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An Opportunity for Renewal and Progress on Science and Democracy
The American people have spoken, and they clearly want a Congress that will prioritize their well-being over corporate interests; that will help ease the affordability crisis instead of worsening it; and most of all, a Congress that will stand up to the authoritarian, destructive impulses of Preside
Letter: No one should lack support in a mental health crisis. Here’s how NAMI Utah can help.
Letter: No one should lack support in a mental health crisis. Here’s how NAMI Utah can help.
Sydney's new $641m Powerhouse arts and science museum to open amid crisis
Due to open on 7 November, the space is mired in controversy as senior executives stand aside during an ongoing misconduct and procurement investigation
How a scientist went from hero to traitor in a US water crisis
When the water in Flint, Michigan, became contaminated with dangerous levels of lead, Dr Siddhartha Roy, then a third year PhD student, was part of the team of scientists who publicly contradicted state and federal claims that it was safe. He became a local hero until a new piece of research challenged the idea that children in Flint had been left permanently brain damaged by the crisis. His adherence to the evidence, no matter who it offended, has earned him the 2026 Maddox prize, which recognises individuals who stand up for science and evidence, despite challenges or hostility. He tells Ian Sample how he reflects on his experience in Flint, and why he lost friends as a result of his work there
AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.
Chesterfield mental health provider charged in $49M Medicaid fraud scheme
A Chesterfield mental health professional was charged for an alleged $49M mental health crisis services fraud scheme targeting Virginia Medicaid.
California decides on housing bonds with Prop. 1 and Prop. 37
Two borrowing measures — Prop 1 and Prop 37 — tackle the state’s affordable housing crisis in very different ways.
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Lebanon cuts power to public bodies as electricity crisis deepens
German Digital Health: Structural Crisis, Structural Opportunity
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Springfield council approves annexation for behavioral health campus
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Rockets vs Celtics Injury Report VanVleet Returns as Capela Sits
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World News in Brief: healthcare crisis in Yemen’s Taiz and Afghanistan, UN mission in Western Sahara ends
The humanitarian crisis in Yemen is worsening, particularly in the southwestern city of Taiz, which is being encircled by paramilitary Iran-backed Houthi forces.
MND Local Guadalajara: How the water crisis is affecting local businesses, fewer dengue cases and a new 'Made in Jalisco' seal
A new "Made in Jalisco" seal has been unveiled, while business leaders disagree on whether the Guadalajara water crisis will slow investment.
We still have a farm crisis
My headline is my thesis. Inaction by Congress this summer and fall, combined with deteriorating economic conditions due to many factors, has compounded a dire situation for Arkansas farmers. We’ve...
We still have a farm crisis
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Barcelona's Transfer Condition Revealed For January Lisandro Martínez Transfer
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A prison sentence is not a death sentence — fix the correctional health care crisis now
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Baltimore Reportedly Has Its Eye on One Bears Player
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79% of Veterans and Service Members Say Politicians and Society Are Leaving Them Behind: Poll
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Three talking points from the Premier League
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The accidental politician who could run Los Angeles
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Health insurers leave millions unpaid for mental health crisis care in California
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Facing the Realities of the Global Energy Crunch
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Georgia Farmers Face Mental Health Crisis as Suicide Rates Increase
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Business Owners Have a Window. Most Aren't Ready to Use It. by Tully Ryan
I spend my working life on both sides of a business sale. As an M&A advisor based in Wilmington, I help lower middle market owners across North Carolina, South Carolina and Virginia sell what they've built. As the founder and CEO of IQExit, I work with the bankers, wealth advisors, CPAs and attorneys who sit beside those owners for years before a sale ever comes up. From both seats, I keep seeing the same thing. The market is ready for our owners. Too many of our owners aren't ready for the market. Start with our own backyard. Wilmington's metro area added more than 12,000 residents between July 2024 and July 2025, a 2.6% jump that ranked seventh in the country. It also posted the highest job growth rate of any metro in North Carolina. I see the same pattern in the growth markets I work in across the Southeast. New residents mean new customers and new workers. They also mean new buyers: people who moved here from corporate jobs and want to own something, private equity groups looking for add-ons in HVAC, electrical, landscaping and other trade services, and younger entrepreneurs who would rather buy a running business than start one from scratch. The ownership numbers are hard to ignore. About half of North