Mamdani publishes names, addresses of all NYC owners to be hit with pied-à-terre tax

 Mayor Zohran Mamdani’s administration has published a searchable database of Big Apple properties that could fall under the state’s new pied-à-terre tax, effectively doxxing thousands of wealthy New Yorkers.

The city’s Department of Finance uploaded the comprehensive list – which purports to cover all unoccupied, non-primary residences in the five boroughs worth north of $1 million – including the full names and addresses of every property owner.

“It’s a reckless and foolish move, especially considering there are potentially thousands of properties on this list that do not qualify as second homes or whose owners will successfully dispute their inclusion,” Council Minority Leader David Carr (R-Staten Island) — whose own home appears on the list — told The Post Monday.

The move follows a widely panned X post by the mayor in which he put wealthy residents on notice to “check your mailbox when you’re back in the five boroughs, because you’ve got mail,” a warning that notification letters were on their way.

“The best city in the world deserves the best parks, libraries, and schools in the world. That’s only possible when we all pay our fair share,” Mamdani wrote Thursday.

The socialist darling has long touted the policy enacted by Gov. Kathy Hochul and Albany Democrats to tax second homes in the city – though critics have warned it could cause property values to plummet.

Mamdani threatened to raise city property taxes by a staggering 9.5% in February unless he was allowed to “tax the rich” to cover a $12 billion budget gap that was later revised down to $5.4 billion.

City Hall estimates the pied-à-terre tax would yield $500 million per year for the Big Apple’s budget. 

But Democratic city Comptroller Mark Levine’s office said the real figure would be closer to $340 to $380 million and could diminish over time.

Unsurprisingly, the colossal database of names and addresses included several A-list New Yorkers, including director Woody Allen, longtime Vogue editor Anna Wintour and actress Cynthia Nixon — a loyal Mamdani supporter.

What is surprising is the document’s sheer size and some of the properties included.

Citywide, The Post counted over 960,000 residences and individuals listed as potentially in line to be hit with Mamdani’s pied-à-terre tax, even though just 31,000 homes were supposed to be subjected to the new levy as he and Hochul initially sold it to the public.

Many of the homes included in the database appeared to be misaligned with a tax aimed at well-heeled residents with multi-million dollar vacation homes, including some two dozen modest homes on Chaffee Avenue in working-class Throggs Neck in the Bronx.

Challenger Drive on Staten Island was another middle-class enclave with dozens of addresses appearing on Mamdani’s list, though it wasn’t clear that they were in fact second homes.

The average home values on Chaffee Avenue and Challenger Drive ranged from mid-$500,000s to the low $800,000s — a far cry from the price tag of your average New York summer residence.

One address appearing on the list is the Breezy Point Shopping Center in Rockaway, Queens, a small outdoor mall containing several shops, which is definitely not a vacation home.

“All the mayor is doing is tanking the luxury home market in NYC and sending millions of dollars in real estate business to other states. But the upside is Mamdani is a shoo-in for ‘Realtor of the Year’ in Texas and Florida,” Carr railed.

Steven Fulop, president and CEO of the Partnership for NYC, a nonprofit business advocacy group, said the list “raises real safety and privacy concerns.” 

“Publishing individual property owners’ names and home addresses raises real safety and privacy concerns that go well beyond the tax debate itself. Transparency about how a new tax is administered doesn’t require putting private citizens’ addresses into a searchable public database that can put people in harm’s way,” he said. 

“In a political climate this polarized, the mayor didn’t need to invite that kind of risk — we should be looking for ways to dial down tensions, not heighten them. We’d urge the administration to revisit this approach.”  

The mayor is just getting started in fulfilling his campaign pledge to siphon funds from rich New Yorkers to bankroll his wealth redistribution agenda.

But it turns out even the middle-class isn’t safe from the pricey giveaways on his wishlist, which are being funded by the $23 billion in taxes Mamdani has backed since being sworn in.

He’s also pushing ahead with a months-long pressure campaign for even more new state taxes, including on city property owners, The Post reported last week.

https://nypost.com/2026/07/27/us-news/mamdani-names-all-nyc-property-owners-who-could-be-hit-with-new-pied-a-terre-tax/

BofA Downplays China's DUV Tool Production Report, Sees Only "Modest Threat" To ASML

 ASML Holding NV shares in Amsterdam suffered their steepest decline in more than a year, breaking below the crucial 50-day moving average after The Information reported that a Chinese state-backed company had begun producing immersion deep-ultraviolet (DUV) lithography machines.

