This is a favorable development. Big businesses generally pay better, do more training, engage less in wage theft and other abuses and have more upward mobility.

I have no problem with Walmart and Amazon. Companies that grow big on their own. Companies like the large hospital conglomerates use legislation to stifle competition. They aren’t big because they offer a superior product at a cheaper price. They are big because they game rules like 340B, quality metrics, and DRG capture. That’s not capitalism.

Obvious now that the issue for the Harvard intellectual class has always been control. Tasked with reforming healthcare, their first step was to deal with those pesky independent primary care physicians by creating a system that would force them to sell to large health systems. The large health systems would be the MBA run non-profit that advertises in the Super Bowl , is paid multiples for the same service compared to a small independent practice, and routinely sticks the uninsured with insane list prices AND then sues them for payment. But they do have quality improvement teams that track meaningless metrics, and lots of well paid MBA admins to pull the trigger on $100 million EMRs, so there is that. I’ve changed my mind on NIH indirects. Even 15% is taxpayer theft. Let’s lower it to 0. Give the full award to researchers engaged in meaningful research and hospitals can negotiate with the researchers directly for “indirect” costs.

I just spoke at length to @EPotterMD and I have asked her for all of the supporting documents, emails, call records, etc which she has agreed to provide. I found her and her story totally credible. @UHC has publically called her a liar, and UHC’s general counsel has told my CLO that Dr. Potter is not telling the truth. We have asked UHC to explain with particularity what Dr. Potter has said and/or written that is false. They have yet to respond to this request. I took down my original post on this matter because UHC’s outside counsel told my CLO that I was wrong and that Dr. Potter was not telling the truth. Based on what I have heard so far, I believe that Dr. Potter is telling the truth and that UHC appears to have denied coverage for a necessary post-surgical overnight stay and interfered with a surgeon mid-operation without good reason. They have also threatened the doctor with defamation and significant financial liabilities. And they have complained to the @SECGov about me. I await UHC’s side of the story and supporting facts before I can conclusively form a view on what has happened here. In the meantime, I have told Dr. Potter that I will cover her legal expenses to defend her from UHC’s claims, and to make sure that she has proper representation so that this is a fair fight. Stay tuned. This should be interesting. And there is a possibility that good will come from this. Healthcare and our insurance system is in trouble and needs a reboot.

Independent physician practice is a bulwark against the waste and fraud of large health systems. DOGE needs to restore this. Things like Stark Law and the physician owned hospital ban would take legislation. Two areas that can be examined with executive action are the quality metric system and 340B. Medicare has spent billions on worthless quality metrics. These then burden physician practices leading to a massive increase in overhead. Slash all metrics and CMMI advanced payment models. 340B is ripping off Medicare and Medicaid. It drives up the costs of drugs and allows hospitals to massively overcharge Medicare/Medicaid for those meds. Reform that system and instantly save billions. Easy targets wins in healthcare.

Facing the Dragon

“Primary care” by doctors should be secondary care. And actual primary care should be done by society (both in infrastructure and culture)