The Doctors’ Lounge

The Doctor's Lounge
  • 4.8 (55)
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Where scalpels meet systems — and physicians say what they really think. Co-hosted by Anish Koka, MD & Anthony DiGiorgio, DO. Candid talks on healthcare policy, reform, physician autonomy & patient care.

  1. 5d ago

    Congressman Tom Oliverson on 340b, the No Surprises Act, gold carding, and more

    Send us Fan Mail Episode 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 Markers 00:00 - Introduction to Dr. Tom Oliverson and his Texas healthcare policy role 01:24 - From Cut and Shoot to Baylor and a medical career 05:01 - Why running for office felt like a calling 08:02 - Why Texas lawmakers are expected to keep real jobs 13:30 - The healthcare affordability committee and the expert testimony it drew 16:28 - Consolidation as a major driver of healthcare cost growth 18:49 - Why direct contracting may replace traditional networks 22:49 - What the future could look like in a Singapore-style transparent market 23:53 - ERISA limits, state authority, and the frustration of federal preemption 25:17 - Medicaid payment, fraud, and what states can still influence 28:06 - Using Medicaid buying power to push back on abusive pharmacy practices 29:15 - 340B as a “Robin Hood” program with perverse incentives 36:03 - Why Texas is pushing transparency on 340B revenue and pricing 37:38 - The gold carding law and prior authorization reform 43:43 - A Capitol cardiac arrest and a real-life case with Dr. Bonnen 46:35 - What Texas can and cannot regulate in state insurance markets 48:47 - Texas roots of the No Surprises Act 51:43 - How Texas arbitration was designed to define fair market value 54:25 - Why the federal NSA lost key guardrails 61:41 - Texas opt-in for ERISA plans and why that matters 66:49 - Cash deductible credit when patients choose cheaper care 68:45 - Compounding, GLP-1 dosing, and preserving access through customization 70:09 - Peptides, prevention, food access, and the case for lifestyle-based care 72:34 - Closing thoughts on free markets, 340B, and healthy food Co-Host Handles @anish_koka and @DrDiGiorgio Show Handle @DRsLoungePod Subscribe Links Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658  YouTube: https://www.youtube.com/@TheDoctorsLoungePod Official Texas House Select Committee on Health Care Affordability page: https://house.texas.gov/committees/committee/059 Dr. 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

    Congressman Tom Oliverson on 340b, the No Surprises Act, gold carding, and more

  2. Sep 1

    Vinay Prasad: COVID, the FDA, and Why Journalism Keeps Getting Medicine Wrong

    Send us Fan Mail The prior uploaded file had 26 seconds that was corrupted.  Restored on this version! Episode Summary: Dr. Vinay Prasad joins the Doctors Lounge in a recorded in person conversation that moves from his time at the FDA to bigger questions about evidence, incentives, and trust in medicine. The discussion focuses on how regulatory agencies actually function, why public health debates have become so politicized, and whether the current healthcare funding model rewards good care or just expensive care. Timestamps: 00:16 - Why the FDA conversation matters now 02:49 - Why Vinay accepted the DC job 04:02 - What can actually change inside the FDA 05:39 - The Exondys approval and commissioner authority 07:22 - Do appointees really steer regulatory decisions? 09:48 - Should the FDA regulate safety or efficacy? 10:31 - Safety, efficacy, and the car analogy 13:04 - Could COVID vaccines have been released earlier? 14:04 - Challenge trials versus large community trials 16:32 - Rolling out vaccines by age and risk 18:05 - Why post COVID myocarditis comparisons are flawed 22:36 - The danger of elite stamped misinformation 24:06 - When medicine became political 26:24 - Why institutions may be too captured to trust 27:24 - The measles death story and missing context 30:17 - Buchanan, Tullock, and the logic of bureaucracy 33:17 - How healthcare swallows trillions with mixed value 35:02 - Why low back surgery is hard to centralize 37:27 - ICD placement and gray zone medicine 39:07 - Who should pay for marginal cancer drugs? 41:10 - Demand subsidies and distorted prices 43:34 - Innovation before large welfare programs 46:53 - Does more money always mean more innovation? 48:48 - Why journalism misses what matters at FDA 51:21 - The No Surprises Act and who really pays 55:42 - Vinay’s broader career path and what comes next 57:34 - Why active clinical practice still matters Co-Host Handles @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe Links Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658 YouTube: https://www.youtube.com/@TheDoctorsLoungePod Dr. DiGiorgio's project "Off Label Ideas" https://www.offlabelideas.com/ Dr. DiGiorgio's on Substack https://substack.com/@drdigiorgio 🔗 Connect with the Hosts: • Dr. Anthony DiGiorgio on X • Dr. Anish Koka on X • Dr. Dan Choi on X • Dr. Sanat Dixit on X

