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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

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

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

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

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

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

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

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

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

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

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

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

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.

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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

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.

"Obamacare Exempt" Plans - STLDI and ACA Coverage: Costs, Choice, and Tradeoffs

Joe Grogan is joined by Michael Cannon (Cato Institute) to break down short-term, limited-duration insurance (STLDI), also known as “Obamacare-exempt” plans. They explain why STLDI can be far cheaper than ACA exchange coverage, how renewal guarantees work, and why allowing more consumer choice can reduce pressure on exchange risk pools.

They also dig into 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. The conversation ends with a broader look at public trust, healthcare fear, and how policy choices shape what insurers can and cannot do.

Timestamps / Chapters00:01 – Intro00:23 – Michael Cannon joins + what STLDI is02:27 – STLDI explained: “Obamacare-exempt” plans, renewal guarantees, and lower premiums06:00 – ACA history: why STLDI was restricted07:46 – International comparisons + pre-existing conditions incentives and the Colette Briggs story12:10 – Why healthcare stays broken: regulation, lobbying, and “government-designed” systems16:59 – Subsidies and the politics of pre-existing conditions22:22 – Renewal guarantees, employer tax exclusion, and why Medicare entered the picture30:37 – Public trust after Brian Thompson’s murder and Cannon’s letter41:56 – Wrap-up

In This Conversation

Key Takeaways

About Our GuestMichael Cannon is the Director of Health Policy Studies at the Cato Institute and a leading voice on the ACA, health insurance regulation, and market-based health reforms.

Podcast TitleDC EKG with Joe Grogan: A Healthcare Policy Podcast

Episode124

Episode TitleRyan Long on the ACA Subsidy Fight, Phantom Enrollees, and Reforming 340B

Episode DescriptionJoe 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 Timestamps00:01 Intro00:23 Welcome, and what is on the agenda01:25 California wealth tax and structural deficits11:20 Enhanced ACA subsidies and the shutdown fight16:54 Income caps, zero premium plans, and phantom enrollees21:50 Fraud, Medicaid exposure, and public trust30:39 Medical loss ratio incentives and ACA market fixes38:41 340B: how arbitrage works and why it drives consolidation44:51 What reform could look like47:20 Closing

SEO KeywordsAffordable 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 GuestRyan 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

DC EKG with Joe Grogan: A Healthcare Policy Podcast

Ep. 122

In this episode of DC EKG with Joe Grogan: A Healthcare Policy Podcast, Joe recaps the first Healthcare AI Policy Summit, held on December 10th in Washington, DC, with his co-host for the event, Naomi Lopez, founder of Nexus Policy Consulting.

They walk through the big themes shaping healthcare AI right now: how HHS is approaching AI adoption, what real regulatory clarity could look like, and how new federal initiatives like ACCESS and TEMPO may reshape chronic disease management for Medicare patients.

Joe and Naomi unpack HHS Deputy Secretary Jim O’Neill’s view of AI in government, from using large models to improve physician productivity, payment integrity, and care coordination to managing privacy and re-identification risk when working with federal health data.

They dig into the ACCESS Medicare payment model and the FDA TEMPO initiative, explaining how these pilots test AI and machine learning tools in real-world chronic disease management (hypertension, diabetes, musculoskeletal pain, and depression), and what that means for Medicare payment models, FDA oversight, and healthcare innovation.

The conversation then widens to physician burnout, interoperability, rural care, and the role of states and federal preemption in setting the rules for healthcare AI. If you care about the real-world impact of healthcare AI on policy, payment, and patients, this episode offers a clear, practical summary of what the summit revealed and what to watch next.

Today Joe and Naomi cover:

Key Takeaways:

Healthcare AI is being built into policy through programs like ACCESS and TEMPO, tying AI tools to Medicare payment and FDA pathways in chronic disease management.

Joe's guest, 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 with Joe Grogan and co-hosted the inaugural Healthcare AI Policy Summit on December 10th in Washington, DC.

 In Episode 123 of DC EKG, Joe Grogan sits down with Jackson Hammond (Senior Policy Analyst, Paragon Health Institute) to unpack what the latest CMS National Health Expenditure (NHE) data says about where U.S. health care is headed.

They break down the June 2025 NHE release, compare it to Jackson’s earlier “Paragon Prognosis” analysis, and explain what changed, what didn’t, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure.

