Thursday, December 11, 2025

The fix for American healthcare already exists

 


The fix for American healthcare already exists

A profitable hospital is being gutted to pay for a $455 million expansion elsewhere. We've solved this problem before. Here's how.


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America spends about $5 trillion a year on healthcare. That’s more than any other country on earth, by a lot. We’re on pace to hit nearly $9 trillion within a decade. For that money, we should have the healthiest population in the developed world. Instead, we’re near the bottom. Among wealthy nations, we rank near the bottom in life expectancynear the bottom in maternal mortalitynear the bottom in infant mortality. We have the highest rates of chronic disease and spend more years living sick than any of our peers. You might think that means we’re at least keeping people alive through their illnesses. But the rest of the developed world is living longer and healthier. We’re just living sicker. We pay more and get less.

That’s not an accident. It’s what happens when you let systems designed to extract wealth from communities run essential services. The ole free market has had decades to prove it can deliver healthcare. It has failed. Objectively and profoundly. It has produced consolidation, asset-stripping, and collapsing access.

Most of the money flowing into American hospitals comes from taxpayers. Medicare. Medicaid. Public subsidies. Tax exemptions. We’re already paying for the system. We just don’t own it. And because we don’t own it, the people who do can shut down our hospitals, strip our communities, under the cover of efficiency.

Ashland, Oregon is one story out of hundreds. I go into some depth here to show you exactly how the process works. As you read the details keep in mind this story is about a “non-profit” hospital. Also keep in mind that the city of Ashland owned this hospital until 2013. It was founded in 1907.

Asante is a nonprofit hospital system based in Medford, Oregon. On December 3, 2025, Asante CEO Tom Gessel announced the company was closing the birth center and most inpatient services at Ashland Community Hospital. Gessel told the community the hospital was “on pace to lose $7.3 million this year.” He said the losses were unsustainable. He said Asante had no choice.

That was a lie.

The Oregon Health Authority requires every hospital in the state to file detailed financial reports. These are public documents. Anyone can look them up. I did. According to Asante’s own filing with the state for fiscal year 2024, Ashland Community Hospital had total operating revenue of $77 million. Total operating expenses of $67 million. Operating income of $10.2 million. Not a loss. A profit. A 13% margin.

One set of books for the regulators. Another set of books for the press release.

Gessel said the hospital was losing $7.3 million. The state filing says Ashland made $10.2 million. That’s not an accounting quirk. That’s two sets of books. One that shows a healthy hospital. One that justifies shutting it down.

How does a $10 million profit become a $7 million loss? Asante runs three hospitals. The flagship is Rogue Regional Medical Center in Medford. That’s where the corporate headquarters sits. That’s where the executives work. That’s where Asante builds its empire. Ashland Community Hospital is eleven miles down the road. Smaller facility. Brings in money treating patients. But Asante doesn’t let that money stay in Ashland.

Ashland makes $10 million. Then the corporate office in Medford sends a bill. Ashland’s share of the CEO’s salary. Ashland’s share of the corporate lawyers. Ashland’s share of the consultants, the IT systems, the strategic planning departments. Ashland’s share of the debt service on the $455 million patient pavilion Asante just opened in Medford. Ashland didn’t ask for any of this. Ashland doesn’t benefit from any of this. But Ashland has to pay anyway.

In 2024 executives and bean counters decided the bill would be $17 million, Ashland’s $10 million profit becomes a $7 million loss on paper. The money doesn’t disappear. It gets wired to Medford to pay for Medford’s expansion. Then Asante points at Ashland’s empty bank account and says the hospital is failing. This is how extraction works. Money is sucked out of our communities, then the thief, Asante CEO Tom Gessel, blame the victims for being broke.

When Ashland closes, where do the patients go? To Rogue Regional in Medford. To Asante’s flagship. To that brand new $455 million pavilion. The revenue consolidates. The overhead disappears. Asante wins twice.

