Robert Panacci retweetledi
Robert Panacci
4.8K posts
Robert Panacci
@RPANACCI
eager to learn...willing to be surprised...expecting to change...able to grow...proud father, husband and everything else
Scottsdale, AZ Katılım Ağustos 2011
562 Takip Edilen204 Takipçiler
@chamath Disappointed - I highly doubt you even feel the effects. Proof that even the “successful” person isn’t perfect. You would be better off supporting how to fix the system rather than criticizing it while you reap the spoils of what’s broken.
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Wow. Awesome. Thanks.
Please also raise my taxes and destroy my children’s education more than you already have so my family and I can stay impoverished, uneducated and in your indentured servitude while we carry your branding on us.
Governor Newsom Press Office@GovPressOffice
IN HONOR OF CALIFORNIA’S 175TH ANNIVERSARY, WE WILL BE ROLLING OUT A VERY SPECIAL DRIVER’S LICENSE FOR EVERY CALIFORNIAN THIS SUMMER! IT WILL FEATURE A HANDSOME, HIGH-QUALITY PHOTO OF ME, GAVIN C. NEWSOM. MANY PEOPLE ARE SAYING IT’S THE BEST LICENSE EVER MADE IN THE HISTORY OF THE WORLD. THIS IS ABOUT CELEBRATING OUR BEAUTIFUL STATE (IT IS NOT ABOUT ME, DESPITE THE VERY HANDSOME PHOTO!). ENJOY! — GOVERNOR GCN
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Robert Panacci retweetledi
Robert Panacci retweetledi
Pope Leo XIV: Jesus told us, blessed are the peacemakers. But woe to those who manipulate religion and the very name of God for their own military, economic, or political gain, dragging that which is sacred into darkness and filth. Yes, my dear sisters and brothers, you who hunger and thirst for justice, who are poor, merciful, meek, and pure of heart—you who have wept. You are the light of the world.
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Robert Panacci retweetledi
Let’s bet on America — not against it. I’m proposing a 10% fee on prediction markets and online gambling to fund an American Innovation Fund—investing in AI, quantum computing, fusion energy, life sciences, and national security tech.
President Xi is investing in the future, whereas President Trump’s cuts in NIH and NSF is defaulting on America’s preeminence. That’s not how you win.
Let’s fund cures, build new energy resources, lead in defense technologies and quantum tech.
Stop falling further behind, start investing in winning again. That’s the American way.
bloomberg.com/news/articles/…
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@elonmusk Voter id laws exist. It is illegal to vote if you’re not an American citizen. Maybe focus on more rational and encouraging ways of getting registered voters to the polls…you’re obfuscating the real issues.
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It is the end of democracy if voter ID is not passed
Savanah Hernandez@Savsays
It’s cannot be understated how unfathomably cooked we are if we can’t even get basic voter ID laws passed in this country.
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It was more than an evil comment, it was a reflection of what has evolved
Gandalv@Microinteracti1
Robert Mueller died last night. He was 81 years old. He had a wife who loved him for sixty years. He had two daughters, one of whom he met for the first time in Hawaii, in 1969, on a few hours of military leave, before he got back on the plane and returned to Vietnam. He had grandchildren. He had a faith he practiced quietly, without performance. He had, in the way of men who have seen real things and survived them, a quality that is increasingly rare and increasingly mocked in the country he spent his life serving. He had integrity. And tonight the President of the United States said good! I have been sitting with that word for hours now. Good. One syllable. The thing you say when the coffee is hot or the traffic is moving. The thing a man who has never had to bury anyone, never had to sit in the specific silence of a room where someone is newly absent, reaches for when he wants the world to know he is satisfied. Good. The daughters are crying and the wife is alone in the house and good. I want to speak directly to the Americans reading this. Not the political Americans. Just the human ones. The ones who have lost a father. The ones who know what it is to be in that first hour, when you keep forgetting and then remembering again, when ordinary objects become unbearable, when the world outside the window seems obscene in its indifference. I want to ask you, simply, to hold that feeling for a moment, and then to understand that the man you elected looked at it and typed a single word. Good. This is not a country having a bad day. I need you to understand that. Countries have bad days. Elections go wrong. Leaders disappoint. Institutions bend. But there is a different thing, a rarer and more terrible thing, that happens when the moral center of a place simply gives way. Not dramatically. Not with a single catastrophic event. But quietly, in increments, until one evening a president celebrates the death of an old man whose family is still warm with grief, and enough people find it acceptable that it becomes the weather. Just the weather. That is what is happening. That is what has happened. The world knows. From Tokyo to Oslo, from London to Buenos Aires, people are not angry at America tonight. Anger would mean there was still something to fight for, some remaining faith to be betrayed. What I see, in the reactions from everywhere that is not here, is something older and sadder than anger. It is the look people get when they have waited a long time for someone they love to find their way back, and have finally