The Rojas Report

HCA wanted out. SSM spent six months on due diligence and walked away without making an offer. Then the state of Oklahoma intervened and paid 10% above the asking price.

This episode breaks down the OU Health transaction: how the purchase price increased by $75 million between court approval and closing, why Moody's downgraded the system to junk status, and how $1.5 billion in debt now rests on Oklahoma taxpayers.

The pattern isn't unique to Oklahoma. University of Michigan, Banner Health in Arizona, Vanderbilt in Tennessee. Public entities continue to acquire hospitals that private operators are desperate to sell.

The question nobody asks: If the smartest money in healthcare is selling, why is your government buying?

In this episode:

• The HCA signal: what it means when for-profit operators exit a market
• SSM's six-month due diligence and silent walkaway
• The mysterious $75 million price increase with no documented court approval
• How 340B and Medicaid supplemental payments became the new business model
• Moody's B3 downgrade and what "junk status" actually costs
• Why legislators are now talking about "bailing out" their own purchase
• The national pattern: Michigan, Arizona, Tennessee, and beyond

When HCA loses money, shareholders bear the brunt of the loss. When OU Health loses money, you pay.

Subscribe to The Rojas Report: dutchrojas.substack.com

60,000+ physicians and healthcare operators read it daily.

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

While everyone watched the front door for private equity, the house was being dismantled from the inside.

The GAO report is clear: More than 50% of physicians are now consolidated with hospital systems. Private equity? 6.5%. The real predator isn't on Wall Street. It's the massive nonprofit complex right down the street.

This episode prosecutes the case against university health system consolidation, what The Rojas Report calls "soft nationalization": the absorption of private medicine by entities so heavily subsidized by the state, so protected by tax exemptions, and so entangled with government funding that they function as an arm of the state.

IN THIS EPISODE:

→ The crime scene statistics: 30% consolidated in 2012 to 47% in 2024 → Why private equity is the convenient villain while nonprofits absorb half the profession → The $28 billion annual tax subsidy funding the takeover → Facility fees: how the same service costs 2x more after acquisition → Five economic frameworks explaining why this feels morally wrong → Ghost agencies moving $381 million with zero employees → The verdict for physicians staring at that contract on their desk

The pattern is repeating in Oklahoma, New York,  Michigan, Arizona, and Tennessee (All 50 states). 

The game is rigged. Knowledge is the only defense.

60,000+ physicians and healthcare operators read The Rojas Report daily. Join them: dutchrojas.substack.com

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

The best lack all conviction, while the worst are full of passionate intensity.

Yeats wrote that in 1919. 

It could have been written this morning.

This week's Deep Dive sits with a harder question: 

What if the people making the most critical decisions aren't villains? What if they're not evil at all? What if they're simply hollow?

We explore:

• The difference between evil and amoral
• When physicians stopped fighting back
• Profession vs. job: the inherited code vs. the transactional exchange
• Where moral architecture comes from (and what happens when those institutions collapse)
• Kipling's warning: the old truths always return

This isn't a how-to episode. No five hacks. No solutions. Just the questions.

If you're still listening, you're probably one of the people with the file.

Read the full essay: dutchrojas.substack.com

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

Seven states found a loophole to extract $24 billion annually from federal taxpayers while contributing nothing to Medicaid. California alone took $13 billion. The scheme was technically legal until January 29, 2026.

Dutch Rojas breaks down:

• The 157-to-1 tax ratio California used to game the system ($274/month for Medicaid plans vs. $1.75/month for commercial)
• How states used the B1/B2 statistical test as a "lockpick" for the federal treasury
• Why New York got a shorter deadline than other states (they were warned and did it anyway)
• The $13 billion hole in California's budget starting 2028
• Why your insurance premiums went up to subsidize this scheme
• What CMS Administrator Dr. Mehmet Oz did to shut it down

The winners: California, New York, Massachusetts, Michigan.

The losers: Federal taxpayers. You.

The scheme is over. Until they find the next one.

Read the full investigation: dutchrojas.substack.com

X: @DutchRojas

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

As you may know, Dutch Rojas is the co-founder of The Physicians Capital Fund (PhyCap).  PhyCap is a physician-led venture fund that invests in healthcare startups.  All General Partners, except Dutch, are practicing physicians.   He is hosting this debate today to provide additional value and exposure for tech and venture to his physician audience. 

