Baseball Arbitration, Benchmarking, and Physician Leverage with Dr. Adam Bruggeman

Send us Fan MailUpdated 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 @DrDiGiorgioShow: @DRsLoungePod🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailEpisode SummaryOrthopedic 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.Timestamps00:00 - Meet Adam Bruggeman and his health policy background02:21 - What the No Surprises Act is designed to do04:14 - Patient protections and baseball-style arbitration08:33 - How often claims reach IDR, and who wins10:54 - Why the arbitration backstop matters in contract negotiations14:35 - The QPA and proposals to tie payments to it19:14 - Why the hosts question QPA as a measure of physician value23:54 - The reported $22 billion cost and uncertainty in the data26:15 - Who pays arbitration costs, and what is known about premiums29:08 - Why New York’s experience may not predict national claim volume31:53 - Out-of-network strategies, physician assistants, and possible gaming34:56 - Medicare rates, insurer market power, and physician consolidation38:47 - Comparing NSA payments with the old out-of-network system42:38 - Physician negotiating power and the limits of independent practice47:10 - Cash-pay surgery, insurance, and maintaining patient access54:39 - How arbitration decisions and offers are being scrutinized61:08 - Why the dispute over a small share of claims matters64:34 - Physician fees as a loss leader for hospital revenueCo-Host Handles@anish_koka and @DrDiGiorgioShow Handle@DrsLoungePodSubscribe LinksSpotify:https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts:https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube:https://www.youtube.com/@TheDoctorsLoungePod🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailEpisode 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.Timestamps00:00 - Cold San Francisco, small talk, and setting up the policy agenda00:01:30 - Previewing Dr. Adam Bruggeman and the next episode on IDR and the No Surprises Act00:03:54 - Why SNAP is the right model to think about when designing healthcare subsidies00:05:48 - No program is perfect, but SNAP may be better than the alternatives00:06:13 - How SNAP can be gamed through cash-equivalent arbitrage and junk food purchases00:07:11 - Why a healthcare HSA-style subsidy would still need rules on eligible spending00:08:01 - SNAP spending has grown from about 6 billion to about 120 billion per year00:09:07 - The risk that healthcare subsidies could also incentivize unhealthy consumption and fraud00:11:22 - Why every government program seems to drift toward vested interests and regulatory capture00:12:18 - The case for a market-based subsidy instead of direct government service delivery00:13:16 - What a fully government-run food system would look like if modeled on Medicare00:14:32 - Government-run hospitals, the VA, and the limits of parallel public systems00:17:02 - Public schools, vouchers, and why incentive structure matters more than more money00:18:25 - Why a subsidized private system may work better than a broad public option00:20:46 - Tiers already exist in American healthcare, whether people admit it or not00:22:39 - How corporate actors lobby for government intervention once subsidies exist00:24:05 - Why a public option may preserve the same distortions rather than fix them00:26:26 - Medicaid fraud news, investigative journalism, and the Nick Shirley reporting00:28:59 - Medicaid fee-for-service versus managed care and the fraud-control trade-off00:31:52 - How 1915 waiver services are especially vulnerable to abuse in fee-for-service systems00:32:46 - The Medicare Advantage debate and disputed overpayment estimates00:35:37 - Traditional Medicare’s own problems with fraud control and payment distortions00:37:13 - Why price suppression harms both physicians and patients00:40:30 - Concussion care as an example of how shortages and waitlists emerge00:43:22 - The moral argument for prices and patient choice00:46:26 - Critiquing the MedPage piece on doctors talking to patients about politics00:48:46 - Why the exam room is the wrong place for political persuasion00:50:48 - The vulnerability of the patient and why political advocacy should stay out of clinical care00:53:19 - Why overt political endorsements can damage