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🎯 Why Listen

When Senator Chuck Schumer joined Dr. Mike’s podcast to discuss “The Truth About the Government Shutdown,” the talk quickly became a lesson in political spin. In this episode, the co-hosts of The Rojas Report dissect Schumer’s claims, challenge Dr. Mike’s deference, and unpack the policy mechanics behind Medicaid, ACA subsidies, and America’s trillion-dollar healthcare debate. Expect blunt analysis, sharp data, and unapologetic truth-telling about what’s really driving costs.

👥 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
• Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University

📌 Episode Overview

The team takes aim at Dr. Mike’s viral interview with Senator Schumer—an “objective” discussion packed with partisan narratives. They analyze the claim that 51,000 lives would be lost if ACA subsidies expire, break down Medicaid’s ballooning cost, and expose how CON laws and physician ownership bans stifle innovation.

They reveal how so-called “cuts” usually mean slower spending growth, not reductions, and how government subsidies distort markets and drive dependency. From the flawed Yale study to the Medicaid surge, the hosts show how fear-based messaging distracts from the real issue: structural inefficiency and lost patient value.

💬 Notable Quotes

• “This isn’t healthcare—it’s politics disguised as compassion.”
• “Schumer’s Law: when your only rebuttal is ‘you want people to die,’ you’ve lost.”
• “Physicians aren’t asking for permission to get rich. We’re asking for permission to build.”
• “Having an insurance card doesn’t mean you have care—it means you’ve been pacified.”

📚 What You’ll Learn

• Why the “51,000 deaths” claim collapses under scrutiny
• How ACA subsidies and Medicaid expansion fuel inefficiency
• The economics of CON laws and physician ownership bans
• What’s driving the trillion-dollar Medicaid curve
• How fear replaces facts in healthcare politics
• Why competition—not control—drives value

⏱ The Episode (Timestamps)

00:00 – Opening & host reunion

02:00 – The “51,000 deaths” narrative

05:30 – ACA subsidy breakdown

08:00 – Rising costs & access failures

17:00 – Medicaid myths and market distortion

21:00 – CON laws & physician freedom

28:00 – The trillion-dollar Medicaid surge

35:00 – Political spin & “you want people to die”

44:00 – Government control vs. patient value

47:00 – What real reform looks like

🔗 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

This episode is a no-holds-barred takedown of how hospitals manipulate billing codes, exploit DRG loopholes, and increase patient risk—all while squeezing out independent physicians. Whether you’re a patient, policymaker, or healthcare insider, you’ll walk away questioning everything you thought you knew about how hospitals operate behind the scenes.

👥 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 doctors dissect the dysfunction in modern hospital billing and patient care—from the abuses of DRG (Diagnosis-Related Group) upcoding to the death of clinical nuance. You’ll hear how hospital administrators have replaced medical decision-making with spreadsheet logic, pushing sicker patients to outpatient settings and putting them at greater risk.

From the financial shell game of “death to discharge” timing to how non-profit systems rake in billions while physicians are told to “be more efficient,” this conversation is a masterclass in healthcare grift. They also explore the breakdown of physician-hospital trust and how the corporatization of medicine is compromising care at every level.

💬 Notable Quotes

“Hospitals get paid the same if you do a craniotomy on a healthy 30-year-old or a 95-year-old in kidney failure.” – Anthony DiGiorgio

• “DRGs reward risk, not responsibility.” – Dan Choi
• “The ‘death to discharge’ metric is not clinical. It’s financial.” – Sanat Dixit
• “The whole system is designed to offload cost and blame—onto doctors.” – Anish Koka
• “We should not be giving up the power of admitting. That’s the control point of medicine.” – Dutch Rojas

📚 What You’ll Learn

• How DRG reimbursement leads to dangerous patient discharges
• Why hospitals push risky patients to outpatient care
• The shocking flat-rate payment system for complex surgeries
• How hospital metrics hide bad outcomes while gaming revenue
• Why physician autonomy is being eroded by administration
• The financial incentive for “just discharge” over “get well”
• How upcoding and quality metrics warp patient care
• Why real reform must come from physicians—not bureaucrats

⏱ The Episode (Timestamps)

00:00 – Intro & physician burnout

03:45 – DRG basics and gaming the system

08:20 – Death to discharge: a dangerous metric

13:00 – Why outcomes don’t match the data

17:40 – Hospital profit motives vs. clinical sense

23:30 – Why hospitals don’t want to admit

27:00 – The decline of physician-led decisions

32:45 – Hospitalists, PAs, and revenue generation

37:50 – Why quality metrics miss the point

42:10 – The real impact on patients

47:00 – Final thoughts: reform or revolution?

