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").

05/30/2026

Secretary Kennedy is not failing.

The frame is working exactly as designed.

If the cause is food, HHS can talk about dyes, ultra-processed labels, dietary guidelines, vaccines, autism, and wellness.

Meanwhile the healthcare cartel keeps facility fees, 340B arbitrage, PBM rebates, consolidation power, CON protection, GME caps, Stark asymmetry, and the physician-owned hospital ban.

The machine loves your smoothie.

-Rojas out

05/29/2026

340B, a program written for poor patients. Used to fund executive bonuses. Welcome to 340B. The most lucrative arbitrage in medicine, and the one nobody is allowed to name.

05/29/2026

I used to write premium checks. Now the checks writes back. Same coverage, opposite direction.

We have a tendency to assume that when a system underperforms, the solution is to make it more efficient.The IDR system ...
05/28/2026

We have a tendency to assume that when a system underperforms, the solution is to make it more efficient.

The IDR system under the No Surprises Act doesn’t underperform. It performs exactly as structured.

Insurers collect premiums upfront.
Physicians deliver care first and collect second.

Every day of payment delay is a day that money sits on an insurer’s balance sheet earning a return.

Multiply 150 days of average delay across 1.46 million annual disputes.

The question isn’t why the system is slow.

The question is why we assume slowness is the problem rather than the product…

https://open.substack.com/pub/dutchrojas/p/they-called-it-patient-protection?r=3mc0ds&utm_medium=ios&shareImageVariant=card

05/28/2026

We don’t have a healthcare cost crisis. We have a healthcare pricing crisis. Costs are knowable. Prices are hidden. An exchange makes prices visible. That’s it. That’s the revolution.

05/28/2026

Most generalist VCs can’t tell you what an EHR workflow actually looks like.

They’re allocating billions on tools physicians will never touch.

US digital health Series B raises through Q3 2025: 30. Three-year average: 63.

The middle of the funding stack collapsed because generalist capital can’t underwrite what it can’t read clinically.

That gap is the entire PhyCap thesis.

Physicians who diligence companies before they fund them have a structural edge capital alone can’t replicate.

Fund I closes May 31, 2026.

05/27/2026

Congressional hearings are the most efficient pressure-release valve in American policy.

Public anger builds.
Reporters publish.

A chairman calls a hearing.
Executives sit at the table for four hours.

Three news cycles later the story is dead and the underlying economics are untouched.

Jason Smith did this in April.

The 501(c)(3) hospital tax exemption is worth roughly $40B a year.
Zero of it moved.

05/27/2026

400 people applied to advise CMS on healthcare reform. They picked 18. None of them run a medical practice. And more than half are on subsidized big health payroll. The committee is working exactly as designed.

Two health systems stand at the center of the Arizona Cardinals’ practice field.Dignity Health, a division of CommonSpir...
05/27/2026

Two health systems stand at the center of the Arizona Cardinals’ practice field.

Dignity Health, a division of CommonSpirit Health, holds 10-year naming rights to the Tempe training facility. Banner Health is the Cardinals’ official healthcare partner.

Combined, they employ over 220,000 people and generate over $56 billion in annual revenue.

Neither pays federal income tax.

One just “transitioned” 351 jobs at a Colorado hospital and closed its emergency room. The other owes its communities $923 million in undelivered community benefits.

Both write checks to the NFL.

This approach represents market capture, structured through a 501(c)(3) nonprofit model.

https://buff.ly/7udY6Dv

05/27/2026

A fortress balance sheet in healthcare has four pillars.

Owned facility economics.
Owned insurance layer (captive or self-funded).
Owned data on patient outcomes and cost.
Owned distribution to employers or directly to patients.

Most physician groups own zero of the four.
Most health systems own three.

That gap is not destiny.
It is a capital formation problem.

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