physician-patient trust00:57:48 - Why academic monoculture is overstated and many dissenters are simply quiet00:59:53 - What is coming next: IDR with Dr. Bruggeman and future healthcare and AI discussions01:01:09 - Hoover Institute Medicare event, 340B, quality metrics, and incremental reformCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe Links:Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailEpisode SummaryThis 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 cultural and existential, not just technical or legislative.Timestamps00:00 - Introducing Andrew Tsang and his healthcare writing background00:53 - From consulting and Medicaid work to healthcare writing03:10 - Why hospitals are political systems, not just businesses05:23 - Mass General Brigham, consolidation, and incentive-driven growth10:20 - What the No Surprises Act is trying to do for patients12:39 - Independent dispute resolution and the provider payer dynamic15:49 - Why arbitration may favor providers and still raise costs18:26 - MLR, insurer incentives, and the limits of cost containment22:19 - Why US healthcare fights over scarce resources instead of throughput23:46 - The scale of utilization management and billing conflict24:23 - Medicare DRGs, coding complexity, and upcoding incentives26:24 - How hospital market power affects commercial pricing28:28 - What actually drives merger strategy inside health systems31:39 - Why insurers and hospitals still claim cost control while behaving differently37:37 - The Tufts and Partners negotiation as a lesson in market power40:33 - Essential benefits, narrow plans, and how coverage rules shape leverage44:42 - Why the US wants both public guarantees and private market incentives47:11 - Vertical integration in insurance and why it is rewarded53:39 - Why policy fixes are incremental and often politically compromised56:21 - Why Andrew left consulting and what felt futile about the work58:18 - The case for healthcare as a cultural and moral problem59:12 - Why selfishness, greed, and apathy may be the real barriers to reformCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePodMr. Andrew Tsang LinkedIn:linkedin.com/in/tsang1219Mr. Andrew Tsang Substack handle is: https://substack.com/@andrewtsangMr. Andrew Tsang Substack Health is Other People link: https://blog.healthisotherpeople.com/?utm_source=global-searchMr. Andrew Tsang Substack Mass General Brigham merger link:https://substack.com/@andrewtsang/note/c-350273328?utmSource=%2Fsearch%2FMass%2520General%2520Brigham%2520merger🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailEpisode 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(03:19) Administrative overload and trying to rebuild trauma services after a tornado(04:43) Why job-hopping did not solve the real problem(07:11) RVU pressure, too few ORs, and the impossible math of employed surgery(08:29) Why administrators miss the clinical big picture(09:59) The COVID straw that broke the camel's back(11:49) Pushback over medication choices and committee control(13:45) Launching James Clinic during the pandemic(16:17) Treating 4,000 COVID patients in four months(17:30) Telemedicine, a low-rent clinic, and building from scratch(18:23) Cash pricing, two-week coverage, and tiered support(19:46) Doubters, happy hypoxia, and why outpatient COVID care worked(21:32) The treatment approach: steroids, antihistamines, and more(23:24) ICU COVID, sedation, vent intolerance, and prolonged intubations(25:51) Omicron, collapsing COVID volume, and pivoting the business(27:30) Pricing mistakes, layoffs, and how a practice has to evolve(28:10) Why the integrative cancer program was underpriced(29:28) Current niches: hormone care, blood pressure, fatigue, mitochondrial support(30:12) Why the market can solve care shortages better than administration(31:46) Why cash pay and patient-funded care reduce conflict over evidence(35:48) Independent medicine requires results, service, and rapid feedback(36:42) Why low prices can limit your ability to help anyone(37:24) Why physicians should consider independence and self-funded models(40:01) Diversifying privileges and not putting all your eggs in one basket(40:52) How a new grad can start as a 1099 contractor(42:39) Networking, call coverage, and building cooperative physician relationships(43:22) Why