Dutch Rojas - Healthcare

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Dutch Rojas - Healthcare American healthcare isn’t broken. It’s built this way. I show you the receipts, daily. Founder ·· 🇳🇱→🇺🇸 [email protected].

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

10/20/2026

UnitedHealth cleared more than $4 billion in a single quarter and raised its forecast. Competitive markets do not produce numbers like that.

Competition grinds margin down. A rival prices under you and the fat erodes. That did not happen here, and the reason is built into the structure. Medicare Advantage, Medicaid managed care, and the pharmacy benefit business run on government contracts and government rules, not on a customer who shops on price.

The patient rarely pays the insurer directly and almost never sees the number. Wall the buyer off from the price and the price holds.

In the same week UnitedHealth reported that profit, Pennsylvania sued the three largest pharmacy middlemen over insulin pricing. Those three control roughly 80 percent of that market. One of them, OptumRx, is a UnitedHealth company.

The spread a state now calls a scheme and the margin UnitedHealth just reported are the same dollars counted from two ends.

The squeeze physicians feel is a closed market protecting the people who wrote its rules.

A free market would have erased that $4 billion years ago. It is still sitting there because the market was never free.

10/20/2026

Eli Lilly wants to see the receipts before it hands over a discount.

In any normal market, that's called doing business.

Some manufacturers now ask tax exempt corporations aka “hospitals” for claims data before honoring 340B pricing, to confirm they aren't paying the same discount twice.

The tax payer funded businesses sued.

On October 8, the industry split into dueling amicus briefs.

Here's what the fight exposes.

When a price is mandated instead of negotiated, no one trusts the numbers, so you get permanent audit warfare instead of a transaction.

A seller that can verify what it's paying for isn't the villain.

It's the one party in this program still acting like a business…

10/20/2026

Imagine paying the hospital CEO in gratitude and giving the nurses the bonus.

The compensation committee would immediately discover the limitations of appreciation.

There would be a serious discussion about market rates, retention, responsibilities, and the risk of losing talented leadership.

All perfectly reasonable subjects.

I’d enjoy hearing the same vocabulary applied with equal enthusiasm to the people working the night shift.

Thanking employees matters. So does staffing the floor adequately, respecting their time, and paying them enough to stay.

If a pizza party is such a compelling retention strategy, try it on the executive search firm…

10/19/2026

A hospital getting a discount on your medicine and you getting a discount on your medicine are two different events!

The patient has every reason to ask whether they will occur on the same day.

340B gives eligible organizations access to discounted drugs.

The defense of the program rests on what that purchasing advantage allows them to do for patients.

Fine.
Follow the benefit all the way through.

A lower acquisition cost tells us what the organization saved.

We still need to know what the patient received.

If the benefit funds other services, name them and show the results.

The hospital’s purchase receipt cannot do all the talking for the patient’s bill…

10/19/2026

I’m curious about politicians who promise cheaper healthcare while defending barriers to opening a competing facility.

What exactly is the plan?

Are we waiting for the existing hospital to become less expensive out of gratitude?

A new business offering the same service for less gives the incumbent a reason to reconsider its price.

Another speech about affordability gives it something to sponsor.

Public officials can demand safe care without protecting existing businesses from the inconvenience of a better offer.

I’d like to hear an affordability speech delivered at the opening of a new competitor.

Preferably with the incumbent hospital’s lobbyist somewhere in the audience, looking uncomfortable.

10/19/2026

Physicians, you keep asking insurers to send you patients.

Have you met the employers paying the premiums?

An employer has people who need care and a budget that gets harder to defend every year.

You have the ability to diagnose, treat, and help those people.

That seems like enough common ground for an introduction.

Start with something you can actually deliver: a defined service, an agreed price, and appointments employees can get.

Give the employer something concrete to buy.

It’s peculiar how much time healthcare spends discussing access while the person paying for the care and the person delivering it have never had lunch.

We regret to inform you that a patient has discovered our drug discount.Naturally, she assumed it would lower her bill.W...
10/18/2026

We regret to inform you that a patient has discovered our drug discount.

Naturally, she assumed it would lower her bill.

We explained that the discount supports our mission. She asked whether she was part of the mission.

An uncomfortable start to the appointment.

She suggested that if the manufacturer accepts less money for her medicine, perhaps we could accept less money from her.

We assured her that the savings help us serve vulnerable patients.

She mentioned that she was a vulnerable patient. Apparently, she had brought her bank statement.

We explained that we evaluate the benefit at the institutional level. She asked whether she could pay her bill at the institutional level.

At this point, we invited someone from patient experience to join us.

She has a compelling story. With her permission, we’d like to feature it in our next fundraising campaign.

Her bill remains due Friday.

10/18/2026

I wonder how expensive healthcare would be without all these companies negotiating the price down.

Employers pay for insurance, brokerage, consulting, networks, and administration. Somewhere underneath all that help, a physician still has to see a patient.

Every intermediary can explain why its particular contribution is essential.

I’d enjoy getting them all in one room and asking for the price before everyone helped.

Then invite an independent physician to quote the actual care.

An employer buying a defined service directly from a physician practice gets to ask some wonderfully ordinary questions:

What does it cost?
What’s included?
When can my employee get an appointment?

These questions become surprisingly difficult once enough experts get involved.

I build businesses that help physicians and employers.

I’m quite comfortable applying the same test to mine: after you pay us, are you better off?

Perhaps we could afford the care if we stopped paying for help that cannot answer that question.

10/18/2026

A physical therapist can sell an employer a block of next year’s appointments today.

Airlines, hotels, and restaurants have been selling Tuesday before Tuesday arrives for quite some time.

Healthcare may survive the experiment.

10/18/2026

Physicians will sell their entire practice to get the purchasing power of a larger organization.

Have we tried buying things together before selling everything?

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Phoenix, AZ

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