Carolina's small businesses have an owner who is 55 or older, and roughly 85% of those owners have no succession plan, according to the North Carolina Employee Ownership Center. Nationally, more than half of Baby Boomer business owners have no documented transition plan. That isn't a crisis yet. It's a timing problem. A lot of businesses will change hands over the next decade, and the prepared ones will get the better buyers and the better terms. Buyers have money and they're using it. But an active market doesn't mean a fast one. The IBBA's latest Market Pulse survey found that Main Street deals took six to 10 months from engagement to close in the second quarter, and lower middle market deals took 11 to 12 months. That clock starts after the owner decides to sell. In my experience, the real preparation has to start years before. Two clocks, two playbooks When I sit down with an owner or their advisor, my first question isn't “What's it worth?” It's “When?” The answer puts the owner in one of two groups. If the owner wants out within 24 months, we're in execution mode. There's no time to rebuild the business. The work is cleaning up what a buyer will test: three years of financials that tie to the tax returns, an add-back schedule you can prove, customer and vendor contracts in writing, a lease that can be assigned, and a price the market will actually pay. The goal is certainty to close. If the exit is two to five years away, the owner has something worth more than time. They have choices. That window is where most value gets built, and most owners waste it by waiting. What kills deals In the lower middle market, deals rarely die over the headline price. They die in diligence, or they get retraded late in the process. I see the same causes again and again. The owner is the business. If every key customer relationship runs through the owner's cell phone, a buyer sees risk and a lender sees more of it. The books don't hold up. Buyers spot weak accounting fast. Statements that get revised mid-process, a revolving door in the bookkeeper's chair, revenue tracked on a side spreadsheet, and margins that slip while sales climb with no clear reason all make a buyer nervous. So does an owner who pushes back when asked for documents. And plenty of private owners run personal expenses through the company. Add-backs are normal. Add-backs you can't document turn into a lower offer. The real estate isn't sorted out. Many owners hold their building in a separate LLC. That's fine, but the lease terms or the property sale should be settled before a buyer shows up, not halfway through diligence. Revenue sits in too few hands. Picture a contractor with 40% of its work coming from one builder, or a service company running on handshake deals. Buyers will still look, but the terms shift toward more seller financing, an earnout, or less cash at closing. Owners and advisors: if your exit is three to five years out • Get a baseline now. Find out where the business really stands today: what a buyer would pay, who that buyer is likely to be, and which gaps would hurt you in diligence. You can't fix what you haven't measured, and the answer is often different from what the owner expects. • Make yourself less necessary. Spend the next few years building a manager or small team that can run daily operations and own customer relationships. Put handshake deals into written contracts. A business that runs without its owner is worth more and is far easier to finance. • Clean the books for three straight years. Buyers and lenders look back at least three years. Separate personal expenses, keep the financials tied to the tax returns, track every add-back as you go, and settle the real estate plan early. A word to CPAs CPAs often see a sale coming before anyone else, and you're usually the most trusted voice an owner has. Year-end meetings are the right time to start this conversation. Here's what I'd ask every CPA to do this season with business owner clients over 55: • Ask the timing question. “Do you see yourself owning this business in five years? If not, who takes it over?” Write down the answer and bring it up again at next year's meeting. • Run a proof of cash and review revenue recognition. Make sure the cash in the bank ties to the revenue on the books. Pay close attention to contractors with work in progress and to companies selling memberships or service plans. These issues are easy to fix with years of lead time and painful to fix a month before closing. • Pair the tax return with an exit readiness review. Invite clients to complete IQExit's Exit Readiness Intelligence (ERI) process as part of year-end planning. It gives you and the client a shared picture of readiness gaps and an indicative value range, and the results come back to you as the advisor. That turns a tax meeting into a planning relationship, and it puts you in position to bring in tax and M&A help early, when choices like purchase price allocation can still save the client real money. Changing the conversation For bankers, wealth advisors and attorneys, the hard part is raising the subject without seeming to nudge a client toward the door. I understand that. Nobody wants to tell a 60-year-old owner it's time to sell. So don't. Ask a different question: “If a buyer called tomorrow, what would they find?” That's a planning question, not a pitch, and it's useful whether the exit is two years out or 15. It's the question we built IQExit to help advisors answer. Whether you're in Wilmington, Raleigh, Charleston, Richmond or anywhere else, owners have a real opening right now. The buyers are out there and so is the capital. The owners who come out ahead will be the ones who start getting ready before they're ready to sell.
