The Treatment Plan with David Usher, M.D.

ReforMedia
  • 5.0 (1)
  • Medicine
  • Updated Daily

The Treatment Plan is a podcast that discusses how healthcare really works, from patient care and weight loss to the systems and incentives behind it all. Each episode unpacks what's working in our healthcare system, what's not, and how healthcare could be better.

Episodes

  1. 12/17/2025

    Healthcare AI: Medicare Incentives, Physician Burnout, and the Cost of Care

    Jack and Dave unpack a recent healthcare AI essay from the venture capital firm 8VC and use it as a jumping-off point to examine why costs keep rising, why wages stay flat, and why the doctor–patient experience feels so broken. They dig into Medicare incentives, AMA-driven reimbursement structures, physician burnout, and the regulatory barriers that make meaningful innovation difficult. The conversation stays grounded in how care actually works today, where AI could realistically help, and where human judgment still matters. It’s a practical look at why healthcare feels stuck, and what changes would actually move the system forward. Episode 9. LINKS ⁠⁠⁠⁠⁠⁠⁠⁠Follow Dave on LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠The Treatment Plan on YouTube⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠The Treatment Plan on Apple Podcasts⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠ReforMedicine Direct Pay Primary Care

    1h 1m

  2. 11/03/2025

    Is This the Future of Healthcare? ICHRA and CHOICE Explained

    In this episode, Jack and Dave discuss the complexities of healthcare funding in the U.S., focusing on the Individual Coverage Health Reimbursement Arrangement (ICHRA) and its implications for employers and employees. The discussion highlights the challenges posed by the Affordable Care Act, the political dynamics surrounding healthcare funding, and the potential for ICRA to disrupt traditional healthcare models positively. They also explore the role of technology in managing healthcare plans and the investment opportunities arising from these changes. Episode 9. LINKS ⁠⁠⁠⁠⁠⁠⁠⁠Follow Dave on LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠The Treatment Plan on YouTube⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠The Treatment Plan on Apple Podcasts⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠ReforMedicine Direct Pay Primary Care

    24 min

  3. 10/13/2025

    The Employer Healthcare Crisis: Costs, Regulation, and Market Dysfunction

    In this episode, Jack and Dave break down recent headlines showing the largest jump in employer health insurance costs in 15 years. They explain what’s really driving those increases—from CMS reimbursement structures and GLP-1 drugs to the perverse incentives baked into insurance commissions—and why Obamacare locked small businesses into an unsustainable system. The conversation explores how regulations designed to protect workers end up stifling innovation, entrenching large corporations, and penalizing small employers. They close by discussing the rise of self-funded plans and the growing movement toward direct, market-driven healthcare. Episode 8. LINKS ⁠⁠⁠⁠⁠⁠⁠Follow Dave on LinkedIn⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠The Treatment Plan on YouTube⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠The Treatment Plan on Apple Podcasts⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠ReforMedicine Direct Pay Primary Care

    49 min

  4. 09/29/2025

    Low-Carb Diets, Obesity Care, and Clinical Simplicity

    In this conversation, Dave and Jack discuss the many responses Dave got on his viral LinkedIn post stating his belief that excess carbohydrate consumption is the primary driver of the obesity crisis (this post). They discuss the importance of simplicity in nutrition and fitness, emphasizing low-carb diets and their effectiveness for weight management. They explore evidence from elite athletes on ketogenic diets, the role of dietitians, and the complexities of individual dietary needs. The discussion also touches on the psychological aspects of weight management, the evolution of dietary choices, and misconceptions about fiber and gut health. They conclude by addressing hydration and electrolyte balance on low-carb diets, highlighting the need for a patient-centered approach in dietary recommendations. Episode 7. LINKS ⁠⁠⁠⁠⁠⁠Follow Dave on LinkedIn⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠The Treatment Plan on YouTube⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠The Treatment Plan on Apple Podcasts⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠ReforMedicine Direct Pay Primary Care

