The Doctors’ Lounge
Where scalpels meet systems — and physicians say what they really think.Co-hosted by Anish Koka, MD & Anthony DiGiorgio, DO. Candid talks on healthcare policy, reform, physician autonomy & patient care.
Medicare Rates, Device Margins, and the Case for Owning the Building
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Episode Summary
Spine surgeon Eric Potts, co-owner of Indiana Spine Hospital, joins hosts Anthony DiGiorgio and Anish Koka to discuss why physicians built a hospital, how it operates without Medicare patients, and what ownership changes for patients and clinicians. The conversation also examines hospital billing, physician incentives, and whether more competition could make care less costly and more responsive.
Timestamps:
00:00:00 - Meet Eric Potts and Indiana Spine Hospital
00:01:10 - Why a surgery center led to a hospital
00:01:28 - The Affordable Care Act’s Section 6001 restriction
00:03:03...
A Healthcare Analyst Becomes the Patient: Birth, Bills, and Better Markets (Updated Video Edit)
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Updated edit of our conversation with Nikhil Krishnan, with a cleaner opening and light filler-word trims.
Out of Pocket founder Nikhil Krishnan joins Anish Koka and Anthony DiGiorgio to discuss what pregnancy taught him about navigating healthcare, and how patients might get better access, clearer prices, and more choice. Drawing on his work as a healthcare analyst and his own family’s care, Krishnan explores where AI could help, where human expertise still matters, and why healthcare markets are hard to make work for patients.
Co-hosts: @anish_koka and @Dr...
A Healthcare Analyst Becomes the Patient: Birth, Bills, and Better Markets (Updated Video Edit)
Send us Fan Mail
Updated edit of our conversation with Nikhil Krishnan, with a cleaner opening and light filler-word trims.
Out of Pocket founder Nikhil Krishnan joins Anish Koka and Anthony DiGiorgio to discuss what pregnancy taught him about navigating healthcare, and how patients might get better access, clearer prices, and more choice. Drawing on his work as a healthcare analyst and his own family’s care, Krishnan explores where AI could help, where human expertise still matters, and why healthcare markets are hard to make work for patients.
Co-hosts: @anish_koka and @Dr...
A Healthcare Analyst Becomes the Patient: Birth, Bills, and Better Markets
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Episode Summary
Out of Pocket founder Nikhil Krishnan joins cardiologist Anish Koka and spine surgeon Anthony DiGiorgio to discuss what pregnancy taught him about navigating healthcare, and how patients might get better access, clearer prices, and more choice. Drawing on his work as a healthcare analyst and his own family’s care, Krishnan explores where AI could help, where human expertise still matters, and why healthcare markets are hard to make work for patients.
Timestamps
00:00 - Meet Nikhil Krishnan and Out of Pocket
02:48 - Pregnancy as a fi...
Baseball Arbitration, Benchmarking, and Physician Leverage with Dr. Adam Bruggeman
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Episode Summary
Orthopedic spine surgeon and independent-practice owner Adam Bruggeman joins The Doctor’s Lounge to explain the No Surprises Act (NSA), its independent dispute resolution (IDR) process, and the controversy over how out-of-network care should be paid. Hosts Anish Koka, Anthony DiGiorgio, and Sanat Dixit examine what the dispute means for physician negotiating power, patient access, and the future of independent practice.
Timestamps
00:00 - Meet Adam Bruggeman and his health policy background
02:21 - What the No Surprises Act is designed to do
04:14 - Patient protections and ba...
SNAP, Medicaid Fraud, and the Case for Letting Prices Work
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Episode Summary:
In this episode, Dr. Anish Koka and Dr. Anthony DiGiorgio talk through the trade-offs of government-run programs using SNAP as a model for thinking about healthcare. They also dig into Medicaid fraud, managed care, Medicare Advantage, and the risks of bringing overt politics into patient encounters.
The discussion is grounded in real policy examples and a shared concern that well-intended programs can balloon, distort markets, and create worse outcomes if the incentives are wrong.
Timestamps
00:00 - Cold San Francisco, small talk, and setting up the policy...