They also connect the spending outlook to Jackson’s paper, “How to Reform the CMS Innovation Center with a Choice and Competition Approach,” and debate whether CMMI is bending the cost curve or just adding bureaucracy without accountability. Jackson argues we should aim for health care so affordable you barely need insurance.

Chapters / Timestamps  00:00 – Intro + welcome  00:55 – Jackson’s background: how he got into health policy  03:39 – Focus areas: Medicare, hospitals, drug pricing, PBMs, 340B  05:14 – What the NHE report is showing  06:14 – $5.2T → $5.6T → $8.6T: why the trajectory matters  08:00 – Why health spending isn’t really “optional”  10:11 – Where the money is going: payer mix + 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 = care”  26:18 – Why provider payments keep rising (post-COVID demand + consolidation)  33:01 – Rural care, consolidation, and the REH / hub-and-spoke model  40:08 – Drug pricing: retrospective vs prospective MFN  49:20 – 2026 outlook + closing thanks

In This Conversation  • NHE 2025: what the June 2025 data confirms about spending growth and the federal share.  • Rising prices, flat health: why prices climb while outcomes lag.  • Medicare and Medicaid: why they remain major budget drivers.  • Coverage vs access: why an insurance card doesn’t guarantee care or better health.  • Hospitals and consolidation: what’s driving higher payments and fewer choices.  • Rural vs urban: why patients bypass local hospitals and what a better model could look like.  • Drug pricing: what MFN approaches might mean for costs and innovation.  • 2026: what Jackson expects next and what reform could realistically look like.

Key Takeaways  • NHE data points to continued, unsustainable spending growth.  • Medicare and Medicaid drive long-term budget pressure.  • Consolidation and payment incentives shape prices as much as utilization.  • CMMI reform hinges on accountability, choice, and competition.  • Smarter drug pricing policy should lower costs without undermining innovation.

About Our Guest  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 wrote “How to Reform the CMS Innovation Center with a Choice and Competition Approach.”

In this episode of DC EKG with Joe Grogan: A Healthcare Policy Podcast, Joe sits down with health economist Tony LoSasso to dissect what serious, workable Obamacare reforms could look like without blowing up the Affordable Care Act entirely. They dig into the structure of healthcare subsidies, why current premium tax credits dull price sensitivity, and how that undermines insurance competition, drives up healthcare costs, and threatens the law's fiscal sustainability.

Tony lays out a path to modernize the ACA with defined-contribution-style subsidies, patient-directed “health freedom” accounts, and targeted support for people with preexisting conditions through high-risk pools, rather than hiding transfer programs inside community-rated premiums. Along the way, they tackle essential health benefits, community rating, Medicare pricing, certificate-of-need laws, and growing hospital market concentration, and ask what a real bipartisan healthcare reform deal might look like in today’s political climate.

In this episode of DC EKG, host Joe Grogan is joined by Ryan Long, Capitol Hill veteran and senior research fellow at the Paragon Institute, to unpack two big health policy debates: the 340B drug discount program and the enhanced ACA premium tax credits. Ryan explains how 340B drives higher drug spending, hospital consolidation, and rising premiums, while often benefiting wealthier hospitals over safety-net providers. He also breaks down why the temporary ACA subsidies are set to expire in 2025, the fraud and enrollment issues they’ve created, and what both parties are gearing up for as the fight continues.

In this episode of DC EKG, Joe Grogan sits down with healthcare entrepreneur and advocate Dutch Rojas to unpack some of the most pressing and misunderstood issues in American healthcare. From his unconventional path from accounting into healthcare to his outspoken advocacy for physician-owned hospitals, Rojas brings a fresh, unapologetic perspective to how we can break through the gridlock of consolidation and outdated policy. Rojas makes the case for why charity care is often used as a business strategy rather than genuine community support, and explains how site-neutral payments could dramatically lower costs for patients and employers alike. He also outlines how innovations like a healthcare commodities exchange could finally deliver the price transparency Americans deserve, and the competition the system desperately needs.

Join host Joe Grogan for an exclusive masterclass with Dr. Robert Burns, James Joo-Jin Kim Professor of Health Care Management at the Wharton School. A nationally recognized expert on the U.S. healthcare system, Dr. Burns unpacks the complex forces driving healthcare costs.

