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

12/12/2025

𝐀 $𝟗𝟎𝟔 𝐌𝐢𝐥𝐥𝐢𝐨𝐧 𝐋𝐨𝐛𝐛𝐲, 𝐚𝐧𝐝 𝐀 𝐎𝐧𝐜𝐞-𝐢𝐧-𝟏𝟓-𝐘𝐞𝐚𝐫𝐬 𝐂𝐡𝐚𝐧𝐜𝐞

For the first time since 2010,
physician-owned hospitals are included in a congressional package.

The hospital lobby has spent $906 million to stop this moment.
That is the equivalent of 16 million primary care visits.

𝐓𝐨𝐝𝐚𝐲 𝐈 𝐭𝐞𝐥𝐥 𝐲𝐨𝐮 𝐰𝐡𝐚𝐭 𝐭𝐡𝐚𝐭 𝐦𝐨𝐧𝐞𝐲 𝐛𝐨𝐮𝐠𝐡𝐭, 𝐚𝐧𝐝 𝐰𝐡𝐚𝐭 𝐰𝐞 𝐜𝐚𝐧 𝐝𝐨 𝐚𝐛𝐨𝐮𝐭 𝐢𝐭.

For six days, I showed you how American healthcare was captured:

→ Day 1: 44 of 51 markets captured or contested by nonprofit systems

→ Day 2: 25 systems with $527B revenue and $0 in taxes

→ Day 3: 70 senators in CON states, $700M in lobbying

→ Day 4: CON laws — the Triple Moat that makes competition illegal

→ Day 5: $125 billion in systematic advantages for health systems

→ Day 6: AMCs collecting 47% more with the same outcomes

Today is Day 7.

The lobbying battlefield: 23-to-1.
$906 million dollars trying to ensure the moratoriums was not turned over.
For every $1 spent by POH advocates, the hospital lobby spent $23

And we're still winning. POH is in the package....

12/11/2025

Who Controls the Supply of Doctors?

The US government pays over $30 billion a year for Graduate Medical Education.
(+ you pay premiums).

The number of funded residency slots has been capped since 1997.

Academic Medical Centers (AMCs) control this pipeline.

They decide how many doctors enter the market.

They decide which specialties grow.
They decide who trains and where.

The American Hospital Association (AHA) lobbies constantly for more GME funding.

What they don’t lobby for: reforms that would break their training monopoly.

12/11/2025

Taxpayer-Funded. Privately Profitable.

The Bayh-Dole Act of 1980 allowed universities and hospitals to patent discoveries made with federal funding.

The original intent was to accelerate innovation.

The result?
Publicly funded research becomes privately profitable.

You pay twice:
→ Once for the research through NIH grants
→ Again for the inflated drug prices
(Plus premiums + copays)

Academic Medical Centers (AMCs) have become expert at extracting value from the research pipeline.

Licensing agreements.
Spinoff companies.
Patent portfolios.

The academic mission provides cover.

12/10/2025

Site-Neutral
Same Doctor. Same Service. 145% More.

Medicare pays 145% more on average for identical services performed in hospital outpatient departments than in physician offices.

Same doctor.
Same stethoscope.
Same flu shot.
Different bill.

This payment distortion directly encourages health systems to acquire independent practices and convert them to HOPDs.

The result:
→ Price inflation
→ Market consolidation
→ Fewer independent options

This is not a market outcome.
This is policy-created arbitrage.

12/10/2025

The $125 Billion Systematic Advantage
Independent physicians are not failing.

They are being out-regulated and out-subsidized.

Every year, large health systems receive over $125 billion in structural advantages that independent practices cannot access.

Today’s article breaks down the 11 Pillars of Systematic Advantage:

→ 340B Drug Pricing:
$54 billion

→ Supplemental Medicaid Payments: $
30+ billion

→ Graduate Medical Education:
$30billion

→ Nonprofit Tax Exemptions:
$37.4 billion

→ Tax-Free Bond Financing
→ Health System-Owned Health Plans
→ Site-Neutral Payment Violations
→ CMS Reimbursement Structures
→ The POH Ban
→ Consolidation Incentives
→ Regulatory Capture

Private equity and strategic consultants view this as regulatory arbitrage, not organic market success.

These are structural monopolies disguised as nonprofit stewards.

Link in comments.

This is Day 5 of a series exposing the structure of American healthcare.

Article release 11am EST.

12/10/2025

We are making progress on our journey through why healthcare insurance has become so expensive, and what you can do about it.