The birth center is where Asante’s manipulation gets specific enough to count. Asante claims only 37 Ashland residents gave birth at the hospital in 2025. Sounds like a dying service. Why keep a birth center open for 37 patients?

Talk to the nurses who actually work there. The real number is around 210 births per year. How do you turn 210 into 37? You stop counting babies and start counting zip codes. Asante only counted mothers who live within Ashland city limits. The mothers who drove from Talent, from Phoenix, from Medford, from across the California border? Asante deleted them from the spreadsheet.

These aren’t random people who wandered in. Ashland’s birth center is the only facility in southern Oregon that offers water births, midwifery-led care, and low-intervention delivery. Women drive an hour or more because it’s the only place within a hundred miles that provides the care they want. Asante erased 82% of the birth center’s patients to make the closure look inevitable.

Here’s what makes this a taxpayer robbery, not just a corporate decision. The hospital’s gross revenue—the sticker price on the care it provided—was over $215 million. But after writing off $139 million in deductions, the actual net revenue was $77 million.

What drives those deductions? We do. Medicare and Medicaid account for nearly $100 million of those adjustments. That proves the vast majority of patients walking through those doors are funded by the federal government. By us.

We’re not asking Asante to keep the hospital open out of charity. We’re paying for this hospital. Medicare pays. Medicaid pays. The tax exemptions Asante enjoys as a nonprofit? That’s us paying too. We fund the patients. We subsidize the system. We just don’t own it.

And because we don’t own it, Asante gets to decide whether our community has a hospital. Asante gets to take our money, wire it to Medford, then tell us we can’t afford to have babies in our own town.

Don’t let the word nonprofit fool you. Just because an organization files as a nonprofit doesn’t mean it isn’t a parasite. Asante extracts wealth from communities the same way any for-profit corporation would. The nonprofit label just means the extraction gets called something else. We spend so much energy hunting for waste, fraud, and abuse in government programs. But the real waste is flowing through government contracts and subsidies into organizations like Asante. They take public money, skim off the top, and deliver less every year. That’s the fraud. It just happens to be legal.

Ashland isn’t unique. This is a business model.

In Philadelphia, Hahnemann University Hospital was bought by private equity, loaded with debt, and closed in 2019. During the pandemic, the owners demanded about a million dollars a month to lease the empty building back to the city. The campus is becoming luxury apartments.

In Illinois, Pipeline Health bought Westlake Hospital promising regulators it would stay open. Court documents later revealed the company had contractual obligations to close it before the sale even finalized. The closure was the plan all along.

In Atlanta, Wellstar Health System claimed massive losses at Atlanta Medical Center while posting profits system-wide. Wellstar had stripped the profitable services and moved them to the suburbs. Once only unprofitable emergency and indigent care remained, Wellstar announced it had no choice but to close. Burdening the entire health system in the area.

The mechanism varies. Real estate extraction. Service-line stripping. Corporate cost allocation. But it always comes down to the same thing: two sets of books. One set that makes the hospital look hopeless. Another that quietly funnels the money somewhere else.

Ashland owned this hospital. For decades, Ashland Community Hospital was a municipal asset. The city ran it. The community controlled it. It worked. Then the system made it impossible to keep.

Not because the hospital was failing. Because the regulatory burden got too heavy. The administrative complexity got too steep. The billing requirements, the compliance demands, the coding nightmares, the capital requirements. A small city couldn’t keep up with all the overhead that has nothing to do with actually treating patients.

So in 2013, Ashland sold to Asante. Not because the community wanted out. Because the system gave them no other choice. There was no federal program to help small cities run hospitals. No administrative backbone to handle the complexity. No support structure that would let communities keep what they built.

The sale included a contract. Asante promised to operate Ashland as a general hospital through 2028. Under Oregon law, that means providing medical, surgical, and maternity services. If Asante broke that promise early, the company would owe the city $4 million.

The city thought that penalty was protection. Asante sees it as a price tag. The hospital made $10 million last year. The fine is $4 million. Asante did the math. Pay the penalty, close the services, redirect the patients to Medford. They’ve already more than paid for the fine.

This is what happens when communities are forced to hand over essential services. The new owners do what owners do. They extract. We do not need more Asantes. We need to support the Ashland Community Hospitals.

So far, we don’t run fire departments this way. Can’t handle the regulatory complexity of fire protection? Sell your firehouse to a regional chain and hope they keep showing up. Nor our water system. Imagine if your town can’t manage the water systems instead of training and support you outsource the pipes to a corporation and pray they don’t jack up your rates.

We don’t need to do it with health care either.

We know how to solve this. We’ve done it before.

When private utilities refused to electrify rural America because it wasn’t profitable, the federal government didn’t just write checks. The Rural Electrification Administration did something smarter. The feds provided engineering blueprints. Technical specifications. Worker training. Financing. The administrative backbone that small communities couldn’t build alone. Then local cooperatives, farmer-owned utilities, and municipal systems did the actual work. Communities owned what they built. The federal government made it possible. Local people made it real.

The USDA does the same thing for farmers right now. County extension agents funded by the federal government provide soil testing, crop advice, veterinary guidance, technical support. The expertise flows from land-grant universities and federal programs. The farming stays local. The farmer keeps the land.

This is how America has always built essential services when the market failed. Federal support. Local ownership. Community accountability. We did it with electricity. We do it with agriculture. We do it with water systems and public libraries and the postal service.

Healthcare could work exactly the same way. A federal program that handles the administrative nightmare. The billing, the coding, the compliance, the regulatory burden that’s crushing small hospitals. Engineering standards and facility guidelines. Training programs for healthcare administrators. Low-interest financing. The backbone that lets communities run their own hospitals without drowning in overhead.

The hospital is already profitable doing the actual work of treating patients. Ashland proved that. Ten million dollars in operating income. The problem isn’t the medicine. The problem is the system sitting on top of it. Remove Asante. Replace the corporate layer with federal support infrastructure. Let communities do for themselves what they’ve always been capable of doing.

Electricity was once more affordable, not just because we regulated the private utilities harder. Because we built a public alternative that competed.

Healthcare needs the same thing. Not more regulations for the extractors to lobby around. Not more subsidies for the extractors to capture. Public ownership. Public competition. Communities running their own hospitals with federal support, the way we’ve done with every other essential service that’s too important to leave to the market.

Here’s the thing about this moment. Americans have been voting for change for twenty years. They chose Obama twice, hoping for transformation. They tried to nominate Bernie Sanders against the will of the Democratic establishment. They’ve nominated Donald Trump three times, elected him twice. Different directions, same impulse: CHANGE the system. Build something new.

The hunger for change is real. The establishment keeps failing to deliver. And now we’re heading into 2026 and 2028, elections that will shape this country for decades.

This is our window. Not to wait for collapse. Not to pray the system fixes itself. To choose a different path.

There’s another way to run an economy. Instead of managing pain, build abundance. If inflation is too high, make more of what people need. If food costs too much, figure out how to grow more food. If housing is unaffordable, build more houses. If healthcare is going to cost $9 trillion a year, build a system that actually treats people before we get there.

We don’t have to wait until something completely breaks to fix it. Healthcare is close to broken. We can see it coming. We can choose to act now.

Building a system that improves people’s lives instead of extracting from them isn’t easy. It means taking on the people who profit from the current arrangement. It means building new institutions and dismantling old ones. It means sustained political work over years.

By God, we can do it. We’re Americans. We built the electrical grid. We built the highway system. We built the greatest agricultural system the world has ever seen. We went to the moon. We can build a healthcare system that doesn’t rob us blind and leave us sick.

We’re not leaves blowing in the wind. We can define our own destiny. With enough unity, with enough clarity about what we’re up against, with enough people who refuse to accept a system designed to extract from them, we can change this.