The Information did not cite the Shanghai-based company that plans to manufacture about five DUV machines this year and roughly 20 in 2027. The firm reportedly assembled teams from other Chinese chip-equipment firms, including Shanghai Yuliangsheng Technology.

ASML builds lithography machines that print transistor patterns onto silicon wafers. Its DUV machines are considered the workhorses of the semiconductor industry, producing highly advanced chips ranging from DRAM and NAND memory to logic and AI chips, as well as smartphone and automotive processors.

Only three weeks ago, we reported that China's leading memory-chip companies are quickly closing the technology gap with their South Korean chip-producing rivals faster than expected, raising concerns that expanding Chinese production could eventually spark a global memory glut.

First reported here on July 6

China CXMT Testing Production Line for Next-Gen Bonded DRAM, Closing Tech Gap With Korea "Far Faster Than Expected"https://t.co/oHI5VEVDRD https://t.co/93ks5sQAf2

— zerohedge (@zerohedge) July 27, 2026

China's largest memory company, CXMT, is reportedly testing a pilot line for bonded DRAM in Hefei (the heart of China's semiconductor industry), a technology that manufactures memory cells and peripheral circuitry on separate wafers before joining them. This process could deliver higher density and performance using older deep-ultraviolet lithography equipment, allowing China to reduce its dependence on advanced EUV machines restricted by US export controls.

The company is also developing HBM3 and HBM3E products, pursuing next-generation CXL memory, and preparing for a potential Shanghai listing. Its reported share of the global DRAM market reached 8% during the first quarter of 2026, and Apple is said to be considering CXMT as a supplier.

The US has been probing ASML for many months out of concern that one of its lithography machines ended up in Chinese hands despite US-led export controls.

Bank of America analyst Didier Scemama commented on The Information's report, telling clients:

According to The Information, China may have started production of DUV immersion litho tools. The article suggests that China have brought together immersion DUV development teams from other Chinese companies but warns that DUV advances are still "at an early stage". Yuliansheng Tech allegedly intends to produce 5 DUV tools this year and 20 next year for domestic Chinese customers, including SMIC, CXMT and Hua Hong. Of note, the article indicates that the immersion tools may be using components from both China and Japan, potentially violating export control restrictions.

Scemama continued:

China is a major market for ASML but threat likely modest

The leading domestic player, SMEE, has yet to demonstrate ArFi systems in high-volume production at 28nm or below, while reports of a Chinese EUV breakthrough have not resulted in a commercial product. China remains an important market for ASML, accounting for roughly 20% of group sales and 44% of DUV revenue in 2026. Replacing ASML would require a domestic alternative with comparable productivity, overlay and cost of ownership. That remains a high hurdle. ASML's NXT:1980Fi already delivers 330 wafers per hour and 2.5nm machine-matched overlay, while successive generations have further improved overlay performance. In leading-edge Chinese logic manufacturing, where EUV is unavailable and multiple patterning is required, even modest reductions in scanner performance could materially lower yields and increase cost per die.

. . .

We think today's weakness is an over-reaction and see current levels as an attractive opportunity.

Domestic DUV machines could eventually increase DRAM and NAND production in China, strengthening suppliers such as CXMT and YMTC while helping alleviate the global memory crunch. The report also suggests that ASML's long-term competitive position could face growing pressure, while the leverage exerted by US and Western export controls over China's access to advanced chips and chipmaking equipment could erode. 

https://www.zerohedge.com/technology/bofa-downplays-chinas-duv-tool-production-report-sees-only-modest-threat-asml

Flashback: Fauci Funded Technique To Hide Evidence Of Genetic Engineering According To RFK Jr.

 Four years ago, Robert F. Kennedy Jr. made an accusation that got him shadowbanned, "fact-checked," and dismissed as a crank: that Anthony Fauci's NIAID had bankrolled the development of a laboratory technique whose primary utility was erasing the fingerprints of human engineering from a manipulated virus - and that the technique was then handed to the Wuhan Institute of Virology.

