One Hundred Twenty-Five Percent

One hundred twenty-five percent. That is the fine California’s health-affordability board may vote in on Wednesday. Hospitals, medical groups, and insurers that grow faster than the state’s cap could owe as much as 125 percent of whatever they spent over the line.

The line ramps to 3 percent a year by 2029. The earliest the fine can actually land is 2028. Two years of data. Then a performance-improvement plan. Then, maybe, a penalty.

I am not cheering a state board. I am looking at the calendar. A Wichita shop with forty people does not have two years. They get a renewal letter this fall. They need a price they can read before they get the bill, not a hearing in 2028 about last year’s overage.

KFF counted the last jump in national health spending: hospitals were 40 percent of it. Retail drugs were 11 percent. That is not a mystery. That is a price list nobody posted.

I am not anti-insurance. Keep a policy for the wreck. Primary care is not a wreck. We take care of patients for a flat monthly fee. No prior auth. No claim. The number on the door is the number you pay.

California can fine a hospital in 2028. We post the fee today.