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DC EKG with Joe Grogan DC EKG Ep 140 | Joe Grogan & Dr. David Eagle: The Hospital Squeeze Guest: Dr. David Eagle, President, American Independent Medical Practice Association Episode Description Joe Grogan sits down with Dr. David Eagle, President of the American Independent Medical Practice Association and board-certified hematologist oncologist from New York Cancer and Blood Specialists, to discuss the collapse of independent oncology practices in America. Dr. Eagle explains how hospital consolidation through aggressive acquisition strategies, combined with punitive reimbursement policies and the 340B drug pricing program, has devastated independent community oncology practices. He details how independent practices declined from 85% of cancer care in 2000 to roughly 45% today, the "uneven playing field" created by 340B, and how policy changes under the Inflation Reduction Act are accelerating the crisis. The conversation covers Medicare payment systems, facility fee exploitation, reimbursement pressures, and the future of cancer care delivery when independent practices disappear. Dr. Eagle also discusses promising advances in cancer treatment including CAR T cell therapy, personalized vaccines, and precision medicine—innovations that may be lost if the healthcare system cannot maintain community-based oncology practices. Key Timestamps 0:54 Joe Grogan welcomes Dr. David Eagle from New York Cancer and Blood Specialists 1:44 Why independent medical practice is important for oncology and the healthcare system 3:38 Current state of independent oncology practices in America 3:42 In 2000, community practices were 85% of cancer care; now roughly 45% 5:04 How hospitals create artificial competition by setting up practices nearby 6:02 The transition when Dr. Eagle's practice was acquired by a hospital system 6:08 How hospitals exploit facility fees while patients pay higher copays 7:11 Medicare Modernization Act 2003: The ASP system shift that squeezed independent doctors 10:18 IRA drug pricing: How add-on payments shrink as negotiated drug prices fall 10:51 2025 physician fee schedule: The grim economic reality for independent practices 12:29 Why independent community oncologists aren't valued by policymakers 15:51 Jeff Faserka: CEO of New York Cancer and Blood, previously in FDA commissioner contention 26:18 340B playbook: How hospitals have spent 15 years acquiring independent practices 32:52 Cancer treatment breakthrough: From leukemia to solid tumors, we're in a new frontier 36:40 Personalized medicine: The future requires maintaining community-based delivery systems Key Topics Hospital consolidation, independent oncology practices, 340B drug pricing program, reimbursement crisis, Inflation Reduction Act, Medicare payment systems, facility fees, CAR T cell therapy, personalized medicine, physician economics, healthcare policy, community medicine Podcast: DC EKG with Joe Grogan | Episode: 140 | Host: Joe Grogan | Guest: Dr. David Eagle, President, American Independent Medical Practice Association Sponsor: Survivors for Solutions - https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios - https://www.stayoncourse.studio

Joe Grogan talks with John Desser, VP and Head of Government Affairs at Health Equity, about market-based healthcare and why Health Savings Accounts (HSAs) may be its future. John's 35-year career runs from an internship in Senator John McCain's office through the Bush administration, eHealth, and now Health Equity. He recounts how the ACA's first draft nearly wiped out private online insurance marketplaces, why healthcare.gov stumbled, and how consumer control can fix healthcare's misaligned incentives. He also reflects on Ron Wyden's universal coverage plan without a mandate, Ted Kennedy's role in bipartisan reform, McCain's skinny repeal vote, and Trump's "give the money to the people" approach. Key Timestamps 1:10 Joe welcomes John Desser of Health Equity 1:26 From foreign policy major to healthcare policy 1:46 Falling into healthcare in McCain's office, summer 1989 2:40 35 years in healthcare, thanks to Dave McIntyre 3:18 Coalition for Affordable Health Coverage and refundable tax credits 4:45 Bill Thomas: Spend as much as Democrats, but spend it our way 6:11 Updating the Archer MSA law 7:30 How Bill Thomas put HSAs in the Medicare Modernization Act 8:06 Leading health policy in the Bush administration 10:45 The uninsured project and Ron Wyden's universal coverage bill 12:03 Why dropping the mandate cost zero coverage 15:09 eHealth: Selling insurance online for a decade 17:05 Waxman's ACA draft and the 100% premium surtax 19:54 The John Dingell meeting that removed the surtax 21:14 The healthcare.gov disaster 22:55 Marketing costs: $20,000 per healthcare.gov sign-up 27:06 Trump administration launches enhanced direct enrollment 30:22 John joins Health Equity in July 2022 30:54 Why HSAs matter: Consumers, not bureaucrats, should ration care 34:18 Trump's "give the money to the people" instinct 35:35 The problem with arbitrary value-based pricing 39:21 ACA criticism: Ted Kennedy's absence and the 60-vote problem 41:51 Why bipartisan healthcare laws are more durable 44:15 "Build a new house next to the old one" 44:50 John Goodman's case for HSAs in Medicaid 45:28 Why every employer plan should include HSAs Key Topics HSAs, market-based healthcare, the ACA, healthcare.gov, online insurance marketplaces, Medicare Modernization Act, Medicaid reform, employer-sponsored coverage, bipartisan healthcare policy, consumer-driven healthcare About the Guest John Desser is VP and Head of Government Affairs at Health Equity, the nation's largest HSA provider, with 17 million total accounts. In more than 35 years in healthcare policy, he has worked for Senator John McCain, led health policy at HHS in the Bush administration, and run government affairs at eHealth during the ACA rollout. He is an expert in consumer-driven healthcare and market-based reform. Podcast: DC EKG with Joe Grogan | Episode: 141 | Host: Joe Grogan | Guest: John Desser, Vice President and Head of Government Affairs, Health Equity Sponsor: Survivors for Solutions – https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast | Producer: Stay on Course Studios