With Fauci's personal diaries now public, Tulsi Gabbard's last-day document dump on the record, Ralph Baric stripped of his NIH grants and placed on leave by UNC, and Fauci himself scheduled to appear under subpoena before the Senate Homeland Security and Governmental Affairs Committee this Wednesday at 8:30 a.m., Kennedy's remarks are worth revisiting.

Here's what he said:

"He [Fauci] funded Ralph Baric to develop a technique called seamless ligation. And that is a technique for hiding the engineering project."

"So, normally, when you do that kind of engineering, you can see it, and you can say, 'That bug was created in a lab.'"

"He [Baric] developed a way of hiding all traces [of what] was developed. And he taught that to the Chinese scientists - to Shi Zhengli."

"There is no public health [reason for this]; it is the OPPOSITE of what you would do if you are interested in public health... To teach people how to hide that only has a nefarious purpose."

Kennedy made the same argument repeatedly around the release of The Real Anthony Fauci, and his complaint was never just that gain-of-function research is dangerous - everyone concedes that now, including the virologists. It was narrower: that U.S. taxpayers paid to develop, and then export, a capability whose only obvious application is defeating attribution.

What "Seamless Ligation" Actually Is

The technique is published, peer-reviewed, sitting on the National Institutes of Health's own servers, and was openly boasted about for the better part of two decades.

Assembling a full-length coronavirus genome from smaller synthetic fragments requires cutting and pasting DNA. Conventional restriction enzymes leave behind junction sequences - "scars" - at every splice point. Those scars are the tell. Line up the genome, spot the regularly spaced artificial seams, and you can say with confidence that a human being built the thing.

Baric's lab solved that problem. Using Type IIS restriction enzymes - which cut outside their own recognition sequence - his team developed an assembly method that leaves no residual site at the junction. The finished genome reads as though it were never cut at all.

Baric's own lab nicknamed it the "No See'm" method - and the full protocol was published in 2008 by Eric Donaldson, Amy Sims and Ralph Baric as Systematic Assembly and Genetic Manipulation of the Mouse Hepatitis Virus A59 Genome in Springer's Methods in Molecular Biology series. Its abstract describes demonstrating "the power of this unique site-directed 'No See'm' mutagenesis approach." "No See'm technology" is listed among the paper's official keywords. The underlying assembly platform had been laid out six years earlier in the Journal of Virology.

The stated scientific rationale is efficiency: no scars means no unwanted mutations at the junctions, and mutants can be generated fast. But efficiency and untraceability are, here, the same property. A seamlessly assembled synthetic genome is indistinguishable from a naturally circulating strain, which is what the method was built to achieve.

Kennedy has put the NIAID funding figure at roughly $212 million to $220 million flowing to Baric over the course of his career.

Meanwhile, Baric was the researcher most affected by the Obama administration's 2014 gain-of-function pause as noted by NPR in "How A Tilt Toward Safety Stopped A Scientist's Virus Research" - and that he was America's foremost coronavirus biologist on the federal dime. Baric and Shi Zhengli went on to co-author the 2015 chimera study in Nature Medicine that the journal was later forced to flag with an editor's note.

In Light Of Fauci's Diary...

Kennedy's longstanding claim is that evidence COVID-19 was man-made was engineered away. 

Baric confirmed the furin cleavage site was his job. In a voluntary transcribed interview with Sen. Rand Paul's staff in April, released this week, Baric - co-author of the 2018 DEFUSE proposal, key contributor to NIAID-funded work in Wuhan - confirmed that the furin cleavage site insertion described in that proposal was his assignment. Per Paul's Reading Room, he also confirmed running an experiment that undercuts the core scientific defense of natural origin, and still cannot explain how he ended up on the February 1, 2020 call with Fauci and the authors of "Proximal Origin."

Fauci's diary shows he knew on day one. The entries Paul released this weekend record that on January 31, 2020 - before most Americans had heard the phrase "lab leak" - Jeremy Farrar patched Fauci into a call with Kristian Andersen and Eddie Holmes about the SARS-CoV-2 furin cleavage site. Fauci's own contemporaneous note: they raised "the possibility that this could have been deliberately inserted and either accidentally released or deliberately released by a crazy person in the lab, the former being the most likely." Roughly half the scientists on that initial call thought the virus looked constructed. Days later, Fauci was on Newt Gingrich's podcast dismissing lab-origin questions: "I've heard these conspiracy theories. And like all conspiracy theories, Newt, they're just conspiracy theories."