With a background in sociology, anthropology, and decades of research, Dr. Burns reveals why so many healthcare reforms fail, what policymakers and business leaders get wrong, and how the U.S. healthcare ecosystem really works behind the headlines. If you’ve ever wondered why American healthcare is so expensive, and what can actually be done about it, this episode is a must-listen.

Critics have been quick to attack the One Big Beautiful Bill (OBBB), but how much of what you’ve heard is true? In this episode, Joe Grogan sits down with Brian Blase to set the record straight on the bill’s health policy reforms and why they matter. From Medicaid funding changes to the role of provider taxes, Brian and Joe break down the bill’s impact, debunk common myths, and explore what’s next for U.S. healthcare policy. They cover how work requirements, eligibility reviews, and a focus on value could transform the system.

Paragon Institute Myth-Busting Series on OBBB: https://paragoninstitute.org/issue-library/obbb-myths-and-facts/

Brian Blase X: https://x.com/brian_blase?lang=en

In this episode of DC EKG, Joe Grogan sits down with Sean Spicer, former White House Press Secretary and host of The Sean Spicer Show. Spicer shares his experiences from working in various political roles, his thoughts on Republican strategies for the midterms, and the challenges of communicating healthcare policies. The discussion also delves into the differences between legacy media and new media, highlighting the need for self-reflection within traditional news outlets.

Stephen Parente, former White House Chief Economist for Health Policy and current Minnesota Insurance Industry Chair of Health Finance and Associate Dean at the Carlson School of Management, joins host Joe Grogan to discuss the state of healthcare transparency. They dive into the pros and cons of price transparency, the impact of the No Surprises Act, challenges for insurers and providers, and what transparency means for healthcare costs and future policy. Parente also hosts the On Background podcast, where he explores key issues in health finance and public policy.

In this episode of DC EKG, host Joe Grogan sits down with Dan Troy, former Chief Counsel of the FDA and a nationally recognized expert on healthcare law and the First Amendment. They explore Troy’s unique journey from free speech litigator to one of the FDA’s top legal voices, examining how the agency regulates what drugmakers, doctors, and companies are allowed to say—and what they’re not. The conversation dives into the legal boundaries of off-label promotion, the impact of direct-to-consumer advertising on patient care, and the growing tension between innovation and regulation in the pharmaceutical industry. Troy also offers his perspective on the Inflation Reduction Act and its potential chilling effect on drug development, underscoring the need for bipartisan support in shaping healthcare policy.

In this episode, Michael F. Cannon, the Cato Institute’s Director of Health Policy Studies, dives into the policy decisions that shaped Medicare and fundamentally distorted the U.S. health insurance market. From how tax incentives nudged Americans into employer-sponsored plans to the unintended consequences that left many seniors uninsured, Cannon breaks down the government’s role in creating systemic challenges in health care. He also explores how tax policy has long been used as a tool to mandate certain health behaviors, and what a less distorted, freer market might look like. If you want to understand the policy roots behind today’s health care complexities, this conversation is a must-listen.

In this conversation, Joe Grogan interviews Peter Pitts, a former FDA associate commissioner and current president of the Center for Medicine and the Public Interest. They discuss the role of FDA advisory committees, the importance of transparency in regulatory processes, and the intersection of vaccination and nutrition in public health. Pitts emphasizes the need for better dosing guidelines for obese patients and the significance of user fees in ensuring predictable FDA reviews. The conversation highlights the challenges and opportunities within the FDA and the broader healthcare landscape.

In this episode of DC EKG, host Joe Grogan interviews historian and political veteran Tevi Troy about the complex relationship between U.S. presidents and powerful industries. They discuss themes from his book The Power and the Money: The Epic Clashes Between Commanders in Chief and Titans of Industry and his op-ed In Defense of Big Pharma. The conversation explores why pharmaceutical companies are often political targets and the impact on innovation, how historical antitrust cases shape today’s tech and biotech battles, insights on Trump’s leadership and the future of the GOP, the importance of communication skills in politics and business, and behind-the-scenes stories from the Trump administration, offering valuable leadership lessons. This episode provides important insights for policymakers, investors, and anyone interested in the intersection of health, economics, and democracy.

