Dutch Rojas - Healthcare

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SanoSurgery brokers surgeries and procedures between hospitals and physicians ("Sellers") and private individuals and self-insured employers ("Buyers").

Hospitals aren’t buying physician practices because they’re better operators.They’re buying them because captive physici...
01/07/2026

Hospitals aren’t buying physician practices because they’re better operators.

They’re buying them because captive physicians bill at facility rates.

Same doctor.
Same procedure.
2-3x the price.

The Progressive Policy Institute just documented this across 9 specialties:

cardiology,
orthopedics,
gastroenterology,
dermatology,
oncology,
urology,
rheumatology,
pulmonology, and ophthalmology.

This is not consolidation to lower premiums.
It’s consolidation to raise premiums even higher!

Every independent practice that sells becomes a billing arbitrage machine for the system that acquires it.

The physician loses autonomy.
The patient pays more.
The system profits.

This is how healthcare got to 20% of GDP.

Not innovation.
Acquisition.

$𝟒 𝐭𝐫𝐢𝐥𝐥𝐢𝐨𝐧 𝐬𝐢𝐭𝐬 𝐢𝐧 𝐭𝐡𝐞 𝐦𝐮𝐧𝐢𝐜𝐢𝐩𝐚𝐥 𝐛𝐨𝐧𝐝 𝐦𝐚𝐫𝐤𝐞𝐭.This is the market that funds hospital expansions, cancer centers, and eme...
01/06/2026

$𝟒 𝐭𝐫𝐢𝐥𝐥𝐢𝐨𝐧 𝐬𝐢𝐭𝐬 𝐢𝐧 𝐭𝐡𝐞 𝐦𝐮𝐧𝐢𝐜𝐢𝐩𝐚𝐥 𝐛𝐨𝐧𝐝 𝐦𝐚𝐫𝐤𝐞𝐭.

This is the market that funds hospital expansions, cancer centers, and emergency departments across America.

Your financial advisor probably called it “safe.”

A Federal Reserve Bank of New York study found something different: actual municipal bond defaults between 2009 and 2019 were 5-20x higher than what Moody’s and S&P reported.

The rating agencies missed 80-95% of defaults.

Sound familiar?

These are the same agencies that slapped AAA ratings on toxic mortgage securities in 2007.

Today’s article breaks down what this means for healthcare infrastructure.

Live at 11:30 EST.

01/04/2026

𝐓𝐡𝐞 𝐀𝐦𝐞𝐫𝐢𝐜𝐚𝐧 𝐞𝐱𝐩𝐞𝐫𝐢𝐦𝐞𝐧𝐭 𝐰𝐚𝐬, 𝐚𝐭 𝐢𝐭𝐬 𝐜𝐨𝐫𝐞, 𝐚 𝐛𝐞𝐭 𝐨𝐧 𝐯𝐢𝐫𝐭𝐮𝐞.

John Adams stated it explicitly: "Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other."

The Constitution distributed power, limited government, and maximized individual liberty precisely because it assumed citizens would regulate themselves.

External constraints were minimized because internal constraints were assumed.
The Founders read their Cicero.
They knew how the Roman Republic ended.
They designed against it.

But they also knew that no design is stronger than the people operating it.
Sunday reflection on what happens when the framework erodes.

The Rojas Report isn't slowing down.Starting Monday:History of CON laws.Why your premiums are so expensive.HCSC and the ...
01/03/2026

The Rojas Report isn't slowing down.
Starting Monday:

History of CON laws.
Why your premiums are so expensive.
HCSC and the Blue Cross Blue Shield scam.
History of the AMA and AHA.
Open letters to governors and lawmakers.
The 2026 Midterm Scorecard.
Policy solutions.
Private solutions.

Healthcare is $5.7 trillion.
Larger than Japan's entire economy.

And nobody is covering it like it deserves to be covered.
That changes now.

$12 versus $150.Same blood test. Same CLIA certification. Same results.$500 versus $4,500.Same MRI. Same machine. Same r...
01/02/2026

$12 versus $150.
Same blood test.
Same CLIA certification.
Same results.

$500 versus $4,500.
Same MRI.
Same machine.
Same radiologist read.

$1,500 versus $6,800.
Same colonoscopy.
Same physician.
Same outcome.
The prices exist.

LaboratoryAssist.com posts them.
RadiologyAssist.com posts them.
ColonoscopyAssist.com posts them.

When you post prices, transparency creates mean reversion.

The outliers compress toward the center.

Premiums follow.
This is mathematics.

17 billion medical transactions in the United States every year.14 billion lab tests.1.8 billion physician consultations...
01/02/2026

17 billion medical transactions in the United States every year.

14 billion lab tests.
1.8 billion physician consultations.
100 million outpatient surgeries.

Zero marketplace.
You can compare flight prices in 30 seconds.
You cannot compare MRI prices in the same city.

Everyone keeps framing healthcare transparency as cost containment.

Wrong frame.

The opportunity is market creation.

Health systems have four moats.None of them are quality.None of them are efficiency.None of them are innovation.FINANCIA...
01/02/2026

Health systems have four moats.

None of them are quality.
None of them are efficiency.
None of them are innovation.

FINANCIAL:
$54B in 340B. $37.4B in tax breaks. $30B+ in Medicaid supplements.

STRUCTURAL:
$30B in GME. Tax-free bonds. Captive health plans.

