Dutch Rojas: The $24 Billion Medicaid Heist

Dutch Rojas on the $825 Million Hospital Deal That Trapped Oklahoma Taxpayers

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 [https://stan.store/dutchrojas] If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit: 👉 Stan.Store/DutchRojas [https://stan.store/DutchRojas]

Dutch Rojas on The Soft Nationalization of Healthcare Delivery & Medicine

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 [https://stan.store/dutchrojas] If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit: 👉 Stan.Store/DutchRojas [https://stan.store/DutchRojas]

Dutch Rojas asks, "What happened to morality?"

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 [https://stan.store/dutchrojas] If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit: 👉 Stan.Store/DutchRojas [https://stan.store/DutchRojas]

Dutch Rojas: The $24 Billion Medicaid Heist

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 [https://stan.store/dutchrojas] If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit: 👉 Stan.Store/DutchRojas [https://stan.store/DutchRojas]

Dutch Rojas on The Hidden Yield Debate: Does Venture Capital Value Extend Beyond IRR?

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 [https://stan.store/dutchrojas] If you want to support these efforts, Buy Dutch a Cigar, connect via socials, or collaborate, visit: 👉 Stan.Store/DutchRojas [https://stan.store/DutchRojas]