The Best Time to Fix Your Business Is When Things Are Going Well by Nathan Tayloe
There's a pattern I've noticed working with growing businesses over the years. Conversations about what needs to change rarely happen when things are going well. They tend to happen when growth slows, a competitor starts winning business, or something that used to work stops producing the same results. By then, the decisions are often harder, more expensive, and more urgent than they needed to be. It's understandable. When revenue is growing, customers are coming in, and employees are busy, there's little incentive to question what's working. Leaders have plenty to manage without creating new challenges for themselves. Running my own business has taught me that it's easy to get caught up in what's happening today and put off improvements you know will matter tomorrow. Those periods of success may actually be the best opportunity a business has to make meaningful improvements. When Success Makes Change Less Urgent Most businesses have things they know could be better. The challenge is finding a compelling reason to address them when everything appears to be working. Maybe the company has outgrown its original positioning. Perhaps internal processes haven't kept pace with growth, or the customer experience has become inconsistent as the organization has expanded. These issues don't necessarily prevent a business from growing. Strong demand can make them easier to overlook, especially when teams are focused on keeping up with the work already coming in. Over time, small inefficiencies become accepted ways of operating. Outdated processes remain in place because they've always worked well enough, and opportunities to improve get pushed aside in favor of more immediate demands. The business continues moving forward, but some of the things supporting that growth aren't getting stronger along with it. The Advantage of Acting Early When a business is performing well, leadership has something valuable: options. There's more flexibility to invest, experiment, develop people, and make thoughtful decisions without the pressure of an immediate problem that needs solving. Compare that with trying to make the same changes when revenue is declining, or the market has shifted. Investments become harder to justify, timelines get compressed, and decisions that could have been made strategically become urgent responses to circumstances. I've seen businesses postpone improvements for years because there was never a particularly good time to address them. Eventually, circumstances decide for them, often when they have fewer resources and less flexibility to respond. Growth Changes What a Business Needs This is especially relevant in a growing market like Wilmington, where new businesses, new residents, and continued investment are creating opportunities across the region. As organizations grow, the expectations placed on them change. Customers expect greater consistency, employees need clearer processes and opportunities, and leadership has to make decisions that support a larger, more complex business. What worked when a company was smaller may still work today, but that doesn't necessarily mean it will support where the organization wants to go next. Sometimes the most valuable improvements are the ones that prepare a business for demands it hasn't experienced yet. That might mean: Strengthening internal processes before they become bottlenecks Developing leaders before the organization depends on them Improving the customer experience before inconsistencies affect retention Revisiting positioning before the market outgrows the company's story None of these changes requires a crisis. They require recognizing that a growing business needs to keep evolving, even when current performance gives leadership little reason to worry. Use the Good Years Wisely Successful businesses don't need to constantly reinvent themselves. There's value in knowing what works and having the discipline to build on it. There's also value in occasionally asking whether the business is as strong as its current performance suggests. Are there problems we've learned to work around instead of solving? Are we still operating the way we did several years ago, even though the business has changed? What would we improve today if we weren't waiting for something to go wrong? Success creates the freedom to ask those questions and act on the answers. The businesses that make the most of that opportunity are often better prepared for whatever comes next. The strongest businesses don't need a crisis to recognize an opportunity to improve. They use the good years to prepare for the years ahead. — Learn more about how we help organizations strengthen their positioning, align their strategy, and prepare for what's next at tayloegray.com, or reach out directly at nathan@tayloegray.com.