A national lab said the same thing in writing. Gabbard's June 18 declassification included an eight-page May 27, 2020 assessment from Lawrence Livermore's International Assessments program concluding that "all of the necessary conditions for an accidental release of a laboratory-modified coronavirus - specifically a coronavirus adapted to recognize human cell receptors - were present" at the WIV in mid-to-late 2019. The documents are online.

And Baric's career is over. As Paul Thacker noted, NIH has quietly removed Baric from all his grants; UNC has placed him on leave and refused to cooperate with federal document requests. Jeffrey Sachs - who chaired the Lancet COVID commission - now points at Baric directly. Robert Redfield told RCI he briefed Mike Pompeo in a SCIF in early 2020: "Mike, this is the smoking gun. This virus came from a lab."

A senior HHS official put it to RCI more bluntly: "Baric designed the gun. But the Chinese built it, and then they pulled the trigger."

The Fingerprint That Wasn't Erased

Kennedy himself never argued the erasure was total - noting a preprint arguing that Baric's fingerprints were visible after all. In October 2022, Valentin Bruttel, Alex Washburne and Antonius VanDongen posted a preprint titled Endonuclease fingerprint indicates a synthetic origin of SARS-CoV-2. Their argument: the SARS-CoV-2 genome contains an oddly regular pattern of BsaI and BsmBI restriction sites - exactly the spacing you'd want for efficient lab dis- and re-assembly, and an anomaly among wild coronaviruses. They found the pattern "more likely a product of synthetic genome assembly than natural evolution."

The preprint was aggressively contested and never formally published. If it holds, the implication is that whoever assembled the virus was less careful than the man who taught the technique.

https://www.zerohedge.com/covid-19/flashback-fauci-funded-technique-hide-evidence-genetic-engineering-according-rfk-jr

Healthcare – Spend More, Get Less

 

Healthcare has things exactly backwards. Normally, when you spend more money, you expect to get more product, service, or value in some form. But in the U.S. healthcare system, Washington keeps spending more (of our money), and we keep getting less ... care.

The latest example is a new set of rules just announced by CMS that govern accountable care organizations and change the metrics and compliance requirements by which they are judged (and funded). The cost of these new regulations is not included in the CMS announcement. It is certain to be substantial, likely in billions, both for the federal government and for providers who must change policies and procedures, fill out new forms, accept constant reviews, and comply...or else.

Along with expense incurred by new rules, CMS announced a cut in reimbursement to physicians. Thus, healthcare will spend more while care providers will get less. Patients will wait longer, have shorter appointment times, and get less care. More people will die needlessly waiting in line for care.

This is not new. In fact, it has been a standard pattern since 1965 when Medicare and Medicaid were passed. It starts with a problem that makes headline news. Retired Americans can’t get employer-sponsored health insurance – leads to Medicare. Twelve-year-old dies “from a toothache” because of lack of care – more stringent Medicaid rules, but reduced reimbursement. “Seniors must choose between health insurance and their medications” – government price fixing.

To “fix” whatever problem makes front page news, Washington passes new legislation or revises current rules adding to the massive regulatory apparatus already in place. This generates more spending on BURRDEN – bureaucracy, unnecessary rules and regulations, directives, enforcement, and noncompliance activities. Between 1970 and 2020, when the number of physicians increased 100 percent, the number of healthcare bureaucrats, nonclinical workers hired to administer BURRDEN, increased more than 4,400 percent! That is forty-four nonclinical workers for every one physician.

Federal regulations and rules produce bureaucratic diversion: healthcare dollars are diverted from patient care to pay for BURRDEN. The end result is death by queue. With insufficient clinical funds, patients wait so long for care, they die while waiting. The Affordable Care Act (ACA) offers an excellent demonstration of “spend more (on bureaucracy), get less (patient care).”

(This author was a founding Director of the New Mexico Health Insurance Exchange which was one of the fifty-one state (and D.C.) exchanges created by the ACA. Thus, he knows details of the ACA from the inside.)

Recall two promises made for the ACA and how they turned out. First, President Obama assured Americans they would “save $2500 on their insurance bill.” Yet instead of spending less, Americans are forced to spend more and more on insurance, from unaffordable to super-duper unaffordable. The second promise was “if you like your doctor or your health plan, you can keep them.” Millions were forced to change physicians or health plans. Increasing numbers of physicians are simply quitting.

