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Fixing our Healthcare System. Healthcare Advocate Dutch Rojas. Host: Mary Talley Bowden MD. Guest: Dutch Rojas (10/28/25, article + video 45:22 includes transcript)
If you are concerned about the massive breakdown and financial costs of America’s healthcare system, do not miss this eye-opening interview.
While Congress squabbles and shuts down the government over healthcare for illegal immigrants and others through the (un)Affordable Care Act (ACA), we learn about the ugly underbelly of this Act, insurance industry takeovers, captured medical groups, non-profit hospital advantages on pricing and taxation, and more in this lively conversation between two people who know stuff. We hope you’ll appreciate this interview as much as we did.
Transcript Summary (Grok ai, edited)
Dr. Mary Talley Bowden interviews Dutch Rojas about U.S. healthcare system's complexities, including the Affordable Care Act (ACA), nonprofit hospitals, insurance practices, and potential solutions.
Dutch Rojas (a Netherlands native despite his non-Dutch last name) shares his background in healthcare finance and advocacy, critiques government policies, and offers practical advice for patients and physicians.
Introduction and Guest Background Dutch Rojas is an expert in healthcare reform. Dr. Bowden discovered him on LinkedIn while starting her direct specialty care clinic, which operates without insurance contracts (breathemd.org). Rojas hosts "The Doctor's Lounge" podcast (tinyurl.com/pte88aux) and authored upcoming book "Too Big to Care." Both criticize nonprofit hospitals.
Government Shutdown and ACA Overview Rojas links the government shutdown to debates over ACA.
ACA is a step toward single-payer healthcare, strongly influenced by industry lobbies.
Pre-ACA, catastrophic insurance was affordable. Example: Rojas policy had $188 monthly premium with a $10,000 deductible.
Before ACA, most people already were covered for pre-existing conditions via workers' comp, Medicare, Medicaid, large self-funded plans, and military programs, leaving only 8 million uncovered. [ED NOTE Yet many more millions were subjected to ACA.]
Criticism of ACA and Political Motivations
ACA is manipulative, with failed promises such as keeping doctors and plans.
Democrats seek control over 20% of GDP through single-payer.
Rojas opposes government control, citing his immigrant background and Marine service.
Rojas volunteers around the country to educate about ACA.
Medicaid Expansion and Funding Tactics Example: California's Medicaid expansion via matching funds increased enrollees without improving outcomes, leading to more federal money coming in. This is a backdoor to single-payer, harming taxpayers. Similar tactics occur nationwide.
Distribution of Healthcare Funds
Insurance companies, not doctors or patients, capture most funds.
Property and casualty insurance generates profits through investments.
Post-ACA, insurance market float grew from $12 trillion to $34 trillion.
Berkshire Hathaway benefits greatly. (Buffett vowed to “fix” healthcare, but why would he want to given that broken healthcare rakes in so much money for his company.)
90% of people never meet deductibles (with many afraid to use their insurance), so premiums enrich insurers.
Healthcare Costs and Premiums
Average premium exceeds $20,000 annually, higher for unions at $28,000-$30,000 with first-dollar coverage.
Rojas considers healthcare costs as America's top issue, draining middle-class families earning $80,000-$120,000.
Reasons for High Costs and Lack of Competition
CMS payment disparities favor hospitals (up to 12x more than independent doctors).
Physician independence dropped from 74% in 2009 to 12% today.
Hospitals acquire practices with inflated payments, reducing competition.
ED NOTE This same consolidation is happening to veterinary practices nationwide.Dr. Oz and Secretary Kennedy have failed to fix arbitrages (simultaneous buying and selling of healthcare services in order to take advantage of differing prices for the same services).
Example: Pay Dutch $10 for a service while paying Dr. Bowden only $1 for the same service, a common practice in non-profit hospitals and some for-profit hospitals as well.
Price Transparency Challenges
Legally, hospitals must post prices but use coded formats like JSON, which are hard to decipher even by professionals and computer geeks.
ED NOTE Here is a geeky blog article about parsing JSON hospital formats: tinyurl.com/47pb4ex5Lobbying allows this practice by altering definitions.
American Hospital Association (aha.org) has outsize (and harmful) influence.
Nonprofit Hospital Subsidies Nonprofits receive $125 billion in subsidies, avoiding taxes on income, property, and state levels. They access tax-free bonds, disproportionate share payments, upper payment limits, and student loan forgiveness. This disadvantages for-profit independent practices.
ED NOTE
St. Luke’s Hospital System (Boise, ID) is an example of a non-profit hospital that operates this way. Shift in Physician Ideology Rojas says doctors are becoming more conservative with life experience, contrasting liberal AMA focus on issues such as climate change, gender affirming care, and diversity/equity/inclusion over accessible and affordable care.
Emerging Solutions and Hope Rojas sees innovation from pressure:
253 practices Rojas visited this year show cost reductions.
Doctors form groups (up to 200) to negotiate better rates with payers such as Blue Cross.
Private sector advances direct contracting.
Employers recognize deductible burdens.
Practical Advice for Patients
Get good faith estimates before procedures (No Surprises Act enforces within $300: cms.gov/nosurprises).
For denials in self-insured plans (105 million covered), contact Human Resources (HR) department for resolution. HRs typically hate conflict and disaffected employees.
Rojas share his personal experiences negotiating bills for childbirth and surgery. Took some doing, but he was successful.
Experience with Alternative Plans Bowden discusses issues with religious sharing plans and services like Coral, which led her to stop contracting due to payment problems.
Related:
The Rojas Report (link below): dutchrojas.substack.com
