Dutch Rojas - Healthcare

A number you have not seen written down anywhere: 1.66%.

That is the share of patient revenue that Michigan 340B hospitals spend on charity care, per the Lown Institute's analysis.

The entire premise of the federal 340B program is that hospitals receiving deep drug discounts pass those savings down to vulnerable patients.

When the largest 340B operator in the state spends a fraction of one percent on charity, the program no longer means what its name suggests.
It means something else.

McKinsey helped opioid companies sell more pills. Now they are on the “fix” healthcare committee by CMS. In healthcare, failing upward isn’t a bug. It’s the org chart.

For years, hospitals told Congress that lien-based billing was a defensive measure for non-paying patients.

In February 2026, their revenue cycle vendor told them something else in writing.

“Hospitals have relied on lien-based billing as a strategy to avoid contractual write-downs.”

Strategy.
To avoid the rate they already agreed to accept.

Physicians will do 14 years of training, work 70 hours a week, and then let insurance companies handle the compounding.

Bold strategy.

Bill Gassen runs Sanford Health. He’s AHA Chair-Elect. He also sits on a federal advisory committee advising on healthcare reform. The guy lobbying against reform is advising on reform. Even Washington blushed.

https://aha.rojasreport.com/profiles/gassen/

Bill Gassen -- AHA Intelligence Dossier Concurrent capture: Gassen simultaneously holds the incoming AHA chairmanship, chairs the AHA's 501(c)(4) lobbying arm, sits on a federal CMS/HHS advisory

A hospital can bill $3,200 for a knee injection a physician does for $400. Same needle. Same drug. Same doctor. Different tax ID. That’s not medicine. That’s government sponsored arbitrage.

The U.S. healthcare system is the only place where being “in-network” still feels like getting mugged by someone you know.

Eight questions just dropped in a CMS rule.
Three of them decide whether physicians ever own hospitals again.

Methodist Le Bonheur garnished the wages of 70+ of its own employees. Taking money out of paychecks it was simultaneously issuing.

The IRS calls this institution a 501(c)(3). Shakespeare would call it something else.

Congress made it a federal crime for a physician to refer patients to her own imaging center. Then wrote an exception that lets hospital systems do it a million times a year. The law didn’t ban self-dealing. It acquired it.