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Original Substack Release Date:  June 14th, 2025

🎯 Why Listen

When the New England Journal of Medicine claims that direct primary care threatens the “common good,” four practicing physicians step into the ring. This episode isn’t just a rebuttal, it’s a full-throated defense of medical freedom, patient choice, and the future of primary care. If you want to understand how Medicaid has morphed from a safety net into a subsidy machine—and why academics and policymakers are terrified of patients controlling their own dollars—this episode is essential.

Co-Hosts

• Dutch Rojas – Founder, Bliksem Health 
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur

Episode Overview

• The NEJM op-ed that sparked outrage: framing DPC as a social harm while ignoring why doctors are leaving the insurance system.
• Why direct primary care isn’t boutique medicine—it’s an economic correction to price-fixing and burnout.
• The Medicaid industrial complex: how states and managed care organizations profit while patients wait for access.
• Real numbers: Centene makes ~$18,000 per member annually, while primary care doctors earn less than plumbers.
• State-level gaming: double enrollment, lax verification, and taxpayer waste.
• A better alternative: DPC + catastrophic coverage + HSAs at less than $7,000/year.
• The hypocrisy of policy academics: designing broken payment systems, then blaming practicing physicians for opting out.

Notable Quotes

• “Primary care doctors are getting paid less than plumbers—and somehow they’re the ones being blamed.” - Dr. Dan Choi 
• “If Medicaid were truly a safety net, why are insurers profiting like it’s Wall Street?” - Dr. Dan Choi 
• “The moment patients control the money, the system collapses—and that’s what terrifies them.” - Dr. Dan Choi 

What You’ll Learn

1. Why the NEJM perspective on DPC gets the economics wrong.
2. How Medicaid expansion shifted from safety net to subsidy scheme.
3. The real cost of managed Medicaid—and who profits most.
4. Why HSAs and direct primary care offer a scalable, patient-centered alternative.
5. How academic medicine fuels policy myths that widen access gaps.

The Episode (Timestamps)

• 00:00 – Opening banter and NEJM op-ed overview
• 02:00 – The ideology behind calling primary care a “common good”
• 06:00 – Economics of primary care and why DPC emerged
• 10:00 – Medicaid’s expansion: safety net or single-payer on training wheels?
• 20:00 – State-level gaming and provider tax loopholes
• 29:00 – DPC + catastrophic plan + HSA: a viable alternative
• 38:00 – Manage

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X