DC EKG

"REFILL" | Dutch Rojas on Healthcare Economics, Direct Contracting, and Tax-Exempt Health Systems (Originally Aired: September 15, 2025)

This is a "REFILL" episode recorded in September 2025. At the time of recording, Dutch Rojas was a healthcare entrepreneur, founder of multiple direct contracting companies, and board member of Physician Led Healthcare for America, with a growing following on social media advocating for market-based healthcare solutions. Joe Grogan sits down with Dutch Rojas, healthcare entrepreneur and social media advocate, to discuss his journey from accounting to building direct contracting companies that revolutionize employer healthcare. Rojas explains how direct contracting allows employers to negotiate directly with physicians, bypassing insurance middlemen. The conversation covers his experience building ambulatory surgery centers, certificate of need laws, self-funded employer plans, and his critique of not-for-profit health systems. Rojas argues that academic medical centers masquerade as not-for-profit organizations while receiving seventy-four subsidies annually from taxpayers, acquiring massive real estate holdings, and avoiding property and federal taxes. He advocates for policy changes on not-for-profit tax status and site-neutral payments, arguing these represent unfair advantages that harm independent physicians and patients. Key Timestamps 0:18 Joe introduces Dutch Rojas and asks who is Dutch Rojas 1:32 Dutch's background, career path, and journey to social media 2:22 Physician-led Healthcare for America and PHA board 4:32 Starting in accounting, real estate investment trust, and ambulatory surgery centers 5:14 150 ambulatory surgery center deals and certificate of need experience 7:34 Building a practice in Scottsdale and expanding to 16 states 9:30 First direct contracting company in 2009 and how direct contracting works 12:45 Self-funded employer plans and 106 million Americans not covered by insurance 15:22 Deals with banks and large employers in New York City 18:09 The difference between clinical medicine and business in medicine 22:15 Building insurance products on top of physician-led care 28:30 How direct contracting saves employers money 32:18 The three companies Dutch has started and sold 38:45 Healthcare as a percentage of GDP and rising costs 42:10 Regulatory hurdles and state-level barriers 46:54 Not-for-profit tax status and academic health systems 48:07 How health systems receive subsidies but claim non-profit status 48:22 Academic medical centers owning four to five percent of city real estate 49:21 Site-neutral payments and payment disparities between settings 50:28 Dutch's social media reach and audience impact Key Topics Direct contracting, healthcare economics, physician-led care, ambulatory surgery centers, certificate of need, self-funded employer plans, not-for-profit health systems, tax exemptions, site-neutral payments, healthcare regulation, real estate holdings, academic medical centers, employer negotiations, insurance reform, market-based healthcare About the Guest (at time of recording, September 2025) Dutch Rojas is a healthcare entrepreneur with over 25 years of experience in healthcare economics and business. He started in accounting and real estate investment, then moved into healthcare, developing over 150 ambulatory surgery centers. Rojas founded multiple direct contracting companies that help employers negotiate directly with physicians, bypassing traditional insurance intermediaries. He serves on the board of Physician Led Healthcare for America. He has built a significant social media following on X (formerly Twitter), sharing his analysis of healthcare policy and economics. Rojas is the author of the Rojas Report and hosts a YouTube channel and Substack focused on healthcare reform and market-based solutions. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Dutch Rojas Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

"REFILL" | Dr. Brian Miller on FDA Regulatory Reform and the Valley of Death in Medical Innovation (Originally Aired: March 21, 2025)

In this "Refill" episode, Joe Grogan sits down with Dr. Brian Miller to discuss the "Valley of Death" - the gap between FDA approval and CMS coverage - and how regulatory reform can accelerate medical innovation. Miller explains how FDA product review can be made more efficient through automation and algorithmic analysis of routine tasks, allowing highly trained reviewers to focus on clinical interpretation rather than data processing. The conversation covers clinical trial reform, device review modernization, third-party review programs, and CMS coverage decision processes. Miller argues that these are operational challenges that can be fixed with executive leadership, and that transforming FDA and CMS procedures is critical to bringing new medicines and devices to patients faster. Key Timestamps 1:23 Brian Miller background and AEI role 2:47 The Valley of Death - gap between FDA approval and CMS coverage 5:06 Making FDA and CMS review processes more synergistic 7:43 Example of hypertension drug review and routine tasks 8:26 Data overload in FDA review process 10:40 Supplemental applications and unnecessary information 12:01 FDA reviewer burnout and middle management proliferation 15:30 Automating routine tasks at FDA 17:33 Clinical trial reform discussion and regulatory risk 20:03 Practical approach for new FDA commissioner and DOGE 21:22 Operational changes needed at FDA 22:48 Tobacco regulation at FDA and resource allocation 25:10 Device world getting short shrift in FDA priorities 27:33 Third-party 510k review program and third-party organizations 29:09 COVID diagnostic tests and pandemic review process 30:51 Reforming CDRH through third-party reviews 31:36 70-year comparison of heart attack treatment advances 32:46 CMS coverage decisions and Coverage with Evidence Development 36:02 Medicare Administrative Contractors (MACs) and local coverage decisions 38:12 Practical market-based approach to MAC appeals 39:54 National vs local coverage decisions and reasonable and necessary standard 42:28 Defining reasonable and necessary through algorithms and guidance Key Topics FDA regulatory reform, Valley of Death, clinical trial reform, FDA product review automation, CMS coverage decisions, Medicare Administrative Contractors, third-party device review, drug development costs, medical innovation, device regulation, regulatory science, operational efficiency About the Guest (at time of recording, March 2025) Dr. Brian Miller is a physician and non-resident fellow at the American Enterprise Institute (AEI) focusing on FDA regulatory policy and Medicare payment policy. He practices medicine at Johns Hopkins Hospital and serves as an associate professor of medicine and business at Johns Hopkins University. His research and policy work emphasize making regulatory systems more efficient to accelerate the development and approval of innovative medicines and medical devices. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Dr. Brian Miller Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

"REFILL" | Peter Pitt on FDA Advisory Committees, Make America Healthy Again, and Drug Pricing (Originally Aired: May 23, 2025)