No Villains, Just Incentives: A Healthcare Consultant Turned Writer on Why the System Fights Itself
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Episode Summary
This episode examines why US healthcare keeps rewarding consolidation, even when it raises costs and makes the system harder to navigate. Andrew Tsang, writer of Health is Other People, brings a cross-industry view from consulting, policy, providers, and payers to explain how hospitals, insurers, and Medicare rules all shape behavior. We discuss why the system feels adversarial, how incentives drive consolidation, and why policies like the No Surprises Act and MLR can produce unintended consequences. The conversation also turns into a broader argument that the real problem may be...
Leaving the Employment Model: Dr. Mollie James on Going Independent
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Episode Summary
Dr. Mollie James joins Anish Koka, MD and Anthony DiGiorgio to talk about what pushed her out of traditional employment, how she rebuilt her practice after bankruptcy and COVID, and why she believes more physicians need independent options. The conversation focuses on the pressures of hospital employment, the power of pricing and cash pay, and practical paths for doctors who want more autonomy.
Timestamps
(00:00) Dr. Mollie James' background and the goal of the conversation
(01:41) Southern Iowa roots, DO training, surgery, ICU work, and leaving academics
From Addiction to Advocacy: Tom Wolf's Journey
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Summary
In this episode, Anthony DiGiorgio and Anish Koka engage with Tom Wolf, a recovery advocate, who shares his personal journey through addiction, homelessness, and eventual recovery. The conversation delves into the complexities of homelessness, the impact of substance use, and the evolving definitions and policies surrounding addiction treatment. Tom discusses the harm reduction approach, its origins, and its implications, while emphasizing the need for accountability and the role of physicians in addressing the opioid crisis. The episode highlights the importance of lived experiences in shaping drug...
You Can't HSA That Away: Rachel Rosenthal on Medicare, Trade-offs, and Zero-COVID Singapore
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Episode Summary
Rachel Rosenthal, an editorial board member at Bloomberg who writes on healthcare and education, joins Anthony DiGiorgio and Anish Koka for a wide-ranging conversation about healthcare reporting, COVID-era lessons, and why Medicare’s fiscal path matters beyond policy circles. The discussion gets into the incentives behind drug pricing, the limits of simplistic villains in healthcare, and why trade-offs, not slogans, are what actually shape reform.
In this episode, Rachel shares how an accidental path from Asia and immigration policy led her into healthcare editorial writing, why the beat is...
Real Doc Speaks: Bureaucracy, Bad Incentives, and the Fight to Keep Doctors in Charge
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In this special add-on episode, Anish Koka and Anthony DiGiorgio welcome Dr. James O'Leary — a Mayo-trained OB-GYN with forty years of experience, former department chairman, ACO board member, and host of the Real Doc Speaks podcast — for a wide-ranging conversation on the erosion of physician-led care. The trio dissects a tragic Nashville case in which four outpatient knee-replacement patients were injected with potassium phosphate instead of bupivacaine after a multi-step, multi-person medication-verification process failed at every checkpoint, using it as a jumping-off point to discuss "kludgeocracy," alert fatigue, surgical-timeout mission creep, and how doct...
The Cost Cure: Ashish Jha's Case for Price Caps, Competition, and Biosurveillance
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Episode Summary
Anthony DiGiorgio and Anish Koka speak with Dr. Ashish Jha, co-founder and CEO of BioRadar, senior fellow at Harvard Belfer Center, and former White House COVID-19 response coordinator, about the future of American healthcare policy. The conversation moves from hospital pricing and insurance design to Medicaid, HSA-based models, and the political realities that shape what reform is actually possible. They also pivot into a second major topic: biothreat detection. Jha explains why he thinks biosurveillance, not just response, will be essential in an era of AI-assisted biological engineering.
...
Congressman Tom Oliverson on 340b, the No Surprises Act, gold carding, and more
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Episode Summary
In this episode of the Doctor's Lounge, Anthony DiGiorgio speaks with Hon. Tom Oliverson, MD, Texas State Representative for House District 130 and chair of the House Republican Caucus. Dr. Oliverson shares how he moved from medicine into public service, why practicing physicians should remain involved in policymaking, and what Texas is doing to address healthcare affordability. They also dig into 340B, prior authorization reform, and the origins of the No Surprises Act.
