Everybody talks about the cost of health care as if it is one single thing. But in our complicated system, many elements contribute to our health care affordability crisis, and some are bigger problems than others. Spending on hospital care accounted for 40% of the growth in national health spending between 2022 and 2024. And when the providers who set those rising prices consolidate their power, families, employers, and taxpayers get squeezed even more.

Over the past few decades, major hospital chains have merged with competing providers and become local monopolies. Since 1998, there have been nearly 1,600 mergers among these systems. It’s no surprise that the Federal Trade Commission now considers 90% of hospital markets highly concentrated.

If a hospital wants the legal privileges of being nonprofit, it should have to earn them every year.

And it’s not just large systems acquiring each other. They have gobbled up doctors’ offices too. Between 2013 and 2018, the share of hospital-owned physician practices more than doubled, and by 2020, more than half of physicians worked directly for a hospital or for a practice owned by one.

This is a problem because these big health systems then use that market power to charge more. Leading budget experts found that after a hospital buys a physician practice, the price of services such as MRI scans, drug infusions, and chemotherapy rises by two to three times their prior cost, and the overall price of health care services increases 14%. One patient saw the out-of-pocket expense of arthritis treatments rise over 1,000% after her outpatient clinic was acquired by a hospital. Despite these increased costs, government research has also shown that hospital mergers do not improve quality.

Another problem is just plain abuse of the tax code. Many of the largest hospital systems are legally “nonprofit,” which makes them tax-exempt, despite behaving like corporate conglomerates. In New York, the vast majority of hospitals are tax-exempt because they ostensibly provide charity care. The result is a substantial public subsidy, estimated as a $9.4 million windfall per hospital.

New York Presbyterian shows how this model can be exploited. Reporting indicates that less than 1% of the services it provides are charitable in nature, yet the institution retains the tax advantages of a nonprofit. In 2021 it recorded roughly $1.5 billion in profits and an operating margin of 17.4%. Its CEO compensation reached almost $11 million per year. It even had resources to sponsor the New York Mets.

This is not just a New York story. Most hospitals claim nonprofit status, but leadership compensation can reach the tens of millions. Those packages persist because the IRS grants large tax benefits and the standards for keeping them are weak. The Lown Institute has documented a wide gap between tax breaks received and community benefit delivered, estimating that fair share deficits in 20 states total $11.5 billion per year. Meanwhile, executives travel on private jets.

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And the care can be anything but caring. Several of the California hospitals in the CommonSpirit Health nonprofit system were disciplined by federal and state officials in 2022, 2023, and 2024 for moving deceased patients to an off-site morgue, where they were stored and even allowed to decompose for months — or in some cases years — without notifying the families.

This is a governance failure. If a hospital wants the legal privileges of being nonprofit, it should have to earn them every year by providing a real, transparent community benefit, meaningful charity care, and outcomes that justify public support. If it wants to operate like a profit-maximizing corporation, then it should pay taxes like one.

Congress already has a starting point. The Senate Health, Education, Labor, and Pensions Committee issued a report on the overuse of charitable designations by nonprofit hospitals and recommended greater federal scrutiny and possible changes in the tax code. That scrutiny should be paired with payment reform, especially site-neutral payments, and stronger antitrust enforcement in markets the FTC already calls highly concentrated.

The status quo is a quiet transfer of wealth from patients, workers, and taxpayers to consolidated hospital systems that can raise prices, claim tax exemptions, and restrict competition. The goal is not to punish hospitals. It is to achieve affordability by restoring the validity of nonprofit status and the power of competitive markets.

​Federal trade commission, Health care affordability, Hospital mergers, Local monopolies, Rising prices, Tax exemption, Transparency, Wealth transfer, Opinion & analysis 

I’ve never felt much sympathy for addicts.

Not the gamblers refreshing their portfolios at 2 a.m., nor the wine devotees who have rebranded a nightly bottle as “self-care,” nor the doomscrollers mainlining outrage as if it were a dietary need.

For decades, coffee attracted suspicion like a stranger at a school gate.