Elizabeth Chamblee Birch, law professor and author of The Pain Brokers, exposes a coordinated healthcare fraud scheme targeting over 100,000 women. Stolen HIPAA-protected health records were weaponized by call centers in India and South Florida to convince women they needed emergency mesh removal surgery. Many women were left permanently incontinent after unnecessary procedures. The scheme involved call centers using stolen medical data, South Florida surgical operations, lawyers creating hidden liens, and litigation funders profiting from women's suffering. Birch introduces the villains: Vince Chabra (online pill mill founder), Blake Barber (travel concierge), and complicit doctors. She also highlights heroes: Barbara Bennis (defense attorney who uncovered the conspiracy) and J.R. Baxter (young plaintiffs lawyer who fought back). The episode reveals how electronic health record systems enabled massive data breaches, how private equity infiltrated the legal system, and what reforms are desperately needed to prevent future schemes. Key Timestamps 0:53  Joe Grogan introduction 1:25  Joe asks Elizabeth about her background 1:37  Elizabeth's background: 21 years teaching mass torts 2:25  Elizabeth's MFA in narrative nonfiction at UGA 3:26  What is vaginal mesh used for? 5:21  Sharon gets intimate stolen medical data in phone call 6:00  Sharon didn't know she had mesh inserted 6:32  Call centers in India and South Florida 7:32  Alpha Law: Frankenstein firm through D.C. loophole 9:31  Outbound calls fueled by illegal stolen HIPAA data 10:12  Sharon's journey through the system 12:39  Sharon's financial devastation: $69-120K lien 13:24  Litigation funders threaten Sharon's house after settlement 15:00  Multi-district litigation vs class action 16:15  The perverse economics of the scheme 17:33  Economics: $15K vs $215K+ for removal 19:10  Women left permanently incontinent after unnecessary surgeries 21:15  Meet Vince Chabra and Blake Barber: the kingpins 26:11  Wolf of Wall Street moment: 14,000 claims for $40 million 27:45  Cold called over 100,000 women, signed 14,000 as clients 28:35  Barbara Bennis: defense attorney hero discovers conspiracy 30:37  Jerry Plummer and J.R. Baxter: young lawyer fighting back 34:36  Electronic health records enabled the data breach 36:07  Women receive $40K average settlement before fees 37:30  Data bias in medicine: gender gap in settlements 42:37  Solutions: anti-kickback statute reform 43:35  Private equity infiltrating law firms: the next frontier Key Topics Vaginal mesh litigation, healthcare fraud, HIPAA violations, stolen health records, call center fraud, litigation funding, private equity, women's health bias, legal reform, unnecessary surgery, settlement bias, data breach, electronic health records Podcast: DC EKG with Joe Grogan | Episode: 139 | Host: Joe Grogan | Guest: Elizabeth Chamblee Birch, Law Professor, University of Georgia Sponsor: Survivors for Solutions – https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios – https://www.stayoncourse.studio