Chapter Markers
00:00 - Introduction to Dr. Tom Oliverson and his Texas healthcare policy role
Vinay Prasad: COVID, the FDA, and Why Journalism Keeps Getting Medicine Wrong
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The prior uploaded file had 26 seconds that was corrupted. Restored on this version!
Episode Summary:
Dr. Vinay Prasad joins the Doctors Lounge in a recorded in person conversation that moves from his time at the FDA to bigger questions about evidence, incentives, and trust in medicine. The discussion focuses on how regulatory agencies actually function, why public health debates have become so politicized, and whether the current healthcare funding model rewards good care or just expensive care.
Timestamps:
00:16 - Why the FDA conversation matters now
02:49 - W...
The Ship Has Sailed: Mike Munger on Medicare, Markets, and Debt
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Episode Summary
Duke political economist and podcast host Mike Munger (The Answer is Transaction Costs) joins Anthony DiGiorgio and Anish Koka to argue that what Americans call "health insurance" isn't insurance at all — it's a social program where, as Bastiat put it, everyone tries to live at the expense of everyone else. Munger walks through why Medicare functions as a bilateral monopoly rather than a market, compares the U.S. system to Germany's competitive-insurer model and Chile's subsidized-private-account system, and lays out the four ways any society rations scarce goods — queuing, pric...
900 Regulatory Hurdles: Why AI Isn't Replacing Doctors Yet
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Episode Summary
With scheduled guest Dr. Geoff Manley pulled away by a medical emergency, hosts Anish Koka and Anthony DiGiorgio turn the episode into a news roundtable. They open on a JAMA op-ed by Neil Khosla and Ezekiel Emanuel arguing AI will replace physicians outright, and push back on both the regulatory timeline and the incentive structure behind it — including why hospitals are slow to adopt AI tools that already exist, like AI scribes and pre-charting. From there they dig into Medicaid: Michigan's $350 million in new staffing costs tied to One Bi...
Inside a $207 Million Verdict: What Every Physician Should Know About Malpractice Trials
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Episode Summary
In a special Tuesday episode, Anish Koka and Anthony DiGiorgio sit down with Heather Tereshko, a Principal at Post & Schell in Philadelphia and a 25-year veteran of medical malpractice defense, to break down the largest medical malpractice verdict in Pennsylvania history — a $207 million judgment against the University of Pennsylvania stemming from a delayed C-section and resulting anoxic brain injury. Using the case as a launching pad, the three walk through how verdict slips are constructed, why Pennsylvania's "increased risk of harm" standard makes cases easier for pl...
Right-to-Try 2.0: Inside the Montana Model with Niklas Anzinger
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Episode Summary
Anish Koka and Anthony DiGiorgio sit down with Niklas Anzinger, a venture capitalist and founder of Infinita VC, to unpack Montana SB535 — a new law that lets doctors administer treatments to patients that have only cleared FDA phase one trials, through licensed "experimental treatment centers" overseen by independent review boards. The conversation covers why Eroom's Law has made drug development slower and more expensive despite scientific advances, how the Montana model differs from existing right-to-try and expanded access programs, the thorny question of who pays when a...
Dan Donoho on Surgical Data Science, Regulation, and the Humanoid OR
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Episode Summary
Anthony DiGiorgio and Anish Koka sit down with Dr. Dan Donoho, an NIH-funded neurosurgeon-scientist at Children's National Hospital and George Washington University, and founder of the Surgical Data Science Collective and the Foundation for Digital Neurosurgery, for a wide-ranging conversation on AI in medicine. Donoho explains why surgeons get almost no structured feedback after a case, walks through a randomized controlled trial showing AI-coached medical students outperformed those coached by humans on simulated tumor resections, and argues that most regulatory "barriers" to deploying AI in healthcare are cultural rather...
Dr. George Tolis on Physician Pay, Private Practice, and a Valve Gone Wrong
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Episode Summary
Cardiothoracic surgeon Dr. George Tolis, chief of cardiothoracic surgery in Boston, returns to The Doctors Lounge with hosts Dr. Anish Koka and Dr. Anthony DiGiorgio for a wide-ranging conversation that opens with the newly proposed 2027 Medicare physician fee schedule and the budget-neutrality rule dating back to 1989 that forces cuts to one specialty to fund raises to another. The conversation moves into why true independent private practice has effectively disappeared, how hospital systems control physician hiring, firing, and pay regardless of what Medicare reimburses, and how locum tenens pay and...