Joe Grogan sits down with Peter Pitt, FDA veteran and expert on healthcare regulation, to discuss FDA advisory committees, the Make America Healthy Again initiative, and critical gaps in pharmaceutical labeling. Pitt addresses why obesity-related drug dosing information is missing from labels, the importance of vaccine safety, food regulation reform, and strategies for lowering drug prices through generic drug reviews and supply chain diversification. He also discusses the need for FDA and CMS to work together and warns against mission creep at CMS. Key Timestamps 0:44 Background: East Coast native, McGill University, from New York City 1:07 How he got a professorship at University of Paris School of Medicine 2:35 Mark McClellan connection and FDA career start 5:19 Conflicts of interest versus interests in FDA advisory committees 7:07 Why people need to be dismissed from advisory committees 9:13 Three basic reasons FDA holds advisory committee meetings 11:08 Why Canada keeps advisory committees secret versus FDA transparency 14:08 Advisory committees for CYA, new science, and lack of consensus 19:44 Op-ed on vaccines and nutrition under Make America Healthy Again 22:44 Cancer drug dosing for obese patients and missing label information 27:15 Learning about drug dosing outside of clinical trials 30:42 Food regulation and FDA's second-class treatment of food safety 32:02 MAHA moment and removing red food dyes from food supply 34:00 Dietary supplements regulation under DSHEA 35:21 Nutrition labeling updates and soda bottle serving sizes 38:21 PDUFA reauthorization and user fees 40:32 User fees about predictability not speed 42:54 CMS mission creep and encroaching on FDA authority Key Topics FDA advisory committees, transparency, vaccine safety, Make America Healthy Again, pharmaceutical labeling, obesity and drug dosing, food regulation, dietary supplements, generic drug review, PDUFA reauthorization, user fees, CMS mission creep, drug pricing About the Guest (at time of recording, May 2025) Peter Pitt is President and Co-Founder of the Center for Medicine in the Public Interest and a visiting professor at the University of Paris School of Medicine. He is a former associate commissioner at the FDA where he oversaw advisory committees and served as a senior policy and communications advisor. Pitt is a native of New York City, a McGill University graduate, and speaks fluent French. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Peter Pitt Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

"REFILL" - Ryan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B

Podcast TitleDC EKG with Joe Grogan: A Healthcare Policy Podcast This is a REFILL of Episode124 - (Original air date: January 27, 2026) Episode Title - Ryan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B Episode Description - Joe Grogan is joined by Ryan Long of Paragon Health Institute and the University of Southern California to break down two fights shaping health policy right now: a California wealth tax pitch framed as a health care fix, and the battle over extending enhanced Affordable Care Act subsidies. They unpack how enhanced subsidies changed who qualifies, why zero-premium plans opened the door to broker-driven enrollment and fraud, and why the medical loss ratio creates perverse incentives that can push premiums higher. They also explain how silver loading and cost-sharing reduction policy distort the exchange market, and what reforms could lower costs without writing a blank check. The episode closes with Ryan's latest work on the 340B program, including why drug arbitrage rewards hospitals with a stronger commercial mix and can fuel consolidation, and why direct, targeted assistance could better support hospitals that truly serve low-income and rural patients. Chapters and Timestamps 00:01 Intro 00:23 Welcome, and what is on the agenda 01:25 California wealth tax and structural deficits 11:20 Enhanced ACA subsidies and the shutdown fight 16:54 Income caps, zero premium plans, and phantom enrollees 21:50 Fraud, Medicaid exposure, and public trust 30:39 Medical loss ratio incentives and ACA market fixes 38:41 340B: how arbitrage works and why it drives consolidation 44:51 What reform could look like 47:20 Closing SEO Keywords | Affordable Care Act, ACA subsidies, enhanced subsidies, premium tax credits, exchange plans, zero premium plans, phantom enrollees, medical loss ratio, cost sharing reduction, silver loading, Medicaid fraud, Minnesota fraud, California wealth tax, 340B program, drug arbitrage, hospital consolidation, site neutral payments, commercial mix, Medicare Trust Fund About Our Guest | Ryan Long is a health policy expert with experience on Capitol Hill, including years in the Speaker's office and on the House Energy and Commerce Committee. He is affiliated with Paragon Health Institute and the University of Southern California. CreditsSponsor: Survivors for SolutionsExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios, https://www.stayoncourse.studio

"REFILL" White House Rivalries and CDC Reform with Dr. Tevi Troy

An episode pulled from the archives, Joe Grogan and Eric Ueland welcome Dr. Tevi Troy, former Deputy Secretary of Health and Human Services, presidential historian, and best selling author of Fight House: Rivalries in the White House from Truman to Trump. First aired in February 2023 at the midpoint of the Biden administration, this conversation diagnoses how White House infighting actually works, why the Biden team leaked so much less than its predecessors, and what discipline does and does not buy a president. From there the conversation turns to the machinery of the State of the Union, why the speech always collapses into a laundry list, and how Ronald Reagan invented the pageantry that every president has copied since. Troy then makes the bipartisan case for reforming the Centers for Disease Control, arguing for a congressional charter and a sharper pandemic mission separate from behavioral health. Along the way Joe, Eric, and Tevi cover Lyndon Johnson and Vietnam, Ed Koch and the art of criticizing opponents without alienating voters, the real origin of the Bull Connor line in Biden speeches, and why Troy believes the Republican party has a brighter future after Trump than the Democrats have after Biden. TIMESTAMPS 0:00 Tevi Troy on a brighter Republican future after Trump 0:47 DC EKG intro 1:10 Joe and Eric welcome Tevi Troy, refill context from February 2023 3:00 Why the Biden White House leaks far less than Trump's did 6:15 Neera Tanden, Afghanistan, and where the grumbling did surface 9:30 Is the press softer on Democratic administrations 12:10 Lessons from the hyper disciplined Bush 43 operation 15:00 Friction as a feature: Johnson, Ford, and creative tension 18:20 Johnson, Vietnam, and the limits of dominating Congress 21:00 Biden faces a Republican House and a debt ceiling fight 24:15 How a State of the Union actually gets built 27:30 Why every State of the Union becomes a laundry list 30:45 Reagan, Lenny Skutnik, and the birth of pageantry 33:50 The case for reforming the CDC with a congressional charter 36:20 Behavioral health versus the pandemic mission 39:10 Ed Koch, Carter, and criticizing without alienating voters 41:40 Where Meacham's Bull Connor line came from 44:30 Troy's path to DC: AEI, Ben Wattenberg, and the PhD 47:15 The conservative movement in flux and the future of the parties 48:33 Wrap up ABOUT OUR GUEST Dr. Tevi Troy is a presidential historian, best selling author, and former Deputy Secretary of the Department of Health and Human Services. An insider's insider in Washington, he warned of US vulnerability to coronavirus in 2016 and has since written widely on the failures at the CDC. He began his career at the American Enterprise Institute working for Ben Wattenberg, earned a PhD from the University of Texas at Austin, and served in a range of roles in the George W. Bush administration, including at the Domestic Policy Council. He is the author of Fight House: Rivalries in the White House from Truman to Trump, What Jefferson Read, Ike Watched, and Obama Tweeted, and Intellectuals and the American Presidency, along with more than four hundred articles. CREDITS Podcast: DC EKG with Joe Grogan Episode: 137b Guest: Dr. Tevi Troy, former Deputy Secretary of Health and Human Services Sponsor: Survivors for Solutions, https://survivorsforsolutions.org Executive Producer: John “CZ” Czwartacki, DC EKG Podcast Producer: Stay on Course Studios, https://www.stayoncourse.studio

"REFILL" | Dr. Jay Bhattacharya on COVID Infection Rates, Natural Immunity, and the Great Barrington Declaration (Originally Aired: July 20, 2023)

