to IPO medical supply affiliate Medline at a $55 billion valuation, a 62% increase from its $34 billion valuation when Carlyle, Blackstone and Hellman & Friedman bought Medline in 2021. The equity return (per an SEC filing) is even higher at 85.5%.
It's the biggest private equity underwriter (PEU) sponsored IPO since KKR took HCA public in 2011. Flashback to 2010:
SEC filings show HCA paid investors $1.75 billion and $500 million in 2010.
The filing shows the impact of PEU's on health care. HCA's interest expense rose from $655 million in 2005 to $2.2 billion in 2007, an increase of over $1.5 billion. Add $1.2 billion in management fees over three years and health care costs go higher.
The PEU impact on healthcare has been more than money, although that has been significant. Missouri Medicine reported private equity brings:
more debt, more bankruptcies, higher prices, and less quality care.Elected officials took forever to restrict "surprise medical billing," a nefarious PEU profit maximizing scheme that harmed people needing emergency room care.
Carlyle, Blackstone and Hellman & Friedman stand to profit handsomely from the IPO. That's in addition to billions already drawn from Medline.
Private equity's preferred "carried interest" taxation remains firmly in place, long after both political teams promised to eliminate the unpopular tax break.
PEUs know how to pay the tax game, they don't pay and any breaks come to them. Medline's latest S-1/A states:
In connection with the Reorganization Transactions, Medline Inc. will enter into a tax receivable agreement with certain of our pre-IPO owners that provides for the payment by Medline Inc. to such pre-IPO owners of 90% of certain tax benefits, if any, that Medline Inc. actually realizes, or is deemed to realize (calculated using certain assumptions)
The greed and leverage boys know how to pull cash from affiliates:
We made payments pursuant to the Services Agreements to BX Management (Blackstone)totaling $270,000, $360,000, $711,000, and $784,000 in the years ended December 31, 2022, 2023, 2024 and the nine months ended September 27, 2025, respectively. That totals $2.1 million
We made payments pursuant to the Services Agreements to Carlyle Management totaling $244,000 and $60,000 in the year ended December 31, 2023 and the nine months ended September 27, 2025, respectively. That's $304,000 in total.
We made payments pursuant to the Services Agreements to H&F Management totaling $120,000 and $133,000 in the year ended December 31, 2024 and the nine months ended September 27, 2025, respectively. Combined that totals $253,000.
Apparently management fees turned into Service Agreements which cost Medline another $2.6 million under PEU ownership.
How many of you have gotten an 62 to 85.5% raise in the last four years? That's probably more like the increase in your health insurance premiums since 2021.
Health care coverage now comes with absurd deductibles and annual "out of pocket" maximums that destroy the perilous finances of those lucky enough to have coverage, should they actually need care.
Trump II's Big Beautiful Bill benefits the billionaires and leaves ACA subsidy recipients out in the cold. This is telling you something.
Politicians Red & Blue love PEU and increasingly, more are one.
