Dutch Rojas - Healthcare

Dutch Rojas - Healthcare Making healthcare affordable and accessible for everyone, everywhere… Email us for information!

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

03/18/2026

VC poured $4.8 billion into healthcare infrastructure companies last year.

Not into clinics.
Not into care.

Into the billing layer.
The EHR layer.
The revenue cycle layer.

They did not “invest” in healthcare.

They’re invested in the toll booth between the physician and the payment.

99.9% of VC money doesn’t treat patients.
It invoices them.

03/17/2026

The hospital “charity care” line in the annual report exists so the CEO can justify his $12 million salary at the gala.

03/16/2026

Site-neutral payment just means a fair fight. Same work, same pay, doesn’t matter whose name is on the gate.

And these hospital systems are spending millions to make sure that fight never happens.

Because they know, they don’t win fair fights.

03/16/2026

A facility fee is what hospitals charge you for the privilege of sitting in a building they didn’t pay taxes to build.

03/16/2026

Hospital-affiliated physicians cost Medicare $30,416 per patient per year.

Independent physicians: $25,000.
PE-affiliated physicians: $22,697.

Medicare pays more for worse outcomes at the entity type that receives $275 billion in subsidies.

The subsidy isn’t filling a gap.
It’s creating one.

03/16/2026

The government projected 17,000 IDR disputes per year.

Actual filings: 490,000.
Physicians win 67-90% of cases.

The law was designed to suppress physician payment. It worked.

The escape valve just costs more to operate than they budgeted.

03/15/2026

If your doctor says “I’d recommend this for my own mother,” ask which hospital he’d send her to. It won’t be the one he works for.

03/15/2026

A restaurant in Minneapolis. 35 seats.
Claimed to serve 18,000 meals a day to hungry children.

Federal disbursements to the parent nonprofit went from $3.4 million to $200 million in two years.

Nobody at the state asked how a restaurant with 35 seats serves 18,000 meals.

Because nobody’s compensation depended on asking.

03/15/2026

America produces more oil than any country on earth.

And yet we still import oil.

Which sounds like the sort of thing you’d only believe if it were written on a government website.

But the explanation is a lovely example of how economic systems behave like evolution, not engineering.

For decades American refiners made a perfectly rational bet. Heavy crude from places like Venezuela, Mexico, and Canada was cheaper.

So they spent billions building extraordinarily complex refineries designed to process the nastiest, thickest oil on the planet.

Think of it as building a factory that turns mud into champagne.

Then something awkward happened.

American shale unlocked enormous quantities of light crude. Lovely, clean, high-quality oil. The petroleum equivalent of a perfectly ripe peach.

The trouble is, our refineries were designed to process stew, not peaches.

So the system does something that sounds insane but is economically sensible.

America exports a lot of its light crude.
America imports heavier crude.

And refineries blend them together to maximise yield.

It’s rather like owning a bakery that exports flour while importing bread dough.

Ridiculous if you think in terms of national pride, perfectly logical if you think in terms of industrial equipment.

The mistake is assuming that a national economy is designed like a machine.

It isn’t.

It’s more like a garden.

Things grow in strange places, adapt over time, and occasionally make decisions that look mad until you realise they are simply responding to incentives.

03/15/2026

Maurice Smith, CEO of Blue Cross Blue Shield Illinois (nonprofit): $34.4 million.

Andrew Witty, CEO of UnitedHealth Group (for-profit): $26.3 million.

The guy with no shareholders,
no quarterly earnings calls,
and no say-on-pay vote made $8 million more.

The nonprofit premium is real.
Just not for patients.

03/15/2026

Nonprofit hospitals receive $275 billion a year in structural subsidies.

They spend 2.3% on charity care.
That’s a 43x return on the word “nonprofit.”
Private equity wishes it had margins like that.

03/13/2026

The strange thing about a $275 billion annual subsidy is that nobody had to hide it.

Medicaid supplemental payments, 340B drug pricing, nonprofit tax exemptions, site-neutral billing differentials.

Every mechanism is public.
Every dollar is documented.

The trick was never secrecy.
It was complexity.

When a system is complicated enough, transparency becomes its own camouflage.

Hospital systems and independent physicians both practice medicine.

One operates inside a $275 billion regulatory subsidy.

The other operates in the actual economy.

The clinical work is identical.
The economic universe is not.

The interesting question is not why this exists.

Subsidies always find their beneficiaries.

The interesting question is why 1,000,080 physicians who fund the system through their taxes have never seen the receipt.

Complexity is not a bug.

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Phoenix, AZ

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