scarcity thinking hurts doctors outside the hospital(44:56) The modifier 25 and CMS reimbursement frustrations(46:28) Fear, pricing transparency, and why patients and doctors both lose(47:42) Knowledge replacing fear in healthcare decisions(49:46) Why splitting procedures across days feels absurd to patients(50:48) The real mechanism problem behind billing rules(53:26) Social media manipulation, CPT complexity, and administrative bloat(55:08) Why single payer does not actually mean simple(56:03) Maverick Medical Ventures and the playbook for leaving the system(58:28) Headwinds, hospital consolidation, and patients seeing huge price jumps(60:15) Monopolization, referrals blocked by system rules, and loss of access(61:11) Why hospital privileges can still be a barrier for outpatient procedures(62:10) Culture wars, division, and the need to align on shared physician priorities(64:46) Closing details: James Clinic locations, Maverick Medical, and Dr. James' handleCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePodDr. Mollie James X Handle@molsjamesDr. Mollie James Websitehttps://maverickmedicalventures.com/🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailSummaryIn 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 policy and the ongoing challenges faced by individuals in recovery. In this conversation, Anthony DiGiorgio and Tom Wolf delve into the complexities of addiction treatment, mental health, and the political landscape surrounding these issues. They discuss the challenges of psychiatric holds, the balance between autonomy and compulsion in treatment, and the failures of current drug policies in major cities. The dialogue emphasizes the need for a recovery-oriented system of care and critiques the harm reduction approach, drawing comparisons to international policies, particularly in Portugal. The conversation highlights the intersection of mental health and addiction, the political ramifications of policy failures, and the urgent need for effective solutions to the ongoing drug crisis.Chapters00:00 Introduction to Recovery Advocacy00:55 Tom Wolf's Journey Through Addiction06:33 Finding Recovery and Advocacy10:08 The Complexity of Homelessness and Addiction11:22 The Evolving Definition of Homelessness12:26 The Impact of Substance Use on Housing15:06 Harm Reduction: A Double-Edged Sword20:30 The Role of Physicians in Substance Abuse25:02 The Historical Context of Opioid Prescription30:02 The Future of Drug Policy and Recovery34:39 Navigating Psychiatric Holds and Treatment Options38:30 The Dilemma of Autonomy vs. Compulsion in Treatment40:40 Evaluating Policy Failures in Major Cities44:51 Building a Recovery-Oriented System of Care47:39 Comparing Drug Policies: Lessons from Portugal49:40 The Intersection of Mental Health and Addiction51:51 The Political Landscape of Addiction Recovery56:55 The Challenges of Acknowledging Policy FailuresCo-Host Handles@anish_koka and @drdigiorgioShow Handle@drsloungepodGuest Handle/Links@Twolfrecoveryhttps://www.tomwolfrecovery.com/Subscribe LinksSpotify: http://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailEpisode 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 both endlessly frustrating and endlessly rich, and how COVID in Singapore changed the way she thinks about public health authority, institutional trust, and policy mistakes. The conversation also turns to her Bloomberg piece on Medicare, where the hosts unpack how spending, deficits, borrowing, and bond markets connect.Timestamps00:00 - Intro and guest introduction00:51 - Rachel’s accidental path from Asia to healthcare writing03:25 - Why healthcare is a “gift that keeps on giving”04:57 - From Medicare to digital twins, the range of the beat06:48 - Why healthcare has no single villain08:17 - The real work behind strong healthcare editorials10:04 - How COVID in Singapore changed her perspective11:40 - Lockdowns, surveillance, and zero-COVID enforcement14:30 - What the pandemic revealed about institutions and trust18:18 - Why Singapore’s approach was understandable, then failed to adapt20:18 - Writing columns that forced policy change23:46 - How school closures exposed institutional dysfunction24:38 - Leadership failures and the need for honesty26:47 - Why source diversity matters in journalism29:35 - The pressure to publish