understood that they are not coming. America is being grieved. Past tense, almost. The idea of it. The thing it represented to people who had nothing else to believe in, who came here with everything they owned in a single bag because they had heard, somehow, across an ocean, that this was the place where decency was written into the walls. That idea is not resting. It is not suspended. It is being buried, in real time, with 7,450 likes before dinner. And the church said nothing. Seventy million people have decided that this man, this specific man who has cheated everyone he has ever made a promise to, who has mocked the disabled and the dead and the grieving, who celebrated tonight while a family wept, is an instrument of God. The pastors who made that bargain did not just trade away their credibility. They traded away the thing that made them worth listening to in the first place. The cross they carry now is a costume. The faith they preach is a loyalty oath with scripture attached. When the history of American Christianity is written, this will be the chapter they skip at seminary. Now I want to talk about the men who stand next to him. Because this is the part that actually breaks my heart. JD Vance is not a bad man. I have to say that, because it is true, and because the truth matters even now, especially now. Marco Rubio is not a bad man. Lindsey Graham is not a bad man. They are idiots, but not bad, as in BAD! These are men with mothers who raised them and children who love them and friends who remember who they were before all of this. They are not monsters. Monsters are simple. Monsters do not cost you anything emotionally because there is nothing in them to mourn. These men are something more painful than monsters. They are men who knew better, and know better still, and will get up tomorrow and do it again. Every small compromise they made had a reason. Every moment they looked the other way had a justification that sounded, at the time, almost reasonable. And now they have arrived here, at a place where a president celebrates the death of an old man and they will find a way, on television, to say nothing that means anything, and they will go home to houses where children who carry their name are waiting, and they will say goodnight, and they will say nothing. Their oldest friends are watching. The ones who knew Rubio when he still believed in something. Who knew Graham when he said, out loud, on the record, that this exact man would destroy the Republican Party and deserve it. Who sat next to Vance and thought here is someone worth knowing. Those friends are not angry tonight. They moved through anger a long time ago. What they feel now is the quiet, irrecoverable sadness of watching someone disappear while still being present. Of watching a person they loved choose, again and again, to become less. That is what cowardice costs. Not the coward. The people who loved him. And in the comments tonight, the followers celebrate. People who ten years ago brought casseroles to grieving neighbours. Who stood in the rain at gravesides and meant the words they said. Who told their children that we do not speak ill of the dead because the dead were someone's beloved. Those people are tonight typing gleeful things about a man whose daughters are not yet done crying. And they feel clean doing it. Righteous. Because somewhere along the way the thing they were given in exchange for their decency was the feeling of belonging to something, and that feeling is very hard to give up even when you can no longer remember what you gave for it. When Trump is gone, they will still be here. Standing in the silence where the noise used to be. Without the permission the crowd gave them. Without the pastor who told them their cruelty was holy. They will be alone with what they said and what they cheered and what they chose to become, and there will be no one left to tell them it was righteous. That morning is coming. Robert Mueller flew across the Pacific on military leave to hold his newborn daughter for a few hours before returning to the war. He came home. He buried his dead with honour. He served presidents of both parties because he understood that the institution was larger than any one man. He told his grandchildren that a lie is the worst thing a person can do, that a reputation once lost cannot be recovered, and he lived that, every day, in the quiet and unglamorous way of people who actually believe what they say. He was the kind of American the world used to point to when it needed to believe the story was true. He died last night. His wife is alone in their house in Georgetown. His daughters are learning what the world is without him in it. And somewhere in the particular hush that falls over a family in the first hours of loss, the most powerful man and the biggest loser on earth sent a message to say he was glad. The world that loved what America was supposed to be is grieving tonight. Not for Robert Mueller only. For the country that produced him and then became this. For the distance between what was promised and what was delivered. For the suspicion, growing quieter and more certain with each passing month, that the America people believed in was always partly a story, and the story is over now, and there is nothing yet to replace it. That is all it needed to be. A man died. His family is broken open with grief. That is all it needed to be. Instead the President said good. And the country that once stood for something looked away 🇺🇸 Gandalv / @Microinteracti1
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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.
