Make common sense great again!

Why is it that all the people that want to tax billionaires, never want to tax not-for-profits? If accumulated economic power is the concern, why should we scrutinize $10 billion controlled by an individual differently from $10 billion controlled by a perpetual tax-exempt corporation? Help me, help you! I’m just a dumb redneck from Louisiana. Educate me. @Jason @bgurley @mcuban @RayDalio @elonmusk @BillAckman @DougKass

Why is healthcare expensive? Emory sponsors the Falcons. UW Health sponsors the Packers. Apparently, America’s tax-exempt hospitals have room in the budget for professional football. The public just doesn’t get to see the price. Here’s where you come in. Tax exemptions leave these institutions with money they would otherwise owe. The public gives up that revenue because these hospitals serve a public purpose. That bargain deserves scrutiny when the hospital starts buying NFL advertising. Every dollar spent on a sponsorship is a dollar unavailable for patient care, financial assistance, or lowering bills. Maybe the advertising generates enough business to justify the expense. Then publish the numbers. Tell taxpayers what you spent, what you received, and how patients benefited. These institutions understand the commercial value of an NFL audience perfectly well. They also understand the financial value of being called a charity. The public deserves to know how much of its generosity ends up in professional football…

Ten medical practices in one city do not need ten separate solutions for payroll, HR, benefits, insurance, and purchasing. They need enough sense to sit in one room.

Physicians: We can’t compete with a $10 billion health system. Me: Maybe you and your colleagues just stop rebuilding the same small company 40 times.

PRICE GOUGING During COVID, the government called out price gouging on toilet paper, hand sanitizer and other essentials. Gas shortage? Price gouging. Natural disaster? Price gouging. But hospitals can charge outrageous prices every single day of every year and somehow we don’t use the same language. Government calls out price gouging everywhere else. Healthcare? Crickets.

Senator, “the government hasn’t done jack shit” is a remarkable performance review to publish about your own workplace. You work there. A 25-year-old handed you a note about struggling to afford a home, a family, and healthcare. I take those concerns seriously. Working hard and watching the future get further out of reach is exhausting. Let’s examine your answer. You took one person’s letter, spoke for an entire generation, declared they had “done everything right,” and assigned blame. That is a lot of certainty to extract from a napkin. The writer gave you two specific problems: housing and healthcare. You pointed at billionaires and their tax cuts. How does that diagnosis help this person afford either one? Show us the connection. Name the policy. Explain the remedy. Which rules make homes harder to build? Which restrictions protect expensive healthcare businesses from competition? Which federal obstacles can you use your office to remove? You can introduce legislation. You can name the interests defending those obstacles. You can ask your colleagues to put their votes on the record. You have legislative power. Use it. And yes, personal responsibility belongs in this conversation. Careers, skills, spending, location. Difficult choices remain part of adult life. Politicians have responsibilities, too. Citizens have to reconsider their choices. Politicians can reconsider the rules they defend. Government has responsibilities to its citizens. That does not make government responsible for everything that happens to its citizens. Government must answer for the obstacles it creates. A sympathetic caption won’t lower this person’s rent. This person put a specific request in your hands. You haven’t named a single law you would change in this post. You are a United States senator. Which law would you change?

Talked to a clinic that just found out their own health insurance premiums are increasing 22% for 2027!?! Did you get a 22% raise? This is unsustainable. Health insurance is a bubble. Fix health insurance to restore the middle class.

You’re being scammed by hospitals and health systems. The American consumer and taxpayer has been taken advantage of for a long time - decades. Believe your eyes. Believe your ears. But most importantly - believe your wallet.

