Scott Becker, founder of Becker’s Healthcare and longtime champion of independent physicians, joins me to talk about what happens when the conversation about healthcare finally leaves boardrooms and finds its way into the open square.
We discuss the evolution of physician media, the gamification of social networks, and how X has become both a forum for free speech and a mirror reflecting medicine’s dysfunctions.
But this episode isn’t just about social media.
It’s about the real shortage in American healthcare, people.
Scott and I dig into:
– Why the U.S. faces a looming primary care collapse
– How NPs and PAs fit into the new triage economy
– Why tech is powerful but powerless without human capacity
– And how healthcare’s next decade will depend on what we choose not to automate
If you care about the future of independent medicine, this is one of those rare conversations that blends realism, optimism, and straight talk.
TOO BIG TO CARE:
If you’re asking, “Why are my health insurance premiums so high?” this is for you…
The University of Michigan Health operates as a $6.9 billion revenue machine while enjoying complete tax immunity.
Here’s what that looks like:
THE NUMBERS DON’T LIE:
• $6.9B annual revenue (rivals major for-profit systems)
• $2.9M CEO salary (more than most Fortune 500 executives)
• -$348M “fair share deficit” (tax breaks exceed community benefit)
• $0 in property taxes paid (despite 2.5M sq ft of real estate)
• $3.4B in tax-exempt bonds issued since 2010
THE PLAYBOOK:
Tax Avoidance at Scale:
Exempt from federal, state, local, and property taxes while operating like a for-profit corporation
340B Program Exploitation: 53 pharmacy contracts generating massive revenue from a program designed to help low-income patients
Medicaid Payment Windfalls: Receiving hundreds of millions in DSH, GME, and UPL supplemental payments on top of regular reimbursement.
Minimal Charity Care: Michigan’s 340B hospitals average just 1.9% of revenue on charity care
WHY THIS MATTERS:
For Physicians: Your employer operates with structural advantages no private practice could match, yet compensation and working conditions don’t reflect these billions in subsidies.
For Lawmakers: Public subsidies (tax exemptions + Medicaid supplements) are flowing to wealthy institutions providing minimal community benefit. The ROI for taxpayers is negative.
For Benefits Consultants: Your clients are negotiating with tax-exempt “nonprofits” that have pricing power, political protection, and zero obligation to operate transparently or affordably.
THE BOTTOM LINE:
When a “nonprofit charity hospital” has a CEO earning $2.9M while running a -$348M fair share deficit, we’re not looking at a mission-driven organization.
We’re looking at a tax-exempt empire.
It’s time to ask: Why do lawmakers allow healthcare systems that operate like corporations, compensate like Wall Street, and pay taxes like churches still receive billions in public subsidies?
What needs to change?
I’m listening.👇
Join The Rojas Report: The Front Line of Healthcare’s Revolution
The Rojas Report with Dutch Rojas cuts through the noise in American healthcare.
From policy fights in Washington to the boardrooms of venture-backed startups, Dutch brings physicians, investors, and entrepreneurs into real conversations about money, power, and independence in medicine.
Now, we’re inviting you to join the conversation.
Independent Physicians:
Tell us why you chose independence—why serving patients directly still matters, and how autonomy makes better medicine possible. The Rojas Report is your platform to show America what real healthcare looks like.
Lawmakers:
It’s campaign season. Our audience of 70,000 physicians and 2.23 million people a month want to hear your vision. How will you tackle rising premiums, physician burnout, and regulatory capture? Tell us how you’ll fix what’s broken.
Healthcare Innovators:
If your startup is making healthcare affordable and accessible for everyone, everywhere, we want your story. Share how your company is rebuilding the economics of care—and what you’ve learned along the way.
Each 30-minute episode is fast, focused, and high-energy—real talk about how to make healthcare work again.
Be part of it.
📧 Email us at info@phycap.com to join the conversation.
🎙 Subscribe on Substack to never miss an episode.
Please visit the causes we support:
Physician Led Healthcare for America (PHA) Physiciansled.com
The PhyCap Fund – Phycapfund.com
Bliksem Health - BliksemHealth.com
Let’s make healthcare transparent, competitive, and free again, one conversation at a time.
