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🎯 Why Listen

When an 88-year-old with dementia lands in the hospital, should we implant a device simply “because we can”? The panel examines futile care, ICU economics, malpractice fears, and the cultural bias to always “do something.” With special guest JP Kolcun, a seventh-year neurosurgery resident, they also debate whether physician-owned hospitals could restore dignity, efficiency, and leadership to American medicine.

👥 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
• Special Guest: JP Kolcun, MD – Seventh-year neurosurgery resident, Rush University, Chicago

📌 Episode Overview

The panel examines costly end-of-life interventions like Watchman devices, asking whether they truly benefit frail patients and what dignity looks like when medicine defaults to “doing something.” In the second half, they debate physician-owned hospitals, exploring how lifting ACA restrictions could improve efficiency, reduce burnout, and restore physician leadership in patient-centered care.

💬 Notable Quotes

• “Wherever the art of medicine is loved, there is humanity.” – Hippocrates, quoted during the episode
• “Government is a poor deployer of capital.”
• “Who would you rather have running a hospital—someone oath-bound, or someone only bound by greed?”

📚 What You’ll Learn

• Why left atrial appendage occluders spark debate about futility and cost at the end of life
• How Medicare’s spending patterns shape hospital incentives
• The tension between physician judgment, family wishes, and systemic pressures
• What Section 6001 of the ACA did to physician-owned hospitals
• Why physician-led care models could improve efficiency and morale in healthcare
• Broader reflections on dignity, values, and the role of physicians in society

⏱ The Episode (Timestamps)

• [00:01:30] Introductions, JP Colcun rejoins the panel
• [00:04:00] End-of-life spending and Watchman device outcomes
• [00:08:00] The 40% mortality problem in device patients
• [00:13:00] Futility, family wishes, and medical-legal pressures
• [00:17:00] Medicare’s role and distorted spending incentives
• [00:22:00] Dignity, third-party payment, and lost physician “quarterbacks”
• [00:30:00] Transition to physician-owned hospitals
• [00:33:00] Section 6001 of the ACA explained
• [00:36:00] Physician burnout and hospital inefficiencies
• [00:44:00] The nonprofit hospital paradox
• [00:50:00] Closing reflections: restoring physician entrepreneurship and values

🔗 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

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🎯 Why Listen

Organ donation is one of the most emotional and misunderstood processes in modern medicine. In this minisode, the hosts tackle the ethics, procedures, and misconceptions around declaring death and procuring organs. Whether you’re a healthcare professional, patient advocate, or simply someone who has “organ donor” on your driver’s license, this conversation offers rare clarity and compassion on a deeply human subject.

👥 Co-Hosts

• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator

📌 Episode Overview

This minisode dives into the practical and ethical dimensions of organ donation—focusing on how doctors determine death, the role of families, and the procedures that follow catastrophic brain injuries. Dr. Anthony DiGiorgio explains the two main pathways to organ donation: brain death and donation after cardiac death (DCD). The discussion explores how organ procurement teams interact with hospitals, why state laws differ (California being unique in honoring driver’s license consent over family objections), and how protocols aim to preserve dignity while enabling life-saving transplants.

💬 Notable Quotes

• “It’s heart wrenching to declare someone dead—these are often young patients who have had some tragedy.”
• “We would never do this on someone who had a meaningful shot at getting up and walking out of there.”
• “There’s a strong wall between the caregiving team and the organ procurement team.”
• “Comfort care protocols ensure patients feel no air hunger—this is about dignity, not hastening death.”

📚 What You’ll Learn

• The two medical pathways to organ donation: brain death vs. donation after cardiac death (DCD).
• Why protocols and wait times (e.g., UCSF’s 90-minute rule for DCD) exist to ensure ethical clarity.
• The legal weight of organ donor status on a driver’s license, and how it can supersede family wishes in California.
• The separation of duties between doctors caring for patients and organ procurement teams.
• How misconceptions—like those fueled by media reports—can distort public understanding of donation.

