You could be an excellent surgeon ten minutes from someone’s house. They may have absolutely no idea you exist. Go live. “I replace hips and knees here in Dallas. Today, I’ll explain what you should ask before agreeing to surgery.” Explain your approach. Discuss recovery. Explain when surgery makes sense and when you recommend another option. Let people hear how you think. Then tell them where to find you.

The number one reason healthcare is so expensive is not tax-exempt hospitals. It is not insurance companies. It is the incentives created by government. At an independent physician’s office, Medicare makes one payment. For services delivered through a hospital outpatient department (HOPD), Medicare makes two payments. Here is an example: Lumbar epidural in a physician’s office: $256. The same procedure through a hospital outpatient department: $741. Nearly three times the payment! It’s utterly ridiculous to be $40 trillion in the hole and then pay 3x as much for the same thing. Same physician. Same patient. Same procedure. Different owner. Higher bill. Changing ownership triples the payment. That payment gap gives hospitals a government-funded reason to acquire physician practices. The more practices a hospital acquires, the more care it moves through the higher-paying system. This arithmetic is not difficult. Congress simply finds it inconvenient. Government rewards hospitals for acquiring physician practices. Congress banned physician-owned hospitals and froze most existing ones at their 2010 capacity. Apparently, physicians are trustworthy enough to perform the surgery. Owning the hospital is where Congress draws the line. Congress approves lawyers, MBAs, and Felons. Not physicians. Tax-exempt hospital systems pay no federal income tax, no state income tax and no property tax. Your grandmother pays property tax. She made the rookie mistake of not calling her house a hospital campus. Government also created 340B. In 2025, 340B covered entities purchased $100 billion in discounted outpatient drugs. That is what they purchased. It does not tell us what they billed. It does not tell us how much they made. The hospital buys the drug at the 340B price. The hospital bills the employer the full contracted allowable amount. The patient pays a deductible or coinsurance calculated from that amount. The patient’s name unlocks the discount. The hospital keeps it. Acquire an oncology practice. Extend the discount. Keep the spread. In 34 states and Washington, D.C., hospitals, ambulatory surgery centers and radiology centers must ask government for permission to open or expand. The incumbent hospital gets to object. Naturally. Who should decide whether a community needs competition if not the company facing it? Then politicians pretend to be surprised when independent physicians disappear, hospital markets consolidate and employer premiums rise. Hospitals and insurance companies are not innocent. Hospitals lobby to preserve these advantages. Insurers pass the resulting expense into next year’s premiums. Everyone follows incentives. Government chose these incentives. The people you elected wrote them into law, protected them for years and now hold hearings to discover who could possibly have done this. Want lower healthcare costs? Pay the same amount for the same service. Let physicians own and expand hospitals. End Certificate of Need laws. Make 340B discounts follow the patient. Americans must demand that government stop subsidizing consolidation and picking winners and losers. Washington pays hospitals more to consolidate, blocks physicians from competing, exempts the winners from taxes and then lectures America about greed.

EVERY LIE HIRES A BUREAUCRAT. Every scam writes a rule. Every theft installs a camera. Every fraudulent claim creates another audit. We complain when bureaucracy grows. We rarely ask what fed it. Someone lied, so now everyone needs documentation. Someone stole, so now everyone gets searched. Someone abused the freedom they received, so now nobody receives it. The bureaucrat did not always cause the problem. Sometimes the bureaucrat is the receipt. Dishonesty does more than harm the person who believed the lie. It raises the cost of freedom for every honest person who comes afterward. If we want fewer rules, we need more people who keep their word. If we want less supervision, we need more people who behave properly when nobody watches. People who govern themselves require less government from everyone else. Every act of dishonesty makes freedom more expensive.