ACA promised savings and care promises never materialized. President Obama’s namesake legislation cost taxpayers $1.76 trillion, mostly for bureaucracy and administration. To defray a large portion of that expense, President Obama took $716 billion from the Medicare Trust, money that had been earmarked to pay for senior care. The Medicare Trustees project that the Trust will run out of money, be insolvent, by 2036 at which time Medicare will be unable to pay for seniors’ hospital care.  ACA bureaucratic diversion contributed to that impending bankruptcy and loss of promised care.

A third example of “spend more, get less” is the recent Minnesota Medicaid fraud. CMS (Centers for Medicare and Medicaid Services) simply paid bills that were presented to it without confirming that the enrollees were real or that they received the goods and services contracted. The Somali fraudsters simply pocketed the money. Nine billion is the current estimate for how much was embezzled just in Minnesota. Other Medicaid scams are being investigated in California, Florida, Ohio, Maine, and New York.

Without effective watchdog activities and absent strict accountability, Medicaid is expending billions “more” while Americans are getting “less,” in fact, getting nothing.  

Third-party payment structure facilitates, even encourages, such “spend more, get less” behaviors. We cannot afford such inefficient healthcare spending: monies expended that do not produce patient care. It is time to consider ways to put patients, not third parties, in control of healthcare spending. After all, it IS their money, and their lives.

 It is time for the Empower Patients Initiative.

Deane Waldman, M.D., MBA, is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former Director of the New Mexico Health Insurance Exchange; and author of award-winning, “Become an Empowered Patient.” 

https://www.realclearhealth.com/articles/2026/07/24/healthcare__spend_more_get_less_1195988.html

Mind the Gap: The growing divide between lifespan and good health

 By Chuck Dinerstein, MD, MBA 

Over the past three decades, global advances in medicine have significantly extended human lifespan, but gains in healthy living have failed to keep pace. This imbalance has created a widening "morbidity gap," where we spend over a decade in poor health. Will a shift in focus for healthcare systems make a difference?

As our lifespan increases, attention has focused on our healthspan – the time we spend living in good health. As a new article in The Lancet points out, differential improvements in our lifespan and healthspan can lead to one of several outcomes:

• Ideally, disability is “compressed” into the very end of life, leaving us with the greatest proportion of healthy lifespan, a period termed the “morbidity gap” in this study.
• Advances in care result in greater survival gains at the cost of an increasing “morbidity gap,” as longer lives paradoxically carry higher risks of disabling conditions.
• As lifespan increases and more chronic medical conditions arise, those conditions are better managed, reducing the severity of the “morbidity gap” if not its length

The Lancet study argues that over the last 30 years or so, improvement in survival has outpaced reductions in non-fatal health loss globally. 

The Growing Chasm

• Between 1990 and 2023, global average life expectancy rose by 9.2 years to 73.8 years, while healthy life expectancy increased by only 7.2 years to 63.1 years. The resulting global "morbidity gap"—the absolute time spent in poor health—increased by about 20%, or nearly two years. This widening occurred in 203 of 204 countries and territories (99.5%), raising the global proportion of life spent in poor health from 13.6% in 1990 to 14.5% in 2023. 
• Instead of our health loss compressing into a brief period at the very end of life, disability builds progressively across the entire adult life course. Nonfatal health loss expands steadily across every adult age bracket rather than being confined to advanced age. 
• That expanding morbidity gap is largely driven by chronic conditions, with five major cause groups accounting for nearly 60% of our unhealthy years globally. The top two are musculoskeletal disorders, primarily low back pain, and depression and anxiety, which steal 1.8 and 1.6 years of health from our lives, respectively. Age-related hearing and sight loss, along with unintentional injuries, i.e., falls, round out the top four. 
• Women, who consistently outlive men, also experience a large absolute and proportional duration of chronic illness, nearly 16% of their lifespan compared to 13% for males. 

The Development Paradox

Highly developed nations successfully avert premature deaths, but their populations end up enduring a longer overall duration of chronic illness. The largest morbidity gap was found in the High Socio-demographic Index (SDI) nations; the SDI is a composite score of fertility for females under 25, mean educational attainment for those age 15 or older, and distributed income per capita. The United States had the greatest morbidity gap at 14 years, while the countries of sub-Saharan Africa had the smallest. 

