Neurosurgeon Elad Levy on the efficiency gains when it comes to research and innovation outside the hospital system.
Sorry too busy counting the 55,000 that died when Covid emergency subsidies to the ACA marketplace expired.
It’s not even clear to me it’s a bad thing when companies that aren’t making money do fail. It’s far worse for the consumer and taxpayer when zombie companies are kept alive.
I remember the catastrophe that was supposed to result when Hahnemann hospital in Philadelphia closed. We were reliably told by people that worked there the government had to act.
Companies (and the government) shouldn’t exist just to employ people.
Republicans will screw these things up just as often as Democrats. Which is why breaking up the health systems or the big health insurance companies would be a bad idea.
We should go after the regulatory drivers of these monopolies (there are many) rather than use the big brother government cudgel to break them up.
Is that why you tried to put doctors out of business and were sued by the AMA?
“Which is more important,” asked Big Panda, “the journey or the destination?”
“The company.” said Tiny Dragon.
Happy birthday 🎂 Dr. Venkatesh @serioustaurean.
Yesterday was Vinay’s last official day at FDA
I’m v grateful I had another chance to work w him over the last year
He’s brilliant, hilarious, creative & did transformational work at FDA
Thanks to him for his service-I look forward to following him on @Sensible__Med + more☀️
Welcome Back Vinay Prasad https://open.substack.com/pub/sensiblemed/p/welcome-back-vinay-prasad?r=n8zko&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true
Repeat after me:
More money and higher insurance subsidies will not fix the American medical system
More money and higher insurance subsidies will not fix the American medical system
More money and higher insurance subsidies will not fix the American medical system
More...
The ABA’s cartel-like control over law school accreditation drives up costs, limits access, and pushes ridiculous ideological mandates over merit.
Ending the Tennessee Supreme Court’s exclusive reliance will expand opportunity AND lower costs.
Great work @USAO_MDTN, @JusticeATR, and @FTC!
This is huge. The American Bar Association is an illegal cartel which for some reason has been given the sole authority to determine who can be an attorney and who can be a law school. Its illegal monopoly needs to be nuked.
Every time you see someone question the No Surprises Act, I want you to consider a few things:
1. The ~4.13 million federal IDR payment determinations (completed arbitrations) under the No Surprises Act represent an extremely small fraction of total U.S. healthcare claims—roughly 0.034%, or about 1 in every 2,900 adjudicated claims—over the same period (April 2022–March 2026).
2. Multiple analyses of CMS public use files and supplemental data show that independent physicians represent a small minority of initiators and determinations.
3. In various periods (2023–early 2025), the top 4–10 initiators (e.g., Radiology Partners, TeamHealth, SCP Health, Envision, and middlemen like HaloMD) account for 45–70%+ of disputes (often 50%+ in recent quarters). Many of these are PE-affiliated hospital-based staffing or specialty groups (emergency medicine, radiology, etc.). Facilities initiate ~20% of provider-side disputes in some periods. The remaining share (after top groups) is hospital-employed physicians.
Now, considering the foregoing, ask yourself why this is being framed, by certain lobbyist-adjacent “think tanks” and legacy corporate media, as a “windfall” for physicians that will drive premiums up?
Yes. And the subsidies grow on autopilot, with the taxpayer picking up nearly the entire premium increase over time.
For the median enrollee this year, the subsidy covers 94% of the total premium, leaving just $42 a month for the enrollee to pay.
Physician-led healthcare leaders from across the country found themselves at an impromptu PHA meeting in San Antonio last night after a busy day of enhancing healthcare for patients:
🏛️ @DrDiGiorgio (CA neurosurgeon) testified on affordability at the Texas Legislature.
🧠 @DrJohnCowan (GA neurosurgeon, congressional candidate) came together with neurosurgery colleagues from across the nation at the @AANSNeurosurg Annual Conference to share the latest advances in neurosurgery before heading back home to the campaign trail.
🏥 @DrBruggeman saw dozens of patients in San Antonio — putting Texans back in motion, back to work and back to the families and activities they love.
🎙️ @DutchRojas now officially a 'healthcare analyst,' per the media — carried the physician-led story through Tulsa, Houston and San Antonio.
These four came away with two conclusions at the end of the day:
1️⃣ Physician-led healthcare is great for patients.
