DC EKG

Stay On Course Studios

Join former White House policy expert Joe Grogan as he cuts through the complexities of healthcare legislation and its real-world implications. Each episode of DC EKG aims to demystify the policies shaping our healthcare system, uncovering how these changes impact patients, providers, and payers across the country.

  1. 2h ago

    Tax Expenditures, 340 B Drug Pricing, and Kidney Donation Reform

    DC EKG with Joe Grogan   Episode 137: Tax Expenditures, 340 B Drug Pricing, and Kidney Donation Reform   Air Date: June 15, 2026   Episode Description In this episode, Joe Grogan sits down with Dr. Ike Brannon, President of Capital Policy Analytics and Senior Fellow at the Jack Kemp Foundation, to discuss hidden tax expenditures, the 340 B drug pricing program, and innovative solutions to the kidney shortage crisis.   Dr. Brannon brings decades of Capitol Hill experience, including roles as chief economist of the House Energy and Commerce Committee and senior advisor to Senator Orrin Hatch. He and co-author Tony LoSasso recently published groundbreaking research in Health Affairs Forefront arguing that the 340 B drug pricing program should be classified as a hidden tax expenditure costing the federal government 15 to 20 billion dollars annually.   The conversation covers how the 340 B program evolved from providing discounted drugs to uninsured patients into a massive subsidy for nonprofit institutions with little benefit to poor patients. Dr. Brannon explains how the same drug acquired at a 340 B discount often results in full commercial copays for patients.   Joe and Dr. Brannon explore other problematic tax expenditures including the mortgage interest deduction, employer health insurance exclusion, and credit union tax breaks. The episode pivots to Dr. Branons passionate work on kidney donation reform. Forty-five thousand Americans die annually from end stage renal failure due to kidney shortage, disproportionately affecting African Americans. Dr. Brannon advocates for fully reimbursing kidney donors for all expenses.   Key Topics 340 B drug pricing program, tax expenditures, pharmaceutical discounts, nonprofit hospitals, mortgage interest deduction, kidney donation, end stage renal failure, organ shortage, entitlement reform, social security, Medicare, federal deficit, health economics   Key Timestamps   0:00 Opening: What should be in a reconciliation bill? 4:38 The 340 B drug pricing program explained 13:54 How the 340 B discount does not reach patients 20:13 Mortgage interest deduction: the most irritating tax break 31:00 Prospects for reconciliation under Trump administration 34:57 The kidney donation crisis: 45,000 deaths per year 39:02 How kidney donation reimbursement would work 40:00 Would you allow kidney sales? The ethical debate 45:13 Final thoughts   About the Guest Dr. Ike Brannon is President of Capital Policy Analytics and Senior Fellow at the Jack Kemp Foundation. He holds a PhD in Economics from Indiana University. Dr. Brannon served as chief economist of the House Energy and Commerce Committee, senior advisor to Senator Orrin Hatch on tax and trade policy, and has worked at the Congressional Joint Economic Committee, Treasury Department, and for the McCain presidential campaign. He is founder of the Prosperity Caucus and focuses on growth-oriented economic policy and healthcare innovation.   Featured Research The 340 B Drug Pricing Program is a Hidden Tax Expenditure Health Affairs Forefront, April 24, 2026 Co-authored by Ike Brannon and Tony LoSasso https://www.healthaffairs.org/content/forefront/340b-drug-pricing-program-hidden-tax-expenditure   Podcast: DC EKG with Joe Grogan Episode: 137 Guest: Dr. Ike Brannon   Sponsor: Survivors for Solutions Producer: Stay on Course Studios Executive Producer: John CZ Czwartacki, DC EKG Podcast

    46 min
  2. Jun 8 ·  Bonus

    "REFILL" - The Economics of Ozempic and Other Weight Loss Drugs (Originally Aired: May 2024)