Do we want to be more like sub-Saharan Africa and other countries with a low SDI? Not so clearly. While the gap between being healthy and dying is smaller, that may well reflect health systems geared primarily to acute rather than chronic illness. 

Is the US morbidity gap, the largest globally, a good thing? As with the previous response, not necessarily. We have a health system that is very good at treating acute illness and preventing deaths – but that advantage comes with inevitable downstream consequences. Consider, for example, breast cancer. In the 1980s, the overall 20-year survival rate was about 40 to 45%. Today, that survival rate has doubled. Breast cancer survivors can experience increased cardiovascular risk due to chemotherapy and radiation, while treatment-induced menopause shifts their metabolism, resulting in central weight gain and muscle loss. There can also be nerve damage and a less well-defined chemo-brain fog. Earlier generations rarely survived long enough for these issues to surface; medicine is now navigating the morbidity gap associated with long-term survivorship, which includes specific long-term effects as well as the general debility that comes with aging.

Individual Responsibility or Public Health

Those more general factors, which the authors note account for much of our unhealthy years, vary with the usual demographics, cultural differences, and geography. 

 

As can be seen, the US’s biggest contributors to our morbidity gap are our relationship with food, tobacco use, and occupational risk. Of the top five, 4 are within our immediate control and do not require any greater intervention from our health systems than a reminder about diet, exercise, and not smoking. Of course, those all require an individual level of responsibility, aided by an occasional prescription. As a physician and fellow human, I can attest to the difficulty in changing behavior. 

It is unclear how we might do better at preventing hearing and sight loss, but our healthcare system can identify needs, and our social service structure can provide mitigation through hearing aids, treatment for cataracts and glaucoma, and adaptive visual aids, i.e., audiobooks and large-print editions. We can predict falls but rarely alter the home environment to provide the necessary infrastructure adaptations, i.e., ramps, handrails, ambient lighting. The loneliness of aging, with its attendant depression and anxiety, can be identified by our physicians, but the solutions lie with our families and social structures that can replace generational households that no longer exist. 

Extending human life without protecting functional well-being represents a bittersweet triumph for modern medicine. As survival gains continue to convert acute fatal events into long-term chronic conditions, public health performance can no longer be measured by solely by longevity. Healthy aging will not come solely from pills and potions; it requires individuals to manage controllable lifestyle risks and for societies to find ways to “strengthen the feeble hands, steady the knees that give way.” That will require more than a shifting focus by healthcare systems.

 

Source: Global, regional, and national trends in the morbidity gap and contributing diseases, injuries, and risk factors, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023 The Lancet DOI: 10.1016/S2468-2667(26)00098-8

https://www.acsh.org/news/2026/07/24/mind-gap-growing-divide-between-lifespan-and-good-health-50245

Pelosi Aide: Restrictions on Physician-Owned Hospitals are Justified

 In 2008, The Washington Post reported on a devastating tragedy. A 44-year-old went into respiratory arrest following elective surgery at a physician-owned hospital in Abilene, Texas. The facility, which only provided limited healthcare services and was not a full-service hospital, did not have the capabilities to handle his medical emergency, and the staff called 911 for help. The man was taken by ambulance to a full-service hospital, but the delay may have cost him his life.

This was not an isolated incident. A subsequent federal Office of Inspector General report found that many physician-owned hospitals were ill-equipped to handle medical emergencies, putting patients at risk. In response, then-Senate Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Chuck Grassley (R-Iowa) wrote, "It's unbelievable that a facility that calls itself a hospital would, at times, not even have a doctor on call or a nurse on duty."

Today, there is a well-orchestrated attempt by special interests to rewrite this history and mislead American policymakers and patients about what physician-owned hospitals are and what they offer.

Some physician-owned hospitals do not meet requirements to maintain a nurse on staff 24/7. They do not always have a physician on call. They do not need to operate an emergency department or be equipped to handle all levels of medical emergencies. And they cannot treat every patient who walks through the door. They call themselves hospitals, but they fail to take on the level of care patients expect out of actual hospitals.

Further, patients and their families don't make these distinctions in moments of need. In an emergency -- a heart attack, a natural disaster, a mass casualty event -- patients expect hospitals (all of them) to be open, equipped, and ready to provide lifesaving care. When facilities cannot meet that standard, lives are put at risk.

