Dutch Rojas - Healthcare

02/06/2026

𝐓𝐡𝐞𝐫𝐞 𝐚𝐫𝐞 𝐭𝐡𝐫𝐞𝐞 𝐩𝐚𝐭𝐡𝐬 𝐟𝐨𝐫 𝐢𝐧𝐝𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐭 𝐩𝐡𝐲𝐬𝐢𝐜𝐢𝐚𝐧𝐬. 𝐓𝐰𝐨 𝐨𝐟 𝐭𝐡𝐞𝐦 𝐫𝐞𝐪𝐮𝐢𝐫𝐞 𝐬𝐮𝐫𝐫𝐞𝐧𝐝𝐞𝐫.

Path 1: Private Equity.
They acquire your practice at 6-12x EBITDA. You solve the economics. You lose autonomy. They flip you in five years.

Path 2: Health System Employment.
They employ you. You solve the economics. You lose ownership. You become a badge number.
Notice the pattern?

Both paths solve the same problem: you pay 30% more than the hospital down the street for the same insurance, the same benefits, the same everything.

Both paths solve it the same way: by demanding you surrender what you built.

PE takes your equity.
Health systems take your autonomy.
Both take your independence.

There’s a third path.
What if you could get their economics without giving up anything?

Not through a merger.
Not through employment.
Through infrastructure.
First pilot hospitals:

85% Rx cost reduction.
25%+ benefits savings.
$1.4M returned to physicians per facility.

Health systems have scale.
Now independents do too.
Without the badge.

02/06/2026

Why did it take CMS twenty years to pursue $17 billion in Medicare Advantage overpayments?

Not why did the overpayments happen, incentives explain that.

Why did nobody act?
Because accountability requires consequences.

And consequences require someone willing to impose them. And in a system where the regulator depends on the regulated, nobody volunteers for that job.

The question was never “how did this happen?”It was always “why would anyone stop it?

CMS is planning to continue its Medicare Advantage audits and overpayment recoveries, according to a Jan. 27 memo. While federal estimates point to $17 billion in overpayments each year, the last major risk-adjustment data-validation recovery took place in payment year 2007. From payment years 2011....

02/05/2026

𝐓𝐡𝐢𝐬 𝐦𝐢𝐠𝐡𝐭 𝐛𝐞 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐢𝐦𝐩𝐨𝐫𝐭𝐚𝐧𝐭 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐚𝐧𝐧𝐨𝐮𝐧𝐜𝐞𝐦𝐞𝐧𝐭 𝐢𝐧 𝟓𝟎 𝐲𝐞𝐚𝐫𝐬. 𝐀𝐧𝐝 𝐭𝐡𝐞 𝐚𝐝𝐦𝐢𝐧𝐢𝐬𝐭𝐫𝐚𝐭𝐢𝐨𝐧 𝐝𝐨𝐞𝐬𝐧’𝐭 𝐞𝐯𝐞𝐧 𝐮𝐧𝐝𝐞𝐫𝐬𝐭𝐚𝐧𝐝 𝐰𝐡𝐲.

Every hospital in America is being forced to publish prices.

Most people hear that and think:
“Cool. Patients can shop now.”

That’s not the real story. Here’s the Dutch insight…

Healthcare is crossing a line it has never crossed before:

It’s becoming computable.

That matters far more to entrepreneurs and data scientists than to patients.

Because once prices exist, a chain reaction starts:

• Markets form
• Benchmarks emerge
• Arbitrage appears
• Bundles can be built
• Risk can be priced
• Forward contracts become possible (yes, my SurgeryFutures)

This is how every modern industry was rebuilt.

Not with speeches.
With data.

This is what incumbents are actually afraid of.

They never feared patients.

They fear:
• Models
• Comparisons
• Graphs
• Rankings
• Dashboards that ask: “Why is this 20x more expensive?”

Opacity protected margins.
Data destroys them.

The Dutch Line:

Price transparency isn’t a “patient-first” policy.

It’s an infrastructure shift.

And when infrastructure changes, power follows.

Healthcare just crossed that line…
Let’s go 🔥🔥🔥

02/02/2026

𝐒𝐭𝐚𝐭𝐞𝐬 𝐚𝐫𝐞 𝐬𝐮𝐩𝐩𝐨𝐬𝐞𝐝 𝐭𝐨 𝐩𝐚𝐲 𝐭𝐡𝐞𝐢𝐫 𝐬𝐡𝐚𝐫𝐞 𝐨𝐟 𝐌𝐞𝐝𝐢𝐜𝐚𝐢𝐝.
Seven states found a way to pay nothing.

