On Tuesday, Travis County commissioners approved a controversial new budget for Central Health that has many wondering why the hospital district is spending so much.

In the upcoming fiscal year, which begins Oct. 1, Central Health will spend a whopping $744 million, which is “an effective 18.4% year-over-year budget increase.” You read that right—the district’s budget is set to grow almost 20% this year.

And it’s not exactly clear why.

Even county commissioners who oversee the district’s finances were perplexed by the massive spending increase. At the budget adoption hearing, Travis County commissioner Brigid Shea said:

“I continue to struggle with out of a $744 million budget, $178.5 million of it is dedicated to total health care services,” Shea said. “That’s less than a quarter of your budget.”

That’s a jaw-dropping observation, and it raises an obvious question. If only 25% of Central Health’s expenditures are going toward healthcare services, then what is the other 75% being spent on?

No one seems to know, but it does seem rather odd that Austin-area progressives, who once supported an 80/20 Rule that forces “insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities,” are so supportive of an institution that spends so much money on everything except health care. Yet again, they hold the private market to one set of standards while holding themselves to none.

Central Health’s new motto may as well be “rules for thee, but not for me.” Or perhaps better yet, “an 80/20 Rule for thee, but none for me.”