Dr. Jay Bhattacharya on COVID-19 Seroprevalence, Natural Immunity, and the Great Barrington Declaration (Originally Aired July 20, 2023) This episode originally aired on July 20, 2023, the same day Stanford University President Tessier-Levine was forced to resign. Dr. Jay offers detailed commentary on the hostile work environment at Stanford and how government, big tech, and academia conspired to suppress scientific voices. Episode Description In this wide-ranging conversation, Joe Grogan and Eric Ueland sit down with Dr. Jay Bhattacharya to discuss his groundbreaking work on COVID-19 seroprevalence studies, the suppression of natural immunity data, and the origins of the Great Barrington Declaration. Dr. Bhattacharya shares his immigrant family story and early recognition that COVID-19 was far more widespread than official counts indicated. He conducted one of the first seroprevalence studies in April 2020 in Santa Clara and Los Angeles Counties, using antibody test kits provided by Major League Baseball, and found that the disease was 40 to 50 times more common than reported cases. The episode covers the intense backlash Dr. Bhattacharya faced for publishing these findings, including death threats, racist attacks, and institutional pressure from Stanford to suppress the research. He discusses how public health authorities suppressed evidence of natural immunity, the unethical decision-making by officials like Tony Fauci and Debbie Birx, and the formation of the Great Barrington Declaration. Dr. Bhattacharya details the coordinated campaign against him, censorship on social media, including Twitter blacklisting, federal government threats to ensure censorship, and the terrible price paid that will echo through generations. He reflects on the failures of scientific institutions and the reforms needed to restore public trust in science. Key Timestamps 4:27 Background: born in India, immigrant family, father was a rocket scientist 14:07 COVID enters consciousness: late December 2019, early January 2020 16:47 Wall Street Journal op-ed calling for seroprevalence studies 19:06 Major League Baseball provides 10,000 antibody test kits 20:30 Study results: 3 percent of Santa Clara had COVID by April 2020 26:12 Death threats, racist attacks, and pressure from Stanford 34:51 Evidence of natural immunity being suppressed by Fauci and Birx 39:52 Genesis of Great Barrington Declaration, October 2020 50:10 Hostile work environment at Stanford and Tessier-Levine impact 56:44 FOIA requests revealing government targeting 1:00:16 Twitter blocklist discovery and Elon Musk's Twitter Files 1:05:00 Reform is needed in the scientific community to restore public trust About the Guest (at time of recording, July 2023) Dr. Jayanta Jay Bhattacharya is a Professor of Health Policy at Stanford University's School of Medicine and a Senior Fellow at the Hoover Institution. He holds an MD and a PhD in Economics from Stanford. Born in Kolkata, India, he immigrated to the US at age four. His research focuses on the health and well-being of vulnerable populations. He has published over 160 peer-reviewed articles and is the author of a leading textbook on health economics. Dr. Bhattacharya co-authored the Great Barrington Declaration and is a co-founder of the Academy of Science and Freedom. Dr. Jay's Current Role (June 2026) Since this episode was recorded in July 2023, Dr. Bhattacharya has assumed significant leadership roles in the federal government. He is the 18th Director of the National Institutes of Health (NIH), confirmed March 25, 2025, and took office April 1, 2025. As of February 18, 2026, he also serves as Acting Director of the Centers for Disease Control and Prevention (CDC), bringing his emphasis on scientific integrity and evidence-based policy to these critical positions. Podcast: DC EKG with Joe Grogan Guest: Dr. Jay Bhattacharya Host: Joe Grogan and Eric Ueland Sponsor: Survivors for Solutions Executive Producer: John CZ

Tax Expenditures, 340 B Drug Pricing, and Kidney Donation Reform

DC EKG with Joe Grogan Episode 137: Tax Expenditures, 340 B Drug Pricing, and Kidney Donation Reform Air Date: June 15, 2026 Episode Description In this episode, Joe Grogan sits down with Dr. Ike Brannon, President of Capital Policy Analytics and Senior Fellow at the Jack Kemp Foundation, to discuss hidden tax expenditures, the 340 B drug pricing program, and innovative solutions to the kidney shortage crisis. Dr. Brannon brings decades of Capitol Hill experience, including roles as chief economist of the House Energy and Commerce Committee and senior advisor to Senator Orrin Hatch. He and co-author Tony LoSasso recently published groundbreaking research in Health Affairs Forefront arguing that the 340 B drug pricing program should be classified as a hidden tax expenditure costing the federal government 15 to 20 billion dollars annually. The conversation covers how the 340 B program evolved from providing discounted drugs to uninsured patients into a massive subsidy for nonprofit institutions with little benefit to poor patients. Dr. Brannon explains how the same drug acquired at a 340 B discount often results in full commercial copays for patients. Joe and Dr. Brannon explore other problematic tax expenditures including the mortgage interest deduction, employer health insurance exclusion, and credit union tax breaks. The episode pivots to Dr. Branons passionate work on kidney donation reform. Forty-five thousand Americans die annually from end stage renal failure due to kidney shortage, disproportionately affecting African Americans. Dr. Brannon advocates for fully reimbursing kidney donors for all expenses. Key Topics 340 B drug pricing program, tax expenditures, pharmaceutical discounts, nonprofit hospitals, mortgage interest deduction, kidney donation, end stage renal failure, organ shortage, entitlement reform, social security, Medicare, federal deficit, health economics Key Timestamps 0:00 Opening: What should be in a reconciliation bill? 4:38 The 340 B drug pricing program explained 13:54 How the 340 B discount does not reach patients 20:13 Mortgage interest deduction: the most irritating tax break 31:00 Prospects for reconciliation under Trump administration 34:57 The kidney donation crisis: 45,000 deaths per year 39:02 How kidney donation reimbursement would work 40:00 Would you allow kidney sales? The ethical debate 45:13 Final thoughts About the Guest Dr. Ike Brannon is President of Capital Policy Analytics and Senior Fellow at the Jack Kemp Foundation. He holds a PhD in Economics from Indiana University. Dr. Brannon served as chief economist of the House Energy and Commerce Committee, senior advisor to Senator Orrin Hatch on tax and trade policy, and has worked at the Congressional Joint Economic Committee, Treasury Department, and for the McCain presidential campaign. He is founder of the Prosperity Caucus and focuses on growth-oriented economic policy and healthcare innovation. Featured Research The 340 B Drug Pricing Program is a Hidden Tax Expenditure Health Affairs Forefront, April 24, 2026 Co-authored by Ike Brannon and Tony LoSasso https://www.healthaffairs.org/content/forefront/340b-drug-pricing-program-hidden-tax-expenditure Podcast: DC EKG with Joe Grogan Episode: 137 Guest: Dr. Ike Brannon Sponsor: Survivors for Solutions Producer: Stay on Course Studios Executive Producer: John CZ Czwartacki, DC EKG Podcast

"REFILL" - The Economics of Ozempic and Other Weight Loss Drugs (Originally Aired: May 2024)

DC EKG with Joe Grogan The Economics of Ozempic and Other Weight Loss Drugs Episode 136.5 (“Prescription Refill” – A replay from the archives) Original Air Date: May 2024 In this episode, Joe Grogan welcomes Ben Ippolito, Senior Fellow in Economic Policy Studies at the American Enterprise Institute, to discuss the rapidly evolving economics of GLP-1 weight loss drugs like Ozempic and Wegovy. Ben explains the two main competitors in this market—Novo Nordisk's Ozempic and Wegovy versus Eli Lilly's Mounjaro and Zepbound. Revealing how insurance coverage decisions drive pharmaceutical marketing strategy. The conversation reveals a critical irrationality in Medicare policy: the statutory prohibition on covering weight loss drugs despite their profound clinical and quality-of-life benefits. Yet these same drugs are covered for diabetes and cardiovascular risk reduction. Ben explores the surprising economics of drug pricing through gross-to-net pricing—the massive gap between list prices and what insurers actually pay through rebates and discounts. The episode examines critical implications of the Inflation Reduction Act's price negotiation provisions. Once Medicare negotiates Ozempic's price, that same price applies to all products using the same active ingredient. This creates cascading market effects: competitors must match those prices to remain on formularies, new entrants face lower pricing power even if clinically superior, and pharmaceutical companies may abandon promising programs due to regulatory uncertainty. Ben argues Congress doesn't need to act immediately to expand Medicare coverage, but likely will within a few years. Joe and Ben discuss unintended consequences of government price regulation, including effects on innovation and drug development pipelines. They explore how price controls announced before elections affect pharmaceutical strategy and development timelines. Concluding with Ben's research on Medicare Advantage and why both Democrats and Republicans scrutinize this private alternative to traditional Medicare. With over 50 percent of seniors enrolled in Medicare Advantage plans, bipartisan interest in reform is reshaping healthcare policy conversations on Capitol Hill. Key Topics GLP-1 drugs, Ozempic, Wegovy, Mounjaro, Zepbound, weight loss medications, obesity treatment, Medicare coverage, drug pricing, Inflation Reduction Act, pharmaceutical competition, rebates, gross-to-net pricing, health economics, cardiovascular benefits, diabetes treatment, Medicare Advantage, healthcare policy, innovation incentives Key Timestamps 00:00 Cold Open: "Turned Up to 11" 00:24 Welcome to DC EKG 00:46 Meet Ben Ippolito (AEI) 03:48 The GLP-1 Landscape: Ozempic, Wegovy, and the Field 05:04 One Drug, Two Names 06:45 Medicare's Weight-Loss Coverage Ban 07:21 Blockbusters and Big Effect Sizes 09:32 Why Isn't Congress Acting? 10:17 Why It Costs Less Than You Think 12:34 The Coverage Irrationality 14:05 Quality of Life as a Real Benefit 15:17 Beyond Weight: Cravings and Addiction 18:21 Devil's Advocate: Why Cover It At All? 19:48 Gross-to-Net and the Rebate Problem 22:41 Why Can't You Just Pay Cash? 25:43 The IRA and the Ozempic Price Cut 27:32 One Ingredient, One Price 30:10 Unintended Consequences in Part D 34:01 New Competitors and Killed Programs 38:03 What's Next: Medicare Advantage 42:04 Wrap-Up and Credits About the Guest (As of May 2024) Ben Ippolito is a Senior Fellow in Economic Policy Studies at the American Enterprise Institute. He holds a PhD and Master's degree in Economics from the University of Wisconsin-Madison and a Bachelor's degree in Mathematics and Economics from Emory University. Ben examines drug pricing policy, Medicare Advantage, and healthcare innovation economics with regular engagement with Congress. Podcast: DC EKG with Joe Grogan Guest: Ben Ippolito Sponsor: Survivors for Solutions Producer: Stay on Course Studios Executive Producer: John CZ Czwartacki, DC EKG Podcast

Tom Barker on The Truth About Drug Pricing Policy

In Episode 136 of DC EKG, Joe Grogan hosts Tom Barker, a top drug-pricing attorney at Foley Hoag and former acting general counsel of Health and Human Services (HHS) under the Bush administration. Tom helped implement Medicare Part D and now advises drugmakers and policymakers on complex pricing issues. The episode traces 20 years of policy: what went right with Part D, what the Inflation Reduction Act (IRA) did, and what effective policy should look like. Tom explains that Part D's success rested on three pillars: private plans only, limited government control over benefit design, and a non-interference clause barring the government from intervening in negotiations among plans, pharmacies, and manufacturers. Competition worked and premiums stayed low, until the government asserted more control and weakened those pillars. The IRA, he argues, was a 16-year Democratic effort to repeal non-interference, creating price controls disguised as negotiations. The Trump administration has taken a different tack, focusing not on the IRA but on MFN and Globe Guard models pegged to other developed countries. Tom also breaks down the 340B program, now the country's second-largest expenditure program, and the fight between manufacturers and covered entities over contract pharmacies. His prescription is simple: let competition work. Speed FDA approval of generics and biosimilars, and trust the marketplace over price controls. He points to hepatitis C, where prices fell sharply once competition entered. In This Conversation The three pillars that made Part D successful for 20 years How non-interference kept government from setting drug prices The IRA as a 16-year Democratic push to repeal non-interference Why Tom calls the IRA price controls disguised as negotiations The Trump administration's focus on MFN and Globe Guard pricing 340B and the battle between manufacturers and covered entities The Chevron repeal's impact on drug pricing law HRSA's proposed rebate model and ongoing 340B litigation Why effective policy means competition, not controls Tom's work helping North Korean defectors and refugees Key Timestamps 1:51 Tom's background at HHS and CMS 2:30 The three pillars of Part D's success 5:10 Why Democrats wanted to repeal non-interference 5:55 Ted Kennedy's compromise and bipartisan votes 11:38 The IRA as a 16-year repeal attempt 12:03 What the IRA changed in Part D 15:02 IRA negotiations vs. real negotiations 16:25 How the excise tax makes it no real negotiation 21:32 Trump's focus on MFN and Globe Guard 25:37 340B's history back to 1991 28:45 340B as the second-biggest expenditure program 29:30 Manufacturer vs. covered-entity acrimony 33:18 The Chevron repeal's impact on pricing 34:54 HRSA's rebate model, the next step on 340B 35:40 The lawsuit over "patient" in 340B 38:18 Tom's advice: let competition work 39:30 Hepatitis C: competition drives prices down 40:34 Competition for gene therapies and CRISPR 41:36 Tom's work for North Korean defectors 44:49 Sponsoring Free North Korea Radio Medicare Part D, drug pricing policy, Inflation Reduction Act, non-interference clause, 340B program, MFN pricing, Globe Guard pricing, pharmacy benefit managers, covered entities, contract pharmacies, biosimilars, generics, federal drug pricing, government price controls, Tom Barker About the Guest Tom Barker is a partner at Foley Hoag in Washington, DC, and one of the country's top drug pricing attorneys. He served as acting general counsel of HHS and chief legal officer at CMS under the Bush administration, where he helped implement Part D from its inception. He is now a go-to expert on drug pricing, and helps North Korean defectors navigate US immigration law. Podcast: DC EKG with Joe Grogan Episode: 136 Guest: Tom Barker Sponsor: Survivors for Solutions - https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios - https://www.stayoncourse.studio