🔗 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

In this fiery and insightful episode, the doctors dissect the political and economic fault lines behind the Affordable Care Act (ACA), the looming government shutdown, and the multi-billion-dollar subsidies keeping America’s healthcare afloat. From insurance distortions and Medicaid loopholes to why the system rewards bureaucracy over care, this is an unfiltered conversation that finally makes sense of why “affordable” healthcare isn’t affordable at all.

👥 Co-Hosts

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

📌 Episode Overview

The Doctors Lounge crew dives deep into how the ACA reshaped the U.S. insurance market—and why its subsidies, risk-pool manipulations, and Medicaid expansions are once again threatening a government shutdown. The conversation unpacks the math, morality, and market failures behind healthcare costs, from “catastrophic” plan bans to how illegal immigration and emergency Medicaid quietly reshape state budgets. The hosts also debate whether the cost-containment systems (like DRGs) ever truly worked—and whether healthcare’s inflation is an inevitable design flaw or a political choice.

💬 Notable Quotes

• “The reason healthcare is so expensive is because you passed the Affordable Care Act.” – Dr. DiGiorgio
• “Subsidies don’t make plans cheaper—they just hide the real cost from consumers.” – Dr. DiGiorgio
• “We’re shutting down the government over 7% of people—how does that make sense?” – Dr. DiGiorgio
• “Hospitals are thriving because DRGs keep going up; physicians’ payments keep going down.” – Dr. Choi
• “I’m a fan of a safety net program for a safety net population—but it has to run lean.” – Dr. DiGiorgio

📚 What You’ll Learn

• How ACA subsidies artificially lower premiums but raise total system costs
• The real distinction between ACA marketplace plans, Medicaid, and “emergency Medicaid” for undocumented immigrants
• Why healthcare cost control mechanisms like DRGs (Diagnosis-Related Groups) failed to contain spending
• The political tug-of-war between safety nets, subsidies, and moral hazard
• How hospitals and insurers profit from inefficiency—and why patients pay the price

⏱ The Episode (Timestamps)

00:00 – ACA subsidies, shutdown politics, and who’s to blame

05:00 – The myth of “affordable” care: how mandates drove up premiums

10:00 – Catastrophic plans vs. essential benefits: freedom or fairness?

15:00 – How subsidies distort the market and reward inefficiency

20:00 – Medicaid, undocumented care, and the “emergency reimbursement” loophole

30:00 – State-level financing tricks and the hidden federal dollars behind them

35:00 – Why hospitals profit under DRGs while physicians stagnate

45:00 – The DRG vs. cost-plus debate: can healthcare costs ever be contained?

50:00 – Insurer incentives, monopolies, and the myth of quality-based care

55:00 – The unfixable math of “affordable” healthcare

🔗 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

This episode of The Doctor’s Lounge cuts straight into one of the most polarizing questions in U.S. healthcare: Did the Affordable Care Act (ACA) fix the system—or hand it to corporate interests? The doctors debate how government mandates, corporate lobbying, and political theater have created a bloated insurance economy that benefits everyone but patients and doctors.

👥 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 doctors dissect how the ACA’s “essential health benefits” reshaped the insurance market—outlawing affordable catastrophic plans and driving premiums sky-high. From the Oregon RCT to RAND data, they reveal how mandated coverage hasn’t improved health outcomes but has fueled massive corporate profits. The group also connects the dots between nonprofit hospitals, political paralysis, and the healthcare bubble that could rival the 2008 financial crisis.

They ask the hard questions:

• Why do politicians fight over “coverage” while ignoring the cost of care?
• Is America heading toward single payer—or collapse?
• Can innovation, transparency, and cash-based models save us from our own system?

💬 Notable Quotes

📚 What You’ll Learn

• How ACA mandates distorted the insurance marketplace
• Why nonprofit hospitals are “too big to care”
• The difference between coverage and care—and why the public confuses them
• How regulatory gridlock blocks innovation in healthcare delivery
• The real economics of “float” and why insurance giants love the status quo
• What happens when the healthcare bubble finally pops

⏱ The Episode (Timestamps)

00:00 – Why tire changes and colonoscopies shouldn’t both be “insurance”

02:00 – Dr. Choi on ACA subsidies and the outlawing of catastrophic plans

06:00 – Essential health benefits: paternalism or policy failure?

09:00 – The illusion of coverage vs. the cost of care

12:00 – The business of “float” and how insurance companies built empires

15:00 – The $34 trillion industry and why catastrophic plans could end it

20:00 – Politicians, ignorance, and the illusion of reform

27:00 – Nonprofit hospitals: charity or corporate real estate giants?

