They say laughter is the best medicine. Surgery works pretty good, too.
Atlanta, Georgia
Joined May 2009
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Daniel McDevitt MD FACS FSVS retweeted
Not every leg cramp is a blood clot, but don’t wait to find out. SVS Vice President Dr. @ShutzeW told @washingtonpost that physicians would much rather rule out a clot than see a patient with a catastrophic one. bit.ly/47seO2J #HighwaytoHealth
Daniel McDevitt MD FACS FSVS retweeted
SVS Vice President Dr. @ShutzeW spoke with @NBCPhiladelphia about Jalen Hurts’ blood clot diagnosis and the importance of prioritizing health during recovery. Blood clots can affect anyone. Learn the risks: bit.ly/4dJ2oXJ #VascularHealth #HighwaytoHealth
Daniel McDevitt MD FACS FSVS retweeted
Why the Virtuous Majority Keeps Losing.
Most people are decent. They work, raise their children, pay their taxes, and don’t lie more than they have to. And yet, again and again, the country is run against them.
How?
Turns out the mechanism has a name: Olson’s logic of collective action. An economist named Mancur Olson worked it out in 1965.
The idea is simple. Imagine a subsidy worth millions to a small group of companies. It costs every taxpayer the price of a coffee. Who will organize? The few, for whom it is worth millions – they will hire lobbyists, fund campaigns, show up at every meeting. The many, each losing the price of a coffee, will do nothing. Nobody marches for the price of a coffee.
Concentrated gains organize. Dispersed losses sleep.
Add the free rider: in a large group, everyone hopes someone else will do the work. So nobody does.
That is why the small organized minority beats the large disorganized majority, almost every time. Not because it is right. Because it shows up.
Now look around. The grant-funded NGO, the bureaucracy defending its budget, the activist network with full-time staff, the lobby with an office next to the ministry. Each has a lot to gain from one more rule, one more program, one more subsidy. The families paying for it each lose a little – and they are busy raising children.
Vice organizes itself, because vice pays its organizers. Virtue has to be organized, because its rewards are spread across everyone.
Olson saw the long-run consequence too. In a second book he argued that stable nations slowly fill up with these organized interests, each defending its slice – until the whole country stiffens and growth stalls. Germany and Japan boomed after the war partly because defeat had swept the old coalitions away.
So what do we do? Olson’s own logic gives the answer.
Make the dispersed costs visible. The coffee nobody notices becomes a bill everyone can read. That is what telling the truth does.
Give the virtuous a reason to show up beyond duty: friendship, community, careers, joy. Movements that last give their members something to belong to.
And remember that the majority never needs to organize all at once. A committed minority is enough to start – the long march proved it. The rest follow once they see they are not alone.
And it needs structure. That is what the network of patriots across Western Civilization – and the Council of Western Civilization at its center – are for. Not to give orders. To show the direction, so the energy is not scattered. To give the vocabulary, so people can name what is being done to them. And to coordinate, so no one fights alone. Olson’s lesson in one line: the organized few beat the disorganized many. So become the organized many.
And here is the good news. Olson wrote in 1965, when organizing cost meetings, letters, money and years. Today it costs a post. The math that kept the decent majority asleep is changing.
The majority does not win by being right. It wins by showing up – together.
We live in an age of complex systems.
Civilization is human nature, multiplied by institutions.
Every human trait, every emotion, every vice gets scaled into its systemic, civilizational expression.
Envy – socialism. If I can’t have it, nobody should.
Pride – central planning. The planner never pays for his plan.
Wrath – cancel culture. The desire not merely to defeat an opponent, but to destroy him.
Sloth – dependency by design. A system that makes idleness safer than effort eventually gets more idleness.
Greed – crony capitalism. Private gains, public losses.
Gluttony – debt. Consuming today what belongs to your children.
Lust – pleasure without consequence, and the empty cradle.
Deceit – propaganda and managed reality: the Systemic Lie. A lie told to one person is a sin; told to millions, it becomes a system.
Love of power – bureaucracy. Every agency finds a reason to grow, and every procedure exists so that nobody can be blamed.
Fear – the compliant society. Nothing may be tried until it is proven harmless, so nothing new is tried. The precautionary principle would have banned fire.
Vanity – virtue signaling. Beliefs worn like jewelry.
Conformity – groupthink. When everyone must agree, collective stupidity masquerades as consensus.
Ignorance – cults and sects. Whoever knows nothing will believe anything.
Resentment – revolutionary politics. The desire not merely to rise, but to bring down those who have risen higher.