  3. Aug 28

    The Ship Has Sailed: Mike Munger on Medicare, Markets, and Debt

    Send us Fan Mail Episode Summary Duke political economist and podcast host Mike Munger (The Answer is Transaction Costs) joins Anthony DiGiorgio and Anish Koka to argue that what Americans call "health insurance" isn't insurance at all — it's a social program where, as Bastiat put it, everyone tries to live at the expense of everyone else. Munger walks through why Medicare functions as a bilateral monopoly rather than a market, compares the U.S. system to Germany's competitive-insurer model and Chile's subsidized-private-account system, and lays out the four ways any society rations scarce goods — queuing, price, lottery, or authority — arguing the U.S. has mostly abandoned price in favor of blunt instruments like certificates of need. The conversation moves through Kenneth Arrow's 1963 uncertainty paper, the RAND cost-sharing experiment, insurer and provider consolidation, the tax exclusion for employer health benefits, and closes on a bleak but pointed read of federal debt, entitlement insolvency, and why Munger thinks the ship on real reform has already sailed. Chapter Markers 00:00 Introduction and welcome 00:58 Why Medicare isn't really insurance 05:40 Comparing the German, English, and Singaporean models 08:38 Medicare for All as a bilateral monopoly 12:25 Demand-side subsidies and the Learjet story 15:03 Value vs. demand — the Medicaid bariatric surgery example 17:56 Certificates of need and rationing without price signals 21:55 The four ways to ration scarce goods 26:41 The RAND experiment and the cost-sharing debate 28:41 Kenneth Arrow's uncertainty paper and market failure 34:16 How Germany decides what to pay doctors 36:05 Mandatory insurance and adverse selection 38:41 Federalism and state-level insurance regulation 41:04 Provider consolidation and the competition problem 45:18 The employer health benefit tax exclusion 46:27 Federal bureaucracy, DOGE, and cutting government 50:13 Medicare and Social Security insolvency 52:24 "Medicare for All" — the punchline 54:59 Closing thoughts: fee-for-service experiments at the margins Co-Host Handles @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe Links Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658  YouTube: https://www.youtube.com/@TheDoctorsLoungePod Dr. Michael Munger on X: @mungowitz Dr. Michael Munger: The Answer Is Transaction Costs podcast links Apple Podcasts: https://podcasts.apple.com/us/podcast/the-answer-is-transaction-costs/id1687215430 Buzzsprout: https://taitc.buzzsprout.com Spotify: https://open.spotify.com/show/05V1tglrMa3ANs0r89OXXg 🔗 Connect with the Hosts: • Dr. Anthony DiGiorgio on X • Dr. Anish Koka on X • Dr. Dan Choi on X • Dr. Sanat Dixit on X

    The Ship Has Sailed: Mike Munger on Medicare, Markets, and Debt

  4. Aug 22

    900 Regulatory Hurdles: Why AI Isn't Replacing Doctors Yet

    Send us Fan Mail Episode Summary With scheduled guest Dr. Geoff Manley pulled away by a medical emergency, hosts Anish Koka and Anthony DiGiorgio turn the episode into a news roundtable. They open on a JAMA op-ed by Neil Khosla and Ezekiel Emanuel arguing AI will replace physicians outright, and push back on both the regulatory timeline and the incentive structure behind it — including why hospitals are slow to adopt AI tools that already exist, like AI scribes and pre-charting. From there they dig into Medicaid: Michigan's $350 million in new staffing costs tied to One Big Beautiful Bill work requirements, the distortions created by the 90% FMAP for expansion populations, Medicaid fraud recovery data, and Anthony's "food stamps for healthcare" pitch for a cash-equivalent alternative. They close by dismantling the widely cited claim that Medicare for All would save 155,000 lives a year, walking through the underlying studies and what randomized data actually shows about insurance and mortality. Chapter Markers 00:16 Introduction and the JAMA op-ed on AI replacing physicians 07:04 Regulatory hurdles to replacing physicians with AI, and billing codes for AI-assisted care 10:08 Why hospitals aren't adopting AI tools that already exist — scribes and pre-charting 17:01 Healthcare's unlimited demand at zero price 18:53 Michigan Medicaid's $350 million work-requirement staffing costs 22:09 How administratively complex Medicare really is 27:27 Medicaid expansion, the 90% FMAP, and state incentives 31:51 The case for "food stamps for healthcare" — a cash-equivalent Medicaid alternative 37:05 Medicaid fraud control units and state-level innovation 40:41 Debunking the 155,000-lives Medicare for All claim 52:21 Medicare for All and the future of private practice 55:34 Wrap-up and next week's guest preview Co-Host Handles @anish_koka and @drdigiorgio  Show Handle @drsloungepod Subscribe Links Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658 YouTube: 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

