HCA Healthcare settled the largest healthcare fraud case in U.S. history. $1.7 billion. Their CEO now sits on the FAH board. The FAH lobbies for the physician-owned hospital ban. On patient safety grounds. FAH: Federation of American Hospitals represents the for profit health systems.

Site-neutral reform would save Medicare $157-180 billion over 10 years. The American Hospital Association (AHA) is stopping it. Lawmakers support the AHA. The calculation they're making is simple: $180 billion beats democracy. They're not wrong about the math.

In March 2010, Congress passed the Affordable Care Act. Buried deep inside was Section 6001. The provision banned new physician-owned hospitals from participating in Medicare. It froze existing physician-owned facilities in place. No new beds. No new operating rooms. No expansion. The American Hospital Association lobbied hard for this provision. Their argument: physician owners would self-refer patients to their own facilities, cherry-pick the healthiest cases, and leave traditional hospitals with the sickest and poorest patients. Members of Congress were paid off. The ban passed. Physician-owned hospitals, which had grown from 67 facilities in the early 2000s to roughly 250 by 2010, suddenly stopped growing.