Cremieux on FDA Reform, Fake Data, and the Columbia Admissions Hack
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Episode Summary
Drs. Anish Koka and Anthony DiGiorgio sit down with independent science writer Cremieux, the pseudonymous Substack author known for auditing primary data and calling out flawed research. The conversation ranges from FDA drug approval reform (Cremieux proposes a two-pathway system separating safety approval from insurer-facing efficacy approval), the divide between well-evidenced GLP-1s and unregulated peptides like BPC-157, and the HRT black-box warning controversy, to the Columbia and NYU admissions data leaks that made national news and implicated NYC mayor Zohran Mamdani. The back half digs into research methodology...
Scott Becker on Building Becker's Healthcare, Physician Supply, and Private Enterprise
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Episode Summary
Anish Koka and Anthony DiGiorgio sit down with Scott Becker, founder of Becker's Healthcare and partner at McGuireWoods, on the business of medicine — his path from healthcare lawyer to media mogul, the real story behind physician supply shortages, why private enterprise (not government) is driving healthcare's real progress, and the debate over breaking up consolidated hospital systems.
Chapter Markers
00:00 Welcome and introducing Scott Becker
01:22 Origin story: building Becker's Healthcare
09:53 The "teach and entertain" media philosophy
14:57 Law school wi...
Martin Shkreli on Drug Pricing, Prison, and the Fraud That Shook Pharma
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Episode Summary
Anish Koka and Anthony DiGiorgio sit down with Martin Shkreli — the former hedge fund manager and pharma executive best known for the 2015 Daraprim price increase and his subsequent prison sentence — for a wide-ranging conversation on drug pricing, patent law, and the state of the pharmaceutical industry. Shkreli walks through his path from a teenage hedge fund intern to founding Retrophin and Turing Pharmaceuticals, defends orphan drug economics and the Orphan Drug Act's seven-year exclusivity window, and argues that patent terms haven't kept pace with the realities of modern drug deve...
Do No Harm: Inside the Fight to Get Identity Politics Out of Medicine
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Episode Summary
Dr. Stanley Goldfarb — nephrologist, former Associate Dean for Curriculum at Penn's Perelman School of Medicine, and founder of Do No Harm — joins Drs. Koka and DiGiorgio to trace how medical education drifted from clinical science toward social activism. Goldfarb recounts the battles at Penn that led to his 2019 WSJ op-ed, the professional fallout that followed, and why he built Do No Harm into a 54,000-member organization with an active litigation strategy. The conversation covers DEI in admissions, implicit bias training, gender-affirming care in minors, nonprofit hospital tax exemption, and what...
The Myocarditis Double Standard: COVID, the Vaccine, and the Pediatric Deaths That Went Unreported
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Episode Summary
Dr. Tracy Beth Høeg returns alongside Dr. Venkatesh Murthy, NIH-funded cardiologist at the University of Michigan, to dissect the Senator Ron Johnson congressional memo detailing pediatric deaths following COVID-19 vaccination — deaths the FDA's own pharmacovigilance team flagged internally but never disclosed publicly. The conversation covers the well-documented double standard applied to COVID myocarditis versus vaccine myocarditis, how journal editors killed papers not for scientific flaws but out of fear of social media backlash, why Korea's autopsy data revealed fatal cases that would never have been identified otherwise, the pos...
David Zweig on Schools, Science, and the Media's COVID Failure
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Episode Summary
Investigative journalist David Zweig joins Anish Koka and Anthony DiGiorgio to discuss his book An Abundance of Caution: American Schools, The Virus, and a Story of Bad Decisions — a heavily cited account of how public health authorities, the media, and a politically homogenous expert class got COVID policy badly wrong, especially for children. The conversation covers why U.S. media coverage was uniquely alarmist compared to the rest of the world, how Americans overestimated child COVID mortality by as much as 40 times, the role of "technological solutionism" in making sc...