2️⃣ San Antonio is one of the most exciting cities in the nation right now.
A long story about ACA enrollment and nothing about the large numbers of improper and phantom enrollees fails to provide vital context and presents a deeply misleading and inaccurate picture of the issue.
In 2025, there were 6.4 million improper ACA enrollees and probably about 4 million phantom enrollees. All well documented and researched.
In Florida, there are 5x as many enrollees in 100-150 FPL coverage as eligible and in Georgia it was nearly 3x!
There has been a huge number of enrollees in the last few years who used no medical care. Double the amount in a normal insurance market.
No mention of GAO's enrollment of 23 of 24 ficticious applicants in fully subsidized coverage.
No mention of CBO’s estimates of substantial improper enrollment in just a small set of non-Medicaid expansion states.
No mention of the three DOJ convictions of massive ACA enrollment fraud schemes.
No mention of the harm to people from unauthorized enrollment and enrollment switching.
No context to the pre-Biden Covid subsidy boost market.
No mention of the nearly 2 million people simultaneously enrolled in the ACA and Medicaid.
And of note, the median net monthly premium is only $42 nationwide with the underlying subsidy, which has grown massively on autopilot, covering 94 percent of the premium.
@jeffreytucker
For more info, see here: https://paragoninstitute.org/private-health/the-greater-obamacare-enrollment-fraud
Yes, undocumented immigrants get free health care.
The white supremacist Charlottesville rally was an SPLC operation?!?
There is just no way this is true, right ?
Completely asinine!
If you even raise an eyebrow in realtime about the obvious stupidity of the system, you get assigned anger management classes.
A pox on the slimy physician enablers of the system.
Yes. Funded, planned, coordinated
and executed.
SPLC was one of the most powerful censorship forces in the country for decades. Lavishly supported by many big American companies for many years. This is astonishing, and deeply concerning.
The NYPD Tuesday named the 18-year-old who allegedly shot and killed 15-year-old Jaden Pierre as he was pistol-whipping the victim during a caught-on-camera beatdown at a Queens park
Zahir Davis, a member of the BG4 gang, is being sought in the shooting at the Nautilus Playground inside Ray Wilkins Park on Thursday, NYPD Chief of Detectives Joseph Kenny said at a media briefing. Police sources said the shooter has connections to Jamaica and may have fled to the Caribbean country after the shooting.
Pierre was attending a water-gun fight he helped organize over social media when an unidentified BG4 gang member recognized him from a previous brawl. Davis joined his fellow gang member in cornering Pierre against a fence, where they were filmed beating the teen as dozens of bystanders stood by recording the attack.
The assault ended when Davis drew a firearm and pistol-whipped the victim, causing his weapon to fire and Pierre to collapse with a gunshot wound to the chest. The Medical Examiner will determine whether the shooting was accidental, police said. [WHAT?]
“When you watch the video, he strikes him in the head with a gun, and as he comes down, the shot rings out,” Kenny said.
Kenny said the ongoing beef stemmed from a prior assault in which the same gang member that incited Thursday’s beatdown jumped Pierre in January. Friends of Pierre responded by beating the assailant in retaliation, the chief said.
The BG4 crew, short for Blitz Gang 4, operates in southeast Queens and is an offshoot of the Money World gang, which has historically feuded with the Snow Gang, Kenny said.
https://www.nydailynews.com/2026/04/21/nypd-names-suspect-amid-manhunt-for-killer-of-15-year-old-at-queens-playground/
What exactly does testing for Lp(a) have to do with MHT?
MHT - Menopause Hormone therapy.
Findings and Conclusions of the Inquiry into the Conduct of an IDF Soldier Who Damaged a Christian Symbol in Southern Lebanon
The inquiry found that during IDF activity in the area of the Christian village of Debel in southern Lebanon, an IDF soldier damaged a Christian religious symbol while another soldier photographed the act. Six additional soldiers were present at the scene and did not act to stop the incident or report it.
The inquiry determined that the soldiers’ conduct completely deviated from IDF orders and values.
The IDF expresses deep regret over the incident and emphasizes that its operations in Lebanon are directed solely against the Hezbollah terrorist organization and other terrorist groups, and not against Lebanese civilians.
