Dhananjay Chatterjee, MD

Most hospitals don't know their costs. Things I've asked for that made them roll their eyes : A BOM for surgeries P&L for each insurance carrier P&L for Medicaid or Medicare business Why do they need consultants for everything. Why doesn't their CSuite know how to do any of it Why do they use GPOs when prices are insane Why do they work with carriers that underpay, late pay, deny everything, waste docs time with denial committees run by 97 yr old pediatricians. Why do they make no effort to sell direct to employers (excluding those on costpluswellness.com to avoid all the carrier abuse , and avoid being sub prime lenders for patient OOP Why do they abuse 340b Why do facilities fees exist Why do they abuse site neutrality Why do they abuse patients with charge master based bills Why do they not push for standard contract templates to reduce admin. Why do they accept so many different ins plans Anyone want to add more And for context, remember I think the biggest insurance companies are worse

No difference in IVUS-guided vs. angio for LM PCI? It is ESCAPE trial all over again. Like pulmonary artery catheters, IVUS is a diagnostic tool. The catheter, per se, doesn’t have a magic power to change the outcome of a procedure. We should move away from doing trials that only compare IVUS vs angio. Trials that successfully advanced the field, such as ULTIMATE and DKcrush VIII(presented at ACC as well) had strict criteria for “real IVUS-guided PCI”. Here, only 65% of the IVUS guided group had a pre IVUS to “guide the PCI”. Prior trials showed that IVUS-guided PCI leads to statistically significantly larger balloons and stents, and more post-dilation. Here we see less POT in the IVUS group. Also, despite most patients receiving less than 2 stents (provisional), the cardiac mortality at 2 years was exceptionally high at 9.5% (Syntax II was 2.8%, DKCRUSH 1.3%, PRECOMBAT 2.7%, all at 5 years). I hope this does not make us lose the recent improvement in imaging uptake. It took us years to convince people that a PA catheter is important in cardiogenic shock because of ESCAPE. I hope the field moves to design better trials with different strategies for imaging-guided PCI, rather than reverting to angio, where you have to guess the calcium arch, a nodule, or even whether the stent is indeed expanded.

Let me help rephrase for you Bernie. Need a loan for college so you can party for a semester and drop out? Taxpayers will loan you money for it. Need an SBA loan for your business ? Taxpayers will guarantee it. For a house ? Taxpayers will guarantee it. And local gov will give you money for your first down payment ! Get sick or are in an accident and you can’t afford your deductible, insurance company denied prescribed care or are uninsured ? You are on your own 😤 Let me add Bernie, the one debt not a single one of us will ever pay off till the day we die ? Our health insurance premiums And before you go in and on about single payer, ask @claudeai to take a look at your proposed Single Payer legislation. You want the Sec of HHS to run it. You can’t have a political appointee run an apolitical position And you expect every provider and doctor to accept whatever rate is set by Medicare. Big hospitals don’t know their costs. They couldn’t do a BOM for any procedure. They have negligible transparency. If they don’t know their costs, and you don’t know their costs, how is it possible for taxpayers, caregivers and patients to get a fair deal ? And the concept of “every other country does it “ ignores the fact that they all converted decades and decades ago, long before you and your peers allowed the extreme vertical integration we face now. Which leads to the question. @BernieSanders , why have you not advocated for the Break Up Big Medicine Bill ?

Doctors in large centers don't realize what a life-changer fast operating room turnover times are. For those that don't know, the turnover time in OR's varies widely between hospitals. That's the time it takes to clean the room and set up for the next case. In efficient hospitals, especially those that are physician owned, it can be as quick as 20 minutes. In large academic hospitals, it can push 4 or even 5 hours. Think of the difference that makes for quality of life, patient care, and revenue. A doctor who has a large waitlist of patients might be at the hospital until 8pm and still only get two surgeries done because the turnover time is so long. That same doctor could get 3 or 4 surgeries done in a more efficient hospital, getting home in time to have dinner with his family. A physician owned hospital would never tolerate a 4 hour turnover time. That's money being lit on fire. Yet hospitals tolerate this all the time because they don't face competition. There's no incentive to run efficient. So the patients have to wait longer for their surgery, the doctors get frustrated, and everybody loses.

