Healthcare reimbursement formulas can look like administrative details buried in spreadsheets and regulations. Until one of them is wrong. In 2006, I discovered an error in the way Medicare calculated payment rates for hospitals across the country. It was understating payments by roughly $1 billion per year. What followed was years of appeals and litigation involving hundreds of hospitals before the matter was ultimately resolved.

Across the country, the cost of living looks very different. What it takes to live in New York City isn’t the same as what it takes to live in Charlotte. But when it comes to federal tax deductions, Medicare policy, and national funding structures, we often treat every place and every taxpayer as if they’re operating in the same economy...