The Doctor's Lounge

Send us a textOriginal Substack Release Date: June 14th, 2025🎯 Why ListenWhen 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-HostsDutch Rojas – Founder, Bliksem Health Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcherAnish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentatorDan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voiceSanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneurEpisode OverviewThe 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 LearnWhy the NEJM perspective on DPC gets the economics wrong.How Medicaid expansion shifted from safety net to subsidy scheme.The real cost of managed Medicaid—and who profits most.Why HSAs and direct primary care offer a scalable, patient-centered alternative.How academic medicine fuels policy myths that widen access gaps.The Episode (Timestamps)00:00 – Opening banter and NEJM op-ed overview02:00 – The ideology behind calling primary care a “common good”06:00 – Economics of primary care and why DPC emerged10:00 – Medicaid’s expansion: safety net or single-payer on training wheels?20:00 – State-level gaming and provider tax loopholes29:00 – DPC + catastrophic plan + HSA: a viable alternative38:00 – 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

Send us a textOriginal Substack Release Date: June 7th, 2025🎯 Why Listen:“Shut up and enjoy your salary.”—What passes for health policy debate in 2025.Does the government actually listen to doctors anymore? Or do they just think we’re a nuisance — good for photo ops, useless in policymaking?In this episode of The Doctor’s Lounge, Dutch and Anthony pull no punches on Medicare:Why Medicare is becoming more of a political weapon than a healthcare programHow physicians are silenced through salary-shaming, cancel tactics, and faux moral outrageThe growing influence of private insurers in Medicare Advantage — and who really benefitsHow policy training for medical students and experts conditions them to obey the system, not challenge itThis isn’t just a rant. It’s a roadmap for resisting. If you’re a doctor, you need to hear this. If you’re a patient, you deserve to know who’s really shaping healthcare behind the curtain.Co-Hosts:Dutch Rojas - Private Healthcare AdvocateAnthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher.Anish Koka, MD – Private practice 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:Medicare covers more than 65 million Americans, but its foundation is under political, financial, and operational strain. A break down how Medicare is structured, the differences between Parts A, B, C, and D, and why Medicare Advantage is both a lifeline and a lightning rod. They connect the dots between low reimbursement rates, rising administrative control, and the silencing of physician voices in policymaking. Along the way, they expose the hypocrisy of those who dictate policy without participating in the systems they regulate — and what it will take to restore physician autonomy and patient-first care.Notable Quotes:“Medicare was built on a promise — but promises need funding and accountability to work.” – Anthony DiGiorgio“When private insurers run Medicare Advantage, the incentives shift — and sometimes patients aren’t the winners.” – Dutch RojasThe Episode:00:00 – Welcome & Introduction01:20 – What Medicare Covers and Who Qualifies05:10 – The Funding Structure of Medicare09:40 – Breaking Down Part A, B, C, and D14:15 – Reimbursement Challenges in Medicare19:25 – Medicare Advantage: Pros and Cons24:50 – How Politics Shapes Medicare Policy30:15 – Real-World Stories from the Field35:00 – Potential Reforms and the Future of Medicare39:30 – Closing Thoughts🔗 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

Send us a text🎯 Why Listen:A candid conversation on whether non-compete clauses in physician contracts harm doctors, patients, and the healthcare system — and what real reform might look like.Co-Hosts:Dutch Rojas - Private Healthcare AdvocateAnthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher.Anish Koka, MD – Private practice cardiologist, Philadelphia; healthcare policy commentator.Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice.Sanat Dixit, MD, FACS Episode Overview:Dutch and Anthony tackle the controversial topic of non-compete clauses in physician contracts — exploring their history, how they affect patient access, and whether proposed bans could change the landscape for both independent and employed doctors. Along the way, they discuss the unintended consequences of eliminating non-competes, the corporate pushback against reform, and what a balanced solution might look like.Notable Quotes:“When a hospital locks down a doctor with a non-compete, they’re really locking down the patients.” – Anthony DiGiorgio“If we want more competition in healthcare, we can’t keep building fences around physicians.” – Dutch RojasThe Episode:00:00 – Welcome & Introduction01:10 – What Are Non-Competes?03:45 – The History Behind Physician Non-Competes07:20 – How Non-Competes Limit Patient Access10:40 – The FTC’s Proposed Ban & Pushback15:05 – Hospital Arguments for Keeping Non-Competes19:15 – Potential Unintended Consequences24:00 – Case Studies: When Non-Competes Hurt Communities29:30 – Alternatives to Non-Competes34:50 – What Real Reform Could Look Like38:10 – Closing Thoughts🔗 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

Send us a textWhy Physicians Need a Voice in Healthcare Policy👥 Hosted by: Dutch RojasDoctors:•Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher at San Francisco General Hospital.•Anish Koka, MD – Private practice cardiologist, Philadelphia; long-time health policy commentator.•Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; early adopter of social media in spine surgery; healthcare advocate.•Sanat Dixit, MD, FACS – Neurosurgeon - Huntsville, AL, Faculty - Vanderbilt University; healthcare entrepreneur.🔍 Episode Overview:In this roundtable kickoff episode, four outspoken physicians join Dutch Rojas in The Doctor’s Lounge to talk candidly about the intersection of medicine, policy, and politics — and why more doctors need to speak up. From certificate-of-need laws to Medicare payment reform, from the Trump administration’s appointments to RFK’s role at HHS, the conversation dives into the structural problems holding back both doctors and patients.The doctors share why they each agreed to join the podcast, the power and pitfalls of physicians engaging publicly, and the need to protect autonomy in a system dominated by corporate healthcare and government bureaucracy.📌 Notable Quotes:• “If you truly want a free society, you need independent physicians.” – Dr. Dan Choi• “Once the government became a plan operator, it invited rent-seeking — and that’s all we’ve seen since.” – Dr. Anthony DiGiorgio• “Our patients trust us. We have to make sure the profession stays noble — and that means fixing the system.” – Dr. Sanat Dixit• “Republicans buy sneakers too. Stick to policy if you want your message heard.” – Dr. Anish KokaThe Episode:00:00 – Welcome to The Doctor’s Lounge00:33 – Meet the Doctors03:11 – Why This Podcast?05:05 – Tuttle Twins & Shaping Culture07:28 – Getting Physician Ideas Heard09:30 – Certificate-of-Need Laws10:53 – Passion for the Profession11:55 – Structural Reforms for a New Administration13:48 – Political Appointments & Culture Shift16:33 – Political Practicality vs. Idealism17:43 – Cynicism from the Lobbying Trenches22:00 – Is Democracy Still Working in Healthcare?23:36 – Behind the Scenes in D.C.24:57 – RFK at HHS30:11 – Metrics for Measuring Change33:45 – The Medicare Problem35:41 – The Case for Physician-Owned Hospitals39:32 – Facility Fees & Payment Disparity46:00 – Site-Neutral Payment Reform50:10 – Policy vs. Politics53:30 – Social Media & Physician Speech59:00 – The Chilling Effect of Employment01:02:14 – Restoring Free Speech for Physicians01:05:00 – Advice for Physicians Considering Speaking Out01:08:00 – Closing Thoughts🔗 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