California is spending $9.5 million per mountain lion on this bridge. The Wallis Annenberg Wildlife Crossing now costs $114 million. It was budgeted at $92 million in 2022 with a 2025 completion date. Governor Newsom stood at the groundbreaking and said the state had committed $54 million and would close it out for another $10 million. Four years later the California Transportation Commission cut an $18.8 million check just to keep construction going. The bridge spans 210 feet of the 101 Freeway in Agoura Hills. The population it exists to save: approximately 10 to 12 adult mountain lions in the Santa Monica Mountains. A 2016 Royal Society study found that adding one new mountain lion per generation was sufficient to prevent extinction. One cat. Every few years. Translocation costs roughly $5,000 to $10,000 per animal. For $114 million you could relocate cougars into these mountains for the next 10,000 years. Banff National Park built 44 wildlife crossings along the Trans-Canada Highway at an average cost of CA$1.1 million per overpass. Those crossings have logged over 250,000 documented animal uses and reduced wildlife-vehicle collisions by 80%. The Netherlands operates 600+ crossings as a national network. California built one. The project employs a dedicated fungi consultant. The native plant nursery’s seed-collection manager makes offerings after each harvest that include pieces of her hair. This is the same state spending $9.7 billion on 9 miles of Purple Line subway extension in LA. Over $1 billion per mile. A 9.3-mile metro line in Toulouse, France, built entirely underground, cost $176 million per mile. The same state whose high-speed rail budget went from $33 billion when voters approved it in 2008 to a current estimate north of $100 billion for a train that connects Merced to Bakersfield and won’t carry a single passenger until at least 2030. The same state staring at a $2.9 billion budget deficit that nonpartisan analysts project could balloon to $35 billion. Banff solved the mountain lion problem 44 times over for less total money than California is spending on one bridge with a fungi consultant and hair offerings.

Who are the California politicians behind the progressive laws that allow a serial child rapist like David Funston to be released from prison early? Funston was described by a judge as “the monster parents fear most”. The CA prosecutor who handled his case tells me it’s the worst she’s seen in her career. In 1995, he sexually assaulted 7 children, including a 5-year-old girl who was left with vaginal trauma after having her own underwear shoved down her throat to stop her screaming. He drove around the Sacramento area using toys and candy to lure small children into his car before beating and raping them. And yet, despite being sentenced to three consecutive 25 to life terms, and a separate 20-year term after being convicted of 16 counts of kidnapping and child sexual assaults, the California Parole Board has found him suitable for early release from prison due to California’s elderly parole laws – pushed by progressive Democrats. In 2020, California Assemblyman @AsmPhilTing (D-San Francisco) introduced AB 3234, which changed California’s elderly parole laws to move parole eligibility from age 60 and 25 years served on a sentence, to age 50 and 20 years served on a sentence. It was signed into law on 1/1/2021 by Governor Newsom after being passed by the state’s Democratic supermajority in the California Assembly. Notably, the law had no exceptions for violent sex offenders. Not even for child rape, forceful sexual penetration, or sodomy by force. California Republicans are trying to change this. In February 2025, CA Republican state senator @SenBrianJones introduced SB 286, which would block anyone convicted of a violent sex offense from qualifying for California’s elderly parole program. In April 2025, SB 286 passed out of the CA Senate’s Public Safety Committee with bipartisan support. But in May 2025, SB 286 was blocked from a vote by the Democratic leadership of the California Senate Appropriations Committee, including the then Chair of the committee, Democratic CA state senator @CASenCaballero (now running for CA Treasurer) who wrote in an analysis of the bill that it would potentially cost the state $2 billion over 10 years to keep inmates in prison longer and that “every dollar spent incarcerating aging adults is a dollar diverted from more effective public investments like rehabilitation.” She added that “tough on crime” policies contribute to prison overcrowding, and “disproportionately harmed communities of color.” The bill has been stalled in the committee ever since. There remain no exceptions to elderly parole for violent sex crimes, and David Funtson may soon be a free man as a result.

“What in the hell is going on in California?" | Sheriff Jim Cooper is furious after a man convicted of molesting eight children in the 90s was granted parole under California's elderly parole program: abc10.com/article/news/l…

Health insurance is basically a subscription service where you pay $800/month for the right to argue with a 22 year old about whether your doctor is lying

The HHS Data continues to bring light to the darkness! Congress just hauled the Big 6 insurance CEOs in front of Ways and Means. Good start. Now do these five. Five people. Ten Medicaid billing entities. $11.8 billion. One operates from Suite 305 and Suite 309 in the same building. $2.3 billion. Another runs two companies with the same name. One comma different. Same address. $809 million. The insurance executives have lawyers and lobbyists. These five have something better: anonymity. Nobody in Washington knows their names. You do now…

A Walmart manager may out earn a pediatric subspecialty surgeon. And everyone acts shocked. And it’s a question @HeathVeuleman , @GeBaiDC and I have discussed. Why is a surgeon’s value determined by a committee instead of a market? In every other domain of human expertise, the extraordinary practitioner captures extraordinary value. The lawyer who wins the impossible case. The architect whose buildings define skylines. The entrepreneur who sees what nobody else sees (me 🫡). They don’t earn 2x their peers. They earn 50x. Medicine is the only profession where a central planning committee, the RUC with the blessing of Medicare (CMS), literally decides what the work is worth. Not patients. Not outcomes. Not demand. A committee of insiders voting on relative value units like Soviet bureaucrats allocating grain. Medicare doesn’t set a floor. It sets a ceiling. And every private payer benchmarks to it. The surgeon who saves a child’s life and the one who barely passes muster operate inside the same narrow band of reimbursement. The signal that says “this person is extraordinary” never reaches the price. Wake up! There is no market! When physicians finally decide to speak up and operated in an actual free market, some would earn hundreds of millions. And some would go out of business. That’s how every other profession communicates value. The discomfort physicians feel about their income isn’t embarrassment. It’s the instinct that something was stolen from them, and they’re accurate. About $10m over a career…

California already has the highest gas taxes in the nation—now politicians want to track how far you drive and tax you for every mile. STOP the Mileage Tax and sign the petition. reformcalifornia.org/forms/petition…

Senator…. The US spends $5T on healthcare. We spend more on healthcare than the entire GDP of all but two countries on earth. The problem isn’t that we don’t spend enough on healthcare. The problem is that the money goes to your political donors instead of to patients.

