Fixing Healthcare | Physician Supporter| Father | Husband
Omaha
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Three findings from our study in @JournalGIM:
1️⃣For-profit hospitals spent less on both labor and non-labor expenses than nonprofit and government hospitals.
2️⃣For-profit hospitals earned a sizable profit margin, while nonprofit hospitals operated with a thin margin and government hospitals incurred a small loss.
3️⃣Nonprofit hospitals, despite receiving generous tax-exempt benefits, in aggregate provided less charity care than government and for-profit hospitals.
Study link: link.springer.com/article/10…
Thank you, Adam Olson, Elizabeth Plummer, & @JohnXJiang1
@JHUCarey @JohnsHopkinsSPH @JohnsHopkins
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Jared Meays retweeted
So how much does it cost to have a baby in the US? The Europeans are really gonna shit themselves at this one.
(caveats - based in new york, good commercial coverage, etc.)
We were billed ~$150K, our insurance paid ~$79K, and our out-of-pocket costs were ~$4300. And this was for a largely uneventful birth cost wise - NICU babies can end up as multi-hundreds of thousands of dollars to occasionally $1M+!
Why are we sharing all of this? IMO healthcare wins because patients are afraid to share their experiences with each other. We gained a lot by having friends who would share their stories with us. This is our family's small part of trying to break that information asymmetry.
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So I went down the rabbit hole of trying to determine what are the economics for someone, who is currently healthy , to go to a HDHP with a 10k plus deductible.
The question I asked is “I dont trust insurance companies. What happens if I have a million dollar emergency and they won’t pay “. All I can say is WTF
If they don’t pay, there are Independent Review Organizations, who are supposed to be independent, and their decision to pay or not is final. I asked for examples of companies. One was ExamWorks. That rang a bell.
These motherfuckers are the same company that issued a ridiculous denial for a patient I was trying to help. So I knew the Too Big To Care, vertically integrated insurance companies hired them to do DENIALS !!! WTF.
The biggest customers of the companies that are the final decision makers for insurance carrier denials, are the biggest insurance companies.
That is beyond fucked up. It’s the definition of conflict of interest. How do state insurance commissioners allow this ?
The high deductible plans that many people say is the solution to fixing how we do insurance, may be effectively compromised
If you are looking at a HDHP, BE CAREFUL
It might just be rigged against you
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😆😔
Vermont Announces Plan to Make Healthcare Affordable by Acquiring Last Independent Physician
MONTPELIER, VT — Vermont officials have identified the final obstacle to affordable healthcare: a physician who still owns his practice.
“He keeps offering patients another place to go,” a state official explained.
Investigators discovered he also charged less than the hospital.
“That sort of behavior threatens the entire system.”
Officials promised the acquisition would simplify comparison shopping. Both quotes would now come from the same billing department.
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Health insurance in 2027: another jump — at least ~8%, employers saying closer to ~11%.
I’ll save everyone some time and write the next five headlines now:
2027: Most expensive year in health insurance history
2028: Most expensive year in health insurance history
2029: Most expensive year in health insurance history
2030: Most expensive year in health insurance history
2031: Most expensive year in health insurance history
The system isn’t having a bad year.
It’s running the same playbook.
Direct Care shrinks insurance’s job to the wreck — membership, posted prices, care too cheap to insure for the oil change.
tiktok.com/t/ZTyrGLykB/
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Jared Meays retweeted
Expectations destroy joy.
Do you want a great life from this day forward?
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People are accepting bigger deductibles just to keep paying for health insurance.
After enhanced ACA subsidies expired, KFF found average premium payments rose 58% in 2026. The average deductible rose $1,027 as enrollment shifted toward higher-deductible plans.
Imagine paying more every month for the privilege of covering more of your own medical bills.
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Business problems feel huge until health problems enter the picture.
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Rivel Storm 8th grade Elkhorn, NE continued their dominance today beating the Joliet, IL Ravens 39-0. Big day for Ethan H. and the Defense. @NENextt
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And this gets passed right along as premium increases. Year after year.
🦔The Blue Cross Blue Shield Association says insurers paid out nearly $1 billion more than usual from AI-assisted hospital documentation in 2024-2025. Hospitals use AI to scan records and find secondary diagnoses that human reviewers missed. More diagnoses means higher reimbursements. But treatment levels haven't gone up.
BCBSA's SVP of data science said AI is "identifying more billable conditions, not sicker patients." Insurers now deploy their own AI to deny those same claims. Patients pay for both through higher premiums.
My Take
This might be the most American healthcare story I've ever read. Hospitals bought AI to find more things to bill for. Insurers bought AI to deny those bills. The technology cost money on each end and the tab went straight to patients through higher premiums. A billion dollars moved and no one got any healthier. The only thing that changed was the size of the invoices.
Two sides of a trillion-dollar industry found a new tool to fight over the same pool of money and the person in the hospital bed pays for all of it. Premiums go up, denials go up, and the AI vendors collect from everyone. If you want to know who AI works for, stop reading the press releases and look at where the money goes. In healthcare it went straight into the billing department.
Hedgie🤗
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Rivel Storm 8th grade goes to Joliet, IL to beat the East St. Flyers 18-7. Nebraska football representing. Tomorrow Joliet, IL Ravens at 2pm. @NENextt
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Jared Meays retweeted
Conditions are perfect for independent physicians.
I am more optimistic today than I was in the late ’90s!
More opportunities to build your practice, overcome the leverage of health systems and PE, and give patients excellent care at a price they can afford.
The business of medicine has changed. Professional fees alone cannot carry the whole thing anymore.
Physicians must to own more of the businesses that support their work and participate in the value they create.
There are terrific models with 20 to 30 years behind them that can help physicians stay independent and win big.
Take a deep breath. Smile! Some of you look like you haven’t tried that since residency.
You have the skills.
Patients need you.
What a time to build.
Government has destroyed medical care in the USA. Single payer lurks as communism creeps. Silver lining: Good doctors exist to work outside the rubble on the ash heap. Better unconstrained. Middlemen cannot set your bone, remove your appendix, do your C-section, drain your subdural, excise your cancer, stent your LAD…only we can, and we will. Out from under the boot. They offer nothing but the promise of our care and skills which is not theirs to give.
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Jared Meays retweeted
Input costs have been pretty stable-when vendors make us a better deal we lower our prices-have done so numerous times. Have increased prices across the board only once (2021) since 1997. GKS
Your posted price bundles the surgeon, anesthesia, facility and follow-up. Which part has been hardest to keep predictable as input costs change?
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Through September 21, there have been no hurricanes in the Atlantic Ocean for the first time since 1914.
Nebraska football has won at least a share of a conference championship every season that no hurricanes formed in the Atlantic
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Buyers are slowly but surely finding the courage to walk away from the networks who will do all they can to thwart the move to affordable high quality. GKS @FreeMarketMed
Once everyone figures out it’s cheaper and generally higher quality to go direct pay, we’re going see some massive changes in healthcare for the better.
Fixing healthcare is urgent.
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Exit the health insurance scam system and never look back
1. Save up $15k and put it in a HYIS
2. Cancel health insurance
3. Join crowdfunded option like @JoinCrowdHealth for true emergencies only
4. Cash pay everything else (cash pay for normal health/medical needs is insanely cheap, and way cheaper than going through insurance)
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It doesn’t matter how much AI comes into healthcare. If network contracts continue to be a discount off of billed charges, with evergreen escalators as the starting point, the compounding will continue to increase costs. Direct Care is the future of paying for healthcare.
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