fast and simplify complex stories31:04 - Are readers, editors, and advertisers all part of the problem?35:18 - Why Medicare is the next major fiscal crisis36:38 - The “one dollar in, three dollars out” problem39:34 - Why uncapped spending removes urgency40:04 - Site-neutral payments and other low-hanging fruit41:31 - Why wealthy seniors still receive subsidies43:33 - How entitlement reform gets politically messy45:41 - Why Medicare matters to bond traders47:01 - Interest rates, mortgages, and everyday life48:30 - Demographics, aging, and the scale of the problem49:22 - Why Medicare for All doesn’t solve the deficit52:06 - Medicare’s complexity and the limits of copying it55:52 - A simple framework: government choices versus private choice57:57 - Who decides preventive care coverage and why that is political59:45 - Health policy as a value judgment, not pure math62:12 - Rachel’s ideal direction: less employer-sponsored distortion, more individual choice64:54 - Defining the real problem before designing reform66:27 - Trade-offs, privilege, and the appeal of security68:01 - Why innovation in delivery and payment still matters69:14 - Why good-faith debate disappears when the frame becomes good versus evil71:07 - Why both left and right need to give ground72:35 - Universal catastrophic coverage as a possible compromise73:35 - Security, coverage gaps, and the need for on-ramps between programs74:32 - Wrap-up and final thoughtsCo-Host Handles@anish_koka and @DrDiGiorgioShow handle@DRsLoungePodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailIn 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 doctors who raise safety concerns get labeled disruptive. From there the conversation moves through OB-GYN malpractice and nuclear jury verdicts, Florida's no-fault birth-injury compensation fund as a possible national model, the maze of state-by-state Medicaid reimbursement and its perverse incentives, and nonprofit hospitals' use of stadium sponsorships as a possible anti-kickback violation, before closing with a rapid-fire "hot seat" round covering ACOs, private equity, scope of practice, physician unionization, and single-payer healthcare.Chapters00:00 Cold open — why isn't Medicaid money reaching physicians?00:34 Welcoming Dr. James O'Leary (Real Doc Speaks)02:34 Why physicians need a voice on social media03:14 The Nashville potassium phosphate medication error09:52 Would a physician-owned hospital have prevented this?10:17 "Kludgeocracy" and getting labeled disruptive14:30 The surgical timeout's mission creep19:35 EMR alert fatigue and lost safety signals22:50 Replacing pharmacy techs with better safeguards24:34 Anish's shift from hospital to outpatient practice30:19 Malpractice, nuclear verdicts, and OB-GYN33:50 Florida's no-fault birth-injury compensation model39:16 Medicaid reimbursement and state-by-state variation50:33 Nonprofit hospitals, sports sponsorships, and the anti-kickback statute55:46 Five hot-seat questions for Dr. O'Leary1:01:51 Direct referrals vs. large health systems1:03:23 Closing thoughts and where to find Dr. O'LearyCo-Host Handles@anish_koka and @drdigiorgioGuest HandleDr. James O'Leary — @realdocspeaksShow Handle@drsloungepodSubscribe Links: Spotify: http://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailEpisode SummaryAnthony 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.Timestamps00:00 - Intro, guest credentials, and the Boston Globe cost cure series00:33 - Why Jha wrote a 10-part reform series instead of one op-ed01:54 - Evidence-based ideas that should annoy someone on every side03:42 - Why state-level health policy matters, not just Washington04:20 - American healthcare’s core pricing problem05:58 - Competition, monopolies, and when price regulation enters the picture06:57 - Scope of practice, insurance design, and administrative burden08:40 - Indiana’s Medicaid-based hospital pricing experiment09:47 - Why provider price caps are controversial11:42 - Site-neutral payments and the hospital lobbying problem13:30 - Why temporary regulation can bridge a monopoly-heavy market16:22 - Why payer competition matters before price caps can reach consumers17:44 - Can temporary government policies ever really be reversed?20:11 - Tackling the demand-side subsidies that fuel consolidation22:39 - FTC enforcement and the