I make ten million dollars a year. I run a nonprofit. I know. Take a moment. A gentleman at CommonSpirit was paid nearly twenty eight million in a single filing year. He served three days of it before he stepped down. Three days. Some men are simply better at mercy than I am. You have read about places like mine. You read the headline, and you felt something. A little ache. A little pride in your community hospital. Thank you for that. I mean it. You have never seen love until you have seen a town love its nonprofit hospital. I saved their grandparents. I saved their parents. I delivered their babies. Now, when they say that, they do not mean me. They mean the nurse who sat with their father at three in the morning while I was asleep in a house they will never see. They mean her. They say me. I take the credit. All of it. I stand at the gala in a tuxedo and accept a standing ovation for work performed by people I am, at that moment, negotiating against. And I never once had to lie. I never said I did it. I simply never said I did not. Gratitude is the cheapest input in my supply chain. It arrives free. It never unionizes. And it goes directly onto my name. You believe I am a charity. You have believed it your entire life. Your mother believed it. And I have never corrected you. Why would I? It is the nicest thing anyone has ever done for me, and you did it for free. Let me tell you what the word actually means. Nonprofit is not a promise. It is not a vow. It is a tax election. Nine letters and a filing. I did not swear anything. I did not kneel. I filled out a form, and a clerk approved it. Everything else came from you. The holiness. The charity. The sacrifice. I never promised any of that. You did. The word profit appears nowhere in my filings. It would look terrible. So I call it surplus. I run a billion dollar surplus and a portfolio that would make a hedge fund blush, and not one word of it is a lie. I did not hide anything. I changed the noun. I could have done all of this in private equity. The arithmetic is identical. But nobody names a wing after a managing director. So I chose the path with the gala. Same extraction. Better applause. Now look across the street at the for-profit clinic. He pays property tax. It funds your schools. He sues fewer patients than I do. And you despise him. You call him greedy. Then you walk under my cross, accept a bill you cannot pay, and thank me on the way out. I am not a better man than he is. I picked a better tax status. So yes. I love the word nonprofit. I did not take a vow of poverty. I filed a form. Poverty is what I sell. It is not what I practice. -Rojas out.

A national healthcare budget is prior authorization for an entire country. The phrase sounds provocative because Americans imagine prior authorization as a form, a phone call, or a denial letter. A national budget makes many of those decisions earlier. Before the patient develops cancer, someone has already decided which medicines the public system will fund. Before the patient needs surgery, someone has already decided how many operating rooms, surgeons, and hospital beds the system can support. Before a physician requests a treatment, someone has already established the clinical and financial thresholds. Budgets are unavoidable. Resources are finite. And we ought to describe their function honestly. A healthcare budget does more than control spending. It controls supply, access, and time. It begins saying no before the patient asks.

I support work. I do not confuse work with paperwork. Certain adults enrolled in Indiana Medicaid will have to complete and document 80 hours per month of work, education, training, volunteering, or another qualifying activity. The state is hiring 400 employees to monitor eligibility as work requirements and more frequent reviews take effect. Many affected Hoosiers already work or qualify for an exemption. They can still lose coverage if the government cannot verify their activity or they miss a document or deadline. If someone completes 80 hours but loses coverage because the paperwork failed, the policy did not measure work. It measured obedience to an administrative process. Do not call a paperwork trap a work requirement.

😂😂😂 Well, well, well. The biggest socialist in Silicon Valley just followed one of loudest healthcare capitalist on X. Welcome, Congressman @RoKhanna. Stay awhile. You may discover that competition, physician ownership, transparent prices, and private capital can fix quite a few problems before Washington creates another program. I’ll follow back. Let’s argue properly.

Suppose restaurants became tax exempt. Five years later they held billions in assets. Paid CEOs $33 million. Reported hundreds of millions in annual surplus. Then argued they deserved even larger taxpayer subsidies. Would anyone still call them charities? Why is healthcare different?

