America’s health insurance cartel is hiding in plain sight.
Eight companies now control OVER HALF the market.

And they’ve turned your premiums into Wall Street gold.

(Thread) 🧵... Since 2009, the seven public insurers that survived the last crash returned between 93% and 1,076%.

You read that right: 1,076%.

2/

Free money.
Fake valuations.
Fantasy startups.

Bill Gurley just rang the bell:

The party’s over.
Welcome back to capitalism.

Here’s the macro reset every founder, LP, and partner needs to hear.

And for those of you who run an independent medical practice this is essential knowledge.

A thread… 🧵 Between 2008 and 2021,
capital lost its mind.

Cheap money was everywhere.

The Fed flooded the system,
rates plummeted,
and venture firms raised faster than they could Google “due diligence.”

What followed?
Delusion.

Valuations broke from gravity.
Growth eclipsed margins.

Narratives outpaced actual numbers.

1/

Warren Buffett just put $1.6 BILLION into UnitedHealth.

Not to fix healthcare.
Not to make it cheaper.

But to profit from the system exactly as it is, broken, bloated, and impossible to escape.

This is anti-American behavior.

1/ 2/ UnitedHealth isn’t just an insurer.
It’s a vertical empire:

Insurance
Clinics
Data analytics
Pharmacy benefit management.

They bill everyone… and they bill big.

THE MAGNIFICENT FOLLY OF KNEECAPPING YOUR OWN DOCTORS

Lets call it “An accidental masterclass in bad policy”.

A 🧵….

Riddle me this:

How do you drive up healthcare expenses while making it harder to see a doctor?

Simple.

Just copy U.S. health policy for the past three decades.

It’s the bureaucratic version of setting your own house on fire and congratulating yourself on the warmth.

1/ Step one:

Make it a illegal for doctors to own the tools of their own trade.

The “Anti-Kickback Statute” , it sounds noble, right?

A crusade against corruption.

In reality?

Physicians may not own hospitals.

However,
Hospitals owned by universities, private equity, MBAs, and insurance companies may own everything in sight.

Funny coincidence.

2/

1/
BREAKING: The Medicaid-insurer model is collapsing in real time.

Centene: down 61%
Molina: down 55%
Humana: lost $300/share
UnitedHealth: down 46% YTD and under federal investigation

This isn’t just a sell-off.

It’s the end of the myth.

🧵 Let’s go. 2/
Centene (CNC):
Down from $80 to $28.
That’s a 61% implosion.

This was Medicaid’s golden goose.

Now?
They’re promising “profitability by 2026.”

Translation:
They were never actually profitable without political cover.

🧵 Health Systems didn’t beat independent physicians.

Health Systems bought Congress,
rigged the rules,
and outlawed competition.

Here are the 11 structural advantages that protect health systems and punish independent physicians.

This isn’t free-market healthcare.
It’s a policy heist.
👇 340B Arbitrage: $54B/year

Health Systems buy cancer drugs at 50% off.

Then bill insurers full price,
and pocket the spread.

Independents physicians?
Pay retail.

The result: buy the oncologist,
bill the difference.

1

Ever wonder how a “nonprofit” health system reports losses on Medicaid while building new towers and launching venture funds?

The answer lies in a little-known mechanism called Upper Payment Limit and it’s worth understanding.

Understanding UPL:
A $14 Billion Question

Let’s do a 🧵…. 1/ What is UPL?

Upper Payment Limit allows states to supplement Medicaid’s low base payments up to what Medicare would have paid for the same service.

Simple concept: Bridge the gap between two government payment rates.

The complexity lies in how states implement this.

Why do physicians keep taking the crumbs?

Why do some of the most intelligent, skilled people on the planet cower to payers, obey nonprofits, and beg for scraps from the system?

Let’s talk about how physicians were turned into silent labor and how to break the spell.

A 🧵…. Physicians aren’t weak.
But they’ve been programmed to behave like they are.

From day one of medical school, you’re trained to submit:

• Obey the attending
• Don’t ask about money
• Don’t challenge the protocol
• Just shut up and survive the gauntlet

It’s not education.
It’s indoctrination.

The Provider Tax Scam:
How States Launder Hospital “Taxes” Into Billions in Federal Cash
A legal scheme. A circular money flow. And a taxpayer-funded jackpot for nonprofit health systems.

Let’s break it down 👇 with a 🧵… Health systems say they “pay taxes to fund Medicaid.”

Sounds noble, right?
But here’s what actually happens:

Health Systems pay a provider tax to the state. The state sends it to Washington D.C.
Washington sends back 2–5x more.

Rinse.
Repeat.

1/

RFK Jr. is now America’s Health Secretary, controlling the agencies that set vaccine policy.

The individuals and the institutions they represent on these committees are not protecting public health.

They’re protecting the funding pipelines of their employers.