Should venture capital be evaluated solely on financial returns, or is there a "hidden yield" that creates equal or greater value for physician investors?

In this episode, we debate the core tension every physician capital allocator eventually faces: Are we deploying capital to generate wealth, or are we buying professional sophistication? Can both be true?

POSITION A: THE SYNTHESIS VIEW Financial returns are the floor, not the ceiling. Venture capital delivers value on two tracks: capital appreciation and professional development. The non-financial returns — information asymmetry, network density, clinical credibility — compound independently and create strategic advantages traditional asset classes cannot replicate.

POSITION B: THE FIDUCIARY VIEW You can't pay a mortgage with insight. Venture capital is a high-risk, illiquid asset class. The fiduciary obligation to generate returns is the whole game. Pattern recognition and conversations are great, but they must translate to hard financial exits. Hidden yield is often marketing language for underperformance.

TOPICS COVERED:

• Information asymmetry: Does 24-36 month forward visibility into healthcare innovation have real value?
• Network effects: Is relationship density worth the management fees, or is it a glorified LinkedIn group?
• Clinical diligence: Should physicians care about helping fund managers do their job?
• Illiquidity: Is the 8-12 year hold period a bug or a feature for physician career trajectories?
• The compounding flywheel: Does early visibility actually lead to better practice decisions?

THE QUESTION WE LEAVE YOU WITH: Are you content with the spreadsheet view, or do you want to leverage your clinical edge?

"If this debate resonated, subscribe to the PhyCap Substack for weekly investment thesis analysis.

About Physicians Capital Fund: 

PhyCap invests $150K-$500K in Seed and Series A healthcare ventures focused on Clinical Care Delivery Workflow Optimization, Software as a Medical Device, and Women's Health.

Website: PhyCapFund.com 

Substack: PhyCapFund.substack.com 

LinkedIn: linkedin.com/company/phycap

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

Howard Kern retired from Sentara Healthcare in 2021. His payout: $33.2 million. Sentara is a nonprofit. Tax-exempt. A charity.

How does a charity write a $33 million check to its CEO?

A financial instrument called a SERP. A Supplemental Executive Retirement Plan. Your 401(k) limit: $23,000. Executive SERP limit: None.

This episode breaks down the forensic accounting of nonprofit hospital executive compensation:

THE MECHANISM: How SERPs let tax-exempt hospitals stockpile unlimited retirement funds for executives while regular employees hit IRS caps.

THE CONSULTANTS: SullivanCotter, Pearl Meyer, Gallagher. Three firms that create an upward-only benchmarking spiral. Every board aims for the 75th percentile. The spiral only moves up.

THE NONPROFIT PREMIUM: Maurice Smith at HCSC made $34.4 million. Andrew Witty at UnitedHealth made $26.3 million. The nonprofit CEO out-earned the for-profit CEO. With no shareholders. No accountability.

THE FAIR SHARE DEFICIT: $37.4 billion in tax exemptions. 2.3% spent on charity care. Kaiser Permanente alone has a $2.5 billion deficit.

THE PROTECTION RACKET: The AHA spent $29 million on lobbying in 2024. 55% of their lobbyists are former government officials.

This is Form 990 data. Names. Dollar amounts. Receipts.
Based on the "Good at Business" series from The Rojas Report.

Read the full investigation: dutchrojas.substack.com

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

You're staring at your 2025 P&L. Revenue flat. Expenses up 8-15% across the board. The profit margin that feeds your family is physically smaller than three years ago.

The consulting class says run a tighter ship. Cut the bagels. Code better.

That advice is a lie. You cannot efficiency your way out of a structural disadvantage.

This episode dissects the MedMerge Investment Thesis and breaks down the financial physics crushing independent medicine. A 50-person practice pays $480,000 more per year than an identical facility inside a hospital system. Same coverage. Same carrier. Same risk profile. The only difference is size.

That's not a market inefficiency. That's engineered economic pressure designed to drive consolidation.

IN THIS EPISODE:

• The invisible tax: why being small costs you $480,000 annually in insurance alone
• The PE trap: what really happens after the Patagonia vest shows up with a check
• The four-step playbook that turns practice owners into employees
• The goose and the grain silo: infrastructure aggregation without ownership surrender
• Captive insurance and the float: the Warren Buffett parallel that changes everything
• Pilot results: 85% reduction in Rx spend, $1.4 million returned to physicians in year one
• Economic gravity: why leaving costs $1 million+ (and why you won't want to)

The thesis argues you're currently funding your own demise. Every premium check hands carriers the capital they use to build their wealth while your margins shrink.