35:00 – Americans waking up to the healthcare paradox

43:00 – The bubble nobody talks about: premiums and power

49:00 – The rise of DPC

🔗 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

What happens when private equity buys hospitals? Do staffing cuts and profit motives compromise patient safety? This episode of The Doctor’s Lounge dives into the controversial world of private equity in healthcare, the role of RVUs and the RUC, and why physicians are losing control over their profession. Expect an unfiltered discussion on power, profit, and the future of independent practice.

👥 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

This conversation unpacks:

• The hidden mechanics of RVUs and the RUC committee (and why most doctors don’t know how their pay is set).
• How private equity staffing cuts may be tied to increased ER deaths.
• Why physicians are forced to “take shelter” with private equity or large health systems.
• The structural inequities in U.S. healthcare that tilt the system against independent doctors.
• The hope found in physician-owned hospitals and physician-led enterprises.

💬 Notable Quotes

• “Just because you have a higher RVU count does not mean you’re a better physician.” – Dr. Dan Choi
• “The real problem isn’t that the RUC exists—it’s that CMS has built an entire system on centrally planned values.” – Dr. Anthony DiGiorgio
• “When private equity is the boss, the boss isn’t a physician—it’s a portfolio manager.” – Dr. Dan Choi
• “We went from 75% independent practice to 12%. That’s the legacy of partnerships that never built enterprise value.” – Dutch Rojas
• “You don’t need to import H1Bs or expand scope. You need to let physicians own hospitals in their own communities.” – Dr. Anthony DiGiorgio

📚 What You’ll Learn

• How RVUs and the RUC committee determine physician pay.
• The risks and trade-offs when hospitals are acquired by private equity.
• Why many “boomer doctors” cashed out, leaving younger physicians holding the bag.
• The differences between profit-driven care and physician-led models.
• Why physician-owned hospitals may be a solution to America’s healthcare crisis.

⏱ The Episode (Timestamps)

00:00 – The growing demand for private practice

02:00 – Private equity: efficiency or exploitation?

06:00 – Explaining RVUs and the RUC committee

15:00 – Gaming the RVU system & compensation models

20:00 – Myths and realities of the RUC process

22:00 – Harvard study: private equity, staffing cuts & ER deaths

27:00 – Physicians vs. portfolio managers: who should run healthcare?

33:00 – Selling out: boomer doctors and the PE cash-out

37:00 – From 75% independent practice to just 12%

39:00 – Physician-owned hospitals as a solution

43:00 – Can capitalism coexist with morality in medicine?

50:00 – What happens if private equity is banned?

52:00 – The federated model and the fight

🔗 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

Ever wonder who actually decides how much doctors earn for surgeries, visits, or procedures? This episode takes you inside the mysterious but powerful Relative Value Scale Update Committee (RUC) — the body that determines physician payments for Medicare and beyond. If you care about fairness in healthcare, innovation, or why a complex surgery can pay the same as a routine one, this conversation is for you.

👥 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

In this special “Side Table” edition, the Doctors Lounge digs into the RVU Update Committee (RUC) — the physician-led but AMA-controlled group that sets values for CPT codes, essentially determining how doctors get paid. The hosts explore:

• How the RUC works and who sits on it
• Why budget neutrality forces specialties to fight for value
• The unintended consequences of central planning, including stifling innovation
• The fairness debate between primary care and high-intensity procedural specialties
• Why physicians themselves are both defenders and critics of the system

💬 Notable Quotes

• “The RUC is essentially central planning — every doctor gets paid the same for the same code, no matter the experience.”
• “Becoming better at your procedure can actually punish you — the faster and safer you get, the less you’re paid.”
• “It’s a system that preserves order, but at the expense of innovation and sometimes fairness.”

📚 What You’ll Learn

• What the RUC is and how it shapes U.S. physician payment
• The mechanics of how CPT codes are valued
• Why Medicare’s budget neutrality keeps physician fees locked in zero-sum battles
• How new technologies like robotics and advanced ablation are undervalued
• Why primary care vs. specialty debates rarely get settled at the RUC table
• The pros and cons of a physician-run payment-setting system

⏱ The Episode (Timestamps)

• [00:00] What is the RUC and why it matters
• [02:00] The history: from “reasonable and customary” to RVUs
• [05:00] Who sits on the RUC and how they’re chosen
• [07:00] Central planning vs. innovation — robotic surgery as a case study
• [10:00] How physician surveys shape payment values
• [15:00] Specialty vs. primary care debates
• [20:00] Why new procedures often get undervalued
• [23:00] Should the RUC be reformed… or blown up?

