Colin Cote

Here’s the funny thing about American healthcare policy… The Democrats keep saying they want to make healthcare affordable. Yet every policy lever they actually pull does the precise opposite. It’s rather like claiming you want to reduce traffic congestion while simultaneously banning bicycles and subsidizing Hummers. Consider Medicare reimbursement rates, possibly the most boring topic in politics, which is precisely why nobody notices what’s happening. The government pays hospital outpatient departments (HOPDs) MORE for the exact same procedure than it pays ambulatory surgery centers (ASCs). And it pays surgery centers (ASCs) MORE than it pays doctors’ offices for in-office procedures. Keep in mind: Same procedure. Same outcome. Wildly different payments depending on the building it happens in. Now, this creates a rather obvious incentive: independent medical practices sell to health systems to access the higher reimbursement rates. The government then acts shocked! I mean SHOCKED! - that healthcare costs keep rising and independent practices keep disappearing. It’s psychological genius, really. They’ve created a system where the rational economic choice for every doctor is the expensive choice for every patient. But wait, it gets better. In 2010, Democrats banned new physician-owned hospitals from opening. These would have been for-profit entities, taking their own financial risk, competing on price and quality. Dangerous stuff, apparently. Meanwhile, they continue funneling $125 billion annually in tax subsidies to “non-profit” hospital systems. You know, the non-profits with the private jets and stadium naming rights and CEOs earning $10 million. They had the presidency and Congress in 2009-2011. Then again in 2021-2023. Did they fix the payment disparities? Ban hospital consolidation? Reform non-profit requirements? No. They banned the competition instead. Here’s what fascinates me: This isn’t a case of “we tried but the Republicans blocked us.” Medicare payment rates are set by CMS - an executive agency. The Democrats controlled it for 12 of the last 16 years. They could have implemented site-neutral payments by Tuesday. They didn’t. So when politicians tell you they want to “save healthcare,” perhaps ask them a simple question: “From whom, exactly?” Because the evidence suggests they’re rather intent on saving health systems from the horror of competition, patients be damned. @HouseDemocrats @GOPDoctors @WaysandMeansGOP @SenateDems @GOPHELP @SenateGOP @elonmusk