Guest: John Bertrand, former Digital Diagnostics   Episode Description Joe Grogan sits down with John Bertrand, a veteran healthcare technology executive who scaled Digital Diagnostics to 75 health systems and achieved the first FDA approval and CMS reimbursement for an autonomous AI diagnostic device without a physician in the diagnostic loop. Bertrand reveals the harsh realities of bringing AI innovation to market: FDA and CMS regulatory frameworks are built for traditional medical devices and physician-driven care, not autonomous AI diagnostics. The conversation covers the shocking CMS reimbursement draft that came in 40-60% below cost of goods sold, the massive first-mover disadvantage in regulated medical device AI, and why reimbursement is the true gating factor for adoption—not clinical superiority. Bertrand explains how workflow integration and financial incentives matter far more than being clinically better. The episode explores the massive gap between what entrepreneurs think should happen with new innovations and the regulatory reality. He concludes with a sobering assessment: if building diagnostic AI again, he would choose supply chain automation instead because the regulatory and reimbursement headwinds are so significant they punish innovators. Where AI is actually making an impact today is patient-facing triage agents, administrative automation, and revenue cycle management—areas with far less friction. KEY TIMESTAMPS 0:40 Joe introduces John Bertrand and his healthcare tech background 1:28 John clarifies he recently left Digital Diagnostics for supply chain work 2:40 John's career: 13 years at Epic Systems across multiple roles 6:10 What does Digital Diagnostics' AI device do? Automating retinal imaging 7:56 First FDA approval and first CMS reimbursement for autonomous AI diagnostic 9:02 Joe's threshold question: shouldn't better innovation be easily adopted? 9:50 Reality: workflow integration and reimbursement matter more than clinical quality 11:50 The adoption curve: all successful FDA-approved AI devices have CMS reimbursement 14:10 FDA experience: desire to help but frameworks built for old technology 15:40 FDA scrutiny on AI exceeds scrutiny on human clinicians 18:05 FDA guidance changes every 6-12 months, creating constant pivoting and delays 20:08 Shifting to CMS: the shocking draft reimbursement story 20:45 Draft came in at $10 per test, needed $30+ to be viable 22:42 Four months of negotiations with CMS to shift value argument 24:40 Process not codified: each company follows unique regulatory path 28:04 Six years at Digital Diagnostics: was it worth it? 28:44 John would not recommend diagnostic AI to new founders 33:02 Turning down multiple diagnostic AI opportunities post-Digital Diagnostics 34:19 AI hype vs reality: where are patients actually seeing life improvements? 34:19 Patient-facing triage agents are the second inning of real AI opportunity 36:25 Reimbursement for chat-based triage: who gets paid? 38:23 Autonomous vs assistive AI: the regulatory gap that exists 40:31 Could Digital Diagnostics have done physician-in-loop from the start? 41:33 Real opportunity: clinical practices deploying their own AI 42:20 State licensing nightmare: deploying AI across 50 states 44:55 The real concern: RCM automation becoming a zero-sum AI bot battle 45:20 Dead Internet Theory applied to healthcare revenue cycle 47:38 Closing: a tour de force on AI healthcare reality Key Topics AI in healthcare, FDA approval process, CMS reimbursement, autonomous AI diagnostics, Digital Diagnostics, diabetic retinopathy, regulatory frameworks, first-mover disadvantage, workflow integration, reimbursement strategy, patient-facing AI, healthcare innovation, regulatory friction, adoption barriers, state licensing, RCM automation, healthcare AI reality   About the Guest John Bertrand is a veteran healthcare technology executive with over 20 years of experience. He spent 13 years at Epic Systems in analyst, product manage

