The entire US Healthcare system runs on one simple trick: You are not allowed to know the price. Just because its been nearly a year....And I post this annually.

He wants to build a personal brand before starting a business. I prefer having something to exaggerate first.

“We need everyone working at the top of their license.” Excellent. What license does the person overruling my surgeon hold?

I want an entrepreneur’s most important meeting to be with a customer. Free entry lets people build a business without first cultivating the people who can keep competitors out. More effort goes into earning our money when political connections buy less protection…

This 💯!!!!!

Owning hospitals apparently wasn’t enough. Vermont’s largest health system also owned the organization distributing money to hospitals. The University of Vermont Health Network owned OneCare, which managed more than $500 million in hospital payments in 2025, its final year of operations. Think about that arrangement. The hospital system delivering the care also owned the organization helping distribute the payments. Vermont abandoned its single-payer proposal. It continued concentrating control over the care and the money. You can learn quite a bit about healthcare reform by checking who owns the reform.

That’s right @DutchRojas is all over this and is 100% correct. And he’s actually done many (if not all) of these things. This would be my top 10 as of today: 1). Capacity Futures: Physicians sell unused OR time, imaging slots, procedural capacity, and future appointment inventory. Perishable capacity becomes a tradable commodity. 2). Purchasing Cooperatives: Independent practices aggregate purchasing power for supplies, pharmaceuticals, malpractice coverage, technology, and administrative services without consolidating ownership. 3). Syndicated Infrastructure: Physicians collectively capitalize ASCs, specialty hospitals, imaging centers, laboratories, and other infrastructure while maintaining independent practices. 4). Employer-Direct Contracting: Physician consortiums sell defined episodes of care, bundled procedures, and longitudinal care arrangements directly to self-funded employers, bypassing traditional intermediaries. 5). Shared Risk Pools: Independent physicians collectively participate in appropriately structured risk-bearing arrangements, including reinsurance and stop-loss strategies, without each practice becoming an insurance company. 6). Intellectual Property and Data Cooperatives: Physicians collectively monetize clinical protocols, appropriately governed outcomes data, research capabilities, and AI infrastructure while retaining governance and economic participation. 7). Specialty Exchanges: Independent physicians establish transparent marketplaces where purchasers can acquire standardized episodes of care with published prices, quality measures, and guaranteed access. 8). Capital and Financing Cooperatives: Physicians aggregate capital to establish investment funds, finance acquisitions, develop facilities, and provide growth capital to independent practices. They become owners of capital rather than perpetual customers of it. 9). Workforce and Talent Exchanges: Independent practices collectively recruit, train, credential, and deploy clinical and administrative personnel. Shared staffing pools transform portions of fixed labor costs into variable expenses while improving workforce utilization. 10). Collective Brand and Distribution Networks: Independent physicians establish shared consumer-facing brands, referral networks, digital marketplaces, and patient acquisition platforms. Each physician retains ownership while benefiting from national distribution, marketing, and collective brand equity.

We should turn that around. No exemption but for the revenue generated...or hell, just do a projection of unrealized gains...and tax that!!!

The hospital bought the practice. Same physician. Same room. Larger bill. Apparently the acquisition improved the building’s bedside manner.

Before lecturing me about my fair share of property taxes, explain the hospital’s exemption. Slowly. I’m just the idiot paying for the street.

I love a good healthcare innovation panel. Six people discussing how to disrupt a physician who wasn’t invited.

A physician who refuses to fund lobbying is counting on the hospital lobby to represent him. It will. As an acquisition target.

You own the practice. Your employees need care. You object to treating them at cost. Fine. We can run the money through an insurer until it feels expensive enough to be legitimate.

A physician’s website tells me where he went to medical school in 1998. Excellent. Can I buy an appointment in 2026?

Hell yeah, this is what needs to be heard by every healthcare CEO! Dutch, did you know that at my hospital, each unit has to raise money for our own morale? Every time I see a flyer for a morale committee fundraiser, I'm reminded how little admin really cares about bedside staff

You cannot sell yesterday’s empty MRI slot. The machine, lease, and much of the staffing expense remain whether a patient arrives or not. An empty appointment produces no revenue to help cover them. That gives an imaging practice a reason to make available capacity easy to find and purchase at a price that makes economic sense. Publish the complete cash offer. Show the actual openings. Let patients book. A negotiated rate tells you what a completed exam might earn. Check the schedule before congratulating yourself on it…

I hate business dinners. Against my better judgement, I went and the guy spent dinner explaining how wealthy people think. Then he spent twenty minutes splitting the check...

Imagine paying the hospital CEO in gratitude and giving the nurses the bonus. The compensation committee would immediately discover the limitations of appreciation. There would be a serious discussion about market rates, retention, responsibilities, and the risk of losing talented leadership. All perfectly reasonable subjects. I’d enjoy hearing the same vocabulary applied with equal enthusiasm to the people working the night shift. Thanking employees matters. So does staffing the floor adequately, respecting their time, and paying them enough to stay. If a pizza party is such a compelling retention strategy, try it on the executive search firm…

Imagine if we bought food through some prepaid food program. You pay in via both taxes and mandated paycheck withholding. Then you get a prepaid food card that lets you acquire food. Because you’re using the food card, prices are obscured. Why post prices? You’re not paying. Everyone gets in the habit of just assuming their food card covers the cost. Food is a basic human right, after all. Asking people to pay out of pocket is inhumane. It might mean that wealthy people get better food. We can’t have that. Then people don’t realize that big grocery conglomerates have been increasing the prices. They fail to see that the independent farmer market or corner store actually has a large discount. We are talking 10x cheaper. Sometimes 30x cheaper. Because, again, food is a basic human right and if you want people to be price sensitive you’re an inhuman monster that wants them to starve. So prices continue to go up, completely unchecked. Now nobody can even conceive of paying for food without third party food cards. A tomato is $23,000! You can’t expect the average American to feed themselves without government assistance! You can’t even conceive a market for food at this point. When people try to make the case that markets would make food cheaper and more accessible, others sneer at them and ask “you can’t expect people to negotiate prices when they’re STARVING, can you?!” So there’s more and more government intervention. Because food is a human right. Totally makes sense.

At this point, Americans must admit the painful but honest truth…we delegated the role of safeguarding our money and our health to 2 parties. Private insurers and Government programs. Both have failed miserably as stewards of our money and our health. We need to take back OUR dollars and advocate for ourselves as those 2 parties have squandered the privilege. It’s that simple.

No argument Both can be true I can only speak to those who I know— everyone who can find an exit Wants to take it We have played nicely We have followed the rules We have ‘put the patient first’ It has resulted in ever worsening working environment— Nibbling at the edges won’t change anything Starting from scratch is not worth it Just biding time until paid exit or enough in 401k No allegiances That’s the reality @brian_blase and @mfcannon and @DeanClancy and John Goodman and their orgs surround themselves with anyone but those who actually practice medicine So their organization’s stances and their white papers- fix nothing @PacificResearch @sallypipes get it - but it’s just a single voice in the conservative ecosystem— drowned out by the others and the influencers who would sell their own mothers for clicks