⏱ The Episode (Timestamps)

• [00:00] Declaring death: brain death vs. cardiac death
• [02:00] Testing and confirming brain death
• [04:00] The role of families and living wills in donation decisions
• [06:00] Organ procurement teams—how and when they get involved
• [08:00] UCSF’s 90-minute DCD protocol explained
• [10:00] Addressing New York Times reporting and public misconceptions
• [12:00] Comfort care, ethics, and ensuring dignity in end-of-life scenarios
• [14:00] Why organ donation is never about pressure, but about honoring life after tragedy

🔗 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

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🎯 Why Listen

North Carolina approved a bill letting some international medical grads practice without U.S. residency. Smart fix for shortages—or a back door for cheaper labor that risks quality? We break down patient impact, wages, malpractice, and what it means for the profession. Plus: Vinay Prasad’s surprise return to the FDA, catastrophic insurance, and why prices stay opaque.

👥 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

• NC Bill 67: Why hospitals pushed it; how it bypasses standard vetting.
• Licensure’s false security—and the “Dr. Death” lesson.
• Will cheaper labor deter U.S. trainees and suppress wages?
• Malpractice/insurance: who absorbs the risk?
• Commoditizing clinicians: PR, checklists, and EHR clicks over care.
• Quick hits: Prasad’s FDA comeback and how the ACA erased catastrophic plans.

💬 Notable Quotes

• “This is an employer-driven bill. Hospitals need cogs, not clinicians.” – Dan Choi
• “Licensure can give a false sense of security.” – Anish Koka
• “Import cheaper labor and U.S. grads will walk.” – Sanat Dixit
• “Killing catastrophic plans killed price signals.” – Anthony DiGiorgio

📚 What You’ll Learn

• How IMG parity reshapes the pipeline—and who wins.
• Why incentives, not slogans, drive workforce behavior.
• The hospital risk calculus: compliance vs. clinical judgment.
• Lobbying’s role in workforce policy.
• How restoring catastrophic coverage could revive real markets.

⏱ The Episode (Timestamps)

• 00:00–07:30 NC Bill 67—IMGs sans U.S. residency
• 07:30–13:00 Licensure gaps & Dr. Death
• 13:00–22:30 Wages, “STEM coolies,” incentives
• 22:30–29:30 NP scope, hospital demand, commoditization
• 29:30–34:45 Professional standards & patient trust
• 34:45–41:00 Lobbying power and politics
• 41:00–48:00 Vinay Prasad, FDA, biotech pushback
• 48:00–54:00 Catastrophic insurance & ACA effects
• 54:00–End Price transparency, DTE contracts, fixing incentives

🔗 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

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🎯 Why Listen

Is there really a physician shortage—or just bad incentives driving doctors out of practice? In this episode, the crew unpacks Representative Greg Murphy’s call for more foreign-trained doctors, the real barriers U.S. medical students face, the role of residency caps, gender dynamics in the physician workforce, and why private practice may hold the key to keeping doctors in medicine.

👥 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 “physician shortage” debate: is it real, or misallocation + burnout?
• U.S. med school demand vs. residency bottlenecks—and the 1997 cap that still shapes supply.
• H-1B visas for international medical graduates: help or band-aid?
• Gender workforce dynamics: why more women physicians work part-time and how that affects access.
• Why doctors leave clinical medicine early—and what would keep them in practice.
• Policy solutions: site neutrality, physician-owned hospitals, and cutting through regulatory capture.

💬 Notable Quotes

• “The ultimate failure of central planning is thinking you can measure physician demand.” – Anthony DiGiorgio
• “We have plenty of talent in the U.S.—why not open more medical schools and residency spots?” – Dan Choi
• “If being a doctor were enjoyable again, we wouldn’t be having this shortage conversation.” – Anish Koka
• “When physicians ran healthcare, the focus was on patients. Locking us out created today’s inefficiencies.” – Dan Choi

📚 What You’ll Learn

• Why residency slots—not interest in medicine—are the true bottleneck.
• How CMS payment and hospital consolidation drive burnout and early exits.
• The economic tradeoffs of foreign-trained vs. U.S.-trained physicians.
• How gender dynamics reshape workforce numbers.
• Policy levers that could restore independence and fix misaligned incentives.

⏱ The Episode (Timestamps)

• 00:00–02:00 Cold open: physician demand, central planning & burnout
• 02:00–06:30 Rep. Greg Murphy, H-1B visas, and the med school acceptance gap
• 06:30–13:00 U.S. applicants denied vs. foreign-trained routes; debt vs. no-debt training
• 13:00–16:30 Gender gap: women in medicine, part-time work, and policy backlash
• 16:30–21:30 1997 residency budget cap and whether slots are the real bottleneck
• 21:30–28:30 Private practice vs. health system consolidation: patient access and efficiency
• 28:30–36:00 RFK Jr.’s comments on physicians, incentives, and the “food as medicine” debate
• 36:00–46:00 Free market fixes: site neutrality, physician-owned hospitals, deregulation
• 46:00–55:00 Burnout, EMR inefficiencies, verbal order regulations, and why physicians leave

••55:00–End Closing reflections + next episode teaser

🔗 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

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Original Substack Release: Aug 23, 2025

🎯 Why Listen

When hope collides with billion-dollar incentives, who protects patients? We unpack Vinay Prasad’s FDA resignation, Sarepta’s $3.2M Duchenne gene therapy, and how accelerated approvals can leave families without the long-term data they deserve.

👥 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

• Vinay Prasad’s exit from FDA/CBER and what it signals about evidence, safety, and politics.
• Duchenne muscular dystrophy, Sarepta’s one-shot gene therapy, and deaths linked to vector toxicity.
• The promise and peril of accelerated approvals—and why confirmatory trials so often stall.
• Left vs. right myths about healthcare; markets, incentives, and why “healthcare is a right” can fail in practice.
• Quick hits: public-good economics in medicine, decentralization vs. central control, and where AI may actually help (RCM, workflow).

💬 Notable Quotes

• “These trials are never gonna get done. It’s a game—with patients as pawns.”
• “The FDA is the Midas touch: approval turns hope into revenue—fast.”
• “You don’t want a world where healthcare is non-excludable and non-rivalrous.”
• “If healthcare is ‘first, do no harm,’ who decides what harm looks like—and who pays the price?”

📚 What You’ll Learn

• How accelerated approval works—and where it breaks.
• Why safety signals (e.g., vector-related liver failure) matter more than press releases.
• The difference between hope, evidence, and incentives in rare disease.
• How political tribes systematically misunderstand healthcare mechanics.
• Practical places AI can improve care operations today.

⏱ The Episode (Timestamps)

• 00:00–01:10 Welcome back & cadence update (new Sunday drops)
• 01:10–07:40 Vinay Prasad resigns from FDA/CBER—context and stakes
• 07:40–13:30 Duchenne 101, dystrophin biology, trial endpoints vs. real outcomes
• 13:30–17:30 Accelerated approval promises vs. missing confirmatory trials
• 17:30–22:30 Safety signals: vector immunogenicity, reported deaths, what pulls look like
• 22:30–28:30 Media/influencer pressure and the politics of “right to try”
• 28:30–41:30 Is healthcare a public good? Scarcity, incentives, and economic reality
• 41:30–50:30 Government, morality, and why central planning fails patients
• 50:30–59:30 AI, agents, and near-term wins in physician workflows
• 59:30–End What we need next from policymakers—and from clinicians

🔗 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

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Original Substack Release Date:  August 29, 2025

🎯 Why Listen

Heard “surprise billing” blamed on doctors? This episode shows how insurers shaped the narrative, how the No Surprises Act (NSA) was meant to protect patients, why weak enforcement broke it, and what Rep. Greg Murphy’s No Surprises Enforcement Act could fix.