🔗 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

Journalist Ben Ryan joins the panel to unpack what really happened during the 2022 monkeypox outbreak, how public health messaging shaped public perception, and why institutions like the CDC are facing a crisis of trust. With decades of experience covering HIV and infectious disease, Ryan shares his perspective on risk communication, stigma, and the politics that shaped pandemic response.

👥 Host

• Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator

⭐ Special Guest

• Ben Ryan – Independent journalist; writer for The New York Times, Washington Post, NBC News, New York Post; author of the Substack Hazard Ratio
• Website: benryan.net
• Substack: benryan.substack.com
• X/Twitter: @benryanwriter

📌 Episode Overview

This episode dives into the monkeypox epidemic and the lessons it offers about public health credibility. Ben Ryan, whose reporting has appeared in leading national outlets, explains why he immediately recognized the outbreak as one concentrated within the gay community—and why public officials failed to say so clearly. The discussion covers stigma, vaccine rollout, behavior change, institutional groupthink, and what the CDC’s politicization means for future outbreaks.

💬 Notable Quotes

• “Children were more likely to be struck by lightning than to get monkeypox.” – Ben Ryan
• “The CDC prioritized not hurting feelings over delivering clear, direct health information.” – Ben Ryan
• “Public trust is lost when officials carve out exceptions for ideology while ignoring obvious risk patterns.” – Ben Ryan

📚 What You’ll Learn

• Why monkeypox spread primarily among gay men and what the data showed in real time
• How fear of stigma influenced CDC messaging—and its unintended consequences
• The role of behavior change vs. vaccination in halting the outbreak
• Why politicization and groupthink are eroding trust in public health institutions
• What lessons from HIV and COVID-19 should have informed monkeypox response

⏱ The Episode (Timestamps)

• [00:00] Why monkeypox caught Ben Ryan’s attention
• [02:00] Introduction to Ben Ryan’s reporting background
• [03:30] CDC departures and politicization
• [05:00] Stigma vs. direct communication in outbreak messaging
• [07:30] Misleading slogans and their public impact
• [10:00] Inside the CDC’s vaccine rollout strategy
• [13:00] Groupthink and public health language shifts
• [15:00] The clash between activism, stigma, and behavior change
• [18:00] How the LGBT community actually responded
• [20:00] Natural immunity, vaccine uptake, and why the outbreak ended
• [22:00] What future outbreaks may look like and lessons for public health

🔗 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 spicy, inside-baseball roundtable on why rural healthcare dollars keep missing physicians, how enterprise EHRs and retail chains distort priorities, and why media narratives around leaders’ health go off the rails. Practical, provocative, and very quotable.

👥 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 crew dissects a new $50B rural health initiative that appears to route funds around independent and physician-owned facilities—prioritizing large systems, pricey EHRs, and even retail partners. They debate Sen. Bill Cassidy and vaccine policy rhetoric, explain how public-choice incentives drive misallocation, and compare U.S. access with Canada’s waitlists (and the medical-tourism pull). They also pick apart Walmart/Dollar General clinic models, why scale struggles without physician workflow design, and how media incentives skew clinical stories—especially around presidential health.

💬 Notable Quotes

• “There’s a lot of money being thrown at them to tell them what to think.” (00:12:58)
• “If a doctor can ace organic chemistry, you can learn HR and build a clinic.” (00:35:58)
• “This is a misallocation of $50 billion.” (00:18:15)
• “Business thinks pull and scale; medicine runs on relationships.” (00:32:00)
• “Truth doesn’t scale if your audience wants rage-clicks.” (00:56:15)

📚 What You’ll Learn

• How funding criteria (affiliations, Epic mandates, retail tie-ins) push out independents.
• Why public-choice theory explains hospital lobbying advantage.
• Where Walmart/Dollar General clinic plays fell short—and what physician design would fix.
• Practical clinic-flow lessons: blueprinting around patient movement and staff placement.
• The difference between population-level policies and individualized bedside decisions.
• How media incentives distort clinical narratives about public figures.
• Why medical tourism grows when domestic access shrinks.

⏱ The Episode (Timestamps)

00:00 Cold open: lobbying, misallocated capital

03:36 Housekeeping + PHA conference preview (19 interviews)

05:06 Senator Cassidy, vaccine takes, and pharma donations discourse

12:59 Why lawmakers misunderstand delivery & finance

15:27 Rural funds, EHR mandates (Epic), and retail partners (Dollar General)

23:07 Canada wait times, border medical tourism, cash-pay joints

28:00 Walmart clinic lessons: price points, demand, and execution

32:00 Scale vs. relationships: designing clinics that actually work

38:00 Presidential health narratives, COVID memory, media speculation

56:15 Ratings, advertisers, and why “truth” often loses to clicks

1:06:20 Next up: 340B and payer–provider “dance”; wr

🔗 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