Joe Grogan sits down with Dr. Anthony DiGiorgio, a neurosurgeon and health policy researcher, for a wide-ranging conversation on the challenges facing America’s healthcare system. Drawing on his experience at a safety net hospital, Dr. DiGiorgio discusses the realities of trauma care, including the treatment of traumatic brain and spinal cord injuries, and the systemic issues within Medicaid that hinder access and quality of care. The conversation also explores the misuse of the 340B program, the ethics and logistics of overlapping surgeries, and the growing crisis of physician burnout. Dr. DiGiorgio shares his advocacy for direct primary care and the promise of AI as tools to reduce administrative burdens and improve patient outcomes.

In this episode of DC EKG, policy expert Ryan Long unpacks the tangled evolution of the 340B program—from its origins in the early 1990s to its explosive, unintended role in today’s healthcare market. Originally designed to help hospitals serving the uninsured access affordable drugs, 340B has morphed into a tool for profit, driving hospital consolidation, inflating costs, and straining the biotech innovation ecosystem. Ryan explains how vague eligibility rules, lack of oversight, and policy loopholes have turned a small support program into a massive $54 billion industry—with no requirement that savings actually reach the patients it's meant to help. This is a must-listen for anyone interested in how drug pricing policy, hospital behavior, and innovation incentives are shaping the future of medicine in America.

In this episode of DC EKG, host Joe Grogan speaks with Kelly Cleary, a partner at Akin Law, about her career in healthcare regulatory law and her experience at HHS. They discuss the recent repeal of the Richardson waiver, its historical significance, and implications for healthcare policy and regulation. The conversation also touches on the end of Chevron deference and its potential impact on agency regulations, as well as personal reflections on the value of government service in shaping legal practice.

In this episode of DC EKG, host Joe Grogan sits down with Dr. Brian J. Miller to dissect the critical barriers slowing medical innovation in the United States. Together, they unpack the notorious "Valley of Death"—the daunting gap between FDA approval and Medicare coverage that delays patient access to groundbreaking treatments and technologies, often by an average of 5.7 years. Dr. Miller shares his insights on how outdated regulatory processes at both the FDA and CMS create unnecessary hurdles for life sciences and technology entrepreneurs. They explore how modernizing third-party reviews, streamlining clinical trials, and reforming coverage decisions could dramatically accelerate the journey from lab to patient.

In this episode, Joe Grogan and Brian Blase dive into the current state of Medicaid, exploring the urgent need for reforms to tackle inefficiencies, improper payments, and discriminatory reimbursement rates. Blase discusses the challenges stemming from the Medicaid expansion under the Affordable Care Act (ACA) and how it has impacted traditional enrollees. The conversation also uncovers the troubling issue of Medicaid money laundering, shedding light on the practice of state-directed payments that sometimes surpass Medicare rates. Together, they discuss the pressing need for a more effective and equitable healthcare system that better serves those in need while ensuring accountability in healthcare spending. This episode is a critical look at how the ACA and Medicaid policies are shaping the future of American healthcare.

In this episode, Joe Grogan and Sally Pipes dive into the future of U.S. healthcare policy, discussing potential reforms under a second Trump administration. They explore executive orders, Medicaid challenges, and the flaws in Canada’s healthcare system. The conversation also tackles a provocative question: Could Canada ever become the 51st state? Sally breaks down the political, economic, and healthcare implications of such a shift. Plus, they discuss California’s wildfire mismanagement and the urgent need for political change.

In this episode, Joe Grogan speaks with Professor Josh Rauh about the ongoing pension crisis in the United States, focusing on the inefficiencies of government pension systems and the impact on taxpayers. They explore the history of government pensions, the shift from defined benefit plans to 401(k) plans, and the alarming statistics of underfunded pensions in major cities like Chicago. The conversation also delves into potential budget cuts under the new DOGE initiative and the urgent need for fiscal responsibility in government spending to address America’s growing financial challenges. Tune in to learn how these issues could shape the future of government efficiency and public pensions.

In this episode, Joe Grogan sits down with Vance Ginn, an economist and host of the Let People Prosper podcast, to dive into healthcare reform, economic policy, and the power of state-level innovation. Vance shares his inspiring journey from his humble beginnings to his role as Chief Economist at the Office of Management and Budget. He discusses his work with think tanks, the challenges of federal spending, and the need for a market-based approach to healthcare to improve outcomes and reduce costs.

Listen to Vance’s podcast, Let People Prosper, for more insights on how economic policies can help individuals and families thrive.

Listen to Let People Prosper