👥 Co-Hosts

• Dutch Rojas – Founder, Bliksem Health
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon; healthcare advocate
• Sanat Dixit, MD, FACS – Neurosurgeon; Faculty, Vanderbilt; entrepreneur

📌 Episode Overview

The insurer-made “surprise billing” label and how network design boxes out small practices.

• NY arbitration (market-based, patient kept out) vs CA benchmarking (median in-network → narrower networks).
• The gap: doctors win arbitrations; insurers don’t pay. Murphy’s bill adds deadlines and penalties.
• Plus: FDA leadership, gene therapy tradeoffs (safety vs efficacy, tiny trials, huge prices), and a quick take on homelessness policy and harm reduction.

💬 Notable Quotes

• “‘Surprise billing’ was insurer spin for an insurer problem.”
• “If you can’t charge fair market rates, you can’t stay independent.”
• “Science doesn’t have a left or right—only signals to read.”

📚 What You’ll Learn

• How network contracting disadvantages small practices.
• Why arbitration design changes insurer behavior.
• How enforcement determines whether NSA works.
• The real-world costs and evidence hurdles of gene therapies.
• Ways practicing physicians can still shape policy.

⏱ The Episode (Timestamps)

• 00:00–03:30 Order vs. healthcare chaos
• 03:30–09:30 Why clinicians wade into policy
• 10:00–13:30 In-network vs. out-of-network
• 13:30–19:00 “Surprise bills” demystified
• 19:00–23:45 NY arbitration vs. CA benchmarking
• 26:30–33:15 The NSA enforcement problem & Murphy’s fix
• 33:15–41:30 FDA, Vinay Prasad, Duchenne gene therapy
• 56:00–1:04:00 Homelessness policy: housing-first vs. institutional care

🔗 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

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Original Substack Release Date: August 9, 2025

🎯 Why Listen

This episode pulls no punches on the future of physician independence. From the looming physician shortage to the retaliatory tactics of insurers, you’ll hear an unscripted conversation about the raw realities inside American healthcare—and the strategies physicians can use to fight back.

👥 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

Three of the country’s sharpest physician voices—and guest Heath Veuleman—expose how insurers, hospitals, and even physicians themselves are reshaping healthcare in America. They tackle the physician shortage, why physician-owned hospitals outperform on cost and quality, and how small practices can unite to take on monopolistic health systems. If you’ve ever wondered what’s really happening behind the curtain, this is the conversation you won’t hear in a boardroom.

💬 Notable Quote

“We’ve only got about 1.1 million physicians left. 38% are going to age out in the next 60 months. Physicians have way more leverage than they know—they just don’t realize it yet.” — Heath Veuleman

📚 What You’ll Learn

• Why 38% of U.S. physicians could be gone in five years—and why it’s not just burnout
• The insurer retaliation playbook used against independent doctors
• How physician-owned hospitals lower costs, improve outcomes, and raise patient satisfaction—but remain shackled by federal law
• Why physicians’ biggest threat is internal: self-sabotage and lack of collaboration
• The business case for direct contracting and bypassing third-party payers
• How to scale small practices into a coordinated force against hospital monopolies

⏱ The Episode (Timestamps)

• [00:00] Why physician-owned hospitals matter
• [06:00] The coming physician shortage and workforce crisis
• [14:00] Why hyper-focused specialty hospitals succeed
• [22:00] Direct contracting: cutting out the middlemen
• [28:00] Insurer retaliation against outspoken physicians
• [36:00] Fragmentation, duplication, and cost inflation in healthcare
• [45:00] Outpatient innovation vs. hospital inefficiency
• [53:00] Regulatory barriers and the moratorium on physician-owned hospitals
• [57:00] Signs we’re at the end of a healthcare cycle
• [01:02:00] Physician leverage, consumer awakening, and the next wave of reform

🔗 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

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Original Substack Release Date: July 20,2025

🎯 Why Listen

Prior authorization is the bureaucratic chokehold strangling American healthcare. But this episode isn’t just venting — it’s a masterclass in how the system got built, why it persists, and where leverage actually lies. From AI-driven denials to Medicare’s looming funding cliff, we break down the forces shaping care today and what physicians and patients can do about it.