Dr. Mark McClellan on How FDA and CMS Should Work Together

Dr. Redfield's Warning: Hantavirus| Bird Flu| Long COVID and More

In Episode 134 of DC EKG, former CDC Director Dr. Robert Redfield joins Joe Grogan to discuss his new book, Redfield's Warning, and break down three major threats to public health: Long COVID, Hantavirus, and bird flu. Dr. Redfield explains the persistent viral reservoirs in long COVID patients, the cognitive dysfunction and autonomic dysfunction that devastate these individuals, and why the federal government must partner with the private sector to develop meaningful treatments. He also walks through the current Hantavirus outbreak on a cruise ship, the human-to-human transmission of the Andes virus strain, and why bird flu is the most likely candidate for the next pandemic. Throughout, Dr. Redfield emphasizes the critical importance of antiviral development and the dangers of gain-of-function research. In This Conversation The current Hantavirus outbreak on a cruise ship and human-to-human transmission The Andes virus strain and why it differs from Sin Nombre and Four Corners Disease Two transmission routes: aerosolization and direct contamination Asymptomatic transmission and the intrinsic bias in testing Why has the US government not developed Hantavirus countermeasures in 70 years Bird flu is the most likely candidate for the next pandemic. Gain-of-function research and the public disclosure of dangerous genetic data Long COVID: viral reservoirs and the need for effective antiviral treatments Why antivirals should be the priority over vaccines for emerging viruses Operation Warp Speed and the importance of private sector partnerships The dismissal of long COVID patients as psychosomatic and the need for validation Key Timestamps 1:49 Details of the Hantavirus outbreak and cruise ship cases 3:00 Two methods of transmission: aerosolization and direct contamination 5:24 Asymptomatic transmission and testing bias 10:35 The Hantavirus family and why the Andes virus goes from human to human 12:35 How nervous should the public be 16:43 Shifting to bird flu and Redfield's Warning 19:00 Bird flu spread in US poultry and mammal populations 22:00 The four amino acids for bird flu to infect humans 23:30 The debate with Fauci over gain-of-function research 27:55 Unregulated gain-of-function research worldwide 33:35 Why antivirals should be the priority 37:55 Long COVID viral reservoirs and treatment gaps 42:37 The economic burden and need for solutions 43:57 The story of Joy and psychiatric misdiagnosis of long COVID 48:12 The solvability of long COVID and the importance of investing Hantavirus, Hantavirus transmission, Andes virus, Sin Nombre virus, Four Corners Disease, cruise ship outbreak, bird flu, avian influenza, gain of function research, Dr. Robert Redfield, CDC Director, antivirals, vaccines, long COVID, pandemic preparedness, infectious disease, virology, Redfield's Warning About the Guest Dr. Robert Redfield is the former Director of the Centers for Disease Control and Prevention. A trained virologist with decades of experience in infectious disease, he has been a leading voice on public health policy, pandemic preparedness, and biosecurity. He is the author of Redfield's Warning: What I Learned as CDC Director and What We Must Do to Be Prepared for the Next Pandemic, available on Amazon: https://www.amazon.com/Redfields-Warning-Learned-Couldnt-Might/dp/1510785051 Podcast: DC EKG with Joe Grogan Episode: 134 Guest: Dr. Robert Redfield, former CDC Director Sponsor: Survivors for Solutions – https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios – https://www.stayoncourse.studio

The European Union Explained with Christiaan Alting von Geusau

In Episode 133 of DC EKG, Joe Grogan welcomes back Dr. Christiaan Alting von Geusau for Part 2 of their conversation, this time turning to the European Union. Christiaan walks Joe through the post-World War II origins of the EU as a peace initiative built around the Schuman Plan, the pooling of coal and steel between France and Germany, and the visionary leadership of Robert Schuman and Konrad Adenauer. He explains why understanding the EU's founding purpose is essential to understanding what has gone wrong since. Joe and Christiaan unpack the principle of subsidiarity, the rise of EU bureaucracy and over-regulation, the ideological capture of Brussels institutions, and the long detour into cultural battles that were never the EU's job to fight. They discuss Germany's strategic mistake of abandoning nuclear energy, the widening economic gap between the US and Europe, and why Friedrich Merz himself has called the EU the world champion of over-regulation. The second half of the episode looks at the US-EU relationship under President Trump's second term, including the Digital Services Act and free speech, decades of European free-riding on American defense, and the rise of bilateral engagement between Washington and individual European capitals. The conversation closes with a sharp discussion of the leadership vacuum across the West and Europe's growing economic dependence on China. In This Conversation How the European Union began as a Franco-German peace project Why the Schuman Plan and the pooling of coal and steel still shape Europe today The principle of subsidiarity and how Brussels has overstepped it Why Germany's abandonment of nuclear energy was a strategic disaster How EU institutions have been captured by ideology The Digital Services Act and the threat to free speech in Europe Why the US-EU relationship is under serious strain Whether Washington should deal with Brussels or with national capitals Europe's leadership vacuum and growing dependence on China Timestamps 0:00 Why Brussels has become the global champion of over-regulation 1:10 Joe welcomes back Christiaan for Part 2 1:32 Christiaan reintroduces himself and his background 3:00 Why the EU is misunderstood on both sides of the Atlantic 4:15 The historical origins of the EU and the Franco-German conflict 6:00 The Schuman Plan and the pooling of coal and steel 11:30 Truman, the Marshall Plan, and Dean Acheson 12:37 What went wrong with the EU 14:50 Bureaucracy, nuclear energy, and the German mistake 19:35 The principle of subsidiarity and why it matters 23:24 Cultural overreach by Brussels 26:44 Friedrich Merz on EU over-regulation 27:28 The widening US-EU economic gap 32:03 Free speech, the Digital Services Act, and Trump 38:33 European free-riding on American defense 44:07 Should Washington bypass Brussels 48:30 The rise of bilateral engagement 51:23 The leadership vacuum across the West 58:30 Europe's economic dependence on China 1:01:12 Wrap-up European Union, EU history, Schuman Plan, Franco-German conflict, subsidiarity, EU bureaucracy, EU overregulation, German nuclear energy, Digital Services Act, free speech Europe, US-EU relations, Trump and the EU, NATO defense spending, Europe-China dependence, transatlantic relationship, Christiaan Alting von Geusau, DC EKG About Our Guest Dr. Christiaan Alting von Geusau is a lawyer, professor, advisor, and host of the podcast The Educated Leader. Born in the United States and raised in the Netherlands, he studied law at Leiden University and Heidelberg University. He earned his doctorate in philosophy of law at the University of Vienna. He leads the International Catholic Legislators Network, serves as the principal of Ambrose Advice, and is the Rector emeritus and Professor of Philosophy of Law and Education at ITI Catholic University in Austria. Podcast: DC EKG with Joe Grogan Episode: 133 Guest: Dr. Christiaan Alting von Geusau Sponsor: Survivors for Solutions – https://survivorsforsolutions.org Executive Producer: John “CZ” Czwartacki, DC EKG Podcast Producer: Stay on Course Studios – https://www.stayoncourse.studio