    900 Regulatory Hurdles: Why AI Isn't Replacing Doctors Yet

  5. Aug 13

    Inside a $207 Million Verdict: What Every Physician Should Know About Malpractice Trials

    Send us Fan Mail Episode Summary In a special Tuesday episode, Anish Koka and Anthony DiGiorgio sit down with Heather Tereshko, a Principal at Post & Schell in Philadelphia and a 25-year veteran of medical malpractice defense, to break down the largest medical malpractice verdict in Pennsylvania history — a $207 million judgment against the University of Pennsylvania stemming from a delayed C-section and resulting anoxic brain injury. Using the case as a launching pad, the three walk through how verdict slips are constructed, why Pennsylvania's "increased risk of harm" standard makes cases easier for plaintiffs to win, how EMR documentation gets weaponized against physicians on the stand, how life-care-plan and non-economic damages get inflated (including "anchoring" tactics like invoking Jalen Hurts's salary), and why juries so often disregard clinical guidelines in favor of narrative and sympathy. The conversation closes with a practical, if sobering, discussion of what physicians could realistically lobby for — tighter expert witness standards, damage caps, and organized legislative pressure — and why none of it is coming easily. Chapter Markers 00:19 Special Tuesday episode and guest introduction: Heather Tereshko 03:22 Heather's background in malpractice defense 05:40 The $207M Penn verdict: how the case started 09:20 Why this is a typical "bad baby" case 11:49 EMR drop-downs and documentation gaps at the center of the case 14:45 The cord blood dispute and the mechanism-of-injury fight 16:01 Judge excludes key testimony on the blood draw 18:33 Inside the verdict slip: factual cause vs. increased risk of harm 25:50 Why "increased risk of harm" doesn't fit this case 27:20 The "team theory" of liability and how the verdict sheet was structured 31:39 Breaking down the $207M damages award 33:06 The life expectancy fight: 29 years vs. 70 years 36:20 Anchoring tactics and the Jalen Hurts salary comparison 39:21 How contingency fees work in Pennsylvania 42:04 "There's no winning": defensive medicine and no-win scenarios 45:14 When health system interests diverge from the individual physician's 46:25 Downstream effects: why community hospitals drop OB services 47:39 No-fault alternatives: New Zealand and Florida's birth injury fund 51:57 Expert witness accountability — or the lack of it 55:58 Venue selection and how it reshaped Philadelphia verdicts 59:04 Damage caps and why economic damages remain unbounded 1:01:54 What physicians can realistically lobby for 1:06:06 Closing thoughts Substack References (Dr. Anish Koka) Referenced during the episode — Anish's Substack posts on the Pennsylvania medical malpractice market and on the Penn ($207M) verdict: PA malpractice market / NAIC data post: https://anishkokamd.substack.com/p/pennsylvania-had-a-functioning-medical Penn verdict case breakdown post: https://anishkokamd.substack.com/p/twelve-people-three-hours-a-207-million Co-Host Handles @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe Links Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658 YouTube: 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