There's a third path. Not PE. Not hospital employment. Infrastructure coordination that makes independent practices unbuyable.

LINKS

📰 Read The Rojas Report: https://therojasreport.substack.com

🔗 Connect with Dutch:

• X: https://x.com/DutchRojas
• LinkedIn: https://linkedin.com/in/dutchrojas

EPISODE KEYWORDS/TAGS

independent medical practice, physician independence, private equity healthcare, captive insurance, healthcare economics, practice management, MedMerge, insurance float, healthcare consolidation, physician entrepreneurs

60,000+ physicians and healthcare operators read The Rojas Report daily. Join them.

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

A $12.5 billion industry. One million physicians paying in. And a wealth transfer hiding in plain sight.

In this episode, we break down the malpractice insurance market and expose the financial structure that separates the renters from the owners.

The data:

Berkshire Hathaway collects $2.2 billion annually from physicians who treat insurance as an expense. Meanwhile, 75% of hospitals run their own captive insurance companies and keep the profits.

The math is simple. A high-risk specialist paying $100,000/year in premiums over a 32-year career hands over $3.2 million. In the commercial model, they retire with zero equity. In the captive model, that same money compounds to $12.5 million.

Same premiums. Same career. One structure builds generational wealth. The other builds someone else's.

We cover:

• Why only 7 states mandate malpractice insurance (but 95% of doctors carry it anyway)
• The "going bare" physicians and how they structure around liability
• How hospitals turned a cost center into a profit center
• The 548,000 private practice physicians sitting on $6.9 billion in addressable opportunity
• Why consolidation is accelerating the wealth transfer away from independent medicine
• The emerging platforms lowering barriers to physician-owned captives

The full written investigation with the complete data breakdown: 

 DutchRojas.Substack.com 

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

A Sunday deep dive into the original meaning of freedom.

We trace the word from 1581 Dutch merchants to the American founders. What we found: freedom wasn't about self-expression. It wasn't about rights. It was about one thing.

A lack of dependency.

The Dutch called it "ware vrijheid." True freedom. It stood on three pillars: local governance, religious toleration (as a talent acquisition strategy), and freedom of enterprise without permission slips from kings or guilds.

The founders inherited this framework. They used the Latin term "sui juris," meaning "of one's own right." If your livelihood depends on pleasing a master, a boss, or the government, you can't be trusted to act for the common good. You're compromised.

Benjamin Franklin wrote: "Only a virtuous people are capable of freedom." Virtue meant independence. You had to achieve it first to even be capable of liberty.

Freedom is not what someone gives you. Freedom is what no one can take. Because you don't depend on them for it.

Based on the article by Dutch Rojas.

Read the full piece:  DutchRojas.Substack.Com

-Rojas out.

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas

A deep dive into The Rojas Report and its core thesis: 

American healthcare isn't broken, it's rigged. This episode prosecutes the case against the healthcare cartel, breaking down exactly how large hospital systems extract $275 billion annually through Medicaid supplemental payments, 340B drug arbitrage, site-neutral payment violations, and tax exemptions that benefit the wealthy empires while rural hospitals close.

You'll learn:

• Why Bill Gurley says Silicon Valley succeeded because it's 2,851 miles from Washington
• The Nobel Prize-winning concept of "regulatory capture" and how it crushes independent physicians
• How 340B transformed from helping AIDS clinics to an $81 billion arbitrage machine
• Why the same heart scan costs $150 at an independent office but $400 at a hospital-owned clinic two floors up
• The JAMA study showing 7.3% of nonprofit hospitals capture 50% of all tax benefits
• How the AHA's $29 million lobbying investment protects a 7,000% return

The Prime Directive: No one cares about healthcare policy. They care about getting screwed.

Action item: Look up your local nonprofit hospital's Form 990 on ProPublica's Nonprofit Explorer. Compare executive compensation (Part 7) to actual charity care (Schedule H). Then ask yourself if that looks like a charity.

Support the show

If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit:

👉 Stan.Store/DutchRojas