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…