  6. Aug 11

    Right-to-Try 2.0: Inside the Montana Model with Niklas Anzinger

    Send us Fan Mail Episode Summary Anish Koka and Anthony DiGiorgio sit down with Niklas Anzinger, a venture capitalist and founder of Infinita VC, to unpack Montana SB535 — a new law that lets doctors administer treatments to patients that have only cleared FDA phase one trials, through licensed "experimental treatment centers" overseen by independent review boards. The conversation covers why Eroom's Law has made drug development slower and more expensive despite scientific advances, how the Montana model differs from existing right-to-try and expanded access programs, the thorny question of who pays when a treatment sits outside FDA approval and insurance coverage, the risks of messy observational data replacing randomized controlled trials, and how Anzinger's work connects to special economic zones like Prospera in Honduras, where he's speaking to the hosts from. Chapter Markers 00:22 Introducing Niklas Anzinger and his path from economics and VC to biotech policy 03:05 Montana SB535 explained — right-to-try, but with a for-profit pathway 06:01 Phase 1 vs phase 2 vs phase 3, and why bypass the later stages 11:37 Does SB535 cover devices as well as drugs 14:15 The semaglutide timeline as a case study in regulatory delay 18:36 Federal right-to-try, the baby KJ case, and why it isn't enough 23:25 The payment problem — how a non-FDA-approved treatment actually gets paid for 33:11 What "smart regulation" would look like with carte blanche over the FDA 48:31 Why Montana's biggest need right now is clinicians, not biotechs 49:57 The practical burden on a private practice running these treatments 53:32 Observational data vs. randomized trials — the risk of junk data 59:15 Is this a domestic answer to China's faster phase one pathway 1:04:22 Roatan, Prospera, and the case for special economic zones in medicine 1:09:18 Closing thoughts and where to find Anzinger's Stranded Technologies podcast Co-Host Handles @anish_koka and @DrDiGiorgio Show Handle @DRsLoungePod Subscribe Links Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658 YouTube: https://www.youtube.com/@TheDoctorsLoungePod Mr. Niklas Anzinger on X:  @NiklasAnzinger Mr. Niklas Anzinger Podcast: Stranded Technologies podcast 🔗 Connect with the Hosts: • Dr. Anthony DiGiorgio on X • Dr. Anish Koka on X • Dr. Dan Choi on X • Dr. Sanat Dixit on X

    Right-to-Try 2.0: Inside the Montana Model with Niklas Anzinger

  7. Aug 1

    Dan Donoho on Surgical Data Science, Regulation, and the Humanoid OR

    Send us Fan Mail Episode SummaryAnthony DiGiorgio and Anish Koka sit down with Dr. Dan Donoho, an NIH-funded neurosurgeon-scientist at Children's National Hospital and George Washington University, and founder of the Surgical Data Science Collective and the Foundation for Digital Neurosurgery, for a wide-ranging conversation on AI in medicine. Donoho explains why surgeons get almost no structured feedback after a case, walks through a randomized controlled trial showing AI-coached medical students outperformed those coached by humans on simulated tumor resections, and argues that most regulatory "barriers" to deploying AI in healthcare are cultural rather than statutory. The conversation moves through the limits of tactile sensation in surgical AI, why he expects innovation to come from small agile practices rather than large insurance-pay hospitals, his family's data science lineage, humanoid robots performing laparoscopic surgery, the anti-data-center backlash, and ongoing surgical AI trials in Ethiopia and Tanzania. Chapter Markers00:16 Introduction and guest background 01:16 The Surgical Data Science Collective and the problem of lost surgical knowledge 03:26 How AI could replace the mentor's voice in a surgeon's head 06:50 Tactile feedback and the limits of video-based AI in surgery 08:47 The RCT: AI coaching vs. human coaching in medical students 11:48 What's the gold standard for grading surgical performance 14:42 Who validates the AI — the EKG problem and patient outcomes as the real judge 17:19 Humanoid robots, self-driving cars, and low-hanging AI fruit in clinics 20:27 Regulatory barriers to AI in EHRs — culture vs. statute 22:09 Doctronic, AI prescribing, and licensure 25:12 Where Dan's interest in data science started 26:39 His father, statistician David Donoho, and the rise of empiricism 28:09 The "don't go into medicine" narrative and why it's wrong 30:26 COVID as a case study in bureaucratic drag on technology adoption 33:27 Should the FDA regulate surgical AI products 35:50 Andromeda Surgical, humanoid robots in the OR, and the cost gap 38:27 The anti-data-center movement and the history of sabotage 39:54 Global AI competition and China's Kimi K3 model 42:41 How to measure whether an AI model is actually better 44:34 Model size vs. training — why prompting changes performance 45:46 What the surgical community currently measures, and why it's the wrong thing 47:23 The Tanzania surgical AI trial and other real-world deployments 49:03 What actually scares Dan about AI 51:21 Will AI democratize power or concentrate it 52:15 Closing questions — what's next, including the Ethiopia partnership Co-Host Handle @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe LinksSpotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658 YouTube: https://www.youtube.com/@TheDoctorsLoungePod Dr. Daniel Donoho Website & X Website: https://www.surgicalvideo.io/ X: https://x.com/ddonoho 🔗 Connect with the Hosts: • Dr. Anthony DiGiorgio on X • Dr. Anish Koka on X • Dr. Dan Choi on X • Dr. Sanat Dixit on X