We are all Ashland Community Hospital. The system is failing us.

But it doesn’t have to be this way. Not in Ashland. Not anywhere. We can build something better. We’re already paying for healthcare. It’s time we owned it. It’s time we built it to serve us instead of bleed us.

That’s the fight worth having.

Corbin

PS: So far we have $210,000 in pledges to launch the SuperPAC that will spread these messages far and wide. Once I know there is enough runway to get off the ground we will launch. That goal is $500K. I think we can get there.

The projects I am working on take a lot of time. If you believe the ideas, research, and perspective I’m providing are valuable please become a paid subscriber. You keep this free.

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Judicial Ethics

 


Judicial Ethics


Yesterday, Third Circuit Court of Appeals Judge Emil Bove attended an event where Donald Trump spoke. That’s an unusual thing for a federal judge to do, even when the president in question is his former client. Federal judges usually avoid political events like the plague.

Doing so would seem especially prudent when the Judge in question is newly appointed to the bench after a confirmation hearing that included testimony about the role he played in the government’s decision to ignore Judge James Boasberg’s order in the El Salvador deportation case. Bove has said that testimony from a whistleblower claiming he said “D.O.J. would need to consider telling the courts ‘fuck you’ and ignore any such order,” isn’t true. He recently submitted a declaration in that case that he provided “privileged legal advice” to others in that matter, without going into the substance of it. Attending a presidential speech in the middle of all of that might have struck other judges as unwise.

The Judicial Conduct and Disability Act of 1980 (“Act”), 28 U.S.C. §§ 351–364, and the Rules for Judicial-Conduct and Judicial-Disability Proceedings (“Rules”) govern the process for making a complaint against a federal judge. You may recall from our past discussions that U.S. Supreme Court justices are not subject to an ethical code. But the rest of the federal judiciary is. And anyone can file a complaint about a federal judge. The Act establishes the process for making them. The Code of Conduct for federal judges says “a judge should refrain from political activity” and shouldn’t attend any events “sponsored by a political organization or candidate.” Judges are also charged with upholding the integrity and independence of the judiciary and avoiding impropriety and the appearance of impropriety in all activities.

There are limits on the type of complaints that can be made. The judicial conduct and disability review process cannot be used to challenge the correctness of a judge’s decision in a case. The process is for complaints about a judge’s conduct. Any person can file one if they believe a federal judge has engaged in “conduct prejudicial to the effective and expeditious administration of the business of the courts” or has become, by reason of a mental or physical disability, “unable to discharge all the duties” of the judicial office.

Complaints go to the Chief Judge of the Circuit where the judge a complaint is filed against sits. It’s up to that Chief Judge to conduct an initial investigation and determine whether the complaint should be dismissed, for instance, because it’s a complaint about how a judge ruled in a case, or whether there is a sufficient reason to appoint a special committee of judges to investigate the alleged misconduct. The Chief Judge must dismiss a complaint where, even if the allegations were true, they would not rise to the level of a situation that is prejudicial to the effective and expeditious administration of the business of the courts. The Chief Judge must also dismiss the complaint if the allegations are frivolous.

Most complaints end with a dismissal, but in some cases, there is an investigation, and it can be significant. When it’s concluded, the special committee submits a report of its findings and recommendations to the judicial council. The council can dismiss a case at this state, or conclude it because corrective action has been taken. But it also has a range of more serious consequences it can impose:

If the order does not dismiss or conclude your complaint, the order may sanction the judge with a range of remedies including:

  • “censuring or reprimanding the judge, either by private communication or by public announcement;

  • ordering that no new cases be assigned to the judge for a limited, fixed period …

  • in the case of a circuit or district judge, requesting the judge to retire voluntarily…

  • in the case of a circuit or district judge who is eligible to retire but does not do so, certifying the disability of the judge so that an additional judge may be appointed …

  • recommending corrective action”

The speech Bove attended was what he might have expected—highly partisan. Bove is one of Trump’s former lawyers, so he is well acquainted with him. Trump was more political than presidential, railing against “the radical left Democrats in Congress” and calling Joe Biden “the worst president in the history of our country.” He also lambasted his former political opponent, Minnesota Governor Tim Walz, who was the Democrats’ Vice Presidential nominee in 2024, as “one of the dumbest governors ever in our history.”