I love 340B. As a nonprofit hospital administrator, I consider it one of the great miracles of American healthcare. It started as a program to help poor patients get access to medicine. Beautiful. Then we found the spread. I buy the drug at the 340B discount. I bill the commercial plan at the regular rate. I keep the difference. The patient gets the deductible. The employer gets the renewal increase. The manufacturer gets blamed. I get a new tower. That is called mission. And the best part? I don’t have to pass the savings to the patient. I don’t have to pass the savings to the employer. I don’t have to lower premiums. I don’t have to prove the vulnerable patient ever saw a dime. I just say “access” three times, put “community benefit” in the annual report, and everyone nods like I’m running a soup kitchen with oncology margins. Then came dual classification. Urban hospital? No problem. I’m rural now. Yes, my hospital is in Manhattan. Yes, my campus sits on billions of real estate. Yes, my lobby looks like a Four Seasons. But on paper? Country doctor. Dusty road. Single stoplight. Maybe a cow. That’s the business model. Rural when I want the subsidy. Urban when I want the commercial rates. Nonprofit when I want the tax exemption. Monopoly when I negotiate with employers. Charity when Congress asks questions. Private equity when I buy physician practices. Wall Street when BlackRock underwrites my bonds. Mission when the reporter calls. This is why I love 340B. Manufacturer must provide the discount. Employers pays full freight. Patients pays out of pocket. I keeps the arbitrage. Then I build a cancer tower and call it hope. Do I pass the 340B discount to the self-funded employer? No. Do I pass it to the fully insured commercial plan? Absolutely not. Do I use it to make healthcare cheaper? Please. I’m a nonprofit hospital administrator. Not a threat to my own margin. In 2024, 340B purchases hit $81.4 billion. That’s scale. I call it stewardship. And I serve vulnerable populations. Use the correct language. Now excuse me. I have to explain why my nonprofit hospital needs another tax exemption, another rate increase, another physician acquisition, another rural designation, and another debt issuance. The poor are counting on me. I love the US taxpayer…

The lesson beneath it all: independence survives when physicians own the practice, own the assets, control patient access, diversify revenue, and build political power equal to that of the institutions trying to buy them. Everything short of that is negotiating the terms of the sale. File the comment by September 14. The docket is open at file code CMS-1848-P. Not because one comment bends a number. Because a comment carries weight when the physicians behind it are funded, organized, and voting. That machine is not built in the week a rule drops. Then build the institution that gives the next comment weight.

Memorial Hermann did not have one lucky year. It recorded seven consecutive surpluses totaling more than $4.3 billion. Through a pandemic. Through a labor crisis. Through record inflation. Patients were told hospitals were barely surviving. The Form 990 says Memorial Hermann never stopped winning.

Do you pay your plumber or mechanic this way? Do you pay them a "Facility Fee" that is way higher than the mechanics fee? Do the parts for your car cost $Thousands and can fit in a pill bottle? Does your Mechanics fee get CUT Every year? #HealthInsurance# #Hospital# #Congress# #Fraud# #Scam# #Corruption#

Site-specific payment fees are not just dumb, THEY'RE CRIMINAL. There is ZERO reason reimbursement should be higher because of the address only! Hospitals now buy practices and call them "outpatient facilities" as part of the grift. What absolute crap!

This is how commercial insurers dinged independent practices for years. You do a suture for the patient after writing prescriptions for antibiotics, but you did not get paid for time or materials for the sutures. You provided injection shots for something that was bothering the patient during his annual wellness visit; you got shafted on the costs for anything done outside the annual wellness visit. But two years ago, I saw @aetna boldly going into the new territory of undercoding, which would be called wage theft in any other industry. But it seems it is allowed in insurance. Then @cigna followed it, and now I hear BCBS too is following it. Soon, Medicare, too, will do it. If you still have a doctor who is seeing you despite your insurance, make sure you do not extend the visit beyond 4 minutes if you want them to continue to see you. This mess has been perpetrated on those who are altruistic, and it is all going to be over. The pendulum will swing, and all insurance companies will lose. With AI, disruption is coming. It will be the death of all insurance if doctors understand what AI can do to medicine.

@DutchRojas I’ve always pushed back against this. If an elderly patient needs say corticosteroid injection, why shouldn’t I do it the same visit to give the patient relief and saved the system money? Because it’s too logical Chapter 7. Govt interference In book #HealthcareFromTheTrenches#