“C'mon, it's Czechoslovakia. We zip in, we pick 'em up, we zip right out again. We're not going to Moscow. It's Czechoslovakia. It's like we're going into Wisconsin.”
I love 340B.
As a nonprofit hospital administrator, I consider it one of the great miracles of American healthcare.
It started as a program to help vulnerable patients access medicine.
Then I found the spread.
I buy the drug at the 340B discount.
I bill the commercial plan at the regular rate.
I keep the difference.
The patient still has a deductible.
The employer still gets the renewal increase.
The manufacturer still gets blamed.
I get a new tower and a bonus!
That is called fulfilling the mission
And the best part?
I do not have to pass the savings to the patient.
I do not have to pass the savings to the employer.
I do not have to lower premiums.
I do not have to prove the vulnerable patient ever saw the benefit.
I just say “access,” put “community benefit” in the annual report, and everyone nods like I am running a soup kitchen with oncology margins.
That is the business model.
Rural when I want the subsidy.
Urban when I want the commercial rates.
Nonprofit when I want the tax exemption.
Monopoly when I negotiate with employers.
Charity when Congress asks questions.
Private equity when I buy physician practices.
Mission when the reporter calls.
Manufacturer gives the discount.
Employer pays full freight.
Patient pays out of pocket.
Hospital keeps the arbitrage.
Then I build a cancer tower and call it hope.
And when Congress gets too curious, my lobbyist calls it protecting access…
-Rojas out.
As an immigrant, I have spent 20 years trying to understand American tipping.
15%?
18%?
20%?
Tip on tax?
Tip before tax?
Tip the guy who handed me a muffin?
Jack Stack BBQ, here in KC, saw the World Cup coming and said: “Relax, Dutchman. We added 20%.”
Finally.
A country built by immigrants has created a tip friendly policy.
I’ve made millionaires. I’ve helped even more people earn six-figure paychecks.
The government hates people like me because we create without asking permission.
The left calls that exploitation. The right praises entrepreneurs, then protects every incumbent cartel that makes entrepreneurship harder.
Same cage.
Different sermon.
Time to change the rules.
The Waggoner Ranch was the largest spread under one fence in America. 510,000 acres. 14,000 head of cattle. 1,200 oil wells. A dynasty that lasted 160 years.
When billionaire Stan Kroenke bought it in 2016, the families living at Lake Diversion had been there for 50 years. They owned their cabins. They leased the land underneath for $1,500 a year.
Six months after the purchase, eviction letters arrived. Five months to vacate. No compensation. No negotiation.
Rick Ellis had just spent $20,000 renovating his cabin. He power-washed a foot of mud out himself. Laid every tile by hand.
His suicide note read: "Stan stole my home."
His wife Annette said: "My husband was worth more than all of your money, Stan."
It was entirely legal. That's the point.
The law does not require billionaires to care about the people whose lives they upend. It only requires them to follow the proper procedures while doing so.
This is what consolidation looks like. Not just cattle. Not just land. Lives.
I'm not mad at this tweet.
I admire it.
It's a clean piece of political warfare, and most people will never see the machine running underneath it.
Here's what it's actually doing.
First, it picks the sides before anyone votes: "doctors are melting down" assigns the uniforms: doctors are emotional and losing, the public is calm and free. A whole profession collapsed into one hostile bloc in four words.
Then it builds an enemy that can't win: no named doctor, no quoted objection. A specific complaint could be answered; a phantom can't, because there's nothing there to rebut.
Then it poisons the jury before the defense speaks. "Elitism about knowing best" pre-labels every physician rebuttal as villainy, so when a real doctor shows up with a real point, the crowd has already been told to ignore it.
Then it manufactures consensus, “it's very clear where the public stands," based on nothing, so dissent stops being a position and becomes deviance. You're not disagreeing with him, you're disagreeing with "the public."
Then it hides the weak claim behind the strong one. The aggressive claim is that a 20-minute prototype from an art company is great and doctors are elitists for doubting it. The retreat position is "you deserve your own data." Challenge the first, and he falls back to the second. The thing nobody argues with is armor for the thing everybody would.
Then it converts a product into a civil right. "As a sovereign individual" turns a scanner subscription into freedom itself, so opposing the gadget reads as opposing your liberty, and the mark picks up the sword and fights for him.
And it rigs the whole thing so the other side loses every way. Doctors object, "see, melting down." Doctors go quiet, "see, they can't defend it." Every exit is his.
Here's the part that matters: strip the populism, and this is corporate PR. Aim the crowd at a rival professional class so the anger never reaches the actual power, the platform that needs a billion scans a month to hit its number.
It's the same operation the PBMs, health systems, and insurers run on you every day.
The physician gets targeted in every version because the physician is the one class positioned to name the extraction out loud.
The structure is excellent.
It's aimed at the wrong target.
Generation Jones Translation Guide:
“Why are people throwing beads at each other?”
Sir, you’ve accidentally wandered into one of the few places in America where the answer to that question is simply, “Because it’s Tuesday.”
The first time I saw Bourbon Street, I spent twenty minutes trying to determine if there was an organized event happening. There wasn’t. That’s just Bourbon Street being Bourbon Street.
Somewhere right now a tourist is asking why people are carrying giant drinks, why a brass band just appeared out of nowhere, and why someone dressed as a pirate is arguing with Elvis.
Welcome to Louisiana. Please keep your hands and feet inside the cultural experience at all times.
There really aren’t any rules. You just go to court. If it fails, go to court again until a judge says you’re all set.
Want a 7th year?
Sure
Broke rules?
Ahhhh, it’s fine.
There AREN’T any rules.
"....to a place I belong" @WVUBaseball punches the first ticket to Omaha! We look forward to new fans and new faces and raising money to fight food insecurity in Morgantown! We've heard the Mountaineers and @PatMcAfeeShow know how to party. We'll find out next week! #roadtoRoccos
With respect, Congressman: you’re polling the internet to fix a problem you were elected to fix.
Ways and Means writes the hospital tax exemption.
You sit on it.
The systems eating private practice aren’t for-profit.
They’re nonprofit.
Tax-free.
“For-profit” is the decoy.
The exemption is the heist.
You don’t need our opinion.
You have the pen.