That's why when Congress wrote the Affordable Care Act (ACA), lawmakers included commonsense accountability measures on physician-owned hospitals (POHs). The "POH-ban" -- as many refer to it -- doesn't stop physicians from running or operating hospitals. Rather, it stops them from cherry picking patients, from threatening the viability of full-service hospitals with emergency care, and from putting patients' safety at risk.

With legislation introduced in Congress to try and reverse these measures, and an aggressive media campaign behind it, it is important to set the record straight.

Many physician-owned hospitals focus on highly specialized services such as cardiac care or orthopedic surgery. But this model isn't simply about offering focused expertise -- it creates a financial incentive to steer certain procedures and commercially insured patients away from full-service hospitals.

Instead of creating a competitive environment, the unlevel playing field fundamental to these limited facilities does the opposite. The lack of services offered, the specific patients seen, the small scale of staff and resources needed to run these facilities is not balanced with that of full-service hospitals, and it breeds an anti-competitive landscape.

That's where the concern lies. This issue is not about ownership -- it is the inherent conflict of interest created by self-referral and the impact those referrals have on a community's access to care. A physician who practices at a hospital can refer select patients to a facility in which they have a financial stake, often for higher-margin procedures, and the patients may not know the limited-service facility lacks emergency capabilities.

Over time, that dynamic shifts resources away from hospitals that are responsible for treating all patients, regardless of complexity or ability to pay, and that are there to pick up the pieces for a limited physician-owned hospital when a case turns dire.

The data bear this out. A 2023 report from Dobson|DaVanzo found that physician-owned hospitals treat fewer Medicaid and dual-eligible patients, and provide less uncompensated care than full-service hospitals. In practice, they disproportionately serve commercially insured patients while leaving more complex and less profitable care to community hospitals.

This imbalance doesn't just affect individual hospitals -- it reshapes entire markets. A 2025 study found that this diversion of care could undermine full-service hospitals' financial stability in rural areas and, ultimately, threatens access to care across communities. At a time when rural hospitals are already under threat, and hospital integration is allowing hospital doors to stay open in communities where access to care is at risk, an increase in physician-owned hospitals would tear away that foundation for entire communities.

When Congress passed restrictions on physician-owned hospitals under the ACA, it was motivated by the clear risk to patient safety and the referral implications without any added benefits to the communities they operated in; it was not the lobbying of the full-service hospitals and health systems that provided the political impetus for the restrictions. Put simply, the inclusion of this policy was not about securing pivotal votes for the ACA.

When Congress acted, it struck a careful balance. The law preserves existing arrangements, and allows for certain expansion of physician-owned hospitals based on community need. Importantly, the law protects patients, banning physicians self-referring patients to the hospitals they own -- a clear conflict of interest that doesn't put patients first -- and it introduces important safeguards to promote safety. And perhaps most notably, at a time when lawmakers are taking a serious look at how to reduce waste and abuse in healthcare, the Congressional Budget Office estimated that the law reduced the deficit by $500 million over 10 years.

These safeguards help ensure that hospitals remain equipped to serve all patients, and today, patients and communities are safer because of them. These safeguards should not be eliminated as recent legislation and misleading lobbying campaigns suggest.

Wendell Primus is a visiting fellow at The Brookings Institution and was formerly staff to Speaker Nancy Pelosi.

https://www.medpagetoday.com/opinion/second-opinions/122329

AMA President: It's Time to Lift Limits on Physician-Owned Hospitals

Since 2010, the Affordable Care Act (ACA) has expanded health insurance to millions, protecting people with pre-existing conditions and strengthening America's healthcare safety net. But one of its lesser-known provisions has yielded unintended consequences. The ACA restricts the creation and expansion of physician-owned hospitals, a policy that stifles innovation, limits patient access to specialty care, and has coincided with growing market power among large hospital systems.

The bipartisan "Patient Access to Higher Quality Health Care Act of 2025" (H.R. 4002) would repeal these statutory and regulatory barriers that restrict the formation or expansion of physician-owned hospitals. More than 90 national medical specialty societies and state medical associations have joined with the American Medical Association (AMA) to strongly support this measure, and for good reason: removing the ACA's restrictions on physician-owned hospitals will unlock benefits for patients, physicians, and communities, without increasing federal spending or administrative burdens.