Let’s walk through the scam👇 a 🧵… You’d think RFK—Mr. “Medical Freedom”—would clean house.

Instead, he now oversees the same federal machinery that rigs vaccine policy in favor of a few massive health systems.

It’s not about science.
It’s not even about pharma.
It’s about institutional revenue flows.
1/

The Medicaid Grift Nobody Wants to Talk About

It starts in Westwood.

A patient walks into UCLA Health for a routine checkup—CPT 99213.
Fifteen minutes.
Maybe less.

The patient thinks she’s seeing a doctor.

What she doesn’t know?
She’s stepping into one of the most profitable transactions in American healthcare.

Let’s break it down.

A 🧵… Scene 1:
Same Patient, Different Doctor

If she’d walked into a small private clinic five blocks away…

The doctor would’ve billed Medicaid directly.
•Gotten paid $42.17.
•Covered rent, payroll, malpractice.

And probably lost $50 on the visit.

That’s not bad business.
That’s Medicaid.
1/

𝐒𝐇𝐎𝐏𝐏—𝐇𝐨𝐰 𝐒𝐭𝐚𝐭𝐞𝐬 𝐏𝐫𝐢𝐧𝐭 𝐚𝐤𝐚 𝐑𝐈𝐏𝐎𝐅𝐅 𝐓𝐚𝐱 𝐏𝐚𝐲𝐞𝐫𝐬 𝐔𝐧𝐝𝐞𝐫 𝐭𝐡𝐞 𝐆𝐮𝐢𝐬𝐞 𝐨𝐟 𝐌𝐞𝐝𝐢𝐜𝐚𝐢𝐝

The most elegant heist in modern American history—and almost no one in Congress can explain it.

Let’s dissect this scheme the way you’d dissect any imperial fraud:
With facts, flow, and a little fire.

A Thread...🧵 Imagine a 17th-century monarchy so broke it begins taxing its own nobility…
Only to send the money back with royal interest, using a fake charity as cover.

That’s SHOPP. Supplemental Hospital Offset Payment Program

A fake tax, a fake payment, and real federal cash.
1/

The Healthcare Vampire Squid:
How BlackRock & Vanguard Ate American Medicine
By @DutchRojas

While you’re fighting a denial at 2 AM, they’re making billions on your CPT codes.

This isn’t conspiracy.
This is Wall Street healthcare capture.

Let’s go.
🧵 2/ Start with a game:
Pick any major health insurer:

UnitedHealth
Elevance (Anthem)
Cigna
Humana
Centene

Now look up the top shareholders.
Same two names every time:

BlackRock. Vanguard.

On paper, Senator Rand Paul appears to be a free market ally: libertarian credentials, medical degree, vocal opposition to government overreach.

But when it comes to healthcare, where the most egregious examples of regulatory capture, price distortion, and monopolistic abuse reside, Paul’s record is, at best, indifferent.

At worst, it enables the very cartel behavior he claims to oppose.

This thread 🧵outlines the facts.
Not the slogans.
Not the soundbites.
Just the receipts.

@RandPaul The Myth of the Free Market Champion

Rand Paul brands himself as a crusader for individual liberty.

He’s built a national platform by opposing vaccine mandates, criticizing the NIH, and warning against federal overreach.

But behind the curtain, in the committee rooms where policy is shaped, Paul has consistently refused to engage on the actual market failures in American healthcare:

He has never led the charge to repeal the moratorium on physician-owned hospitals, despite being one of the only physicians in the Senate.

He has taken no action to champion site-neutral payments, the single most bipartisan policy lever to reduce price disparities and level the playing field between independent physicians and hospital-owned monopolies.

He has offered no support to repeal Certificate of Need laws in Kentucky despite Kentucky being one of the most CON-heavy states in the country.

He has not fought to expose 340B abuses, GME manipulation, or the way nonprofit health systems weaponize tax exemptions to crush competitors and consolidate power.
2/

UCLA Health (@UCLAHealth)

𝗧𝗵𝗲 𝗡𝗼𝗻𝗽𝗿𝗼𝗳𝗶𝘁 𝗧𝗵𝗮𝘁 𝗣𝗮𝘆𝘀 𝗟𝗶𝗸𝗲 𝗚𝗼𝗹𝗱𝗺𝗮𝗻 𝗦𝗮𝗰𝗵𝘀
𝘢𝘯𝘥 𝘎𝘪𝘷𝘦𝘴 𝘓𝘪𝘬𝘦 𝘎𝘰𝘰𝘥𝘸𝘪𝘭𝘭.

A thread 🧵 on velvet cartels,
tax-free empires and 𝘁𝗵𝗲 𝗹𝗮𝗿𝗴𝗲𝘀𝘁 𝘀𝗰𝗮𝗺 in California healthcare.
1/ @UCLAHealth 𝗨𝗖𝗟𝗔 𝗛𝗲𝗮𝗹𝘁𝗵 𝗶𝘀 𝗮 “𝗻𝗼𝗻𝗽𝗿𝗼𝗳𝗶𝘁.”

