Issue #20: What Hospitals Actually Get Paid

Kansas 238%, Colorado 304%, New Mexico 355% of Medicare. Every hospital's negotiated rates, from the files they are required to publish, now free and searchable.

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

We've moved to americanhealthcareconundrum.com

The American Healthcare Conundrum has a new home, and you're already subscribed.

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

Newsletter

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

Newsletter

Issue #8: The Denial Machine

How insurers use prior authorization denials to extract $24 billion per year from Medicare Advantage patients

Newsletter

Issue #7: The GLP-1 Gold Rush

The fastest-growing drug class in history costs 3-5x more in America. We modeled what happens when Medicare starts paying.

Newsletter

Issue #6: The Supply Closet

Original analysis of 5,480 hospitals reveals $28 billion in addressable supply waste

Newsletter

Issue #5: The Paper Chase

How $200 billion a year in billing complexity and administrative overhead inflates U.S. healthcare costs

Newsletter

Issue #4: The Middlemen

How Pharmacy Benefit Managers extract $30 billion a year from the drug supply chain, and what to do about it

Newsletter

Issue #3: The 254% Problem

Why a hip replacement costs $29,000 in America and $10,000 almost everywhere else

Newsletter

Issue #2: The Same Pill, a Different Price

Why nine top-spend Medicare drugs cost up to 581x more in America than abroad

Newsletter

Issue #1: The OTC Drug Problem

How Medicare Part D overpays for brand drugs with cheaper over-the-counter equivalents