Cowardice – institutional silence. Everyone sees the problem. Nobody wants to be the first to name it.
Distrust – surveillance and control. When people no longer trust one another, they demand a system to watch everyone.
Guilt – a civilization ashamed of itself. The heir taught to despise his inheritance.
And the virtues:
Courage – free speech. Every right we have was first defended by someone who was afraid and spoke anyway.
Curiosity – science. The willingness to ask questions that might destroy what we think we know.
Ambition – meritocracy, or its corruption. Properly directed, ambition builds civilizations. Under the wrong incentives, it builds careers at civilization’s expense.
Honesty – trust, and markets that work. Where a handshake holds, a contract is cheap.
Shame – manners and honor. The rules nobody needs to write down. A people that loses its sense of shame needs a law for everything.
Responsibility – the market and the courts. Whoever decides should bear the consequences.
Patience – savings, cathedrals, families. Every cathedral was begun by people who knew they would never see it finished.
Hope – investment and children. Both are bets on tomorrow.
Gratitude – transmission. The willingness to receive an inheritance, preserve it and pass it on.
Perseverance – institutions that outlast their founders. The ability to keep building long after the original enthusiasm has faded.
Wisdom – constitutional limits. The recognition that no individual, however brilliant, should be trusted with unlimited power.
Joy – the feast, the festival, the laugh. A regime that can’t take a joke can’t take the truth.
Love of the particular – family and nation. Universal principles do not require us to abandon particular loyalties.
And two principles that determine whether a civilization survives:
Envy versus gratitude – Does a society teach its children to resent what others have, or to build upon what previous generations gave them?
Irresponsibility versus stewardship – Does a generation consume its inheritance, or pass on something greater?
Not merely personal virtues, but what determines whether a civilization can transmit its achievements across generations.
A system is a human trait, multiplied by millions – and given a budget.
And now a new multiplier is arriving: AI.
Whatever a system rewards, AI can reward faster, across more decisions, at a scale previously unimaginable, everywhere, at once.
Build a model that flatters, and it will flatter billions.
Build one that suppresses inconvenient truths, and censorship can become automatic.
Build one that seeks the truth, and truth will scale like never before.
The technology is a multiplier. The incentives determine what gets multiplied.
And the stakes go beyond the present generation.
The decisive question about AI is not how intelligent we make it. It is which human nature we encode into the systems that will shape the next generation.
That is why systems matter so much. The question is no longer only "is this person good?" It is "which of our traits does this system reward and multiply?"
A civilization is made of what it rewards, what it punishes, and how. Millions of daily decisions – who gets hired, who gets promoted, who gets heard, who gets silenced – accumulating into a system that works, or doesn’t. That lives and thrives, or dies.
Show me what a system rewards, and I will tell you what it will turn its people into.
And the expression of traits into systems requires structures. So even if the virtuous traits are the majority, if they are not active and organized, then the vicious ones will prevail. Vice organizes itself. Virtue has to be organized.
So do not be passive.
Tell the truth. Have courage. And build.
Daniel McDevitt MD FACS FSVS retweeted
Secretary Kennedy, the cheaper operating room in Massachusetts requires the expensive hospital’s permission to open.
That belongs in the speech.
The Boston joint replacement gap is real. Blue Cross reported commercial claims prices ranging from $17,910 to $73,987 in the Boston market in 2015.
More than a decade later, the spread is being presented as a revelation.
Look at who gets permission to compete.
In 2008, Massachusetts removed the exemption that let physician-owned surgery centers open without Determination of Need approval.
The state’s own Health Policy Commission calls what followed an effective moratorium on new ASCs.
In 2017, the state lifted it with conditions. New centers needed an affiliation with a certified accountable care organization.
A center in an independent hospital’s primary service area needed that hospital’s approval. The commission’s conclusion: the requirements effectively gave hospitals approval power over most new surgery centers.
The incumbent gets a say in whether its competitor opens. In the commission’s 2023 data, Boston had one ASC.
Then there is the payment system you oversee.
Medicare still pays hospitals more for many services that can safely be performed in independent offices or surgery centers.
CMS has narrowed some of that gap. In 2026, it expanded site-neutral payment to drug administration at certain off-campus hospital departments and expanded the ASC covered-procedure list. It has proposed adding imaging without contrast at those departments for 2027.
Good. Keep going!
A hospital billing address is not better care. Paying extra for it grants an advantage before anyone compares outcomes.
