Kris Oliver

[Murray Rothbard @MurraySuggests]

The Iranian navy, which has been destroyed eight times, has apparently closed the Strait of Hormuz again, because the United States, for the seventh time, won the war that wasn’t a war, so now the United States has to open the Strait of Hormuz that was already open before the not-war began.

The not-war began because Iran had uranium that was totally, completely, beautifully obliterated, so they can’t build the nuclear bomb they weren’t building, which is why the United States had to start the not-war it definitely didn’t start.

Now the United States, which has nuclear weapons, is threatening to use nuclear weapons to stop Iran from getting nuclear weapons, because nuclear weapons are far too dangerous for countries with nuclear weapons to allow other countries to have.

If the United States saw the United States doing what the United States does in other countries, the United States would invade the United States to liberate the United States from the tyranny of the United States.

[S.🎧 @1ssve]

People who post on LinkedIn and love their corporate career terrify me.

[Kris Oliver @koliver]

Interesting facts on @Rangers City Connects from the great @buddyebsen.

[Your Dark Companion @YDC_DFW]

Discover the story behind the colors! From cochineal red's ancient significance to the vibrant papel picado celebrating joy, explore the rich cultural tapestry woven into these designs. #CulturalDesign #Storytelling #ArtHistory

[Kris Oliver @koliver]

I approve this message.

[Miles Brundage @Miles_Brundage]

Diet Coke is a great human achievement

Delicious 100% of the time in canned/bottled form (but also customizable with fountain machines), produced and distributed at an unimaginable scale, probably OK for you, no animal-derived ingredients, loved across political + other lines

[Texas Rangers @Rangers]

Red Fridays are back!

In celebration of our City Connect debut tonight, repost for a chance to win this merch pack 🔥

[Kris Oliver @koliver]

Still painful...

[Baseball Bros @BaseballBros]

Best lineup that never won a World Series?

[Kris Oliver @koliver]

A+ tweet

[Christopher Hale @ChristopherHale]

To understand the Christian faith, we can go with the former gym front-desk worker turned blogger, or we can go with the Successor of St. Peter.

[Kris Oliver @koliver]

A+

[David French @DavidAFrench]

This isn’t just a little bit wrong. It’s spectacularly wrong.

Can we please stop believing that wealth — even vast wealth — grants a person any particular historical, moral, or cultural insight?

[Kris Oliver @koliver]

A good, albeit depressing, summary of healthcare in the USA.

[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.

[Peter Mallouk @PeterMallouk]

For the first time ever, the U.S. is spending more on interest payments ($1.23T) than on national defense ($1.16T).
The cost of past debt now exceeds the cost of protecting the nation.
The bill for decades of borrowing has come due.

[Cato Institute @CatoInstitute]

Immigrants and their US-born children use significantly less welfare per person than native-born American adults and their dependent children, a new report by Cato’s @AlexNowrasteh and @JeromeFamularo shows.

https://t.co/lLcJ02oyo3

[Barchart @Barchart]

The Top 1% of U.S. earners now have more wealth than the entire middle class

[Patrick Heizer @PatrickHeizer]

Not only has every Republican since Eisenhower increased the deficit...

But every Democrat since Carter has decreased the deficit.

[Steven Rattner @SteveRattner]

New data shows that over 86% of ICE arrests didn’t involve anyone accused or convicted of a violent crime.

cc: @CBSNews

[Saganism @Saganismm]

“You meet saints everywhere. They can be anywhere. They are people behaving decently in an indecent society.”

— Kurt Vonnegut

[Gandalv @Microinteracti1]

This video should unsettle anyone who takes the United States seriously as a nation.

Because it exposes something dangerous: the trivialization of the world's most consequential office. It shows how carelessly the power, credibility, and accumulated moral authority of a superpower can be squandered for a few seconds of viral attention.

