Why a seven-story glass building in North Miami forced the government to shut down

America can't afford its medical system. It also can't stop spending. A reckoning is coming, and the fight over Obamacare subsidies that led Democrats to shut the government is only the latest proof.

It’s a nice building. A very nice building.

In September, the University of Miami Health System opened an outpatient medical center in North Miami, part of a $4 billion development project called “SoLé Mia.”

Last week, the building got a lot of attention on X. Sadly, it was the wrong kind.

A heart surgeon at the university’s medical school posted a lush filmed video of the center’s lobby — which looks more like a five-star hotel, complete with giant chandelier and a pianist tinkling a grand piano.

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(Healthcare costs a lot. Fortunately, Unreported Truths is still a bargain.)

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No doubt the surgeon, Dr. Yiannis Chatzizisis, was sincerely proud of the U’s new baby. Chatzizisis seems like a good doctor and guy. He’s not a publicity hound. He has all of 1,491 followers on X.

But the reaction on X was… less than favorable.

Rogan O’Handley, who posts as “DC Drano,” wrote that the lobby’s opulence “proves they’re lining pockets, not helping patients” — a comment viewed 2.2 million times.

“When hospitals look like luxury 5-star resorts and families can’t afford even basic care, is it medicine or is it greed?” another poster wrote. A physician wrote that he “absolutely love[d] how much this video has been dunked on… The egregious “non-profit” and tax-exempt status of these health systems is laughable.”

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(So much light! Sadly, the colonoscopies upstairs still require a tube where the sun don’t shine.)

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Calley Means, a top advisor to Robert F. Kennedy Jr., offered an even more pointed take: “This is grotesque.”

You get the idea. After briefly trying to defend the video, Chatzizisis gave up and deleted it. But as one wise poster noted, deleting the video doesn’t solve the problem:

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(Note: I called the medical center a hospital, it’s not a hospital. If it were a hospital it would have to have an emergency room, and that might make it less attractive to the people coming in for high-profit outpatient care.)

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Just how much did the University of Miami spend on SoLé Mia? It hasn’t said.

But in July 2024, it applied to Miami-Dade County to sell $500 million in bonds, specifying that $239.3 million would go to building “Phase II” of the “SoLe Mia Ambulatory Center.”

It seems possible the center, which is 336,000 square feet over seven floors, cost as much as a half-billion dollars — well over $1,000 per square foot, as much as or more than a high-end Manhattan skyscraper.

This is nuts. The building is a bunch of office and surgery suites. It closes at 5 p.m. and isn’t open on weekends. It may need some backup power so the lights won’t go out in the middle of a facelift, but it does not require a hospital’s infrastructure.

But UMiami Health is a regional hospital system competing for patients in one of the wealthiest parts of the United States. High-end procedures (and to a lesser extent donations from satisfied rich folk) pay its bills, including the multi-million dollar salaries of its top executives.

So, yeah, it needs a new surgery center that looks like this:

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Okay, maybe needs is the wrong word. Does anyone really need a Range Rover? A Ford Explorer is basically the same vehicle for one-third the price.

But hey, it takes money to make money. And you don’t want the neighbors to think you aren’t doing well.

Pretty much the same principle here.

Picking on this building specifically and the University of Miami is a little unfair. High-end hospitals all over are on a race to the top. They’re spending as much as they can on new construction and figuring they’ll make it back by gaining market share to squeeze insurers. If they win, they win. If they lose, they merge with the winners.

This trend preceded Obamacare, but its expensive bureaucratic requirements have accelerated it. The bigger the system, the more widely it can spread the bureaucratic overhead that Obamacare generates.

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(The reporting you won’t get anywhere else.)

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It’s all fun and games, especially for hospital executives, except that American healthcare is now so expensive that it can only survive with massive government subsidies, as I wrote last month. Bloated does not begin to describe the system.

A non-catastrophic insurance policy without very high deductibles now runs $25,000 to $30,000 a year for a family of four, more in high-cost areas. Most working Americans are shielded from that reality by employer subsidies, but if they aren’t, it’s backbreaking. Even upper-middle class Americans have little hope of being able to pay it — whether they buy a plan on the private market or through the Obamacare state exchanges.

So Obamacare — the signature Democratic policy achievement of the last 20 years — cannot function without massive subsidies that are required in part because of Obamacare. But the portions of those subsidies that are aimed at middle-class and upper-middle-class people are expiring.

The Democratic answer to this is not to consider working with Republicans to fix Obamacare, much less start to work on broader changes to the system. It’s to shut the government in order to force another zero or two onto the blank check Washington now writes to subsidize Obamacare policies.

For now, Republicans are saying no.

And that’s why a seven-story ambulatory surgical center in Miami has shut the government.

The bigger question is whether Republicans will give in once Obamacare price increases go through and the full extent of premium increases for next year becomes apparent. Experience suggests they will, especially with the media baying at them. Since World War 2, the American solution to our broken, inefficient, overmedicalized healthcare system has always been to throw more money at it.

Measured by lobby quality, it’s working.

Measured in almost any other way, it’s a disaster.

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Last month’s piece, which goes into more detail about the overall trainwreck: