DC EKG

Guest: John Bertrand, former Digital Diagnostics Episode DescriptionJoe 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 TIMESTAMPS0:40 Joe introduces John Bertrand and his healthcare tech background1:28 John clarifies he recently left Digital Diagnostics for supply chain work2:40 John's career: 13 years at Epic Systems across multiple roles6:10 What does Digital Diagnostics' AI device do? Automating retinal imaging7:56 First FDA approval and first CMS reimbursement for autonomous AI diagnostic9:02 Joe's threshold question: shouldn't better innovation be easily adopted?9:50 Reality: workflow integration and reimbursement matter more than clinical quality11:50 The adoption curve: all successful FDA-approved AI devices have CMS reimbursement14:10 FDA experience: desire to help but frameworks built for old technology15:40 FDA scrutiny on AI exceeds scrutiny on human clinicians18:05 FDA guidance changes every 6-12 months, creating constant pivoting and delays20:08 Shifting to CMS: the shocking draft reimbursement story20:45 Draft came in at $10 per test, needed $30+ to be viable22:42 Four months of negotiations with CMS to shift value argument24:40 Process not codified: each company follows unique regulatory path28:04 Six years at Digital Diagnostics: was it worth it?28:44 John would not recommend diagnostic AI to new founders33:02 Turning down multiple diagnostic AI opportunities post-Digital Diagnostics34:19 AI hype vs reality: where are patients actually seeing life improvements?34:19 Patient-facing triage agents are the second inning of real AI opportunity36:25 Reimbursement for chat-based triage: who gets paid?38:23 Autonomous vs assistive AI: the regulatory gap that exists40:31 Could Digital Diagnostics have done physician-in-loop from the start?41:33 Real opportunity: clinical practices deploying their own AI42:20 State licensing nightmare: deploying AI across 50 states44:55 The real concern: RCM automation becoming a zero-sum AI bot battle45:20 Dead Internet Theory applied to healthcare revenue cycle47:38 Closing: a tour de force on AI healthcare realityKey TopicsAI 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 GuestJohn 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 Timestamps0:00 Intro and why the Healthcare AI Policy Summit matters2:00 Summit recap: big themes and regulatory pressure points6:00 Jim O'Neill at HHS: regulatory clarity and adoption inside government12:00 ACCESS explained: Medicare chronic disease management payment model18:00 TEMPO explained: FDA's risk-based approach for chronic care tools24:00 Wearables, remote patient monitoring, and virtual ICU models30:00 Privacy, de-identification, and re-identification risk35:00 AI inside HHS and FDA: productivity, payment integrity, care coordination41:00 Reducing admin burden and physician burnout47:00 Rural healthcare: scaling diagnostics and access with AI52:00 Interoperability and data sharing: APIs, friction, and incentives58:00 State AI laws versus federal preemption1:04:00 2026 outlook: tech companies as Medicare Part B providers1:09:00 Wrap-up and what to watch nextKey TopicsHealthcare 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 integrityAbout 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 GroganHost: Joe GroganGuest: Naomi LopezSponsor: Survivors for SolutionsExecutive 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 DescriptionJoe 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 Timestamps0:23 Michael Cannon joins and what STLDI is2:27 STLDI explained: Obamacare-exempt plans, renewal guarantees, and lower premiums6:00 ACA history: why STLDI was restricted7:46 International comparisons and pre-existing conditions incentives12:10 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 Medicare history30:37 Public trust after Brian Thompson's murder and Cannon's letter41:56 Wrap-up and key takeawaysKey TopicsSTLDI 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 policyAbout 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 GroganHost: Joe GroganGuest: Michael CannonSponsor: Survivors for SolutionsExecutive 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 Timestamps0:18 Joe introduces Dutch Rojas and asks who is Dutch Rojas1:32 Dutch's background, career path, and journey to social media2:22 Physician-led Healthcare for America and PHA board4:32 Starting in accounting, real estate investment trust, and ambulatory surgery centers5:14 150 ambulatory surgery center deals and certificate of need experience7:34 Building a practice in Scottsdale and expanding