At least one ethics complaint has already been filed against Bove and there are likely to be more.

Bove told MS NOW reporter Vaughn Hillyard that he was “just here as a citizen coming to watch the president speak.”

The complaints against Bove may get traction or they may go nowhere. But that’s not the point. Federal judges shouldn’t engage in arguably improper behavior and then shrug it off by claiming they did it in their personal capacity. I was taught as a U.S. Attorney that I didn’t even have a personal capacity; that I was on the job, working for the American people, 24-7. The same is true of federal judges. They get life tenure. In exchange, they should refrain from behavior that is arguably permissible if it could damage the integrity of the judiciary or create even an appearance of impropriety. That’s the job. If you don’t want it, then don’t become a federal judge. Otherwise, you might just as well say “F*** the courts.”

If Civil Discourse helps you make sense of the legal and political whirlwind we’re all living through, I hope you’ll consider becoming a paid subscriber. It’s your support that lets me devote the time and care this work deserves.

We’re in this together,

Joyce

Boebert misused campaign funds visiting Kid Rock at a rodeo

 





MAGA Rep. Lauren Boebert has been caught red handed improperly spending thousands of dollars of campaign money for personal expenses.


Boebert reportedly used her campaign funds to buy $925 worth of tickets to see her rumored boyfriend, washed up singer Kid Rock, at a rodeo and then spent around $2500 at a nearby hotel. If verified, this would violate federal campaign finance laws.

Boebert was so proud of herself, she even posted a photo on Twitter after the event.

This is exactly the kind of corrupt misuse of campaign money that landed disgraced former Rep. George Santos in prison. It is apparently no coincidence that Boebert fought to get Santos a pardon from Trump: she must have thought she could be next. 


Endless Boebert scandals remind us how important it is to work to defeat her as soon as we can. 


That’s why Colorado Turnout Project is leading the effort to beat Boebert this election. 


Our team has been a thorn in Boebert’s side since Boebert was first elected. During the January 6, 2021 Capitol riot, Boebert publicized Speaker Nancy Pelosi’s whereabouts as violent MAGA rioters stalked the hallways searching for enemies of Donald Trump and chanting “Hang Mike Pence”:

Since then, Colorado Turnout Project has worked every day to defeat Lauren Boebert. In 2022, we committed massive financial resources to unseat Boebert when all the pundits, consultants, and pollsters said she was untouchable. Boebert only survived that election by a minuscule margin of 546 votes — one of the closest contests in the entire country. 


Now, Boebert is more vulnerable than ever before. She has cut health care, raised costs for everything, and enraged the farmers and cattle ranchers in her district that she needs to win reelection.


Colorado Turnout Project is doubling down to get rid of her this election. And we need you with us to do it.

This is a grassroots-led effort, but we need your support to beat Boebert once and for all. Can you chip in $5, $25 or more to fuel Colorado Turnout Project’s critical work to defeat Lauren Boebert and flip multiple GOP House seats in Colorado from red to blue this year?

If you've saved your payment information with ActBlue Express, your donation will go through immediately:

Or donate monthly to kick Lauren Boebert out of Congress for good

Thank you for joining us. We will defeat Boebert, together. 


Gratefully,


— Colorado Turnout Project Team

Mail checks to:


Colorado Turnout Project

140 W. 29th St., P.O. Box 169

Pueblo, CO 81008


The fix for American healthcare already exists

  The fix for American healthcare already exists A profitable hospital is being gutted to pay for a $455 million expansion elsewhere. We...