From the moment the report of the incident was received, the IDF has been working to assist the local community in replacing the statue.
Accordingly, it was decided that the soldier who damaged the Christian symbol and the soldier who photographed the act will be removed from combat duty and will receive 30 days of military detention. The remaining troops who stood by have been summoned for clarification discussions that will be held later on, after which further command-level measures will be determined.
Procedures regarding conduct with religious institutions and symbols were reinforced to the troops prior to their entry into the relevant areas, and will be reinforced again for all troops in the area following the incident.
The findings of the inquiry were presented to the Chief of the General Staff and the Commander of the Northern Command.
The Chief of the General Staff condemned the incident and stated that it constitutes unacceptable conduct and a moral failure, far exceeding any acceptable standard and contradicting IDF values and the expected conduct of its troops.
Economists James Buchanan and Gordon Tullock warned everyone in the 1960s about the self serving bureaucracy and the rent seeking that have come to define Medicare.
@DrDiGiorgio explains on an upcoming episode of @DRsLoungePod
“It didn’t matter that he founded an anarchist group with a documented public record of violence, vandalism, and incitement against certain ethnic and religious groups.”
“They had accidentally interviewed a white person. They were not pleased.”
Universities need to lose every single tax dollar they get via grants and federally backed low interest loans.
These institutions can go to the many crackpot philanthropists who love this stuff for funding.
Competition will improve quality and cost. Doctors shouldn’t act like cartels. We should be happy to compete in an actual open market. Let the nurses hang up a shingle.
The patients must be informed and have the freedom to choose, though!
"Physician-owned hospital restrictions were never about protecting patients. Instead, they represented a legislative carve-out crafted to insulate hospital monopolies from meaningful competition — the political price necessary to secure pivotal votes for the ACA’s passage. The consequences have been diminished patient choice, growing costs and a lack of physician autonomy in providing care." @PostOpinions @DrDiGiorgio @anish_koka @DrBrian4Health
How an Obama-era restriction strengthens hospital monopolies https://wapo.st/4cRXUxM "
The stats here are kind of remarkable. BART's new fare gates have led to a 1,000-hour decline in clean up time; 41% drop in crime; and $10 million increase in projected revenue. https://www.theatlantic.com/ideas/2026/04/fare-gate-society-bart/686868/?utm_source=twitter&utm_campaign=ntatl&utm_medium=social
Young people just don’t understand.
Dr. Koka, I agree 100% with you. Average American medical graduates have almost $250k in debt and are willing to work anywhere to pay off their loans.
There are many residency programs in medicine/FP that simply need to fold. They often deliver poor quality training and are largely being used for cheaper labor
From the article: “I’d accept wait times of, say, ten weeks longer than today for elective hip and knee replacements, spinal fusions or disc repairs, cataract surgery, MRI scans, colonoscopies, and similar elective procedures.”
Patients have repeatedly demonstrated, with their wallets, that they are not willing to sacrifice that.
And there is no need to sacrifice that. With cash pay these things can be obtained cheaply and quickly.
This is just more central planning authoritarianism telling you, the patient, what you should sacrifice.
read my latest @PirateWires!
Let’s end Medicare funding for Residency training slots and then see what the shortage looks like.
We have too many residency programs that turn out specialists and hospitalists.
The market is completely distorted by Medicare reimbursement for procedures and Medicare funding of residency training.
End GME funding (another give away to the hospital-industrial complex that’s bleeding America dry) and you get a much better sense of what training programs actually need to exist.
Justice has finally been served, though the heart remains heavy. Four yrs after the tragic loss of Karthik, a Canadian court has found his killer guilty of 1st-degree murder. While no verdict can fill the void, this is a monumental step for our family. Rest in peace, little bro
Only one chance in this lifetime…
Like watching sunset at the beach from the most foreign seat in the cosmos, I couldn’t resist a cell phone video of Earthset. You can hear the shutter on the Nikon as @Astro_Christina is hammering away on 3-shot brackets and capturing those exceptional Earthset photos through the 400mm lens. @AstroVicGlover was in window 3 watching with @Astro_Jeremy next to him.
I could barely see the Moon through the docking hatch window but the iPhone was the perfect size to catch the view…this is uncropped, uncut with 8x zoom which is quite comparable to the view of the human eye. Enjoy.