 👥 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

What happens when AI is weaponized on both sides of prior authorization? One side uses it to deny care, the other to fight back with automated letters of medical necessity. In this episode, the panel dives into:

• How insurers and employers hold the real keys to pre-auth.
• Why 66% of patients covered by self-funded plans could eliminate it tomorrow.
• The Medicare cliff — and how boomer physicians’ choices set up today’s workforce.
• Whether raising the Medicare eligibility age or tying licensure to Medicare participation are realistic fixes.
• Why restoring physician autonomy may be the only path to sustainable care.

This is a roadmap for doctors and patients alike who want to see through the illusion of “insurance as healthcare.”

💬 Notable Quotes

• “This system isn’t designed for patients. It’s not designed for physicians. It’s designed for delay, denial, and distraction.” – Dutch Rojas
• “Every week, I get calls: friends of friends who can’t get in to see a specialist for months. That’s the storm coming.” – Dan Choi, MD
• “If you took lifetime Medicare contributions and put them in an HSA, indexed to the S&P 500, every retiree would have $2 million. Are you telling me they couldn’t manage their care better than Medicare can?” – Anthony DiGiorgio, DO
• “Doctors don’t value themselves. They accept crumbs, when they’re sitting on a goldmine of skill and trust.” – Dutch Rojas
• “We’re spending billions managing the money instead of managing the medicine.” – Sanat Dixit, MD

📚  What You’ll Learn

• Why AI is now a central player in the prior auth wars.
• The real difference between self-funded and fully insured plans — and why HR may hold the key to faster approvals.
• How boomer physicians’ decisions shaped today’s lack of autonomy in medicine.
• The economic and political pressures that make Medicare access increasingly fragile.
• Practical steps doctors can take now to push back on pre-auth and reclaim time for patients.

⏱ The Episode (Timestamps)

• [00:00] Welcome & Dan Choi’s foot drop case
• [05:30] Prior auth: emergency vs elective realities

🔗 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

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Original Substack Release Date: Jun 18th, 2025

🎯 Why Listen

This week’s episode takes you inside the chaos rocking organized medicine: ACIP’s sudden purge, the AMA’s meltdown, and the war over who really speaks for America’s doctors. If you’ve ever wondered how medical “consensus” is manufactured—and who benefits—this is the episode to hear.

👥 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

RFK Jr. just dismissed the entire vaccine advisory committee (ACIP). The AMA immediately demanded a Senate investigation. Physicians across the country are furious, divided, and asking: who speaks for medicine now?

The hosts dissect:

• The politics and economics hidden inside “independent” vaccine committees
• The AMA’s emergency session and whether medical trainees really control policy
• Why doctors keep fighting each other while insurers and hospitals grow stronger
• Whether this is the turning point for physicians to stop tweeting—and start reclaiming their profession

💬 Notable Quotes

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

📚 What You’ll Learn

• Why the ACIP purge matters far beyond COVID
• How the AMA House of Delegates really works (and why residents and students may wield outsized power)
• The difference between public health paternalism and authoritarianism
• Why private practice viability might be medicine’s most important battlefield

⏱ The Episode (Timestamps)

• 00:00 – Setting the stage: RFK Jr. fires ACIP
• 02:00 – What ACIP is and why it lost credibility
• 07:00 – Economics, conflicts of interest, and vaccine committees
• 12:00 – Groupthink, ideology, and dissent in medicine
• 20:00 – From COVID mandates to authoritarian overreach
• 25:00 – Inside the AMA House of Delegates emergency resolution
• 35:00 – Who really controls the AMA (students, residents, administrators?)
• 42:00 – Why physicians keep fighting themselves instead of uniting
• 48:00 – The case for saving—and reforming—the AMA
• 50:00 – A call to arms: private practice and physician-led advocacy

🔗 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

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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