Drug Pricing, Broken Incentives, and the 340b program Fixes Washington Won't Touch
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Episode Summary
Ryan Long — former senior policy advisor to Speaker Kevin McCarthy and current non-resident senior scholar at the USC Schaefer Institute — joins Drs. Koka and DiGiorgio for a deep dive into the structural failures driving American drug pricing. The conversation covers the list-to-net price bubble and why patients pay cost-sharing on a fictitious number, how the IRA's price-setting mechanism disincentivizes both new drug development and subsequent indications, and why the 340B program — sold politically as a lifeline for safety net hospitals — systematically funnels the most money to wealthy health systems with hig...
The Atom Bomb Speaks: Tracy Høeg on COVID, Myocarditis, and the FDA From the Inside
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Episode Summary
Dr. Tracy Høeg — physician, epidemiologist, and former Acting Director of the FDA's Center for Drug Evaluation and Research — joins Drs. Koka and DiGiorgio for her first interview since being fired from the agency in May 2025. She traces her unusual path from ophthalmology dropout to professional ultramarathoner to one of the most consequential and contested researchers of the COVID era, walking through her school transmission studies, the myocarditis preprint that detonated on social media, and what she actually found when she got inside the FDA: career scientists who were sharp...
The ER Doc Who Quit the System - and Built His Own
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Episode Summary
Dr. Noah Kaufman - board-certified emergency physician with 20 years in the ER, seven seasons on American Ninja Warrior, and a new direct acute care practice in Denver - joins Drs. Koka and DiGiorgio to talk about why he walked away from the employed medicine model and built Cough Care, a cash-pay, fully transparent urgent care. The conversation covers the broken economics of emergency billing, why most urgent care is a race to the bottom, how price signals change both patient and physician behavior, and what a parallel direct care...
The Cholesterol Debate: What the Keto Influencers Get Right (and Wrong)
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Episode Summary
Dr. Greg Katz, preventive cardiologist at NYU Langone and co-host of Beyond Journal Club, joins Anish to dissect the online cholesterol debate — specifically the claims made by science communicator Nick Norwitz, who has maintained an LDL over 500 mg/dL on a low-carb diet for seven years with no coronary plaque on CTA. Katz takes the data point seriously, walks through the limitations of coronary CTA and the flawed Keto CTA study, and explains why he still believes the burden of proof lies with those arguing diet-induced hypercholesterolemia is...
Gaming the System: LTACHs, Guidelines, and the Evidence Problem in American Medicine
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Episode Summary
Dr. Anil Makam — hospitalist, health services researcher at UCSF, and faculty at Zuckerberg San Francisco General — joins Drs. Koka and DiGiorgio for a wide-ranging conversation on the hidden mechanics of American healthcare. Makam breaks down long-term acute care hospitals (LTACHs): what they're for, how regional variation and perverse payment incentives have distorted their use, and what the 2016 site-neutral payment reforms actually did to the market. The conversation then shifts to Makam's research on clinical practice guidelines — specifically his 2018 study showing that the majority of ATS recommendations were ground...
The FDA, Unicure, and the Limits of Accelerated Approval
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Episode Summary
Anish sits down with Adu, a med student and biotech investor, to work through the FDA's contested handling of Unicure's AMT-130 — a gene therapy for Huntington's disease delivered via stereotactic brain injection. They debate whether the underlying data justifies approval, why the agency's mid-course reversal has rattled the investor community, and what the Sarepta precedent should have taught everyone involved. The conversation broadens into a bigger question: given that desperate patient populations will always demand access to anything showing a signal, who is actually best positioned to make the ca...
Salty About Medical Education: Bryan Carmody on What the System Gets Wrong
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Episode Summary
Pediatric nephrologist, medical educator, and "Sheriff of Sodium" Dr. Bryan Carmody joins Drs. Koka and DiGiorgio to challenge some of the most persistent narratives in American medicine. From the AAMC's physician shortage projections — which Carmody argues serve the interests of medical schools more than patients — to the mechanics of the residency match, application fever, ERAS pricing, and the largely unrealized promise of pass/fail Step 1, Carmody brings his characteristic data-driven skepticism to each topic. The conversation closes on what's arguably the most consequential question: what should residency selection actually be o...
