Some hospitals do not have a reimbursement problem. They have a management problem. We have studied and met in person with leaders from more than 250 hospitals. Many are in real trouble and yet the vast majority fail to deploy the basic disciplines required to run a serious institution. Accounting? Barely. Cost accounting? What’s that? Supplier accountability? Too busy. Contract management? Nope. Service-line profitability? Mostly guesswork. Physician alignment? Usually an employment contract and a press release. The failures are never-ending. Then leadership tells the community the hospital needs higher reimbursement, more subsidies, another acquisition, or protection from competition. It is like they are operating in outer space, completely detached from the elementary laws of business. A hospital is an essential institution. That makes competent management more important, not less. Before demanding more money from patients, employers, taxpayers, and the government, hospitals should be able to explain where the money they already receive actually goes. You cannot reimburse your way out of institutional incompetence. And Congress believed banning physicians would help. Perhaps Congress would consider banning ineptitude.