Day 5 of 7 Drop is at 11AM CST.

The Rojas Report just hit #10 in Health Policy on Substack.

3,200+ subscribers.
No ads.
No PAC dollars.
No CON blocking you from reading.

And the price for a year is less than what a non-profit health system collects for a single aspirin.

🔥🔥🔥🔥🔥🔥🔥

12/09/2025

How the Hospital Industry Captured Healthcare
Here's the playbook they ran:

Don't oppose government—partner with it.
The AHA supported Medicare because guaranteed payment was worth more than independence.
Write your own rules.
The Joint Commission is a private organization created by the industry. It sets the standards. The government enforces them.
Make the system complex.
340B, GME, DSH, UPL, facility fees. An alphabet soup no outsider can understand.
Capture the regulators.
Staff the review boards with your people. Fund the campaigns of the legislators who write the rules.
Call it public interest.
Every restriction is framed as protecting access, quality, communities. Never mention protecting profits.

They ran this playbook for fifty years.
It worked perfectly.
Today's article tells the complete story.

12/09/2025

20% Higher Health Insurance Premiums.

Every Year.
In CON states, health insurance premiums are higher.

Studies show an average 20% more per year per person.
That doesn't sound like much.

Until you multiply by millions of people.
Over decades.

The hidden tax of protected monopolies.

Paid by every family.
Every employer.
Every taxpayer.

The hospitals call it "community benefit."

I call it what it is: extraction.

12/07/2025

In every empire, there are gatekeepers.

Not the ones who build.
The ones who block.

In American healthcare,
they don’t wear white coats.

They wear flag pins.
They sit on committees.

They cash checks from the same systems they’re supposed to regulate.

72 of 100 sitting U.S. senators accepted $10,000 or more from pharmaceutical and health product PACs in 2024.

35 of those seats are on the ballot next November.

They voted to keep the physician ownership ban, written by health system lobbyists in 2010.

They killed site-neutral payment reform, protecting the facility fee markup.

They defended Certificate of Need laws in their home states, where health systems literally vote on whether competitors can exist.

Tomorrow I publish the names.

The exposed.
The complicit.
The ones who cashed the checks and looked away.

$700 million bought their silence….

12/05/2025

Geographic monopolies aren’t a bug.
They’re the business model.

Market concentration among the top nonprofit systems:

→ UPMC controls ~70% of Pittsburgh
→ Mass General Brigham controls ~65% of Boston
→ Intermountain controls ~65% of Utah
→ Sutter Health controls ~55% of Northern California
→ Yale New Haven controls ~50% of Connecticut

When you control 50%+ of a market:
• You set prices
• Insurers have no leverage
• Employers have no alternatives
• Physicians have one option: work for you

This is why premiums in Captured states average $701/month while Competitive states average $580/month.

12/05/2025

Yesterday I published the 50-State Nonprofit Healthcare Map.

Today you meet the players.
The 25 Most Powerful Nonprofit Health Systems in America:

1. Kaiser Permanente — $115.8B
2. CommonSpirit Health — $37.5B
3. Advocate Health — $34.8B
4. Providence St. Joseph — $30.7B
5. UPMC — $29.9B
6. Ascension — $28.6B
7. Trinity Health — $23.9B
8. Mass General Brigham — $20.6B
9. AdventHealth — $19.8B
10. Cleveland Clinic — $17.1B

Combined revenue of the top 25: $527 billion.
That’s more than the GDP of Norway.

Tax exemptions received: $37+ billion annually.
Federal income tax paid: $0.

These are the systems that control American healthcare.

They set the prices.
They employ the physicians.
They lobby for the laws that protect them.

Full breakdown with all 25 systems, market share data, and analysis in comments 👇

12/03/2025

Five ideas that would lower U.S. healthcare costs immediately:

1. Repeal Certificate of Need laws.
They restrict supply, block competition, and protect incumbents.

2. Lift the ban on physician ownership in hospitals.
When physicians compete, costs fall and quality rises.

3. Expand ASC capacity everywhere.
Most states still restrict the lowest-cost, highest-value surgical setting.

4. Eliminate nonprofit tax loopholes.
If you behave like a corporation, you should be taxed like one.

5. Eliminate site-of-service payment differentials.

The same service at two different prices is not a market, it’s a subsidy.

Address

3219 E. Camelback Road, Suite 249
Phoenix, AZ

Website

http://www.bliksemhealth.com/

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