Hungary Election After Orban with Christiaan Alting von Geusau

In Episode 132 of DC EKG, Joe Grogan sits down with Dr. Christiaan Alting von Geusau for a timely discussion on Hungary’s election, Viktor Orbán’s loss, and what comes next under Peter Magyar. Christiaan explains why the size of the election wipeout surprised even seasoned observers, why the mainstream narrative about democracy in Hungary misses key facts, and why the new Hungarian parliament remains entirely on the right side of the political spectrum. Joe and Christiaan break down the structure of Hungary’s political system, the collapse of Orbán’s long-running coalition, the rise of Peter Magyar out of a political scandal, and the challenge of governing with a brand new party full of political newcomers. They also discuss whether Western media is misreading the result as a rejection of conservatism and why the more important question may be whether the new government has the experience to govern effectively. The second half of the episode turns to Hungary’s position on Russia and Ukraine, the country’s cultural conservatism, the future of its relationship with the European Union, and the dangers of revenge politics after a major political transition. This is a wide-ranging conversation on democracy, power, media narratives, and the future of Hungary in Europe. In This Conversation What happened in Hungary and why Orbán lost so badly Who Peter Magyar is and why his rise shocked the political class Why Hungary’s new parliament is still entirely right of center What the election means for democracy and conservatism Hungary’s position on Russia Ukraine and the European Union Why the competence of the new government may matter more than ideology The risks of revenge politics after a major political transition Timestamps0:00 Is Hungary’s election really a repudiation of conservatism0:55 Joe welcomes Christiaan Alting von Geusau1:14 Christiaan’s background and his dual US Dutch perspective4:00 Why Hungary matters and what makes its politics unique5:30 What happened in Hungary and why the wipeout was so large10:06 How Hungary’s electoral system magnified the result11:48 What happened to Fidesz and the Christian Democrats12:37 Why the new parliament is still entirely right of center16:00 The scandal that changed Hungarian politics18:20 Peter Magyar’s rise and political comeback20:00 Who Peter Magyar is and what he believes22:50 What changes Peter Magyar is likely to make24:00 The risks of governing with political newcomers28:50 What this means for Russia Ukraine and the EU34:33 Will Hungary remain culturally conservative36:34 Are Western media misreading the result41:06 Has Christiaan’s view changed since election night43:24 The economic challenges facing the new government44:04 Why revenge politics can damage a country48:03 Outro Hungary election, Viktor Orban, Peter Magyar, Christiaan Alting von Geusau, Fidesz, Christian Democrats, Hungary politics, European Union, Russia Ukraine war, democracy, conservatism, revenge politics, cultural conservatism, political transition, DC EKG About Our GuestDr. Christiaan Alting von Geusau is a lawyer, professor, advisor, and host of the podcast The Educated Leader. Born in the United States and raised in The Netherlands, he studied law at Leiden University and Heidelberg University and earned his doctorate in philosophy of law at the University of Vienna. He leads the International Catholic Legislators Network, serves as principal of Ambrose Advice, and is Rector emeritus and Professor for Philosophy of Law and Education at ITI Catholic University in Austria. Podcast: DC EKG with Joe GroganEpisode: 132Guest: Dr. Christiaan Alting von GeusauSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Stay on Course Studios – https://www.stayoncourse.studio

Obamacare, HSAs, and Reference Pricing with Dr. John Goodman

In Episode 131 of DC EKG, Joe Grogan sits down with Dr. John Goodman to discuss what both parties continue to get wrong about healthcare, why patient incentives still matter, and how market-based reforms could lower costs and improve access. Drawing on decades of work in health economics and policy, Dr. Goodman explains how special interests helped shape Obamacare, why supply-side constraints still distort care, and why patients are too often left out of the policymaking process. The conversation then turns to Health Savings Accounts, Medicaid reform, emergency room overuse, and why policymakers remain so resistant to giving patients more control over healthcare dollars. Dr. Goodman also outlines his view that self-directed care and consumer choice can improve value and expand access, especially for vulnerable populations. In the second half, Joe and Dr. Goodman dive into reference pricing as a major reform idea. Using real-world examples, they discuss how clearer prices and patient-driven decision-making could create more meaningful competition across healthcare markets. The episode closes with a broader conversation on bipartisan reform, the tax code, and why durable change remains so hard to achieve in Washington. In This Conversation What both parties keep getting wrong about healthcare How special interests shaped Obamacare and why patients were left out Why HSAs remain controversial and what they change about incentives Medicaid reform, emergency room use, and patient access How self-directed care can improve outcomes and satisfaction What reference pricing is and why it could create real competition Why bipartisan healthcare reform keeps breaking down in Washington Timestamps0:00 How special interests shaped Obamacare0:46 Joe welcomes Dr. John Goodman1:09 Dr. Goodman’s background and the origins of HSAs5:22 What both parties get wrong about healthcare7:36 Why physician supply stays restricted9:26 Spending more without getting healthier14:16 What Washington should actually be debating15:52 Insurance that meets patients’ needs20:06 HSAs and consumer-directed care22:29 Why Medicaid patients rely more on emergency rooms24:50 Medicaid reform and letting patients pay the difference28:07 Self-directed care and “Cash and Counseling.”29:35 Reference pricing explained32:14 How reference pricing could reshape insurance markets36:06 Why Dr. Goodman is optimistic40:36 The tax code and healthcare policy44:22 Where to find Dr. Goodman’s work45:42 Outro Obamacare, health savings accounts, HSA, John Goodman, Joe Grogan, healthcare reform, healthcare policy, Medicaid reform, emergency room visits, patient incentives, consumer-directed care, reference pricing, tax policy, bipartisan reform, healthcare economics About Our GuestJohn C. Goodman is President of the Goodman Institute for Public Policy Research and is widely known for his work in health economics, Health Savings Accounts, and consumer-directed healthcare reform. Podcast: DC EKG with Joe GroganEpisode: 131Guest: John C. GoodmanSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Stay on Course Studios – https://www.stayoncourse.studio

