Dutch Rojas - Healthcare

11/25/2025

Why are your premiums high?

Want to understand how the U.S. medical device industry really works?

Don’t follow the technology.

Follow the reimbursements.

This isn’t a free market.

It’s a tightly controlled growth machine built on the Centers for Medicare and Medicaid (CMS) payment policy and protected by the American Hospital Association.

Device companies scale by riding procedure volume and procedure volume is manufactured by how CMS pays.

Raise payment for joints?
Implant sales spike.

Green light electrophysiology?
EP labs explode.

Offer add-ons for robotics? Hospitals rush to buy da Vinci machines they can barely operate.

Health Systems, with the American Hospital As****es (AHA) as their PR and legal shield, use site-of-service markups and facility fees to justify outrageous pricing.

That margin?
It buys the devices.
It funds the expansion.
It locks in procurement deals.
It feeds consolidation.

This is excellence in strategy.
Large systems mean predictable volumes and long-term tech loyalty.
The device sector loves it.

That’s why med device lobbyists sing in harmony with CMS and the AHA, not out of shared values, but shared incentives.

So what threatens this cozy triad?

Independent docs.
Site-neutral payments.
Price transparency.

In other words: competition.

That’s the battle line.
Don’t mistake opposition to reform as a policy debate.

It’s just margin defense.

11/24/2025

“Give all power to the many, they will oppress the few.
Give all power to the few, they will oppress the many.” — Alexander Hamilton

This is the story of American healthcare in one sentence.

When CMS, state regulators, and giant health systems hold all the power, the results are predictable: prices are hidden, competition is illegal, physicians can’t open facilities without permission from their competitors, consolidation replaces choice, and premiums climb while outcomes don’t.

Certificate of Need (CON) laws are a perfect example. They don’t protect patients, they protect monopolies.

Price opacity isn’t an accident, it’s a business model. And consolidation isn’t efficiency, it’s control.

If America wants lower premiums, better care, and real access, we don’t need more regulatory centralization.

America needs the opposite: price transparency, open competition, the end of CON, and a healthcare system where physicians and patients, not CMS and monopolies, decide what care looks like.

Power works best when it’s closer to the people who actually use it.

That’s how you restore affordability.
That’s how you regain freedom.

11/23/2025

Healthcare is the defining issue of the midterms.

It is not immigration,
not inflation,
not foreign policy.

No household budget has risen faster than health insurance.

No industry has consolidated more rapidly (Thank you )

No sector hides prices more aggressively.
(Thank you State Governors)

The core problem:

The US subsidizes monopoly behavior and outlaw competition.

I have met a handful of US lawmakers that articulate a policy agenda around transparency, site-neutral payments, 340B reform, and CON repeal.

The rest?
Lost in the sauce or intentionally naive.

Healthcare will decide this election.
Everything else is commentary.

11/22/2025

Every functional industry has three markets.
Healthcare has zero.

Patients can’t shop, employers can’t compare,
and investors can’t discipline inefficiency.

That’s why premiums never fall.

11/21/2025

A physician lawsuit is directly challenging the legality of certificate-of-need (CON) laws, which require providers to get state approval before building new facilities or offering new services.

This hurts incumbent health systems who are protected from competition, and helps independent physicians and patients who would benefit from more choice and lower prices.

CON laws are the definition of a government-granted monopoly. They’re a relic of the past that stifle innovation and keep prices high. It’s time to let the market work. You don’t need permission to compete.

https://www.carolinajournal.com/eye-surgeon-dhhs-clash-over-con-laws-future-in-north-carolina/

Lawyers for a New Bern eye surgeon and state health regulators spent 2 ½ hours Tuesday arguing in court over the future of the state’s certificate-of-need restrictions.

11/21/2025

Tennessee’s is the 44th worst state for affordable premiums.

The bastion of free enterprise they say, while screwing over families.

And I’d blame it on all the Hollywood people that moved to Franklin, but it wasn’t them.

Tennessee sells a very specific story.

Low taxes.
Light regulation.
Business-friendly.

A state where government “gets out of the way” so entrepreneurs can build.

That branding isn’t subtle, it’s central to Tennessee’s identity.

Legislators campaign on it.
Chambers of commerce advertise it.
Corporate recruiters evangelize it.

But the moment you step into healthcare,
the story collapses.