That policy does not establish what caused the Blue Cross spread. It does expose the contradiction: Washington condemns the expensive setting while still paying a premium to use it.
The insurance finding is separate. Trinity College reported that economist Gerardo Ruiz Sánchez found 60 percent of the negotiated rates he studied exceeded the hospital’s own cash price.
Patients pay premiums expecting bargaining power. They deserve to know when the hospital’s cash offer was better.
Publishing the price is not the same as being allowed to take it.
If a plan shows the cheaper option and then makes choosing it cost more out of pocket, it has built a museum of affordable care.
Please enjoy the prices without touching the savings.
For scheduled care, the buyer needs an offer that can be accepted: a defined episode, a named physician and facility, meaningful quality information, and a price agreed before treatment.
The benefit design has to let the employer and the patient to keep the difference.
The competitor has to be allowed to open.
Markets cannot discipline prices they cannot see.
They also cannot discipline a hospital whose competitors need permission to open.
Publish the prices.
Stop protecting them.
@SecKennedy
@DrOzCMS
@CMSGov
@HHSGov
@GOPDoctors
@GOPHELP
@WaysandMeansGOP
Daniel McDevitt MD FACS FSVS retweeted
Great meeting with great folks
Register now for the 2027 Annual Meeting: oeisweb.com/meetings/2027-an…
Daniel McDevitt MD FACS FSVS retweeted
A physician wants to own the facility where she operates.
Suddenly, everyone discovers financial incentives.
The hospital wants to own the facility, employ the physician, and collect the revenue.
Apparently, ethics improves when you add a boss.
Daniel McDevitt MD FACS FSVS retweeted
$37,824 for a family of four.
Milliman’s 2026 Medical Index. Average person hit $8,460 — up 7.9%, the biggest climb in over a decade outside COVID. Pharmacy alone jumped 14.8%. Outpatient facility care is about a third of the bill and has quadrupled for that family since 2005.
That’s not a benefit. That’s a second mortgage with copays.
We take care of patients for a flat monthly fee. No claim. No network. The number on the door is the number you pay.
milliman.com/en/insight/2026…
Daniel McDevitt MD FACS FSVS retweeted
Single payer will never need 218 votes in the House.
State-backed academic systems are constructing it through vertical integration.
They acquire hospitals, employ physicians, control referrals, operate pharmacies and, in several markets, own insurance businesses.
Tax exemption and public capital subsidize the expansion. Regulatory privilege constrains whoever might compete with it.
Multiple insurance companies can survive inside this arrangement. Their continued existence creates administrative pluralism, which looks remarkably similar to consumer choice from a sufficient distance.
Then every insurance card leads to the same medical empire.
Payer count becomes irrelevant after one institution controls the supply.
Daniel McDevitt MD FACS FSVS retweeted
📢We are excited to share that UVA Surgery's BRAND NEW Integrated Vascular Surgery Residency is now accepting applications through ERAS. Apply today!
@MedicineUVA #VascularSurgery #VascularSurgeryResidency #SurgicalResidency #Match2027 #ERAS2027
ALT UVA’s new ACGME-accredited Integrated Vascular Surgery Residency is accepting ERAS applications! Our inaugural resident begins July 2027, receiving comprehensive training, progressive autonomy and individualized mentorship.
Daniel McDevitt MD FACS FSVS retweeted
📢We are excited to share that UVA Surgery's BRAND NEW Integrated Vascular Surgery Residency is now accepting applications through ERAS. Apply today!
@MedicineUVA
#VascularSurgery #VascularSurgeryResidency #SurgicalResidency #Match2027 #ERAS2027
Daniel McDevitt MD FACS FSVS retweeted
Medicare’s 2027 physician pay proposal is out.
Qualifying APM docs: $33.17 (−1.19%)
Everyone else: $32.84 (−1.68%)
The statutory updates are positive. The cut comes from the 2.5% 2026 bump expiring.
Comments close Sept 14.
federalregister.gov/document…
If this hits your clinic, say so on the record.
Daniel McDevitt MD FACS FSVS retweeted
CPT revenue is within "royalties"-While physician reimbursement falls, the AMA profits
Daniel McDevitt MD FACS FSVS retweeted
Private equity can buy a medical practice, change the paperwork, and double or triple its value before changing anything about patient care.
As always Michael makes an extremely intelligent observation.
A ton of money is being made rolling up healthcare practices.
Physicians should be asking how this keeps happening and why they have been unable to defend themselves.