    1h 7m

  5. 09/15/2025

    Exercise, Calories, Satiety, and Rethinking Obesity

    Jack and Dave break down some of the most misunderstood areas of weight loss: the real role of exercise, why “calories in, calories out” oversimplifies the problem, and how satiety, especially from protein, drives sustainable results. (00:00) Intro Setting up today’s topics: exercise, calories, satiety, and fiber. (01:15) Exercise and Weight Loss Why exercise is essential for health but overrated as a weight loss tool. (06:40) Fitness Industry vs. Medicine How obesity was framed as a wellness problem until recently recognized as a disease. (15:56) Processed Foods and Corn Syrup The 1970s food environment shift that fueled the obesity epidemic. (21:14) You Can’t Out-Exercise Carbs Insulin resistance and why average people can’t burn off a bad diet. (26:01) Calories In/Calories Out Debate True but incomplete — why low-fat dieting and calorie math fail most patients. (29:58) Protein vs. Fiber for Satiety Protein as the real driver of fullness, and why “just eat salads” doesn’t work. (36:39) Sugar, Cravings, and Hormones How sugar hijacks the brain, why fat + carbs together are dangerous, and the role of ghrelin in hunger. Episode #06. -- LINKS ⁠⁠⁠⁠⁠Follow Dave on LinkedIn⁠⁠⁠⁠⁠ ⁠⁠⁠⁠The Treatment Plan on YouTube⁠⁠⁠⁠ ⁠⁠⁠⁠The Treatment Plan on Apple Podcasts⁠⁠⁠⁠ ⁠⁠⁠⁠ReforMedicine Direct Pay Primary Care

    42 min

  6. 09/02/2025

    Obesity, Carbohydrates, and the Medical Weight Loss Debate

    In this episode, Jack and Dave dive deep into the obesity crisis, exploring why rates have soared in the U.S. and globally, and what that means for public health and healthcare costs. Dave shares his clinical perspective on carbohydrates as the central driver of obesity, why traditional dietary guidelines may have backfired, and how his patients respond to low-carb and carnivore-style interventions. They also wrestle with the tension between population-level nutrition advice and the realities of individual health. This conversation cuts past diet fads to examine the structural and clinical roots of America’s weight problem. Topic list: Intro and framing: obesity crisis in America Obesity stats, healthcare costs, military readiness Clinical view: conditions and cancer risks Low-fat diet era and carb surge Core thesis: obesity driven by carbs Policy, industry influence, disinformation Obesity as symptom vs. root cause Carbs are carbs: all become glucose Two-week carnivore challenge results Body makes its own glucose Insulin, fat storage, diabetes progression High-fructose corn syrup and processed food Individual vs. population diet differences Athletes and carb-loading Carbs as performance enhancer Why dietary shifts feel radical Exercise, energy balance, “eat less, move more” Carbs as addictive and inflammatory Closing takeaways: carbs unnecessary, obesity food-driven Episode #5. LINKS ⁠⁠⁠⁠Follow Dave on LinkedIn⁠⁠⁠⁠ ⁠⁠⁠The Treatment Plan on YouTube⁠⁠⁠ ⁠⁠⁠The Treatment Plan on Apple Podcasts⁠⁠⁠ ⁠⁠⁠ReforMedicine Direct Pay Primary Care

    58 min

  7. 08/18/2025

    The 40% Problem: Why I Ditched Insurance Billing for Direct Pay

    In this episode, Jack and Dave discuss the launch and very early days of Dave's direct pay practice. TOPICS Opening/intro The Medical Economics magazine moment Business planning phase The E-Myth discussion Non-compete agreement navigation Location selection and setup Early marketing efforts First year challenges/successes Lessons learned/closing thoughts He shares the pivotal moment when a Medical Economics Journal article about direct pay healthcare sparked his transformation, walking through the essential business planning phase that preceded launching his independent practice. From writing business plans and securing loans to navigating non-compete agreements and choosing the perfect strip mall location, Dave reveals the practical steps and strategic decisions that turned his vision into reality. Learn how he leveraged existing relationships, embraced the E-Myth principles, and built a sustainable direct primary care model that prioritized both patient care and business viability. Episode #04. LINKS ⁠⁠⁠Follow Dave on LinkedIn⁠⁠⁠ ⁠⁠The Treatment Plan on YouTube⁠⁠ ⁠⁠The Treatment Plan on Apple Podcasts⁠⁠ ⁠⁠ReforMedicine Direct Pay Primary Care

