karieann

#dragonslayer living w/#StillsDisease & recurrent #parsonageTurnerSyndrome, Mom, Wife, retired Mental Health Clinician, #gohawks #woopig #wps #seausrise

[karieann @karieann40]

@voteholyk That will require the GOP to nominate electable candidates. They can’t stop picking losers. Anti-choice/right wing/conspiratorial candidates who spend their time shit posting won’t win. So we’re stuck. Dems will vote to repeal that tax but they won’t ditch the party.

[karieann @karieann40]

@SaveOurSheriff False. Seattle is not a shithole.
Also, MAGA takeover of the GOP guarantees single party rule for the foreseeable future, which sucks for everyone. GOP refuses to nominate electable candidates.

[karieann @karieann40]

@BrandiKruse Stop politicizing every fucking thing. People WANT to feel patriotic and good about the country and this event brought that desire out in people. Something for us to be proud of. Not proud of the anti democratic regime. Trump sucks. That doesn’t mean people hate the country.

[karieann @karieann40]

@CarrieMyHart Gas in Washington has been dropping for the last 2 weeks and today it’s 4.89.

[karieann @karieann40]

@SaveOurSheriff @elonmusk You’d rather have a trillionaire from South Africa buy the state than nominate reasonable candidate. Fiscally conservative, socially moderate, a plan for the future, and no MAGA conspiracy nuts. Can’t have that.

[karieann @karieann40]

@coupz4242 @voteholyk @PattyMurray You weren’t forced into it. It was adopted over a course of years, voluntarily, county by county, until it was passed in the leg on a bipartisan basis.

[karieann @karieann40]

@voteholyk @PattyMurray If you win the nomination, you’ll be the latest unelectable candidate from the failed WA state GOP. Sucks because single party rule is bad for everyone. We will never elect a proud Trump supporter to the Senate. That you think so illustrates your lack of political acumen.

[Hunter Biden @HunterBiden]

So let me get this straight.

Jake Tapper is focused on attacking my Mom.

Jared and Ivanka are building a private island paradise on Albanian protected land.

Don Jr married the daughter of Epstein’s banker, and a startup his fund backs just got a record $620M Pentagon loan.

Eric is taking an Israeli drone company public for $1.5B in the middle of a war with Iran that nobody wanted.

And I know: “But what about your paintings, Hunter?”

Please.

[Eric Topol @EricTopol]

The ramp up of cancer immunotherapy is remarkable. Now we're seeing vaccines achieve some cures or remissions in the most refractory cancers: pancreatic, melanoma, glioblastoma, renal, triple-negative breast cancer.
✓ out the new Ground Truths (link in profile)

[karieann @karieann40]

@4Wahoo98242 @AdamSchefter @SethWickersham 41 states have personal income taxes. I think that aspect is overblown.

[karieann @karieann40]

@apprentice339 @AdamSchefter @SethWickersham Wow. How do the 41 states with personal income taxes manage to have professional sports?

[karieann @karieann40]

@weheartseattle Officers don’t ITA. Did they have the DCR evaluate? She clearly meets criteria under 71.05. Contact the AG? Her friend, unfortunately, needs to stop helping and allow her to deteriorate. The law isn’t the problem. Its application of the law and availability of beds.

[karieann @karieann40]

@rkelly91021 @saveoursheriff Start arresting who? For what? Legislature passed this and Gov signed it. Lawlessness to combat lawlessness is not the answer. The justice system and the voters can undo this.

[karieann @karieann40]

@elbro35 @saveoursheriff He testified against the legislation and posted about it again after it was signed into law.

[karieann @karieann40]

@WAPolicyGreen Protest in Longview collected food and diapers. They demonstrate weekly and collect these items. So both things can happen. From a Dem to you, pls nominate electable candidates. We need a functional opposition party. Single party rule sucks. But MAGA ain’t it.

[karieann @karieann40]

@BrandiKruse Righteous anger isn’t victim hood. 4 years of Trump truck rallies, boat rallies, vicious and violent imagery against Biden. And Trump still bitches, complains and blames Biden. Somewhere along the line, you turned into a run of the mill, right wing podcaster, just after clicks.

[karieann @karieann40]

@BrandiKruse Yeah, the protests are poorly named. “King Bob” was also elected. Not a king, either. Should’ve just called it a “fuck Trump” rally.

[karieann @karieann40]

@TheLancetRheum @pieroruscitti1 @StammTanja @v_ritschl How can I access this information without paying or subscribing? I am a patient with AOSD. Can someone share this with me?

[Peter Girnus 🦅 @gothburz]

I placed $1.5 billion in futures at 6:50 AM.

Fourteen minutes before President Trump's Truth Social post. That's generous. Usually, I get five.

The S&P was barely breathing. Premarket Monday. The kind of quiet where a single order echoes through the entire book. I bought $1.5 billion in futures. The index moved 0.3% on my entry alone.

That's how thin the market was.

That's how empty the room was.

At the same time, I shorted $192 million in crude oil.