    Dan Donoho on Surgical Data Science, Regulation, and the Humanoid OR

  8. Jul 31

    Dr. George Tolis on Physician Pay, Private Practice, and a Valve Gone Wrong

    Send us Fan Mail Episode Summary Cardiothoracic surgeon Dr. George Tolis, chief of cardiothoracic surgery in Boston, returns to The Doctors Lounge with hosts Dr. Anish Koka and Dr. Anthony DiGiorgio for a wide-ranging conversation that opens with the newly proposed 2027 Medicare physician fee schedule and the budget-neutrality rule dating back to 1989 that forces cuts to one specialty to fund raises to another. The conversation moves into why true independent private practice has effectively disappeared, how hospital systems control physician hiring, firing, and pay regardless of what Medicare reimburses, and how locum tenens pay and device pricing expose the arbitrariness of professional fees. The back half of the episode turns to a widely discussed case of a cardiac valve implanted upside down in a young patient, with Tolis walking through how tunnel vision and ECMO can mask a never event for days, why he holds the surgeon fully accountable while condemning the social media pile-on that followed, and how palliative care should never be initiated without physician involvement. The episode closes on innovation in cardiac surgery — minimally invasive and robotic mitral repair, the Ross procedure, bilateral mammary artery use, valve selection, and how thirty-day outcome metrics quietly discourage surgeons from doing what's best for patients long-term — along with a candid discussion of industry money and conflicts of interest in medicine. Chapter Markers 00:00 Welcome back, Dr. George Tolis 01:09 The proposed 2027 physician fee schedule 05:20 Budget neutrality since 1989 and the flat physician bucket 10:09 Tolis: physicians are compensated less, not necessarily paid less 16:41 Barriers to going private and the PSA model 21:03 The painful transition to an independent physician ecosystem 25:25 Locum tenens pay, valve pricing, and "it's all by design" 33:51 The case: a valve placed upside down 40:01 Tunnel vision, distraction, and 110% concentration in the OR 50:45 Palliative care involvement and the organ-harvesting narrative 55:50 Reader comments: minimally invasive mitral surgery pushback 1:03:02 Competition, capitalism, and information asymmetry in medicine 1:13:02 Bio AVR vs. mechanical valve in a 57-year-old 1:15:28 Bilateral mammary arteries and the 30-day outcomes problem 1:17:46 Prospective payment, DRGs, and device cost incentives 1:25:08 Industry relationships and physician disclosures 1:29:05 GLP-1s, honoraria, and what counts as conflict of interest Co-Host Handles @anish_koka and @drdigiorgio Show Handle @drsloungepod Subscribe Links Spotify: https://open.spotify.com/show/44vw8eirsKKnjgNIrdDvrR Apple Podcasts: https://podcasts.apple.com/us/podcast/the-doctors-lounge/id1832097658 YouTube: https://www.youtube.com/@TheDoctorsLoungePod Dr. George Tolis's Previous Appearance on The Doctor's Lounge Dr. Tolis first joined The Doctor's Lounge about two months ago. Watch that episode here: https://x.com/DRsLoungePod/status/2055619280855515141?s=20 Dr. George Tolis on X @georgetolisjr 🔗 Connect with the Hosts: • Dr. Anthony DiGiorgio on X • Dr. Anish Koka on X • Dr. Dan Choi on X • Dr. Sanat Dixit on X

    Dr. George Tolis on Physician Pay, Private Practice, and a Valve Gone Wrong
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About

Where scalpels meet systems — and physicians say what they really think. Co-hosted by Anish Koka, MD & Anthony DiGiorgio, DO. Candid talks on healthcare policy, reform, physician autonomy & patient care.

Information

  • Creator
    The Doctor's Lounge
  • Years Active
    2025 - 2026
  • Episodes
    77
  • Rating
    Explicit
  • Copyright
    © 2026 The Doctors’ Lounge
  • Show Website
    The Doctors’ Lounge

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