DC EKG

In Episode 131 of DC EKG, Joe Grogan sits down with Dr. John Goodman to discuss what both parties continue to get wrong about healthcare, why patient incentives still matter, and how market-based reforms could lower costs and improve access. Drawing on decades of work in health economics and policy, Dr. Goodman explains how special interests helped shape Obamacare, why supply-side constraints still distort care, and why patients are too often left out of the policymaking process. 

The conversation then turns to Health Savings Accounts, Medicaid reform, emergency room overuse, and why policymakers remain so resistant to giving patients more control over healthcare dollars. Dr. Goodman also outlines his view that self-directed care and consumer choice can improve value and expand access, especially for vulnerable populations. 

In the second half, Joe and Dr. Goodman dive into reference pricing as a major reform idea. Using real-world examples, they discuss how clearer prices and patient-driven decision-making could create more meaningful competition across healthcare markets. The episode closes with a broader conversation on bipartisan reform, the tax code, and why durable change remains so hard to achieve in Washington. 

In This Conversation

What both parties keep getting wrong about healthcare

How special interests shaped Obamacare and why patients were left out

Why HSAs remain controversial and what they change about incentives

Medicaid reform, emergency room use, and patient access

How self-directed care can improve outcomes and satisfaction

What reference pricing is and why it could create real competition

Why bipartisan healthcare reform keeps breaking down in Washington

Timestamps0:00 How special interests shaped Obamacare0:46 Joe welcomes Dr. John Goodman1:09 Dr. Goodman’s background and the origins of HSAs5:22 What both parties get wrong about healthcare7:36 Why physician supply stays restricted9:26 Spending more without getting healthier14:16 What Washington should actually be debating15:52 Insurance that meets patients’ needs20:06 HSAs and consumer-directed care22:29 Why Medicaid patients rely more on emergency rooms24:50 Medicaid reform and letting patients pay the difference28:07 Self-directed care and “Cash and Counseling.”29:35 Reference pricing explained32:14 How reference pricing could reshape insurance markets36:06 Why Dr. Goodman is optimistic40:36 The tax code and healthcare policy44:22 Where to find Dr. Goodman’s work45:42 Outro

Obamacare, health savings accounts, HSA, John Goodman, Joe Grogan, healthcare reform, healthcare policy, Medicaid reform, emergency room visits, patient incentives, consumer-directed care, reference pricing, tax policy, bipartisan reform, healthcare economics

About Our GuestJohn C. Goodman is President of the Goodman Institute for Public Policy Research and is widely known for his work in health economics, Health Savings Accounts, and consumer-directed healthcare reform. 

Podcast: DC EKG with Joe GroganEpisode: 131Guest: John C. GoodmanSponsor: 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


Why does 340B incentivize higher costs and hospital consolidation 


Contract pharmacies, diversion risk, and fraud exposure 


Who really benefits from 340B and why rural hospitals can lose out 


Medicare Part D premium pressure and the IRA tradeoffs 


Copays vs coinsurance and what seniors experience at the pharmacy counter 


Fraud, program integrity, and why limited resources should go to patients who need them 

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


Why state AI bills are accelerating and what is driving them


“Mega measures” that try to regulate frontier models, child safety, jobs, and copyright in one bill


New York and California style rulemaking with national spillover


The Micron example and how permitting and lawsuits can stop progress


Algorithmic discrimination laws and why healthcare gets hit hardest


Mental health chatbot bans and the access and workforce tradeoffs


Preemption and why Congress keeps punting


Alternative models: inventories, learning labs, sandboxes, and targeted gap fixes

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

In Episode 128 of DC EKG, Joe Grogan is joined by Kat McDavitt and Lisa Bari, co-hosts of the Health Tech Talk Show, for a practical conversation on what the next wave of health IT policy could unlock for patients and innovation.

They break down the proposed HTI 5 rule from ONC, why it is framed as deregulation, and how it aims to shift the market away from long EHR certification checklists toward one core goal: data that moves. The conversation digs into information blocking, TEFCA, patient access, and the reality of who controls health data in practice.

Joe presses a simple question: if it is “my data,” why do patients still struggle to pull a complete record? Kat and Lisa explain how HIPAA is often used as a barrier instead of a bridge, how secondary data use markets operate, and why privacy gets complicated in a world of apps, brokers, and advanced compute.

They also explore how HTI 5 connects to the AI wave, why state AI laws can create risk for innovation, and whether ideas like a Medicare app library help patients or end up picking winners too late.

In This Conversation


What HTI 5 is and why ONC is scaling back parts of EHR certification


Information blocking, TEFCA, and what real interoperability requires


Patient access vs business-to-business exchange and why complete records are still hard to get


HIPAA and the gap between intent and real-world data sharing


Screen scraping, automation, and why data access is becoming an AI issue


State AI regulation and federal direction on AI policy

,Timestamps0:36 Intro1:14 Welcome Kat McDavitt and Lisa Bari2:05 Lisa on her new role and what she is working on4:17 First reactions to HTI 5 and EHR deregulation7:34 HTI 5 in plain English11:27 Who controls health data and why this rule matters14:08 Why patients still cannot easily access complete records17:36 HIPAA and how it is used today22:24 Privacy outside HIPAA and secondary use25:50 How HTI 5 targets information blocking28:16 Screen scraping and why it is controversial36:09 How HTI 5 connects to healthcare AI47:28 Medicare app library concerns52:05 Closing and where to find Health Tech Talk Show

Health Tech Talk Show YouTube channel: https://www.youtube.com/@HealthTechTalkShow/streams

SEO Keywords (Megaphone)HTI 5, ONC, information blocking, TEFCA, interoperability, healthcare APIs, HIPAA, health data access, healthcare AI policy, data liquidity, screen scraping, Medicare app library

About Our GuestsKat McDavitt is co-host of the Health Tech Talk Show, President and Founding Partner of Innsena, and CEO and Founder of the Zorya Foundation.Lisa Bari is the Vice President of Policy and Partnerships at Innovaccer, where she leads health and AI policy, government relations, and global partnerships. She is the creator and host of the Policy Stack podcast, co-host of the Health Tech Talk Show, and a board member of the Zorya Foundation. Previously, she was the founding CEO of Civitas Networks for Health.Podcast: DC EKG with Joe GroganEpisode: 128Guests: Kat McDavitt and Lisa BariSponsor: 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:

Dr. Sethi’s background and why he returned to Tennessee to practice trauma care

Why Healthy Tennessee was created and how prevention can reduce downstream costs and complications

How volunteer health fairs work, who shows up, and why many attendees now have insurance but still cannot get appointments

The role of insurers, employers, food banks, and community partners in scaling prevention and screening

How private equity consolidation can narrow access and accelerate monopolies in rural markets

Policy ideas that could move clinicians to rural communities, including better reimbursement and stronger incentives

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

Rural access problems are not only about coverage; they are about workforce, consolidation, and appointment availability.

Administrative and EHR burdens can push small practices toward sale, accelerating consolidation.

Prevention works when it is local, trusted, and paired with real follow-up pathways.

Incentives matter; better rural payments and stronger recruitment tools can move clinicians where they are needed.

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.

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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