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(Welcome to the “Most Important Story of the Week”, my bi-weekly strategy column analyzing the most important (but often not buzziest) news story of the last two weeks. I’m the Entertainment Strategy Guy, a former streaming executive who now analyzes business strategy in the entertainment industry. Please subscribe.) Well, I had a simple article planned for this week. Called “Whoa, I Missed It!”, I’d take a gander at a few important-but-under-the-radar stories I didn’t cover while I wrote about all things “Skydance. (Formerly known as “the saga of Netflix trying to buy Warner Bros., but not Discovery, then Paramount-Skydance bought all of Warner Bros. Discovery”.) Alas, that article will have to wait. Netflix made news. Ironically, my “Whoa, I Missed It!” article would have mostly been about “content” strategy decisions, which is also what today’s article is about. But instead of the entire industry, this article will only cover Netflix’s decision to upend their film and TV content teams. Just that! So that’s the full topic of the day. I’m going to tackle the issue in the opposite direction of the way “stuff” flows: uphill. We’ll start at film, then move onto TV, and then onto the CEOs themselves, and the strategy questions that still remain. But we start with the numbers driving this. Let’s dive in. Subscribe Most Important Story of the Week - Netflix Upends Their Corporate Hierarchy I’ve got a lot of thoughts, but we’ll start with the most common response to yesterday’s article. Let’s Talk Stock Price More than one person, responding to what I published two days ago, pointed out that, well, actually, the thing driving Netflix’s actions is this: In short, stock price! Even if Netflix isn’t obsessed with their own share price—they probably are, but, for the record, my strategic advice to every CEO is to absolutely ignore stock prices, which will, ironically, probably help the stock price long-term—most everyone thinks they are. By the way, I prefer market capitalization to stock prices, because it’s a more apples-to-apples way to compare companies: But there’s an even better way to look at it, and it kinda casts some doubt on the entire push here: price-to-earnings. I have a long list of articles that I wish I had written, and chief among them is an article titled, “Am I Still a Netflix ‘Bear’?” meaning someone who thinks Netflix’s stock is overvalued. As of last summer, Netflix had solved their biggest problem—which for me (circa 2019) was the lack of free cash flow—but their stock was CRAZY overvalued. That’s this chart here: Why did Netflix’s stock price increase to a price-to-earnings ratio of 50 last summer? What financial metric changed so quickly? Nothing. Given that, historically, mature entertainment companies average 10 to 20, with 16 being the average, that increase made little sense. Netflix’s stock swoon these last eight or so months wasn’t irrational; the stock price rise last year was. So if you want a really hot Netflix take, here it is: Netflix’s stock price has been going down because the financial industry recovered its senses, not because of any strategic mistake. Yes, that would imply that cleaning house may have been a mistake. That’s why the charts yesterday are so important, because they show that Netflix did have a strategic problem (a lack of hits) and that’s what they moved to address. (One could also argue the industry drastically overrated Netflix’s growth prospects, but that’s a financial industry problem, not a Netflix strategy problem per se. Some growth estimates are just crazy. *cough* AI *cough*) Now, the last time Netflix’s stock price crashed—circa 2022—it gave them an opening. I’d argue Netflix insiders knew they needed to expand post-COVID-19 crisis, adding advertising, cracking down on password sharing, and dabbling in sports. But if they had done that when their stock price was high, it would give folks a reason to second guess their strategy. (Arguably, last year, when Netflix pursued the Warner Bros. merger, it gave the industry a chance to review their business.) Instead, after the 2022 fall, they had the opening to make strategic changes. We may see Netflix pivot again following this latest slide. For example, the “binge versus weekly” conversation is alive and well again. Same for expanding into theaters even more. And adding both linear channels and streaming bundles. And maybe more either social, user-generated, vertical, or creator content. But the first shift came with who is making the content calls. A Message from Our Sponsor Last winter Pulp Fiction was on Netflix. For those same 90 days, it was also free, with ads, on Pluto TV and the Roku Channel. That is not a glitch, and it is not rare. The title has run on 20 different US streaming services since 2019, across 80 separate windows, and for more than 600 of those days it sat on a paid subscription service and a free ad-supported one at the same time. Almost nobody can see this, because when a title leaves a service, the record that it was ever there tends to leave with it. Reelgood keeps that record, dated to the day rather than the month: 4MM+ movie, show and episode titles across 300+ services globally, with timestamped arrivals, departures and moves across SVOD, AVOD, TVOD and vMVPD. Licensing teams price