In any other major democracy, this behavior from a head of state would trigger a constitutional crisis. Paris would burn. Berlin would convene emergency sessions. In the Nordic countries, resignation would follow within hours. Across functioning democracies, the public, institutions, and political class would recognize this for what it is: an assault on the dignity of the state itself. Leaders are not free to perform as entertainers without consequence. National honor is not personal property, it's held in trust.

But the United States is not just another country with a provocateur in charge. It is the linchpin of global order. It maintains formal alliances and security guarantees with forty to fifty nations. It underwrites the financial architecture, trade systems, and diplomatic frameworks that billions of people depend on daily. When the American president speaks—or posts—it doesn't land as satire, meme, or personal whim. It reads as a signal about what the country is becoming.

American power has never relied solely on carrier strike groups or economic output. It has rested on something more fragile and more valuable: trust. The belief that beneath domestic turbulence lies institutional seriousness, predictability, and a baseline commitment to dignity. That belief is now disintegrating in real time.

Millions of American companies operate globally. They negotiate multibillion-dollar contracts in environments where reputation is currency. Boardrooms in Frankfurt, Singapore, and Dubai aren't debating whether a post was clever—they're asking whether the United States remains a reliable partner. Whether agreements signed today will be honored tomorrow. Whether American leadership has devolved from institutional to purely theatrical.

Consider tourism, which sustains millions of American jobs—airlines, hotels, restaurants, museums, entire regional economies. Soft power isn't an abstraction. It materializes in flight bookings, conference locations, study-abroad programs, and decades of accumulated goodwill. A quiet, decentralized boycott doesn't require government action—only a collective sense that a nation no longer respects itself.

Now picture this image being studied by foreign ministers, central bank governors, defense strategists, and sovereign wealth fund managers. Picture them asking a coldly rational question: How do we write binding thirty-year agreements with a country whose public face will be this, relentlessly, for years to come? How do we plan for the long term when the tone is impulsive, mocking, and unbound by the gravity of office?

This is where the real calculus begins. Trillions in foreign capital depend on confidence that America is stable, credible, and rule-governed. That confidence is now being traded for what, exactly? Applause from an online mob? A dopamine rush from manufactured outrage? Content designed to dominate the news cycle rather than serve the national interest?

Every serious nation eventually confronts this choice: burn long-term credibility for short-term spectacle, or safeguard the reputation previous generations bled to build. The United States spent eighty years constructing an image of reliability, restraint, and leadership under pressure. That image wasn't born from perfection—it came from a visible commitment to standards that transcended impulse.

This isn't a partisan issue. Europeans who value democratic norms recognize something ominously familiar here. Americans—Democrat and Republican alike—who believe in responsibility and restraint should see it too. Power attracts scrutiny. Leadership demands discipline. A superpower cannot behave like a reality TV contestant without paying a price.

The presidency is not a personal broadcast channel. It's a symbol carried on behalf of 330 million people and countless international partners who never voted but whose lives are shaped by American decisions anyway. Every post either reinforces or erodes the idea that America can be counted on when it matters most.

So the question is no longer whether this is offensive. The question is whether this is who America chooses to be: a nation that trades a century of hard-won reputation for viral moments. A country that replaces statecraft with content creation. A republic governed like a season of reality television.

History offers a harsh lesson here. Great powers don't fall because enemies mock them. They collapse when they begin mocking themselves—publicly, proudly, and without grasping the cost until it's far too late.

Stay connected,
Follow Gandalv @Microinteracti1

[ᗰᗩƳᖇᗩ @LePapillonBlu2]

‘Til the day I die, I will never understand how this wasn’t the end of it, right from the very beginning.

[Amity @amitylee13]

We aren’t voting our way out of this.

[Cato Institute @CatoInstitute]

The US immigrant population generated more in taxes than they received in benefits from all levels of government every year from 1994 to 2023.

The Cato study provides the first-ever 30-year analysis of the fiscal effects of immigration on government budgets. Learn more from @David_J_Bier.

https://t.co/MfkUXoopp4