This is a legacy episode recorded in January 2026. At the time of recording, Naomi Lopez was founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. Joe Grogan sits down with Naomi Lopez from Nexus Policy Consulting to recap the first Healthcare AI Policy Summit held in December 2025 in Washington, DC. They discuss big themes shaping healthcare AI, HHS approaches to AI adoption, and what regulatory clarity could look like. The conversation covers new federal initiatives like ACCESS and TEMPO that may reshape chronic disease management for Medicare patients. They unpack HHS Deputy Secretary Jim O'Neill's vision for AI in government, including using large models to improve physician productivity, payment integrity, and care coordination. They dig into ACCESS Medicare payment model and FDA TEMPO initiative, explaining how these pilots test AI tools in real-world chronic disease management for hypertension, diabetes, musculoskeletal pain, and depression. The discussion widens to physician burnout, interoperability, rural care, states and federal preemption, and what tech companies becoming Medicare Part B providers could mean for healthcare innovation. Key Timestamps 0:00 Intro and why the Healthcare AI Policy Summit matters 2:00 Summit recap: big themes and regulatory pressure points 6:00 Jim O'Neill at HHS: regulatory clarity and adoption inside government 12:00 ACCESS explained: Medicare chronic disease management payment model 18:00 TEMPO explained: FDA's risk-based approach for chronic care tools 24:00 Wearables, remote patient monitoring, and virtual ICU models 30:00 Privacy, de-identification, and re-identification risk 35:00 AI inside HHS and FDA: productivity, payment integrity, care coordination 41:00 Reducing admin burden and physician burnout 47:00 Rural healthcare: scaling diagnostics and access with AI 52:00 Interoperability and data sharing: APIs, friction, and incentives 58:00 State AI laws versus federal preemption 1:04:00 2026 outlook: tech companies as Medicare Part B providers 1:09:00 Wrap-up and what to watch next Key Topics Healthcare AI, ACCESS payment model, TEMPO initiative, FDA regulation, Medicare reimbursement, chronic disease management, AI in government, physician productivity, care coordination, wearables, remote patient monitoring, privacy and de-identification, rural healthcare, interoperability, state AI regulation, federal preemption, healthcare innovation, payment integrity About the Guest (at time of recording, January 2026) Naomi Lopez is the founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. She co-founded a healthcare AI working group and co-hosted the inaugural Healthcare AI Policy Summit in December 2025 in Washington, DC. Her work focuses on how regulation, Medicare and Medicaid policy, and state law shape healthcare innovation, access, and affordability. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Naomi Lopez Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

In this "REFILL" episode, Joe Grogan sits down with Jackson Hammond from Paragon Health Institute to unpack what the latest CMS National Health Expenditure data says about where U.S. healthcare is headed. They break down spending trends from $5.2 trillion to projections of $8.6 trillion, explaining what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. The conversation connects spending outlook to Jackson's work on CMS Innovation Center reform and debates whether CMMI is bending the cost curve or adding bureaucracy without accountability. Jackson argues we should aim for healthcare so affordable you barely need insurance, exploring how choice and competition could reshape the system. Key Timestamps 0:55 Jackson's background and how he got into health policy 3:39 Focus areas: Medicare, hospitals, drug pricing, PBMs, and 340B 5:14 What the NHE report is showing 6:14 Healthcare spending trajectory: $5.2T to $8.6T and why it matters 8:00 Why health spending is not really optional 10:11 Where the money goes: payer mix and per-enrollee costs 12:23 Medicaid costs, provider taxes, and state financing tactics 15:58 Medicare spending pressure and fiscal risk 21:06 Misconception: coverage equals care 26:18 Why provider payments keep rising after COVID demand and consolidation 33:01 Rural care, consolidation, and rural emergency hospital models 40:08 Drug pricing: retrospective versus prospective MFN approaches 49:20 2026 outlook and closing thoughts Key Topics National Health Expenditure, healthcare spending, CMS reform, CMS Innovation Center, Medicare spending, Medicaid costs, hospital consolidation, rural healthcare, drug pricing, PBMs, 340B program, provider payments, patient-centered care, healthcare affordability, choice and competition, fiscal policy About the Guest (at time of recording, January 2026) Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's Paragon Prognosis analyses and has written extensively on CMS Innovation Center reform and strategies for making healthcare more affordable through competitive market approaches. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Jackson Hammond Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