The independent physician pays income tax on what he earns. His building carries property tax. He borrows in the taxable commercial market, personally guaranteed. He buys drugs without a health system’s scale. When he performs a procedure in his office rather than in a hospital-owned department, the insurers can pay him less for identical work. The Health Care Cost Institute measured a primary care visit at $217 in the outpatient setting against $116 in the office. The difference is the facility fee. And if he and his partners want to build a hospital, Section 6001 of the Affordable Care Act closed that door in 2010. Physician ownership is still perfectly legal. His hospital cannot bill Medicare for the patients he sends it. He competes against an institution his own taxes helped capitalize. Article drops tomorrow....

WASHINGTON — Hospitals Explain They Cannot Return Billions In Overpayments Because They Already Turned The Money Into Buildings The nation’s largest hospital lobby urged regulators to abandon plans to recover money the Supreme Court determined hospitals were overpaid. “The money is gone,” a spokesman explained. “It is a cancer center now.” Regulators offered hospitals additional time to return the money. Hospitals rejected the offer, explaining that they oppose both immediate repayment and the dangerous precedent of eventually repaying anything. The hospitals will keep the buildings. Taxpayers may keep the Supreme Court decision.

WASHINGTON — Hospital Lobby Denounces Cruel New Proposal To Pay Hospitals What They Actually Paid The American Hospital Association filed comments opposing a federal proposal to reimburse hospitals for discounted drugs at roughly the amount hospitals paid for them. The group warned that paying hospitals based on acquisition cost would devastate the vulnerable communities hospitals serve. “This rests on a flawed survey,” said a spokesman, referring to the survey in which hospitals reported their acquisition costs. “Our members cannot absorb a payment rate based on arithmetic.” The AHA urged CMS to preserve the current system, under which hospitals buy drugs at a discount, bill insurers at full price, keep the spread and call the difference charity.

The Questions to ask your Broker before renewal. Write these down or copy and paste them. 1. How much are you paid on my account — ALL of it? Commissions, overrides, bonuses, contingent compensation, retention payments, trips, and anything else, direct or indirect. 2. Who actually pays you — me, or the carrier? 3. Do you earn more when my premiums go up? 4. Am I a fiduciary of this health plan? 5. Will you accept fiduciary status on this plan, in writing? 6. What do my hospital contracts actually pay as a percentage of MEDICARE — not as a "discount" off billed charges? 7. Do I own my claims data, and will I receive it — complete and monthly? Detailed? 8. Who keeps the pharmacy rebates — and can we audit the PBM contract? 9. Will you help me pull the federally mandated machine-readable files and see the actual negotiated rates at my top hospitals? 10. If I use a network, are fees charged for negotiation of out-of-network claims? Pro Tip: The fiduciary liability on your health plan is yours, and employees have started suing plan sponsors over exactly the money these questions expose. Your broker keeps the commission either way. If they can't answer these questions clearly, confidently, and in writing, they're either uninformed or working for someone else's benefit — not yours. Walking away isn't rude. It's prudence, and prudence is your legal duty.

The @DutchRojas newsletter is the best resource for healthcare policy. I subscribe to the newsletter, and that is why I always sound so knowledgeable about healthcare! @HeathVeuleman @anish_koka @DrDiGiorgio @DrBruggeman

Tennessee’s nonprofit hospitals receive tax advantages on the promise that they put communities first. That promise deserves scrutiny. Sixteen hospitals have already been cited over price transparency failures. Patients shouldn’t have to guess what care costs while hospitals continue collecting the benefits of nonprofit status. clarksvillenow.com/local/let…

Thankfully they banned physician owned hospitals. That got rid of all the corruption.

We could all use some @dutch wisdom on a Monday!

America did not borrow $40 trillion because entrepreneurs produced too much. Washington promised more wealth than the country had created. Now politicians want to punish the same capital, businesses, and entrepreneurs required to produce what government already promised. You cannot solve a production deficit by punishing production. We need more of it.

The American insurance cartel is not capitalism. Single payer would not cure its concentration of power. It would complete it. Put the money under the patient’s control. Let physicians compete! Publish actionable prices! Allow entrepreneurs to enter! Let capital build the capacity patients need.

The federated model is key.