slow pace of market change23:53 - Why policy experts should give leaders workable alternatives26:27 - Hospitals are not villains, but incentives matter27:32 - Site-neutral payment and physician-owned hospitals as starting points28:57 - Cash payments, deductibles, and value-based insurance design29:49 - The outline of a possible deal among hospitals, insurers, and policymakers33:34 - Medicaid work requirements and what the evidence says35:36 - Why eligibility should be easier for people who qualify38:02 - Medicaid as a value statement about universal coverage40:19 - Program integrity, fraud, and long-term sustainability43:43 - Why Jha changed his mind on pay-for-performance and EHRs45:14 - His critique of quality metrics and the value of empirical humility46:14 - Why HSAs are attractive but imperfect47:23 - Living under an HSA and why behavior changes49:47 - Why Medicare for All is politically and operationally hard50:41 - Uwe Reinhardt, Denmark, and why systems depend on politics and people53:18 - Why sick people often make irrational cost decisions57:02 - Smarter copays, true emergencies, and the limits of consumerism58:24 - Why disagreement should stay respectful and not personal60:20 - Pivot to bioterrorism and biological weapons61:07 - Why BioRadar was created and what problem it is solving63:18 - AI, state actors, and the shrinking barrier to bioweapons64:18 - Why the risk of an engineered pathogen in the next five years worries Jha65:31 - Jha’s view that COVID was more likely a lab leak than a natural origin66:30 - Guardrails around gain-of-function research and Fauci criticism68:46 - The difference between a dangerous outbreak and a stealth pandemic71:38 - How biosurveillance can avoid overreaction while still catching real threats73:13 - Why better surveillance could have changed the COVID response75:16 - Wrap-up, bipartisanship, and the value of trade-offsCo-Host Handles@anish_koka and @DrDiGiorgioShow Handle@DRsLoungePodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658YouTube: https://www.youtube.com/@TheDoctorsLoungePod🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X

Send us Fan MailEpisode 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 Markers00:00 - Introduction to Dr. Tom Oliverson and his Texas healthcare policy role01:24 - From Cut and Shoot to Baylor and a medical career05:01 - Why running for office felt like a calling08:02 - Why Texas lawmakers are expected to keep real jobs13:30 - The healthcare affordability committee and the expert testimony it drew16:28 - Consolidation as a major driver of healthcare cost growth18:49 - Why direct contracting may replace traditional networks22:49 - What the future could look like in a Singapore-style transparent market23:53 - ERISA limits, state authority, and the frustration of federal preemption25:17 - Medicaid payment, fraud, and what states can still influence28:06 - Using Medicaid buying power to push back on abusive pharmacy practices29:15 - 340B as a “Robin Hood” program with perverse incentives36:03 - Why Texas is pushing transparency on 340B revenue and pricing37:38 - The gold carding law and prior authorization reform43:43 - A Capitol cardiac arrest and a real-life case with Dr. Bonnen46:35 - What Texas can and cannot regulate in state insurance markets48:47 - Texas roots of the No Surprises Act51:43 - How Texas arbitration was designed to define fair market value54:25 - Why the federal NSA lost key guardrails61:41 - Texas opt-in for ERISA plans and why that matters66:49 - Cash deductible credit when patients choose cheaper care68:45 - Compounding, GLP-1 dosing, and preserving access through customization70:09 - Peptides, prevention, food access, and the case for lifestyle-based care72:34 - Closing thoughts on free markets, 340B, and healthy foodCo-Host Handles@anish_koka and @DrDiGiorgioShow Handle@DRsLoungePodSubscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrRApple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658 YouTube: https://www.youtube.com/@TheDoctorsLoungePodOfficial Texas House Select Committee on Health Care Affordability page:https://house.texas.gov/committees/committee/059Dr. Tom Oliverson on X:https://x.com/TomOliverson🔗 Connect with the Hosts:• Dr. Anthony DiGiorgio on X• Dr. Anish Koka on X• Dr. Dan Choi on X• Dr. Sanat Dixit on X