This is a legacy episode recorded in January 2026. At the time of recording, Michael Cannon was Director of Health Policy Studies at the Cato Institute, a leading voice on healthcare reform, the Affordable Care Act, and market-based health policy solutions. Episode Description Joe Grogan sits down with Michael Cannon from the Cato Institute to discuss short-term, limited-duration insurance (STLDI), also known as "Obamacare-exempt" plans, and why they can be significantly cheaper than ACA exchange coverage. Cannon explains how renewal guarantees work and why allowing more consumer choice can reduce pressure on exchange risk pools. The conversation covers the politics of pre-existing conditions, how ACA rules change insurers' incentives, and why coverage debates often miss the real drivers of cost, access, and quality. They also discuss public trust in healthcare following the Brian Thompson murder and explore how policy choices shape what insurers can and cannot do. Key Timestamps 0:23 Michael Cannon joins and what STLDI is 2:27 STLDI explained: Obamacare-exempt plans, renewal guarantees, and lower premiums 6:00 ACA history: why STLDI was restricted 7:46 International comparisons and pre-existing conditions incentives 12:10 Why healthcare stays broken: regulation, lobbying, and government-designed systems 16:59 Subsidies and the politics of pre-existing conditions 22:22 Renewal guarantees, employer tax exclusion, and Medicare history 30:37 Public trust after Brian Thompson's murder and Cannon's letter 41:56 Wrap-up and key takeaways Key Topics STLDI insurance, short-term limited-duration plans, ACA coverage, renewal guarantees, risk pools, pre-existing conditions, insurance regulation, healthcare costs, consumer choice, affordability, public trust, healthcare policy, market-based reform, junk insurance debate, employer-based coverage, Medicare policy About the Guest (at time of recording, January 2026) Michael Cannon is the Director of Health Policy Studies at the Cato Institute and a leading voice on healthcare reform, the Affordable Care Act, health insurance regulation, and market-based health policy solutions. He is a policy expert focused on expanding consumer choice and reducing the regulatory barriers that limit access to affordable coverage options. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Michael Cannon Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

Joe Grogan sits down with Ryan Long, healthcare policy expert and senior research fellow at Paragon, to discuss three critical healthcare policy issues facing Congress. First, the Congressional Budget Office's landmark analysis of the 340B drug pricing program, which revealed the program increases federal spending, drives up premiums, and channels most benefits to wealthy hospitals rather than those serving low-income patients. Second, the enhanced premium tax credits set to expire at the end of 2025, which have been plagued by fraud and fraudulent enrollment. Long explains how unscrupulous brokers have exploited the system, enrolling people without their knowledge, with billions in improper payments going to insurance companies. Third, the Inflation Reduction Act's devastating impact on Medicare Part D, including premium increases from thirty to sixty dollars monthly, coinsurance replacing copays, and seniors paying higher out-of-pocket costs despite the legislation's promise to lower drug costs. Key Timestamps 1:20 Welcome to DC EKG and introduction of Ryan Long 2:15 Congressional Budget Office analysis of 340B program 4:06 Why CBO conducted the 340B study 4:25 How 340B increases federal spending and premiums 4:58 Studies showing 340B drives higher-cost drug utilization 5:30 Will CBO analysis lead to legislative reform efforts 6:15 Program expansion from 90 to 2,600 participating hospitals 8:06 Timeline for 340B reform legislation 10:43 340B program growth from two billion to sixty-six billion annually 11:52 Why insurance companies support limiting 340B 12:20 Enhanced premium tax credits and ACA credits expiring 14:22 Difference between baseline and enhanced ACA credits 16:34 Zero-dollar plans and fraud mechanisms 18:19 Broker fraud and fraudulent enrollment schemes 21:09 How fraudulent brokers exploit free plans and commission structure 22:53 Paragon study showing four times over-enrollment in Florida 25:30 Misleading polling about ACA credits expiring 28:18 Groups pushing misleading messaging on enhanced credits 29:31 Political dynamics and Republican position on credits 33:17 Government shutdown politics and Democrat strategy 36:09 Elevance exiting standalone Medicare Part D plans 38:03 Migration from Part D to Medicare Advantage due to IRA 39:15 How IRA's out-of-pocket cap restructuring increased premiums 40:34 Coinsurance replacing copays and cost shift to seniors 42:20 IRA using fictitious list price to calculate negotiated savings 44:47 Multiple factors causing Medicare Part D premium increases Key Topics 340B program, Congressional Budget Office, drug pricing, hospital consolidation, enhanced premium tax credits, ACA fraud, fraudulent enrollment, broker fraud, government subsidies, Medicare Part D, out-of-pocket costs, coinsurance, Inflation Reduction Act, pharmaceutical pricing, program integrity About the Guest (at time of recording, September 2025) Ryan Long is a Senior Research Fellow at the Paragon Health Institute and affiliated with the USC Schaefer Center for Health Policy and Economics. He is a healthcare policy expert with extensive experience on Capitol Hill, including service as a staffer on the House Energy and Commerce Committee and chief health policy advisor to Speaker Kevin McCarthy. Long specializes in healthcare reform, pharmaceutical pricing policy, Medicare and Medicaid issues, and legislative strategy. Podcast: DC EKG with Joe Grogan Host: Joe Grogan Guest: Ryan Long Sponsor: Survivors for Solutions Executive Producer: John CZ Czwartacki, DC EKG Podcast

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

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

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

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

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

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