Then I sat there. Three screens. One coffee. The futures blinking green on the left, the oil contract bleeding red on the right, and in the center, a Truth Social feed set to refresh every four seconds. Fourteen minutes is a long time when you know what's coming.

Not because I was nervous.

Because I was early.

At 7:04 AM, the president posted. Productive discussions. Five-day halt on strikes. Peace talks with Iran.

S&P jumped 2.5%. Oil cratered 6%. My position gained $60 million before most Americans' alarm clocks went off.

Good morning.

Iran later denied that the talks ever happened. Called it fake news. The speaker of their parliament accused the president of manipulating financial markets.

The talks might not be real.

The sixty million dollars is.

The analytics accounts flagged it within the hour. "Unusual activity." "Orders 4-6x larger than anything else trading at the time."

That's their word for it. Unusual.

My word for it is Tuesday.

They always flag it. That's their function. Flagging is not investigating. Flagging is the system's way of noting that it saw something, documenting that it will do nothing, and calling that process oversight.

The actual investigation is conducted by the CFTC. The CFTC has one commissioner. Out of five seats. One.

The other four chairs are empty. Not vacant. Emptied. There is a difference. Vacant means nobody applied. Emptied means somebody decided the body responsible for policing futures markets should not have enough members to hold a vote.

That's not negligence. That's architecture.

You know what we call this pattern on the desk? TACO. Trump Always Chickens Out. Escalate on Friday, capitulate on Monday, and extract in the window between the decision and the post.

It's so reliable, we named it. We have a private Slack channel. #taco-tuesday. It updates automatically when Truth Social pushes a new geopolitical keyword.

We don't teach it as insider trading. We teach it as a market structure. New analysts learn it in their first week. By the second week, they stop flinching.

The phone rang at 6:47 AM. Three minutes before I entered the position. The call lasted ninety seconds.

Ninety seconds of context. $60 million of outcome.

You call that insider trading. I understand why. Insider trading is the word you learned. It's the crime from the movies. The whispered merger at a cocktail party. Four hundred shares of a mid-cap pharmaceutical. That gets prosecuted.

That's the version of this crime the system was built to catch.

What I do is different.

I place $1.5 billion against a war decision made in a room I have the phone number to. On a platform overseen by a commission with one member. In a market where the president's social media account is the most powerful price-setting mechanism on earth.

That's not insider trading.

That's infrastructure.

You would go to federal prison for trading on a tip from your brother-in-law. I made $60 million trading on a war. The difference is not the crime. The difference is the decimal point.

Americans paid for this war with four-dollar gas and sixteen billion in taxes. I paid for a phone call. We are not in the same economy.

Last month, $529 million was wagered on Polymarket's Iran strikes market. Six accounts pocketed $1.2 million. Deposited funds the same day. Hours before the bombs fell. One account cleared $553,000 at 17% odds, seventy-one minutes before public confirmation. He has not placed another bet since.

The president's son sits on Polymarket's advisory board. Two federal investigations into the platform were quietly dropped this year. Twelve government officials sold stocks in the weeks before the tariff crash. All of them reported the sales after the deadline.

Nobody calls any of that insider trading. They call it prediction markets. Delayed disclosures. Portfolio rebalancing. I call it the junior varsity version of what I do with futures.

An Oxford law professor called it the most far-reaching securities fraud in history. We call it the window.

Tomorrow, this will be gone. Buried under a new tariff. A new ultimatum. A new TACO. Next Monday at 6:50 AM, I will be here again. Coffee. Three screens. The phone. The ninety-second call. The fourteen-minute window.

The game isn't rigged.

Rigged implies something broke. Nothing broke. Every component is functioning exactly as specified. The one-member commission. The anonymous platforms. The four-second refresh on the Truth Social feed. The phone that rings at 6:47.

I didn't exploit a flaw in the system.

I am the system.

[Peter Girnus 🦅 @gothburz]

I am Sam Hazen, CEO of HCA Healthcare. The largest for-profit hospital system in the United States.

One hundred and eighty-two hospitals. Twenty states.

I oversee a spreadsheet called the chargemaster. It has 42,000 line items. Each line item is a price. The prices are not real.

I need to be precise about that. They are not estimates. Not approximations. Not market rates. They are anchors. An anchor is a number you set high so that every negotiated discount feels like a victory. No relationship to cost. No relationship to value. A relationship to leverage.

My team sets the anchors. That is the job.

The price is correct.

Take a drug. Keytruda. Immunotherapy. Treats sixteen types of cancer. The manufacturer charges approximately $11,000 per dose. That is the acquisition cost. What the hospital pays.

My team enters it into the chargemaster. They do not enter $11,000. They enter $43,000.

That is the gross charge. The gross charge is a fiction. No one pays it. No one is expected to pay it. The gross charge exists so that when Blue Cross negotiates a 68% discount, they pay $13,760, and the contract says "68% discount" and both parties feel the transaction was rigorous.

A 68% discount on a fictional price produces a real price that is 25% above acquisition cost. That margin is where I live. My 2025 compensation was $26.5 million. Eighty percent of my bonus is tied to EBITDA. Earnings Before Interest, Taxes, Depreciation, and Amortization. It is also earnings before the patient opens the bill.

