Issue #19: The 340B Spread
How hospitals buy drugs at steep federal discounts, bill insurers at full price, and keep $10.3 billion per year more than they deliver in documented charity care
Issue #18: Coding for Dollars
How hospital documentation programs shift Medicare discharges into higher-paying severity tiers, and the 1 billion dollars per year a faster recalibration cycle could recover
Issue #17: The Part B Pharmacy Premium
How Medicare Part B pays 1.8 times the international price for physician-administered biologics, generating $6.2 billion per year in recoverable savings
Issue #16: The Other 100 Drugs
Medicare negotiated 25 drugs. The next 100 brand products carry the same international price gap, and roughly $16 billion a year in recoverable savings.
Issue #15: The Facility Fee Scam
How hospital-owned clinics bill Medicare two to four times the office rate for the same procedure, and the $2.55 billion a year a site-neutral fix would recover
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Issue #14: The Specialist Tax
How a 30-year-old payment cascade overpays procedural specialty work relative to primary care and international peers, generating $28 billion per year in recoverable excess
Issue #13: The Nonprofit Lie
How $46 billion in annual tax exemptions flows to nonprofit hospitals that deliver less charity care per dollar than the for-profit chains paying full taxes
Issue #12: The Consolidation Tax
How hospital mergers raise commercial prices and pass $13 billion per year into employer premiums
Issue #11: The MA Overpayment
How Medicare Advantage gets paid more for the same patient
Issue #10: The Procedure Mill
How fee-for-service payment generates $7.6 billion per year in low-value Medicare and all-payer spending, and why New York pays 6.7x what Vermont does for the same evidence-poor procedures
Issue #9: The Employer Trap
How 32 years of premium growth moved $125,340 in wages through ERISA plans into the hospital-PBM-insurer stack, and what Form 5500 finally lets us measure