Why investors wait for someone else to say yes.

20 Oct 2026 · 27 min
27:24

Leon Eisen, PhD, presents his weekly analysis of U.S. middle‑market venture rounds (US$5‑100 M) using his proprietary Eisen Fundability Score. He shows that the surge in healthcare funding is not due to superior companies but to the presence of "last signatures" – investors or entities that have already put money or risk at stake. Returning investors, reinsurers, regulators, government contracts, and product‑using corporate buyers act as underwriters, dramatically increasing round size. Two standout cases (Stand and Pathways) illustrate that a stranger‑lead investor or a major customer can also serve as the decisive signature. Eisen distills these insights into five fundraising rules (bring an underwriter, treat the last investor as a reference, secure a product‑using buyer, size seed to a milestone, name your lead) and a five‑step playbook (score your round, lock current investors, obtain an external fact, open with who already said yes, follow up with facts). He concludes with market observations about healthcare’s share, the role of lead investors, and the emerging trend of customers leading rounds, urging founders to secure the last signature before seeking venture capital.

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