340B, Part D, and the Real Drivers of Drug Costs with Ryan Long

In Episode 130 of DC EKG, Joe Grogan sits down with Ryan Long to unpack two policy stories that are driving real-world drug costs and healthcare spending: the 340B program and the fallout from Medicare Part D changes under the Inflation Reduction Act. Ryan explains why the current 340B structure can incentivize higher costs, hospital consolidation, and contract pharmacy expansion, while often directing the biggest windfalls toward larger, wealthier systems rather than truly resource-constrained hospitals. They cover contract pharmacies, exposure to diversion and fraud, Medicare Part B reimbursement dynamics, and why reforms need to address the incentives baked into the program. They then turn to Medicare Part D, the shift from copays to coinsurance, premium pressure, the accelerated move into “catastrophic” coverage, and what happens when Washington promises savings that do not materialize. The episode closes with a broader look at fraud, program integrity, and why durable reform requires Congress to act. In This Conversation Why does 340B incentivize higher costs and hospital consolidation Contract pharmacies, diversion risk, and fraud exposure Who really benefits from 340B and why rural hospitals can lose out Medicare Part D premium pressure and the IRA tradeoffs Copays vs coinsurance and what seniors experience at the pharmacy counter Fraud, program integrity, and why limited resources should go to patients who need them Timestamps0:00 Why the 340B structure drives higher costs and consolidation0:37 Ryan Long joins Joe1:13 What has changed in 340B, and why it is getting attention6:57 Payer mix, spreads, and why wealthier systems benefit more11:06 How 340B expanded post-2010 and contract pharmacies16:56 Why contract pharmacy reform alone does not fix the incentives22:11 Medicare Part D and what the IRA changed24:23 Explaining the donut hole28:54 Premium increases, catastrophic coverage, and cost shifting32:26 Copays to coinsurance and unexpected out-of-pocket changes40:37 Fraud exposure and program integrity52:09 Where to find Ryan’s work52:38 Outro 340B program, contract pharmacy, hospital consolidation, drug pricing, Medicare Part D, Medicaid rebate, Affordable Care Act, healthcare spending, healthcare costs, fraud exposure, policy impact, legislative reform, patient assistance About Our GuestRyan Long is a Fellow at the Paragon Health Institute and a Scholar at the USC Schaeffer Center. He previously served as health policy lead for Speaker Kevin McCarthy and is a longtime Energy and Commerce veteran focused on drug pricing, Medicare, Medicaid, and healthcare spending reform. Podcast: DC EKG with Joe GroganEpisode: 130Guest: Ryan LongSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Stay on Course Studios – https://www.stayoncourse.studio

340B | Part D | the Real Drivers of Drug Costs with Ryan Long

In Episode 130 of DC EKG, Joe Grogan sits down with Ryan Long to unpack two policy stories that are driving real-world drug costs and healthcare spending: the 340B program and the fallout from Medicare Part D changes under the Inflation Reduction Act. Ryan explains why the current 340B structure can incentivize higher costs, hospital consolidation, and contract pharmacy expansion, while often directing the biggest windfalls toward larger, wealthier systems rather than truly resource-constrained hospitals. They cover contract pharmacies, exposure to diversion and fraud, Medicare Part B reimbursement dynamics, and why reforms need to address the incentives baked into the program. They then turn to Medicare Part D, the shift from copays to coinsurance, premium pressure, the accelerated move into “catastrophic” coverage, and what happens when Washington promises savings that do not materialize. The episode closes with a broader look at fraud, program integrity, and why durable reform requires Congress to act. In This Conversation Timestamps0:00 Why the 340B structure drives higher costs and consolidation0:37 Ryan Long joins Joe1:13 What has changed in 340B, and why it is getting attention6:57 Payer mix, spreads, and why wealthier systems benefit more11:06 How 340B expanded post-2010 and contract pharmacies16:56 Why contract pharmacy reform alone does not fix the incentives22:11 Medicare Part D and what the IRA changed24:23 Explaining the donut hole28:54 Premium increases, catastrophic coverage, and cost shifting32:26 Copays to coinsurance and unexpected out-of-pocket changes40:37 Fraud exposure and program integrity52:09 Where to find Ryan’s work52:38 Outro 340B program, contract pharmacy, hospital consolidation, drug pricing, Medicare Part D, Medicaid rebate, Affordable Care Act, healthcare spending, healthcare costs, fraud exposure, policy impact, legislative reform, patient assistance About Our GuestRyan Long is a Fellow at the Paragon Health Institute and a Scholar at the USC Schaeffer Center. He previously served as health policy lead for Speaker Kevin McCarthy and is a longtime Energy and Commerce veteran focused on drug pricing, Medicare, Medicaid, and healthcare spending reform. Podcast: DC EKG with Joe GroganEpisode: 130Guest: Ryan LongSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Stay on Course Studios – https://www.stayoncourse.studio

State AI Laws, Preemption and Health Innovation with Adam Thierer

In Episode 129 of DC EKG, Joe Grogan sits down with returning guest Adam Thierer, Resident Senior Fellow for Technology and Innovation at the R Street Institute, to break down the surge of state by state AI laws and why a patchwork approach could slow innovation, especially in healthcare. Adam explains how more than a thousand state AI bills are flooding the zone, what types of “everything bills” are emerging, and why some states are trying to set national standards from Albany or Sacramento. Joe and Adam connect the federalism debate to real world health innovation, including mental health chatbots, algorithmic discrimination laws, and why compliance costs hit “little tech” hardest. They also discuss Adam’s “AI Articles of Confederation” framing, the failed effort to create a federal moratorium on state AI rules, and what a better model could look like, such as regulatory inventories, learning labs, and sandbox style approaches that allow experimentation without shutting innovation down. Key link: https://www.rstreet.org/commentary/congress-should-lead-on-ai-policy-not-the-states/ In This Conversation Timestamps0:00 What is happening with state AI bills right now1:36 Adam’s background and how he got into AI policy5:55 The shift from federal regulation to state action10:27 What these state bills try to regulate13:29 Micron, permitting delays, and stopping progress20:00 Why some red states are pushing AI Bills of Rights26:24 “AI Articles of Confederation” and why it matters31:01 The attempted moratorium in the “big, beautiful bill”38:03 Preview of “The AI Terrible Ten” and worst state models39:43 Mental health chatbot bans and the mental health crisis44:25 What governors should do instead of rushing to regulate49:05 What Adam is tracking next51:48 What AI tools Adam uses52:42 Where to find Adam’s work SEO Keywordsstate AI laws, AI policy, federal preemption, healthcare innovation, algorithmic discrimination, mental health chatbots, interoperability, AI regulation About Our GuestAdam Thierer is a Resident Senior Fellow at the R Street Institute focused on technology and innovation policy. He writes and speaks widely on AI governance, federalism and preemption, and how regulatory models can either accelerate or stall innovation, including in healthcare. Podcast: DC EKG with Joe GroganEpisode: 129Guest: Adam Thierer, Resident Senior Fellow, Technology and Innovation, R Street InstituteSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios – https://www.stayoncourse.studio