Free Markets, Private Equity, and the Moral Case for Medicine
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Episode Summary
Jared Rhoads, founder of the Center for Modern Health and senior lecturer in health policy at the Dartmouth Institute, joins Drs. Koka and DiGiorgio for a wide-ranging conversation on the philosophical foundations of healthcare policy. Rhoads — an Objectivist in the tradition of Ayn Rand — argues that physicians have a right to pursue health, not a right to be given it, and walks through what that distinction means for real policy debates: FDA drug approval, prior authorization, the ban on physician-owned hospitals, private equity in medicine, and foreign-trained physician licensure. The...
George Tolis: TAVR, Broken Training, and What's Really Wrong With Cardiac Surgery.
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Episode Summary
Dr. George Tolis, section chief of coronary and general cardiac surgery at Brigham and Women's Hospital, joins Drs. Koka and DiGiorgio for a wide-ranging conversation on the state of cardiac surgery. He makes the case that TAVR — while genuinely transformative for the right patient — is being systematically applied too broadly, driven by industry incentive and the erosion of meaningful surgical consent. He discusses his collaboration with John Ioannidis that found no statistically significant mortality benefit for any new cardiac surgery technique introduced over the past 35 years, the paper's rejection by e...
Center-Right in a White Coat: Pradeep Shanker on AI, Vaccines, and Medical Orthodoxy
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Episode Summary
Radiologist, National Review senior contributor, and prominent center-right voice in medicine Pradeep Shanker joins Anish Koka and Anthony DiGiorgio for a wide-ranging conversation that covers AI's real (and overstated) role in radiology, the structural dysfunction of GME funding and physician immigration, what went wrong with COVID policy from both the left and right, the asymmetric treatment of physicians like Mary Bowden versus institutional failures like Aduhelm, and whether America is still a creedal nation. Pradeep and Anish agree on more than expected — and disagree sharply where it counts.
...
The Surgeon Who Refused to Bow: Dr. Eithan Haim on Blowing the Whistle at Texas Children's
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Episode Summary
Dr. Eithan Haim, a general surgeon in the Dallas area, joins Anish to walk through the events that took him from chief resident at Baylor to facing four federal felony counts and up to 10 years in prison. While rotating at Texas Children's Hospital in 2022 and 2023, Haim learned that the hospital's pediatric gender medicine program — which TCH had publicly announced it was shutting down in March 2022 — was in fact still operating, with puberty blocker implants being placed in children as young as 11. He took redacted information to journalist Christopher Rufo, the...
From Babylon to Baylor: How Insurance Went Off the Rails
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Anish and Dr. DiGiorgio trace the history of insurance from ancient Babylonian bottomery contracts through Egyptian workers' guilds, Greek risk-pooling societies, Lloyd's of London, and the birth of actuarial science — then walk forward into the Great Fire of London, the 1929 Baylor hospital plan, Henry Kaiser's vertically integrated care, the World War II wage-freeze tax subsidy that chained health coverage to employment, Medicare in 1965, and the ACA in 2010. Along the way they unpack why the insurance model breaks down when applied to events with a 100% chance of happening (like primary care visits), why government-imposed pr...
Outpatient Brain Surgery: How Buffalo Built America's Only Neurosurgical ASC
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Episode Summary
Anish and Anthony are joined by Dr. Elad Levy — Professor and Chair of Neurosurgery at the University at Buffalo, holder of the L. Nelson Hopkins Endowed Chair, and one of the country's most prolific physician innovators — for a wide-ranging conversation on how he and his partners built Atlas Surgery Center, the only physician-owned outpatient neurosurgery center in the United States, now performing roughly 3,000 cases a year including outpatient angiograms, carotid stenting, brain aneurysm treatment, gamma knife radiosurgery, and complex spine work. Dr. Levy walks through the operational efficiencies that let...
The Intellectual Case Against Medicare: Buchanan, Tullock, and the Rules of the Game
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Anish and Dr. DiGiorgio dig into the intellectual debate that preceded the 1965 passage of Medicare, focusing on the economists — James Buchanan, Gordon Tullock, Friedrich Hayek, Ludwig von Mises, Milton Friedman, and George Stigler — whose arguments against centralized healthcare proved remarkably prescient. They trace how Buchanan's public choice theory (political actors behave as self-interested economic actors) and Tullock's concept of rent seeking (firms spending capital to capture government wealth transfers rather than create value) explain exactly what happened to American healthcare: runaway costs, regulatory capture by industry, EHR mandates that entrenched a handful of vend...