to 16 states9:30 First direct contracting company in 2009 and how direct contracting works12:45 Self-funded employer plans and 106 million Americans not covered by insurance15:22 Deals with banks and large employers in New York City18:09 The difference between clinical medicine and business in medicine22:15 Building insurance products on top of physician-led care28:30 How direct contracting saves employers money32:18 The three companies Dutch has started and sold38:45 Healthcare as a percentage of GDP and rising costs42:10 Regulatory hurdles and state-level barriers46:54 Not-for-profit tax status and academic health systems48:07 How health systems receive subsidies but claim non-profit status48:22 Academic medical centers owning four to five percent of city real estate49:21 Site-neutral payments and payment disparities between settings50:28 Dutch's social media reach and audience impactKey TopicsDirect 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 healthcareAbout 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 GroganHost: Joe GroganGuest: Dutch RojasSponsor: Survivors for SolutionsExecutive 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 Timestamps0:44 Background: East Coast native, McGill University, from New York City1:07 How he got a professorship at University of Paris School of Medicine2:35 Mark McClellan connection and FDA career start5:19 Conflicts of interest versus interests in FDA advisory committees7:07 Why people need to be dismissed from advisory committees9:13 Three basic reasons FDA holds advisory committee meetings11:08 Why Canada keeps advisory committees secret versus FDA transparency14:08 Advisory committees for CYA, new science, and lack of consensus19:44 Op-ed on vaccines and nutrition under Make America Healthy Again22:44 Cancer drug dosing for obese patients and missing label information27:15 Learning about drug dosing outside of clinical trials30:42 Food regulation and FDA's second-class treatment of food safety32:02 MAHA moment and removing red food dyes from food supply34:00 Dietary supplements regulation under DSHEA35:21 Nutrition labeling updates and soda bottle serving sizes38:21 PDUFA reauthorization and user fees40:32 User fees about predictability not speed42:54 CMS mission creep and encroaching on FDA authorityKey TopicsFDA 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 pricingAbout 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 GroganHost: Joe GroganGuest: Peter PittSponsor: Survivors for SolutionsExecutive Producer: John CZ Czwartacki, DC EKG Podcast

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.TIMESTAMPS0:00   Tevi Troy on a brighter Republican future after Trump0:47   DC EKG intro1:10   Joe and Eric welcome Tevi Troy, refill context from February 20233:00   Why the Biden White House leaks far less than Trump's did6:15   Neera Tanden, Afghanistan, and where the grumbling did surface9:30   Is the press softer on Democratic administrations12:10   Lessons from the hyper disciplined Bush 43 operation15:00   Friction as a feature: Johnson, Ford, and creative tension18:20   Johnson, Vietnam, and the limits of dominating Congress21:00   Biden faces a Republican House and a debt ceiling fight24:15   How a State of the Union actually gets built27:30   Why every State of the Union becomes a laundry list30:45   Reagan, Lenny Skutnik, and the birth of pageantry33:50   The case for reforming the CDC with a congressional charter36:20   Behavioral health versus the pandemic mission39:10   Ed Koch, Carter, and criticizing without alienating voters41:40   Where Meacham's Bull Connor line came from44:30   Troy's path to DC: AEI, Ben Wattenberg, and the PhD47:15   The conservative movement in flux and the future of the parties48:33   Wrap upABOUT OUR GUESTDr. 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.CREDITSPodcast: DC EKG with Joe GroganEpisode: 137bGuest: Dr. Tevi Troy, former Deputy Secretary of Health and Human ServicesSponsor: Survivors for Solutions, https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Stay on Course Studios, https://www.stayoncourse.studio

