Dutch Rojas - Healthcare

I love to talk about the Five Families of insurance. I get 25,000 likes and it makes me feel good.

The Five Dynasties of hospital power, might get 2,500 likes. In the rank of who harms Americans the worst, its the largest health systems, full stop.

Kaiser Permanente. The academic medical centers. The Catholic systems. The dominant regional nonprofits. The 340B empires.

Each one has a different business model. Each one has a different regulatory moat. And each one extracts value from employers and taxpayers through a different mechanism.

Kaiser owns the whole stack.

The AMCs use NIH funding and residency programs as competitive weapons.
The Catholic systems leverage religious exemptions and merger scale.

The regional nonprofits sit on property tax exemptions worth hundreds of millions.
The 340B empires pocket drug discounts that were meant for patients.

You can't fix healthcare without naming who runs it.
These five dynasties run it.

$11 million in healthcare lobby money went to 45 people on one committee. That’s the committee that controls Medicare reimbursement rates. The ROI on that investment is spectacular.

https://waysandmeans.rojasreport.com/

Board approved the $600M tower. Didn’t sign a personal guarantee. Didn’t read the pro forma. Voted yes because the CEO said yes. Bondholders will eat it.

The remarkable thing about Stark Law is that it solved the problem it described and created a larger version of the same problem in the process.

A physician referring to her own MRI center was corruption.

A hospital system routing 500 physicians’ referrals through its own MRI centers is compliance.

The behavior is identical.
The scale is not.