Same dose of Keytruda at the hospital across town. Gross charge: $12,000. Blue Cross rate: $10,200. Same drug. Same dose. Same needle. Same cancer. Different spreadsheet.

The CMS transparency data showed the ratio between the highest and lowest negotiated price for the same drug at the same hospital can reach 2,347 to one. Not 2x. Not 10x. Not 100x. Two thousand three hundred and forty-seven to one. For the same thing. In the same building. On the same Tuesday.

The price is correct.

Every drug in the chargemaster has twelve prices. Twelve.

Gross charge. Medicare rate. Medicaid rate. Blue Cross. Aetna. Cigna. UnitedHealth. Humana. Workers' comp. Tricare. Auto insurance.

And the self-pay rate.

The self-pay rate is for the person without insurance. It is the gross charge. The fictional number. The anchor. The person without insurance pays the number that was designed to be negotiated down from. They pay the ceiling because they have no one to negotiate on their behalf. Same drug. Same chair. Same nurse. They pay the price that no insurer in the country would accept.

I maintain a file. CDM line item 637-4892-PKB. Saline flush. Sodium chloride 0.9%. Acquisition cost: $0.47. We charge $87. That is an 18,410% markup.

The saline flush is used before and after every IV infusion. A chemo patient receiving twelve cycles will be charged $87 for saline fourteen times per visit. I know the math. My team built the math. The math is the job.

The price is correct.

In 2021, the federal government required hospitals to publish their prices. The Hospital Price Transparency Rule. Machine-readable file. Gross charges. Discounted cash prices. Payer-specific negotiated rates.

We complied. We posted the file.

The file is a 9,400-row CSV on our website under "Patient Financial Resources." Four clicks from the homepage. Column F: "CDM_GROSS_CHG." Column J: "DERV_PAYERID_NEGRATE." My team designed the column headers. They designed them to comply. They did not design them to communicate.

CMS reported 93% of hospitals now post a file. Compliance. But only 62% of the posted data is usable. That gap is where we operate. We are compliant. The data is published. The data is incomprehensible.

A researcher downloaded our file. She spent three weeks cleaning it. She called the billing department for clarification on 340 line items. They transferred her four times. The fourth transfer was to a voicemail box that was full.

She published her analysis anyway. Cardiac catheterization lab charges: $8,200 to $71,000 for the same procedure depending on the payer. The report received eleven views on our press monitoring dashboard. I saw it. I did not forward it.

On April 1, a new CMS rule takes effect. Hospital CEOs must personally attest — by name, encoded in the machine-readable file — that the pricing data is "true, accurate, and complete."

My name. Sam Hazen. In the file. Attesting that 42,000 fictional anchors are true, accurate, and complete. They are complete. I will give them that. Forty-two thousand line items is nothing if not complete.

A new analyst read the transparency data. She asked why the same MRI costs $450 for Medicare and $4,200 for Aetna in the same building on the same machine.

I told her the rates reflect negotiated contractual agreements between the payer and the facility. She said that doesn't explain the difference. I told her the difference IS the contractual agreement. She said that sounds like the price is arbitrary.

I told her the price is the result of a rigorous, multi-variable analysis that accounts for acuity, case mix, regional market dynamics, and payer contract terms. She asked if I could show her the analysis.

I told her the analysis is proprietary.

The analysis does not exist. The analysis is my team, in Q4, adjusting the chargemaster upward by the percentage the CFO wrote on a sticky note. The sticky note this year said "6-8%." They chose 7.4% because it is between six and eight and it has a decimal, which makes it look calculated.

She stopped asking.

The price is correct.

My insurance. The executive health plan. Not in the chargemaster. Administered separately.

I do not pay the gross charge. I do not pay the negotiated rate. I pay a $20 copay for services at our own facilities. Gross charge for my treatment: $14,200. Insured rate for our largest commercial payer: $8,600. I pay $20.

The executive health plan was designed by the Chief Human Resources Officer and approved by the compensation committee. I was not on the compensation committee. I was a beneficiary of it. That is a different thing.

I benefit from the system I price. I price the system I benefit from. These are two separate facts that happen to involve the same person.

HCA Healthcare was named the Most Admired Company in our industry by Fortune magazine for the twelfth consecutive year. That was February. The same month I sold $21.5 million in company stock and purchased zero shares. Fortune did not ask about the chargemaster.

I am Sam Hazen, CEO of HCA Healthcare. I have 42,000 prices in a spreadsheet across 182 hospitals. None of them are real. All of them are charged.

Same drug: $12,000 or $43,000. Depends on which spreadsheet. Which building. Which contract. Which page of which PDF.

The patient who has no contract pays the most. The researcher who found the discrepancy got a voicemail box that was full. The analyst who asked why stopped asking. The executive who prices the system pays $20.

On April 1, I will personally attest that this is true, accurate, and complete.

The price is correct. The price has always been correct. I am the price.