against every prior window. Rights teams check what a licensee actually delivered, and when. Pick a title you think you know: data.reelgood.com/title-availability Film - Dan Lin Want to know why I don’t opine on individual film or TV executives, especially new hires? Dan Lin. As I always caution, it’s really, really, really tough to predict which executives will succeed in new roles and which won’t. The successful head of co-production/finance partner, Rideback, Lin was considered for the head of DC Studios job before taking the job as the head of Netflix. By all accounts at the time, this was a smart hire. (That’s my read of the news coverage anyways.) But now that Netflix has fired Dan Lin, we got a slew of news stories about how he was doing a terrible job. In sports media, Bryan Curtis, new Substack writer/podcaster from The Ringer, calls this the “now you tell us” story, when you only hear the bad news after a star athlete leaves a sports team. In this case, now they tell us that Dan Lin was bad with talent after he got kicked out the door. So was Dan Lin a flop? It’s actually tough to say. While film moves faster than TV, even two years isn’t really enough time to evaluate a person’s output. The new head hasn’t really taken control. As Emily Horgan noted, it takes much longer than two years to produce animated films, so yeah, it’s definitely too early to judge in that domain. As for live-action films, I just published an article by Brandon Katz called “Netflix’s Summer of Bummer”, but I’d point out Netflix had a bad summer two years ago too. Arguably, their best summer came from KPop Demon Hunters last year and Happy Gilmore 2, the latter of which I saw credited to Lin. Then, the stories came out that Dan Lin clashed with talent, both Ben Affleck and Greta Gerwig, classic “now they tell us” factoids to explain his firing. This may have been true, but also should have been expected given that he was given the mandate to bring budgets back in check, especially after Rebel Moon. So if he made folks upset, well, that’s what he was hired to do! But also, he was described as “well-liked” at his hiring! In that case, I’m a bit sympathetic to Lin, since he may have been undercut by senior leadership, as often happens. Basically, a CEO hires a subordinate to be their “bad cop” and keep budgets in check, but then when talent complains, the CEO ends up undercutting them. That’s how I think you end up with a Narnia movie as expensive as any of the other flops, along with a film executive the town no longer likes. As a result, I think that Netflix is now executing a classic “hire the opposite” move by hiring Peter Rice. This phrase comes from my experience following football and basketball coaching decisions, where teams generally hire the opposite of who they just had. If you have an offense-minded head coach, hire the defensive guy. Or in college football, if you have a strong recruiter, then you pivot to an “X’s and Os” type of guy. Or in pro basketball, if you have a very analytically minded coach, you hire the player-friendly guy. I see that here. After dropping Scott Stuber—arguably a talent-friendly executive with lax budget control—Netflix hired the business guy to keep costs in check. Now Netflix is pivoting back to Peter Rice and presumably a more talent-friendly regime. (Disney, by the way, has done this twice: hiring business guys to succeed talent-friendly Bob Iger. It didn’t work out last time.) When it comes to Peter Rice…we’ll see! Maybe he works out, but maybe he doesn’t. I’d actually say the biggest problem is that Netflix still hasn’t solved its “IP Problem”, in that they don’t own much IP, so they just have a lower hit rate. The new executive won’t solve that. (Though buying Lionsgate would help.) Share “Content” - Bela Bajaria I almost published yesterday’s article after this column, but ended up flipping the order, because it told the story so well. So if you want the data for why Netflix is looking at TV to fix their problems, it’s in that article, this graph in particular: I know I just wrote that it’s often hard to judge executives, but Bajaria ran TV for six years and film for three and a half more. That’s more than enough to judge hit rates, and Netflix needs more hits. That’s the story. Since 2023, Netflix hasn’t had as many hit shows as it used to, and many of its previous power house TV shows have ended their runs (Stranger Things most of all). Also, many shows from 2020 to 2022 probably pre-dated Bajaria’s tenure. (That said, one thing may have been outside of Bajaria’s control, which I explain below.) Let’s lump some content strategy thoughts about Netflix and TV into one place: We’re just getting started with this issue, but the rest is for paid subscribers of the Entertainment Strategy Guy, so if you’d like to find out… Why I partially blame Squid Game for Netflix’s latest troubles… What is “the football trap”... Why it might not be the TV shows or films’ fault at all… What change I don’t think Netflix will make... How Bela Bajaria evolved Netflix’s TV strategy in smart ways… Whose departure likely submarined Bajaria’s final few years… One sneaky explanation for Netflix’s content struggles... And a whole lot more... ...please subscribe! We can only keep doing this great work with your support.
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