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JOIN US!
pa.exchange/marketplace/1c…
You can also purchase tickets to the home opener against Orange County SC and $8 will also be donated! We hope to see you there!
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Economics, Empathy and the Egregious Inequity of Cancer Treatment - read for free!
@robertpanacci/note/p-189024933?r=5hg2a&utm_medium=ios&utm_source=notes-share-action" target="_blank" rel="nofollow noopener">substack.com/@robertpanacci…
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Every dollar helps! Join me as I take steps to end #pancreaticcancer #phoenixpurplestride
secure.pancan.org/site/TR/Purple…
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Robert Panacci retweetledi
I’m not sure there’s ever been a president more distant from the ideals of the Founders of the United States and the Framers of the Constitution—and more detached from the core American culture of liberty, individualism, and self-determination—than President Trump.
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Oblivious to facts. The comparison is not even close. Do better.
Appt’d Reps Robert Gates (Def), Ray LaHood (Transp.), and Chuck Hagel (Def).
Endorsed and expanded Bush's TARP bailout.
Held a bipartisan health care summit
Deficit plan w/ Boehner.
2011 Budget cutting $1T in spend
Gregg Nunziata@greggnunziata
One of the reasons Obama was such a polarizing is, contrary to our system, he governed like the political minority party has no right to exist, no part to play in government. Same as Trump does, on a far slimmer majority.
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Is the U.S. and the world really going to hell? It doesn’t have to…but we need truth and empathy to rise up if we want to survive. open.substack.com/pub/robertpana…
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@ddale8 your work is truly valuable…this administration is void of all integrity and believes the American public (or at least their supporters) are total idiots. They (trump et al) can’t handle the truth.
Daniel Dale@ddale8
President Trump’s post threatening to block the opening of a major new US-Canada bridge was filled with important omissions and misleading claims. - Trump professed astonishment that the Canadian government would expect him to support the project. He didn’t mention that he explicitly endorsed the project in a 2017 joint statement with then-PM Trudeau, calling it a “vital economic link” and saying he looked forward to its quick completion. - Trump, complaining about Canada, said “we should own, perhaps, at least one half of this asset.” But the state of Michigan already owns half of the bridge. - Trump said, “I will not allow this bridge to open until the United States is fully compensated for everything we have given them.” But Canada paid for the entire bridge construction. - Trump complained about a Buy American waiver Obama granted the project, then claimed the waiver let Canada “not use any American products, including our Steel.” But the waiver actually allowed Canadian and US steel to be treated equally in consideration for the project, and numerous Canadian officials and Republican former Michigan Gov. Rick Snyder say some American steel was indeed used. (Also worth noting the Obama administration said it was granting the waiver out of a “basic notion of fairness” because the project was a “unique circumstance…under which Canada is assuming all financial liability and risk for the construction.”) Fact check: cnn.com/2026/02/10/pol…
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Sober perspectives on a changed world: the audacity to speak this truth out loud, from his perch, is both admirable and necessary. I don’t believe Trump will ever truly understand the chaos created, or the irreparable damage that may never heal weforum.org/stories/2026/0…
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“He’s gonna sell Ukraine to Russia…” I get the negotiating, it’s the Freudian slips that are concerning.
Aaron Rupar@atrupar
Q: Have you heard this audio that Bloomberg has of Witkoff coaching the Russians on how to appeal to you? TRUMP: That's a standard thing. He's gotta sell this to Ukraine, he's gonna sell Ukraine to Russia. That's what a dealmaker does. I haven't heard it but I heard it was standard negotiation.
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