But 𝘣𝘦𝘩𝘪𝘯𝘥 𝘵𝘩𝘦 𝘩𝘢𝘭𝘰 𝘪𝘴 𝘢 𝘵𝘢𝘹-𝘢𝘥𝘷𝘢𝘯𝘵𝘢𝘨𝘦𝘥 𝘦𝘮𝘱𝘪𝘳𝘦:
• Sky-high prices
• Billions in real estate
• $2M+ executive payouts
• And some of the stingiest charity care in California.
2/

UnitedHealth just lost $288 billion.

The CEO vanished.
The DOJ is circling.

But sure, tell me again how “essential” they are.

A thread 🧵on the implosion of America’s biggest health insurer @UHC —and what it says about our system:
[1/] UnitedHealth ($UNH), the largest health insurer in the U.S., is under federal criminal investigation for possible Medicare fraud.

Stock is down 50%.
CEO Andrew Witty “resigned” for personal reasons.

Investors are stunned.
Patients?
Just trying to get someone to approve their MRI.
[2/]

𝗨𝗻𝗶𝘁𝗲𝗱𝗛𝗲𝗮𝗹𝘁𝗵𝗰𝗮𝗿𝗲 𝘄𝗮𝘀 𝘁𝗿𝗮𝗱𝗶𝗻𝗴 𝗮𝘁 $𝟲𝟬𝟬 𝗷𝘂𝘀𝘁 𝟰𝟬 𝗱𝗮𝘆𝘀 𝗮𝗴𝗼.
𝘛𝘰𝘥𝘢𝘺 𝘪𝘵 𝘤𝘭𝘰𝘴𝘦𝘥 𝘢𝘵 $308.01

𝗧𝗵𝗮𝘁’𝘀 𝗻𝗼𝘁 𝗮 𝗱𝗶𝗽.
That’s a controlled demolition.

Let’s talk about the “market correction” nobody’s calling what it is.

#HealthFinance #UNH @UHC 𝗥𝗲𝗮𝘀𝗼𝗻 𝟭:
𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝘂𝗻𝗱𝗲𝗿𝘄𝗿𝗶𝘁𝗶𝗻𝗴 𝗹𝗼𝘀𝘀𝗲𝘀 𝗶𝗻 𝘁𝗵𝗲𝗶𝗿 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗔𝗱𝘃𝗮𝗻𝘁𝗮𝗴𝗲 𝗯𝗼𝗼𝗸.

Translation:
The house bet on sick patients not being too sick.
The house lost.

Actuaries are re-running the numbers—and sweating.

But don't worry, there are some "influencers" on X on LinkedIn who know better.
Go ahead and buy the dip.
You said you were going to 3 weeks ago...

As usual, they were just talking
And they were wrong 3 weeks ago, and they are wrong today.

#MedicareAdvantage
#InsuranceMath
2/

Blue Cross Blue Shield of Michigan made $36.3 billion last year.

Did you know Blue Cross Blue Shield of Michigan is a NON PROFIT?

Their CEO walked with $15.7 million.

Charity grants to clinics?
$914,000.

Let’s talk about the nonprofit lie in healthcare.

A thread...🧵 That $914K in grants is 0.0025% of revenue.
It’s less than a rounding error.

Blue Cross Blue Shield extracted $36.3 Billion from the good people of Michigan and and will pay:

No income tax

No state taxes

No property taxes

FYI Michigan, your politicians suck.
2/

The U.S. healthcare system isn’t broken.
It’s an engineered scam, legalized corruption wrapped in non profit labels, lab coats, billing codes, and suits.

Here’s the one stat that proves it—and why you’re broke, sick, and still on hold with your insurer.

A thread..🧵 Big Pharma, Big Insurance, Big Medical Devices:

Together they employ 3,006 lobbyists in D.C.

That’s 5.6 lobbyists per member of Congress.

Not healthcare.
Corporate occupation.
(2/)

Saint Francis Health System: where “nonprofit” means $2 billion in assets, tax-free perks, and the most aggressive medical debt lawsuits in Oklahoma.

Jesus heals.
Saint Francis sues.

Let’s unpack how a “charitable” hospital plays the system like Goldman Sachs in scrubs:

A 🧵… First, the numbers:

Annual surplus: $129.1 million
Revenues: ~$1 billion
Net assets: Nearly $2 billion

That’s not a hospital.
That’s a healthcare empire.

And yet… it’s a nonprofit, so it pays zero in federal income taxes.
2/

You think your insurance denied your claim?

It didn’t.
Your employer did.

Here’s what most people don’t know about how health benefits work…

A 🧵 Over 65% of employer-sponsored plans are self-funded.

That means:

The employer pays the claims.
The employer designs the plan.
The employer benefits when care is denied.
2/