DC EKG with Joe Grogan Episode 137: Tax Expenditures, 340 B Drug Pricing, and Kidney Donation Reform Air Date: June 15, 2026 Episode DescriptionIn 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 Topics340 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 explained13:54 How the 340 B discount does not reach patients20:13 Mortgage interest deduction: the most irritating tax break31:00 Prospects for reconciliation under Trump administration34:57 The kidney donation crisis: 45,000 deaths per year39:02 How kidney donation reimbursement would work40:00 Would you allow kidney sales? The ethical debate45:13 Final thoughts About the GuestDr. 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 ResearchThe 340 B Drug Pricing Program is a Hidden Tax ExpenditureHealth Affairs Forefront, April 24, 2026Co-authored by Ike Brannon and Tony LoSassohttps://www.healthaffairs.org/content/forefront/340b-drug-pricing-program-hidden-tax-expenditure Podcast: DC EKG with Joe GroganEpisode: 137Guest: Dr. Ike Brannon Sponsor: Survivors for SolutionsProducer: Stay on Course StudiosExecutive 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 ConversationThe three pillars that made Part D successful for 20 yearsHow non-interference kept government from setting drug pricesThe IRA as a 16-year Democratic push to repeal non-interferenceWhy Tom calls the IRA price controls disguised as negotiationsThe Trump administration's focus on MFN and Globe Guard pricing340B and the battle between manufacturers and covered entitiesThe Chevron repeal's impact on drug pricing lawHRSA's proposed rebate model and ongoing 340B litigationWhy effective policy means competition, not controlsTom's work helping North Korean defectors and refugeesKey Timestamps1:51 Tom's background at HHS and CMS2:30 The three pillars of Part D's success5:10 Why Democrats wanted to repeal non-interference5:55 Ted Kennedy's compromise and bipartisan votes11:38 The IRA as a 16-year repeal attempt12:03 What the IRA changed in Part D15:02 IRA negotiations vs. real negotiations16:25 How the excise tax makes it no real negotiation21:32 Trump's focus on MFN and Globe Guard25:37 340B's history back to 199128:45 340B as the second-biggest expenditure program29:30 Manufacturer vs. covered-entity acrimony33:18 The Chevron repeal's impact on pricing34:54 HRSA's rebate model, the next step on 340B35:40 The lawsuit over "patient" in 340B38:18 Tom's advice: let competition work39:30 Hepatitis C: competition drives prices down40:34 Competition for gene therapies and CRISPR41:36 Tom's work for North Korean defectors44:49 Sponsoring Free North Korea RadioMedicare 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 BarkerAbout the GuestTom 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 ConversationThe current Hantavirus outbreak on a cruise ship and human-to-human transmissionThe Andes virus strain and why it differs from Sin Nombre and Four Corners DiseaseTwo transmission routes: aerosolization and direct contaminationAsymptomatic transmission and the intrinsic bias in testingWhy has the US government not developed Hantavirus countermeasures in 70 yearsBird flu is the most likely candidate for the next pandemic.Gain-of-function research and the public disclosure of dangerous genetic dataLong COVID: viral reservoirs and the need for effective antiviral treatmentsWhy antivirals should be the priority over vaccines for emerging virusesOperation Warp Speed and the importance of private sector partnershipsThe dismissal of long COVID patients as psychosomatic and the need for validationKey Timestamps1:49  Details of the Hantavirus outbreak and cruise ship cases3:00  Two methods of transmission: aerosolization and direct contamination5:24  Asymptomatic transmission and testing bias10:35  The Hantavirus family and why the Andes virus goes from human to human12:35  How nervous should the public be16:43  Shifting to bird flu and Redfield's Warning19:00  Bird flu spread in US poultry and mammal populations22:00  The four amino acids for bird flu to infect humans23:30  The debate with Fauci over gain-of-function research27:55  Unregulated gain-of-function research worldwide33:35  Why antivirals should be the priority37:55  Long COVID viral reservoirs and treatment gaps42:37  The economic burden and need for solutions43:57  The story of Joy and psychiatric misdiagnosis of long COVID48:12  The solvability of long COVID and the importance of investingHantavirus, 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 WarningAbout the GuestDr. 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/1510785051Podcast: DC EKG with Joe GroganEpisode: 134Guest: Dr. Robert Redfield, former CDC DirectorSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John "CZ" Czwartacki, DC EKG PodcastProducer: 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 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

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. --- 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