The “open-for-business” state suddenly behaves like a command-and-control economy where innovation is regulated, competition is restricted, and powerful incumbents enjoy government protection that no other industry would ever receive.

In healthcare,
Tennessee is not conservative.
It is 100% communist.

And it’s destroying Tennessee families in ways its politicians refuse to acknowledge.

11/20/2025

When government runs business,
failure becomes permanent.

There’s no consequence for the planners,
only for the people.

In healthcare,
it’s the same story, bureaucrats design the rules, but it’s physicians, patients, and taxpayers who live with the fallout.

The state never feels the pain of its own mistakes; it just writes a bigger check and calls it reform.

That’s why physician ownership isn’t a trend, it’s a transfer of power.

Away from regulators, middlemen, and political committees, and back to the exam room, the operating room, and the patient.

Freedom in medicine isn’t abstract.

It’s the ability to decide,
to innovate, and to be accountable for outcomes.

That’s what separates those who build from those who merely manage.

11/20/2025

How many times have you heard someone say, ‘I’ve got insurance, I’m not paying for it’.

You have no idea how expensive that sentence really is.

Here’s the thing: premiums are claims plus margin.

That’s the formula.
If claims rise, premiums rise.

Every time someone says ‘run every test’ because they’re not thinking about cost, every specialist referral because ‘insurance covers it,’ every brand-name drug when generic works fine, those costs aren’t absorbed by magic.

They’re priced in.

So when people say, ‘I have insurance, I don’t care what it costs,’ what they’re really saying is, ‘Please, charge me more next year.’ And that’s exactly what happens.

And in a fully-insured plan?

You’re also financing the carrier’s profit margin, their marble lobbies, their compliance department, and their risk buffer.

Self-funding means you only pay for claims plus administration.

Everything else stays in your pocket.

Insurance isn’t cost control.
It’s prepayment with overhead.

And the more detached we get from the real price of care, the easier it is for the system to keep printing money on our apathy.

So no, you’re not paying now.
You’re paying forever.

Unless we change the incentive structure, which is exactly what site neutral payments, 340b reform, direct contracts, captives, federations, cooperatives, reference pricing, and direct primary care do

Every dollar wasted on overpriced and mispriced care is a dollar that can’t go to wages, benefits improvements, or staying competitive.

11/19/2025

Milton Friedman once asked:
“Why do welfare programs with noble objectives so often deliver disappointing results?”

His answer:
“You cannot do good with someone else’s money unless you first take it away.”

That’s the healthcare system today, force and coercion disguised as compassion.

True reform doesn’t come from bureaucrats.
It comes from price discovery, competition, and consent, not confiscation.

11/19/2025

Big corporations and universities got in bed with Congress and started making the rules.

That’s where the US Healthcare System began.

Take a $20,000 surgery.

In a free enterprise market, another doctor can step in and say,
“I’ll do it for $15,000.”

Then maybe someone else says, “I’ll do it for $12,000, and show better outcomes.

Competition drives prices down and quality up. Simple.

But that’s not how healthcare has worked since the 1960s.

That’s when the government started picking winners and losers, not the patients.

The government passed legislation that put up walls around the market, gave power to health system monopolies, and let middlemen take a cut from everyone.

Now, prices go up and nobody even knows what anything costs.

And the doctors who want to compete?
They’re buried in red tape.

And the patients that want lower premiums?
They’re busy fighting the uni-party.

11/18/2025

Here’s what a real market would look like:

Every hospital and clinic posts real all-in prices.

Certificate-of-Need laws are repealed so new entrants can compete.

Nonprofits lose tax exemptions if they hide prices or hoard profits.

Employers and patients contract directly with physicians, no rent-seeking intermediaries.

Subsidies stop flowing to insurers and “health systems” that game risk pools and call it reform.

Free enterprise isn’t the problem.
Price opacity is.

11/18/2025

“What’s the bravest thing you’ve ever said?” asked the boy.
“Help,” said the horse.

Most people think bravery looks like charging into battle or standing alone against the crowd.

But sometimes it looks like telling the truth when silence would be easier.

Sometimes it’s admitting you’re tired, scared, or lost.

And sometimes it’s asking for help when you’ve built your whole life on being the one who helps others.

We’ve built a culture that celebrates strength but punishes vulnerability.

That’s backwards.
Real strength is saying, I can’t do this alone.

Charlie Mackesy captured something timeless in that one word.

“Help” doesn’t make you weak, it makes you human.

And that’s enough.