REGULATORY:
Site-neutral violations. CMS favoritism. The POH ban.

MARKET:
Consolidation incentives.
Political access.
Regulatory deference.

$150 billion+ in annual advantages.
Not earned.
Assigned.

Independent practices don’t have access to any of them.

They face a 100% tax burden, compared to 0% for them.

They borrow at commercial rates against tax-free bonds.

They buy drugs at market price against 340B discounts.

And when they lose market share, the consultants call it “inevitable consolidation.”

It’s not inevitable.
It’s engineered.

In 2010, 80% of physicians owned their practice.In 2024, less than 20% do.Where did they go?They got bought by “nonprofi...
01/01/2026

In 2010, 80% of physicians owned their practice.
In 2024, less than 20% do.

Where did they go?

They got bought by “nonprofit” hospital systems.

Here’s the playbook:

1) Hospital identifies successful independent practice

2) Hospital offers to “partner” (buy)

3) Physician sells, becomes employee

4) Hospital raises prices 145% for the same services. Thanks

Competition eliminated

The physician gets a salary and a boss.
The patient gets higher bills.
The hospital gets market control.

This is called “vertical integration” in business school.

In healthcare, it’s called Monday.

The Dutch Line:
Every time a nonprofit hospital buys a physician practice, competition dies, and health insurance rise.

They call it “expanding access.”

I call it what it is: consolidation dressed in scrubs.

The hospital called it a partnership.
The physician called it bu****it.
The patient received a 40% premium increase.

Only one of them was surprised.

The trajectory is set.If nothing changes: 1. Fewer physician-owned practices 2. Higher healthcare costs 3. Weaker innova...
01/01/2026

The trajectory is set.

If nothing changes:
1. Fewer physician-owned practices
2. Higher healthcare costs
3. Weaker innovation
4. Declining access in underserved areas

This is all math.

When you subsidize consolidation,
you get consolidation.

When you penalize independence,
you lose independence.

When you eliminate competition,
prices rise.

Every policy that protects health system margins accelerates this cascade.

340B doesn’t lower drug costs for patients.
Tax exemptions don’t fund charity care.
GME dollars don’t train more physicians.

They fund expansion.
They fund acquisition.
They fund the elimination of alternatives.

The road ahead isn’t uncertain.
It’s inevitable, unless the policy changes.

A “nonprofit” university hospital in Virginia sued a patient for $13,000.She was a schoolteacher.They garnished her wage...
12/31/2025

A “nonprofit” university hospital in Virginia sued a patient for $13,000.

She was a schoolteacher.
They garnished her wages for 3 years.

The university hospital’s CEO made $4.2 million that year.

Here’s what “nonprofit” actually means in American healthcare:

It means they don’t pay property taxes.
It means they don’t pay income taxes.
It means they don’t pay sales taxes.

It does NOT mean:
∙They don’t make money
∙They don’t hoard cash
∙They don’t sue you into poverty

The 25 largest nonprofit hospital systems in America hold over $324 billion in assets.

Read that again.
$324 billion.

They have legal teams whose entire job is collections.

They put liens on homes.
They garnish wages from people making $40,000 a year.

And they do it all while flying a “nonprofit” flag that exempts them from $150+ billion in taxes annually.

The Dutch Line:
The word “nonprofit” is doing a lot of work. None of it for you.

The schoolteacher couldn’t opt out of the system.

But you can opt into understanding it.

Health systems aren’t winning.They’re being carried.What it looks like:→ Systems expanding market share→ Independent pra...
12/31/2025

Health systems aren’t winning.
They’re being carried.

What it looks like:
→ Systems expanding market share
→ Independent practices struggling
→ Rising costs
→ Declining choice

What it actually is:
→ Regulatory capture
→ Policy-driven advantages
→ Structural monopolies
→ Nonprofit labels hiding market control

Strip away the narrative.

Health systems don’t outperform independent physicians on cost.

They don’t outperform on quality.
They don’t outperform on access.

They outperform on lobbying.
Every certificate of need law.
Every site-neutral payment violation.
Every 340B carve-out.
Written by the same people who benefit from them.

This is all public record.

Follow the policy.
Find the moat.

𝐃𝐞𝐦𝐨𝐜𝐫𝐚𝐭𝐬 𝐜𝐚𝐧’𝐭 𝐦𝐚𝐧𝐚𝐠𝐞 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞.𝐑𝐞𝐩𝐮𝐛𝐥𝐢𝐜𝐚𝐧𝐬 𝐰𝐨𝐧’𝐭 𝐫𝐞𝐟𝐨𝐫𝐦 𝐢𝐭.15 years. No plan.No site-neutral fix.No physician-owned h...
12/30/2025

𝐃𝐞𝐦𝐨𝐜𝐫𝐚𝐭𝐬 𝐜𝐚𝐧’𝐭 𝐦𝐚𝐧𝐚𝐠𝐞 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞.
𝐑𝐞𝐩𝐮𝐛𝐥𝐢𝐜𝐚𝐧𝐬 𝐰𝐨𝐧’𝐭 𝐫𝐞𝐟𝐨𝐫𝐦 𝐢𝐭.

15 years. No plan.

No site-neutral fix.
No physician-owned hospitals.
No PBM reform.
No nonprofit accountability.

$9 billion walks out the door in Minnesota.
Both parties point fingers.

Taxpayers foot the bill.

Healthcare decides 2026.
Healthcare isn’t broken. It’s rigged.

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