This is curious. Why would Newsom veto a unanimous bill from the California legislature requiring reporting on cost and outcome data on the Homelessness spending??

@BernieSanders The American Dream is bleak now because you and your buddies in Congress can’t be trusted to manage a single cent of taxpayer money with any accountability. Seizing assets and promptly losing them while failing audits is not a solution, it’s a continuation of a death spiral.

Yes: We need a wealth tax on billionaires.

A restaurant in Minneapolis called Safari. Seats 35 people. Claimed to serve 18,000 meals a day to hungry children. The federal government paid them for every single one. The children didn’t exist. The meals didn’t exist. The money did. And it’s gone. This is just one piece of a $9 billion Medicaid fraud in Minnesota, the largest in American history. Today I’m publishing the whole investigation. The fraud. The cover-up. The whistleblowers who were ignored.

why not just raise income tax rates? because your real intent is not to just “provide healthcare”. you’re masking that you are proposing the creation of, for the first time in the 250 years of this American republic, an organized government seizure of private property from citizens. you’re calling it a “wealth tax” or a “billionaires tax” or “millionaires tax” or whatever nom du jour polls well. but at the end of the day, it’s the seizure of private property from citizens by the government. citizens that earned money, paid their fair taxes on those earnings (53% if they live in California) and are now being told they need to hand over after-tax assets because the government has failed to provide promised services with the revenue it’s collected, and are now re-casting their own failure to be a socio-economic inequity that must be justly resolved... a slippery slope that has never gone anywhere good (see economic effects in USSR, Cuba, Venezuela, France and Norway wealth tax etc.) the American founders fled tyranny in Europe and this amazing nation was populated by immigrants (myself and your parents) from around the world not just looking for a “better life” but for a place where they could have freedom from tyrannical governments that can take what they want from private citizens. a great nation borne of property rights, the rule of law, and endowed freedoms to believe, speak, or act. these principles led to the greatest run of innovations, successes, and widespread increase in prosperity, for all citizens, ever seen. the citizens, the individuals, not the institutions, delivered this progress. those who invented, who toiled, who bled, who sacrificed, who took risk and persevered, who led, and who changed the world, are not charlatans, kleptocrats, or oligarchs. they’re what made us all better off. prosperity is a measure of america’s success, not its failure. it is your principle that is so offensive, as evidenced by the broad disdain for your flippant flirtation with the darkest of human fantasy - socialism. you and other neo-socialists have led so many of us to reflect on America’s history and what it is becoming. that now leads so many to consider, so unnecessarily, leaving their homes for a place where everyone stands up to shout down the principle you suggest. because if your ideas are now considered moderate, it’s clear this titanic is sinking. that a “simple tax” of taking assets that have been earned, through toil and tribulation, rightly taxed, and preserved, should now be unjustly seized, is your solution to a problem of obvious government mismanagement and outright fraud, tells us that your true motivation lies not in giving people healthcare but in cutting down success and deleting the system of prosperity and opportunity for all. i don’t care, and neither should anyone else, what the sum total market value of a private citizens private assets might be. it is none of my business and should be none of yours. because, again, once you open that pandora’s box, we might as well study Lord of the Flies … there is literally nothing stopping 51% of citizens demanding that their government go out and seize 100% of the private property of the 49%. want to give healthcare to people in need? do your job and fix healthcare. make it affordable. want to be lazy about it? then do your job lazily and raise income taxes. want to take private property from private citizens who have paid their fair share of taxes and legally earned their property, then honestly declare that it is envy, not inequity, that you strive to resolve…

@RoKhanna @Jason Does your wife want it to be taxed?

@Jason It's not my money. It's my wife's pre marriage. Its fully disclosed in my public disclosures. And I am for taxing it more. I look forward to a future appearance on All In to discuss the policies!

.@RoKhanna since you believe in the wealth tax, would you start us off with a voluntary accounting of your entire net worthy and assets, then give five percent to the state of California? Please lead by example 🫡

Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies. They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight. Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient. This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country

@jedicath @TheEKGGuy @EM_RESUS @Toaster_Pastry Anterior changes from RV injury from ischemic RV marginal branches

Cath lab activated. Which artery was the culprit (I was surprised). FYI I never remember the criteria @TheEKGGuy @EM_RESUS @Toaster_Pastry

Dear @Humana: it speaks volumes that you won't even cover a numbing cream that makes accessing a patient's Port more comfortable, and instead invent a specious argument about it "not being a drug" Do better (like @mcuban, who saved this patient money through @costplusdrugs)