3 reasons:
You have no balance sheet.A guy with three rental properties owns more appreciating assets than an independent medical practice producing millions of dollars in annual revenue.
The physician built a very good job. The income can be substantial. And almost every dollar gets distributed, taxed, or spent. Very little remains inside an enterprise that accumulates value.
The valuable assets have been separated from the practice.
Physicians bought interests in surgery centers, hospitals and medical real estate individually.
Meanwhile, the practice generated the patients, referrals and surgical volume that made those investments valuable while retaining none of the ownership.
You built the accounting system around minimizing this year’s taxes.
The books tell you what came in, what went out, and how much you can distribute. They rarely help the practice allocate capital, carry investments, measure enterprise value or build a balance sheet.
Then private equity arrives.
They buy the income stream at four to six times EBITDA, combine it with dozens or hundreds of other practices, and sell the larger platform at a much higher multiple.
Nothing magical happened.
The physicians spent decades producing the value. Private equity understood where to hold it…
18% of physicians are now independent. That’s a shit show for patients.
A TON of money is being made by rolling up healthcare practices.
A client of mine runs his own PE firm.
He buys practices around a 4-6x EBITDA multiple.
As soon as he closes, the practice becomes worth 12x because it's now part of his larger 200 practice platform. That's up to a 3x return day 1.
How's that for an implied IRR?
Daniel McDevitt MD FACS FSVS retweeted
Real numbers that tell the tale. And that doesn’t count ANY of the many other burdens/hurdles to a viable independent practice. This was never docs “ letting it happen”. It was designed and orchestrated to kill private practice
Why did Doctors give up their own practices?
Our practices were stolen from us. We didn’t allow anything. Why would a Doctor sacrifice 7-10 years of their life to be treated like dogs?
Doctors are paid with RVU Coupons, not money when we submit a bill for payment to your Health Insurance. The RVU Coupons are then redeemed for cash to feed our children. We can’t buy a a slurpee with RVUs.
They started paying Doctors with RVUs in 1992.
1 RVU in 1992 was worth $31.00. Without even a pay raise, Adjusted for inflation 1 RVU should be worth $71.00.
1 RVU in 2025 was worth $32. That’s a 56% pay cut.
You can’t pay staff, rent, electricity, medical supplies or feed your children without money.
Physician independence was stolen by your Health Insurance and Hospitals.
Daniel McDevitt MD FACS FSVS retweeted
Dear physician,
Your instinct is to work harder every time the system demands more of you.
This approach is a trap.
You can never satisfy the system.
It is only a matter of time before it moves the target to extract more productivity from you.
Daniel McDevitt MD FACS FSVS retweeted
Healthcare has prices everywhere and price discovery nowhere.
Take one procedure performed in one hospital on one morning.
The hospital has a chargemaster price.
Every insurer has negotiated another price.
Medicare has an administered price.
The hospital may offer a cash price.
The patient may receive an estimate that resembles none of them.
Which one tells an employer what the procedure is worth?
None of them can.
The chargemaster is a sticker price. The negotiated rate records the bargaining power of two organizations. Medicare reflects a government formula. The estimate comes wrapped in qualifications.
Money changes hands, but no open market establishes the price.
That distinction becomes unavoidable when an employer tries to contract directly with a physician, surgery center, imaging center, laboratory, or pharmacy.
The employer asks a simple question:
What should we pay?
Most direct contracts eventually fall back on a percentage of Medicare. Not because Medicare discovered the value of the service, but because healthcare has no trusted market price of its own.
That is the infrastructure we never built.
Price transparency can reveal what hospitals and insurers negotiated in private.
Price discovery allows qualified buyers and sellers to establish an executable price through trade.
Healthcare does not need another portal filled with downloadable files.
It needs a market that can answer the employer’s first question.
Daniel McDevitt MD FACS FSVS retweeted
Celebrating Pediatric Vascular Care:
Dr. Alex Fairman
For Alex Fairman, MD, the path to vascular surgery began long before medical school.
bit.ly/45whThg
The “Medicare for All” discussion is reminiscent of Obama’s 2008 presidential campaign slogan “Hope and Change”.
It was never precisely clear what that actually meant.
And that was the beauty of it.
In an atmosphere of vagueness, people filled in the blanks with personal aspirations. It was very compelling because it meant whatever anyone wanted it to mean at the time to themselves.
The details of M4A are never really outlined in a practical way. Therefore, it’s easy to imagine it anyway that suits you. Nancy Pelosi famously announced that we had to pass the ACA to find out what’s in it.
Trip me once…..