Nathan Bell

@XcentricXennial @Gianl1974 Probably not many real pics of the actual conditions, and if that’s what it looked like in 2019, do you think is any more humane in 2026?

@Gianl1974 Why use two photos from McAllen,TX in 2019 as evidence of conditions in El Paso,TX in 2026? Seems kind of on the nose in the fishing for outrage clickbait department.

ICE guards are betting on which detainee will kill themselves next. The AP just exposed the savage conditions of a detention camp in El Paso. The Associated Press got inside Camp East Montana. What they found should be on the front page of every newspaper in this country until it closes. About 3,000 people packed in per day. Loud, unsanitary quarters crawling with insects. Food so scarce that detainees steal from each other just to eat. Disease spreading through filthy rooms, showers, and restrooms that go uncleaned. People losing weight. People unable to see a doctor. People losing their minds. Staff made nearly one 911 call per day in the camp's first five months. One call captures a man sobbing after being assaulted by another detainee. Another has a doctor describing a man banging his head against a wall while expressing suicidal thoughts. A nurse calls about a pregnant woman in severe pain with coronavirus. Detainees suffering seizures, some resulting in serious head trauma. Ages ranged from a 19-year-old who fell from a bunk to a 79-year-old who couldn't breathe. And then there's the detail that should haunt this administration for the rest of its existence. Owen Ramsingh, a former property manager from Columbia, Missouri, who spent weeks in the camp before being deported to the Netherlands, told the AP he overheard a security guard talking about a betting pool among the staff. They were wagering on which detainee would be next to die by suicide. The guard said he had put $500 in. The total pot rode on the outcome. Ramsingh said the talk was particularly devastating because he had contemplated suicide himself. Guards are gambling on the deaths of people in their custody. People who are hungry. People who are sick. People who are begging for help through 911 calls that come in every single day. And the staff turned it into a game. This is not some rogue facility. This is the system working exactly as this administration designed it. Overcrowded by policy. Underfed by neglect. Understaffed by choice. They built a place where human beings deteriorate and then the people paid to watch over them place bets on who breaks first. The AP has the data. The recordings. The interviews. The court filings. This is documented. This is real. This is happening right now in El Paso, Texas, in the United States of America. Share this. Do not let them bury it under another news cycle.

Elite Democrats -- rather than admitting that they ran flawed, centrist campaigns in 2016 and 2024 -- are prepared to govern their selection of a presidential nominee by racism, sexism, homophobia and Christian nationalism. Good work, people.

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.

Yesterday, CVS-Aetna agreed to pay $117.7 million to settle whistleblower claims that they defrauded Medicare by submitting incorrect diagnosis codes to increase their Medicare Advantage payouts. Obvious question: Why are companies with documented histories of defrauding government programs still allowed to participate in them? Read more about the settlement: on.wsj.com/4lmV6LM

@AGoldmund In 5 years when Schumer is demented and sitting in a political gulag, they’ll stand him in front of a podium with pretend cameras and he’ll be spewing this same stuff from the deepest recesses of his animal instincts

@AGoldmund Probably feels like the good old days

@hasanthehun @Joshua4Congress Or are we the suckers/loser for buying that it was ever about anything more than identifying with a charismatic white takes-what-he-wants alpha male

maga are cattle btw. totally owned by parasitic capital. they said they were voting for trump for no new wars, releasing the epstein files, & getting prices down. not one of those things happened & they still love him. barely sentient peasant brained losers.

As a former federal prosecutor, I can explain this: They. Were. Not. Even. Trying.

@MichaelSLinden Not to mention the higher your tax bracket, the greater portion of your income that is derived in ways there are loopholes that get you out of having to actually pay that rate

Well, for one thing, the overall average federal tax rate is about 17%, not 40%. So, yeah, there's that.

.@JamesTalarico: The only minority destroying America is the billionaires. Trans people are 1% of the population. Muslims are 1% of the population. Undocumented people are 1% of the population. We are focused on the wrong 1%. Trans people aren't taking away our healthcare. Muslims aren't defunding our schools. Immigrants aren't cutting taxes for themselves and their rich friends. It’s the billionaires and their puppet politicians. The culture wars are a smokescreen. They want us looking left and right at our neighbors instead of looking up at them. The biggest divide in our politics is not left versus right, it’s top versus bottom.

@AGoldmund Gonna share yours?

@AGoldmund Fever Ray, pick any album but I’ll always go for their self-titled debut album

@rcbregman I’m assuming that it is using AI for every time it is operating but I could be wrong there. And of course the price of compute and efficiency of processors is bound to go down, but still

@rcbregman What do you think the real cost of using it is, if you include the cost of energy and depreciation on the hardware that is producing both the creation of the app, and the operation of it? The cost of subscribing is bound to go up, no?

For people who are still underwhelmed by AI: I was about to buy a $100 teleprompter app, but decided to vibe-code one in 2 prompts. Asked Claude to make a website for it as well. (For context: I'm a historian, never coded a line in my whole life)

@AGoldmund Too soon

@farrmacro When the $ becomes worthless due to inevitable oversupply, BTC’s value will become more apparent. The fraud taking place in crypto is a failure of law enforcement and regulation. BTC and crypto are agnostic, they are just a tool.

I do love that everyone gets it now. Except for retail, apparently.

@davidbessis “This will be the end of wokeness” was a dead giveaway for a total blowhard

r = 0.352, 12.4% of variance explained This might be the end of wokeness, but we've officially entered the age of LLM-enabled idiocy, where millions of innumerate jerks will believe they can prove the Riemann Hypothesis or challenge the efficacy of vaccines in just a few prompts.

@AGoldmund Cognitive equivalent of jamming a stick in the spoke. Limped to the end of the tweet

Wtf is an impeachable offense at this point?

@brianschatz Seems like an acceptable level of “collateral damage” to me. Might help generations of folks think a little bit more deeply about who they associate with, and what level of questionable ethical behavior to accept in those people

I don’t think you should be imprisoned for being mentioned in the files, but there are millions of impressive, good people not in them, so let’s give them a chance to be our moral, financial, academic, and political leaders. It would have been time to turn the page in any case.