Advancing Patient Outcomes and Access

Empirical studies and government analyses suggest that physician-owned hospitals can increase competition and patient choice while delivering high-quality specialty care. A 2005 study conducted for CMS found that physician-owned cardiac hospitals delivered patient outcomes comparable to, and on several measures better than, competitor hospitals, with high rates of patient satisfaction. These findings challenge the assumption that federal restrictions are needed to protect patients from lower-quality care, especially when patients require specialty care.

Beyond delivering strong outcomes, physician-owned hospitals also bring a nimble approach to care delivery, quickly adapting to meet patient needs. Consolidation among hospitals and insurers is reducing competition and driving up costs, leaving fewer options, especially in vulnerable communities. Leading health economists have shown how this consolidation undermines quality and restricts patient access. Physician-owned hospitals have the potential to act as a competitive counterweight in markets where consolidation has taken hold.

Most physician-owned hospitals today are in urban and suburban markets. Restoring physicians' ability to build and expand these hospitals could allow the model to reach more rural and underserved communities that have been hit hardest by hospital closures and consolidation -- creating new options where patients currently have few and helping preserve the physician-patient relationship.

Accountability and Coordinated Care

Expanding physician leadership in hospitals supports higher levels of coordinated and integrated care, a goal at the heart of respected models like Kaiser Permanente and Mayo Clinic. Physician engagement supports the adoption of team-based care, alternative payment arrangements, and a more streamlined patient experience through "one-stop shopping." This kind of physician-led collaboration is designed to reduce waste and duplication and facilitate smarter, more coordinated care.

When physicians lead and own hospitals, they have a direct stake in patient outcomes and total cost. This accountability can translate into responsive, higher-quality care that centers on patients' needs.

Setting the Record Straight

Critics have long argued that physician-owned hospitals "cherry pick" healthier, more profitable patients. The evidence tells a more precise story. The 2005 CMS study of referral patterns at cardiac, surgery, and orthopedic specialty hospitals concluded, "we are unable to conclude that referrals were driven primarily based on incentives for financial gain." A 2021 study in the Journal of Health Economics reached a similar conclusion: individual physician-owners do not selectively refer their healthier or more profitable patients to the hospitals they own.

The same study found physician-owned hospitals tend to draw a somewhat healthier patient mix overall, tied to where these hospitals are built and to the patient populations physician-owners already treat, not to doctors steering sicker patients elsewhere.

A separate line of criticism focuses on emergency and safety-net services, suggesting that physician-owned hospitals are ill-equipped to manage emergencies. Because grandfathered physician-owned hospitals are a small, capped share of the hospital market, and because any future growth would occur under the same emergency care and Medicaid nondiscrimination requirements that already apply to them, these concerns are best addressed through those existing safeguards rather than an outright ban on growth.

Statutory and Regulatory Issues

Physician-owned hospitals have always been held to the same rigorous standards as all other hospitals. Since 2010, when the ACA restrictions took effect, they have also been subject to additional ownership disclosure and growth-restriction requirements that no other hospital type faces. Those restrictions were eased in 2020, but a 2023 rule reinstated and further tightened them beyond even what the ACA itself required. These expanded rules make it harder for hospitals to grow or serve vulnerable communities, placing additional burdens on facilities that could otherwise help address local care gaps. As a result, patients now face fewer choices, higher costs, and less innovation in their local healthcare systems.

Healthcare policies have real-world consequences, in this case fewer hospital options and a healthcare system that stifles physician initiative and entrepreneurship. The AMA urges Congress to rescind these rules, restore needed flexibility, and encourage innovation.

A Logical Step Forward

Removing ACA restrictions on physician-owned hospitals is a logical, evidence-based step toward a more dynamic, patient-focused health system. This reform would increase innovation, competition, and access to care without raising federal spending.

Especially in areas with hospital consolidation or closures, physician-owned hospitals represent a promising avenue for new options for patients and communities. Congress should pass H.R. 4002, eliminate unnecessary regulatory barriers, and let America's physicians deliver the specialty care and innovation that patients deserve.

Willie Underwood III, MD, MSc, MPH, is president of the American Medical Association (AMA).

https://www.medpagetoday.com/opinion/second-opinions/122332