𝗧𝗮𝘅 𝘁𝗵𝗲 𝗶𝗻𝘀𝘂𝗿𝗲𝗿𝘀.
𝘎𝘦𝘵 𝘧𝘦𝘥𝘦𝘳𝘢𝘭 𝘮𝘢𝘵𝘤𝘩.
𝗥𝗲𝗶𝗺𝗯𝘂𝗿𝘀𝗲 𝘁𝗵𝗲 𝗶𝗻𝘀𝘂𝗿𝗲𝗿𝘀.
𝘒𝘦𝘦𝘱 𝘵𝘩𝘦 𝘥𝘪𝘧𝘧𝘦𝘳𝘦𝘯𝘤𝘦.

The insurers paid nothing net.
The states paid nothing net.

𝗙𝗲𝗱𝗲𝗿𝗮𝗹 𝘁𝗮𝘅𝗽𝗮𝘆𝗲𝗿𝘀 𝗽𝗮𝗶𝗱 𝗳𝗼𝗿 𝗲𝘃𝗲𝗿𝘆𝘁𝗵𝗶𝗻𝗴.

Read Here: 👇
https://buff.ly/DTe09C0

02/02/2026

Independent physicians talk about fighting consolidation.

Here’s a truth: Patients trust the physicians that make things simple.

One clear, all-in price signals honesty.
Honesty attracts volume.

Health systems compete on leverage.
Independents can compete on trust.

Trust wins long term.

02/01/2026

How do nonprofit boards justify $30 million CEO packages?
They hire consultants.

The cycle:
1. Board hires consultant
2. Consultant benchmarks against "peers."
3. Board sets pay at the 75th percentile
4. This becomes next year's benchmark
5. Repeat

Every board wants to pay above average.
No board hires a consultant to recommend below-market.
The consultants know who pays their fees.

The spiral only moves up.

SullivanCotter. Pearl Meyer. Gallagher.

Three firms.
One direction.

https://dutchrojas.substack.com/p/the-tax-shelter-with-an-emergency

01/31/2026

The nonprofit status doesn't constrain executive pay.
It removes the constraints.

Maurice Smith, HCSC (nonprofit): $34.4 million
Andrew Witty, UnitedHealth (for-profit): $26.3 million

The charity CEO out-earned the shareholder-accountable CEO.
No quarterly disclosure.
No say-on-pay vote.
No shareholders to object.

Just a board, a consultant, and a SERP.

There’s a retirement plan you’ve never heard of.

01/31/2026

𝐖𝐡𝐲 𝐲𝐨𝐮𝐫 𝐜𝐨𝐦𝐦𝐞𝐫𝐜𝐢𝐚𝐥 𝐡𝐞𝐚𝐥𝐭𝐡 𝐢𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 𝐩𝐫𝐞𝐦𝐢𝐮𝐦s 𝐰𝐞𝐧𝐭 𝐮𝐩:

When states underfund Medicaid through gimmicks, they create cascading effects.
Federal deficits increase → Interest rates rise → Inflation rises → Your costs rise.

Medicaid reimbursement stays artificially low → Hospitals cost-shift to commercial payers → Your employer plan picks up the slack.

States use Medicaid matching funds for "programs outside Medicaid's scope" (CMS's words) → Healthcare system gets less → You pay more.

The $24 billion annual extraction didn't disappear.
It came from somewhere.

It came from you.

This is why I write about policy.
Because policy is how they pick your pocket without you noticing.

California taxed Medicaid plans 157 times higher than commercial plans. Then reimbursed the insurers entirely with federal dollars. The state kept the difference. You paid for it.

01/31/2026

An $8,000 max out-of-pocket makes a hysterectomy a household financial event.

That’s not abstract.
That’s family money.

When physicians publish real prices, families can plan instead of panic.

Transparency doesn’t cheapen medicine.
It shows respect for the patient’s reality.

01/30/2026

$125 billion in 2025.
$275 billion in 2026.

That's not inflation.
That's not population growth.
That's a 120% increase in one year.

The health system legibility machine isn't broken.

Health systems now capture $275 billion annually in structural advantages to advance consolidation.

Not revenue.
Not profit.

Advantages built into law, tax code, and federal programs.

01/30/2026

$275 billion.

That's the annual subsidy flowing to health systems.

Not patients.
Not doctors.
Not your community.

Health systems.

And you're paying for it.
Every premium.
Every tax dollar.
Every bill you can't afford.

This is the moat.
This is why health insurance premiums rise.
This is the number they don't want you to see.

01/29/2026

$90 billion in Medicaid payments you can't access.

$81 billion in drug pricing spreads you can't capture.

$37 billion in tax exemptions you don't receive.

$16 billion in training funds you never see.

$14 billion in payment differentials for identical services.

$275 billion total.

Every year.

Flowing to health systems.
Not because they're better….