    56 min

  8. 07/17/2025

    Primary Care Pay, Physician Burnout, and the Case for Direct Pay Models

    In this episode, Jack and Dave dive into the economics, culture, and structure of primary care in America. They unpack why so few medical students choose family medicine, how RVUs shape physician incentives, and the burnout that stems from misaligned systems. Dave shares why he left a major health system to launch a direct pay primary care clinic and what he’d tell other physicians who feel stuck. If you’ve ever wondered why it’s so hard to get good primary care, this episode connects the dots. Timestamps: (00:00) Intro (00:29) Challenges in Primary Care  (01:36) Understanding Primary Care Specialties  (03:15) Family Medicine vs. Internal Medicine and Pediatrics   (05:12) The Role of OB-GYN in Primary Care  (06:48) Shortage of Primary Care Physicians  (07:39) Personal Journey into Primary Care  (10:13) Financial and Structural Issues in Primary Care  (12:09) Impact of Big Systems on Primary Care  (18:25) The Role of Nurse Practitioners and Physician Assistants  (19:16) Patient Perception and Systemic Issues  (26:10) Primary Care Physician Burnout  (28:44) Understanding Burnout in Healthcare  (29:23) Impact of the Affordable Care Act  (30:07) Exploring Direct Pay Primary Care  (30:46) Personal Journey and Challenges  (32:24) Financial Considerations and Family Impact  (33:37) Negotiating Contracts and Non-Compete Clauses  (40:00) The Importance of Market Understanding  (42:17) Building Trust and Transparency in Practice  (46:07) Creating a Sustainable Practice Model  (47:51) Future Discussions & Outro Episode #03. LINKS ⁠The Treatment Plan on YouTube⁠ ⁠The Treatment Plan on Apple Podcasts⁠ ⁠Follow Dave on LinkedIn⁠ ⁠ReforMedicine Direct Pay Primary Care

    49 min

  9. 06/30/2025

    How Health Plans Work, Who Makes the Decisions, and Why Primary Care Matters

    Nearly half of all Americans get their health insurance through work. But most employers don’t realize they’re running a second business: healthcare. In this episode, Jack and Dave discuss how employer-sponsored insurance actually works—from fully funded plans to self-funded strategies—and why so many companies are bleeding cash without realizing it. They talk about the hidden role of PBMs, the rising trend of direct primary care, and how smart employers are taking control of their costs without sacrificing quality. Topics include: Why your premiums keep rising (even in a “good” year)How PBMs manipulate costs behind the scenesThe difference between fully funded and self-funded plansReal-world examples of employers slashing spend without cutting careWhy primary care alignment is the key lever to taking back control of your healthcare spending This episode is for CFOs, HR leaders, or people just trying to understand their own health plan better. Episode #02. LINKS The Treatment Plan on YouTube The Treatment Plan on Apple Podcasts Follow Dave on LinkedIn ReforMedicine Direct Pay Primary Care

    45 min

  10. 06/12/2025

    The One Big Beautiful Bill: HSAs for DPC, On-Site Clinic Reform, Future of Primary Care

    In this episode, Jack and Dave discuss the implications of the One Big Beautiful Bill, healthcare policy, particularly in relation to direct primary care and health savings accounts (HSAs). They explore the changes that allow HSAs to be used for direct primary care memberships and the significance of on-site employee clinics. The discussion also touches on the broader implications of government involvement in healthcare and the future of direct primary care as a viable alternative to traditional healthcare systems. Follow Dave on LinkedIn: https://www.linkedin.com/in/davidjusher-reformedicine/ ReforMedicine Direct Pay Primary Care: https://www.reformedicine.com/ Listen to The Treatment Plan on YouTube and Apple Podcasts! healthcare, policy, direct primary care, HSA, legislation, employee clinics, insurance, healthcare reform, government involvement, healthcare costs Episode #001.

    47 min
  • 10 Episodes

About

The Treatment Plan is a podcast that discusses how healthcare really works, from patient care and weight loss to the systems and incentives behind it all. Each episode unpacks what's working in our healthcare system, what's not, and how healthcare could be better.

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