Addiction, to me, has always looked less like an illness and more like a failure of will. Which makes this confession awkward.

Mr. Coffee

I am, demonstrably, an addict — a coffee addict, to be specific. Three cups daily, minimum. Four when my sleep quality files for early retirement. I have never pawned jewelry, put my family through an intervention, or woken up in a city I have no memory of arriving in. But remove coffee from my routine, and my tolerance for other people’s existence, already a carefully managed resource, drops to levels more commonly associated with Patrick Bateman. If you have never related to that sentence, congratulations on your even temperament and your decaf. But bear in mind that you’re also, statistically, in the minority.

In America, the world’s most instructive laboratory for excess, coffee consumption has hit historic highs. Entire office towers function because of it. So do emergency rooms. It powers long-haul truckers and early-morning construction workers. Coffee, for tens of millions of Americans, is less a habit than a non-negotiable term of existence.

And unlike most dependencies, this one keeps passing its medical exams with flying colors.

Fill ‘er up

A new, long-term study published in the Journal of Affective Disorders, tracking over 400,000 people, arrived at a finding that seems almost conspiratorially convenient for people like me: two to three cups a day correlates with measurably lower rates of anxiety and depression. The effect doesn’t erase your suffering or rewrite your difficult childhood. The risk simply drops, noticeably and consistently.

The mechanism is straightforward. Caffeine blocks adenosine, the chemical your brain uses to announce that it is done for the day. Dopamine rises to fill the gap. Concentration improves. The effect feels dramatic because at the neurochemical level, something genuinely dramatic has happened. This is not a trick the mind plays on itself, but chemistry doing exactly what chemistry does.

For decades, coffee attracted suspicion like a stranger at a school gate. Too stimulating. Too addictive. A gateway to jittery dysfunction. The warnings came confidently and often. Then the studies accumulated, the data became less impeachable, and coffee was acquitted of most charges.

Beyond the bean

Caveats exist, as they always do. Five cups daily and the benefits plateau, then reverse. The same compound that steadies you begins rattling the cage. To be fair, anyone drinking five cups of coffee a day has larger questions to answer about his life choices, and caffeine is probably the least of his concerns.

The bean, at least, has always been transparent about the transaction. You know exactly what you are getting and exactly what it costs.

What has been done to the bean is another matter entirely.

Somewhere between the postwar diner and the present moment, coffee got kidnapped. Starbucks, once a straightforward purveyor of decent espresso, became a laboratory specializing in whipped, drizzled, and syrup-fortified structures that happen to contain trace amounts of coffee. Syrups compounding upon syrups. Whipped cream deployed where no cream has any reasonable business. Names so elaborate they require careful study and occasionally a second opinion.

At some point, ordering coffee became something you perform rather than something you do.

The prices reflect the absurdity: six or seven dollars for something containing more sugar than a child’s birthday cake, sharing only a nodding acquaintance with the actual coffee bean.

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Teddy’s choice

The backlash arrived. Starbucks has watched American foot traffic fall as customers stopped finding the ritual worth the receipt. Black coffee is gaining ground. Strong, simple, unbothered by the season, it is coffee that commits to tasting like coffee.

There’s something satisfying in that correction. Not moral superiority — nobody earns virtue by ordering an Americano — but a return to proportion. The unnecessary removed, the thing itself restored. Real coffee demands nothing from you. No rehearsed order, no twelve-step customization, no theatrical pause before naming your flavor preferences. Hot water meets ground bean; the transaction is completed. The fog between you and the day lifts on schedule.

And so I have made my peace with the label. Addict, junkie, dependent — the word changes nothing about what is in the cup. There are considerably worse things to crave. Voltaire drank dozens of cups a day. Beethoven counted out exactly 60 beans every morning. Theodore Roosevelt consumed a gallon before most men had finished breakfast. All three left the world considerably more interesting than they found it. Correlation may not be causation, but it is a remarkably consistent pattern among people who got things done.

​Addiction, Starbucks, Theodore roosevelt, Dopamine, Coffee, Lifestyle, Make america healthy again