HTI 5, Health Data Control and AI with Kat McDavitt and Lisa Bari

In Episode 128 of DC EKG, Joe Grogan is joined by Kat McDavitt and Lisa Bari, co-hosts of the Health Tech Talk Show, for a practical conversation on what the next wave of health IT policy could unlock for patients and innovation. They break down the proposed HTI 5 rule from ONC, why it is framed as deregulation, and how it aims to shift the market away from long EHR certification checklists toward one core goal: data that moves. The conversation digs into information blocking, TEFCA, patient access, and the reality of who controls health data in practice. Joe presses a simple question: if it is “my data,” why do patients still struggle to pull a complete record? Kat and Lisa explain how HIPAA is often used as a barrier instead of a bridge, how secondary data use markets operate, and why privacy gets complicated in a world of apps, brokers, and advanced compute. They also explore how HTI 5 connects to the AI wave, why state AI laws can create risk for innovation, and whether ideas like a Medicare app library help patients or end up picking winners too late. In This Conversation ,Timestamps0:36 Intro1:14 Welcome Kat McDavitt and Lisa Bari2:05 Lisa on her new role and what she is working on4:17 First reactions to HTI 5 and EHR deregulation7:34 HTI 5 in plain English11:27 Who controls health data and why this rule matters14:08 Why patients still cannot easily access complete records17:36 HIPAA and how it is used today22:24 Privacy outside HIPAA and secondary use25:50 How HTI 5 targets information blocking28:16 Screen scraping and why it is controversial36:09 How HTI 5 connects to healthcare AI47:28 Medicare app library concerns52:05 Closing and where to find Health Tech Talk Show Health Tech Talk Show YouTube channel: https://www.youtube.com/@HealthTechTalkShow/streams SEO Keywords (Megaphone)HTI 5, ONC, information blocking, TEFCA, interoperability, healthcare APIs, HIPAA, health data access, healthcare AI policy, data liquidity, screen scraping, Medicare app library About Our GuestsKat McDavitt is co-host of the Health Tech Talk Show, President and Founding Partner of Innsena, and CEO and Founder of the Zorya Foundation.Lisa Bari is the Vice President of Policy and Partnerships at Innovaccer, where she leads health and AI policy, government relations, and global partnerships. She is the creator and host of the Policy Stack podcast, co-host of the Health Tech Talk Show, and a board member of the Zorya Foundation. Previously, she was the founding CEO of Civitas Networks for Health.Podcast: DC EKG with Joe GroganEpisode: 128Guests: Kat McDavitt and Lisa BariSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Julie Riga, Stay on Course Studios – https://www.stayoncourse.studio

Rural Health on the Front Lines: Dr. Manny Sethi on Access, Private Equity, and Prevention

Episode 127 Rural Health on the Front Lines: Dr. Manny Sethi on Access, Private Equity, and Prevention In Episode 127 of DC EKG, Joe Grogan sits down with Dr. Manny Sethi of Vanderbilt and Healthy Tennessee to talk about what rural health looks like up close and what policy changes could actually improve access. Dr. Sethi shares his story growing up in small town Tennessee as the son of immigrant physicians, then training as an orthopedic traumatologist and treating high-energy injuries that often collide with chronic disease and limited access to care. The conversation centers on why rural communities struggle to find primary care and specialists, how administrative burden and electronic medical record requirements can crush independent practices, and why private equity and large systems buying clinics can reduce real access for patients. Dr. Sethi also explains how Healthy Tennessee built a volunteer, community-based model of prevention through health fairs that screen hundreds to thousands of people, partner with food banks, and connect high-risk patients to follow-up care. If you care about rural healthcare, access to care, private equity in medicine, physician shortages, preventative care, EHR burden, Medicaid, Medicare, and community health, this episode is a practical look at what is broken and what can be done. In This Conversation Joe and Dr. Sethi cover: Timestamps (Audio platforms) 0:52 Intro 1:14 Meet Dr. Manny Sethi (Vanderbilt, Healthy Tennessee) 4:38 Why he launched Healthy Tennessee 6:59 Volunteers, screenings, and what the health fairs deliver 12:09 Who shows up and why access is still hard even with insurance 21:51 The biggest rural health problems and the access crunch 24:18 Private equity buying practices and what changes for patients 28:24 What policy fixes could actually move doctors to rural areas 31:41 Follow-up care for uninsured and high-risk patients 34:09 Trauma care realities and why we pay for sickness, not wellness 40:27 Faith, meaning, and why he keeps doing the work Key Takeaways About Our GuestDr. Manny Sethi is an orthopedic traumatologist at Vanderbilt and co-founder of Healthy Tennessee, a nonprofit he launched with his wife in 2011 to bring prevention and screening to underserved communities through volunteer-driven health fairs and partnerships across the state. --- Show Sponsor: Survivors for Solutions – https://survivorsforsolutions.org Executive Producer: John “CZ” Czwartacki, DC EKG Podcast Producer: Julie Riga, Stay on Course Studios – https://www.stayoncourse.studio

Alzheimer’s in Real Life: Sue Peschin on Early Detection, Biomarkers, CED, and the ASAP Act

In Episode 126 Joe speaks with Sue Peschin, President and CEO of the Alliance for Aging Research, about what Alzheimer’s and dementia look like in the real world and how policy determines who gets help and when. Sue explains the mission and 40–year history of the Alliance for Aging Research and lays out the scope of the Alzheimer’s crisis in plain language: who is affected, how dementia types differ, and why neuropsychiatric symptoms like agitation, psychosis, and depression are so often ignored in policy and practice. They discuss why early detection matters more than ever now that disease-modifying therapies and amyloid inhibitors exist, and why so many cases are still missed in primary care. Sue walks through new blood biomarkers, digital cognitive assessments, and how Medicare coverage, CED restrictions, and the proposed ASAP Act will shape access to testing and treatment. Joe and Sue also dig into Coverage with Evidence Development (CED) in Medicare, whether CMS is overstepping what Congress intended under Section 1801, and how restrictive coverage decisions have limited access to Alzheimer’s drugs to a tiny fraction of eligible patients. Finally, they talk about caregiver burden, stigma around behavioral symptoms, and what families and clinicians can realistically do today. If you care about Alzheimer’s, dementia, early detection, blood biomarkers, Medicare coverage, CED, the ASAP Act, primary care, caregiver burden, vascular dementia, and aging research, this episode connects the science with the politics and the lived experience. In This ConversationJoe and Sue cover: Timestamps (Audio platforms) Key Takeaways About Our GuestSue Peschin is President and CEO of the Alliance for Aging Research, the leading nonprofit focused on advancing science, policy, and education to improve healthy aging and access to care. At the Alliance, Sue has driven national work on Alzheimer’s, dementia, neuropsychiatric symptoms, Medicare policy, CED reform, and aging research, empowering older adults and caregivers to advocate for better care.