    DC EKG with Joe Grogan The Economics of Ozempic and Other Weight Loss Drugs Episode 136.5 (“Prescription Refill” – A replay from the archives) Original Air Date: May 2024 In this episode, Joe Grogan welcomes Ben Ippolito, Senior Fellow in Economic Policy Studies at the American Enterprise Institute, to discuss the rapidly evolving economics of GLP-1 weight loss drugs like Ozempic and Wegovy. Ben explains the two main competitors in this market—Novo Nordisk's Ozempic and Wegovy versus Eli Lilly's Mounjaro and Zepbound. Revealing how insurance coverage decisions drive pharmaceutical marketing strategy. The conversation reveals a critical irrationality in Medicare policy: the statutory prohibition on covering weight loss drugs despite their profound clinical and quality-of-life benefits. Yet these same drugs are covered for diabetes and cardiovascular risk reduction. Ben explores the surprising economics of drug pricing through gross-to-net pricing—the massive gap between list prices and what insurers actually pay through rebates and discounts. The episode examines critical implications of the Inflation Reduction Act's price negotiation provisions. Once Medicare negotiates Ozempic's price, that same price applies to all products using the same active ingredient. This creates cascading market effects: competitors must match those prices to remain on formularies, new entrants face lower pricing power even if clinically superior, and pharmaceutical companies may abandon promising programs due to regulatory uncertainty. Ben argues Congress doesn't need to act immediately to expand Medicare coverage, but likely will within a few years. Joe and Ben discuss unintended consequences of government price regulation, including effects on innovation and drug development pipelines. They explore how price controls announced before elections affect pharmaceutical strategy and development timelines. Concluding with Ben's research on Medicare Advantage and why both Democrats and Republicans scrutinize this private alternative to traditional Medicare. With over 50 percent of seniors enrolled in Medicare Advantage plans, bipartisan interest in reform is reshaping healthcare policy conversations on Capitol Hill. Key Topics GLP-1 drugs, Ozempic, Wegovy, Mounjaro, Zepbound, weight loss medications, obesity treatment, Medicare coverage, drug pricing, Inflation Reduction Act, pharmaceutical competition, rebates, gross-to-net pricing, health economics, cardiovascular benefits, diabetes treatment, Medicare Advantage, healthcare policy, innovation incentives Key Timestamps 00:00 Cold Open: "Turned Up to 11" 00:24 Welcome to DC EKG 00:46 Meet Ben Ippolito (AEI) 03:48 The GLP-1 Landscape: Ozempic, Wegovy, and the Field 05:04 One Drug, Two Names 06:45 Medicare's Weight-Loss Coverage Ban 07:21 Blockbusters and Big Effect Sizes 09:32 Why Isn't Congress Acting? 10:17 Why It Costs Less Than You Think 12:34 The Coverage Irrationality 14:05 Quality of Life as a Real Benefit 15:17 Beyond Weight: Cravings and Addiction 18:21 Devil's Advocate: Why Cover It At All? 19:48 Gross-to-Net and the Rebate Problem 22:41 Why Can't You Just Pay Cash? 25:43 The IRA and the Ozempic Price Cut 27:32 One Ingredient, One Price 30:10 Unintended Consequences in Part D 34:01 New Competitors and Killed Programs 38:03 What's Next: Medicare Advantage 42:04 Wrap-Up and Credits About the Guest (As of May 2024) Ben Ippolito is a Senior Fellow in Economic Policy Studies at the American Enterprise Institute. He holds a PhD and Master's degree in Economics from the University of Wisconsin-Madison and a Bachelor's degree in Mathematics and Economics from Emory University. Ben examines drug pricing policy, Medicare Advantage, and healthcare innovation economics with regular engagement with Congress. Podcast: DC EKG with Joe Grogan Guest: Ben Ippolito Sponsor: Survivors for Solutions Producer: Stay on Course Studios Executive Producer: John CZ Czwartacki, DC EKG Podcast

    43 min
  3. Jun 1

    Tom Barker on The Truth About Drug Pricing Policy

    In Episode 136 of DC EKG, Joe Grogan hosts Tom Barker, a top drug-pricing attorney at Foley Hoag and former acting general counsel of Health and Human Services (HHS) under the Bush administration. Tom helped implement Medicare Part D and now advises drugmakers and policymakers on complex pricing issues. The episode traces 20 years of policy: what went right with Part D, what the Inflation Reduction Act (IRA) did, and what effective policy should look like. Tom explains that Part D's success rested on three pillars: private plans only, limited government control over benefit design, and a non-interference clause barring the government from intervening in negotiations among plans, pharmacies, and manufacturers. Competition worked and premiums stayed low, until the government asserted more control and weakened those pillars. The IRA, he argues, was a 16-year Democratic effort to repeal non-interference, creating price controls disguised as negotiations. The Trump administration has taken a different tack, focusing not on the IRA but on MFN and Globe Guard models pegged to other developed countries. Tom also breaks down the 340B program, now the country's second-largest expenditure program, and the fight between manufacturers and covered entities over contract pharmacies. His prescription is simple: let competition work. Speed FDA approval of generics and biosimilars, and trust the marketplace over price controls. He points to hepatitis C, where prices fell sharply once competition entered. In This Conversation The three pillars that made Part D successful for 20 years How non-interference kept government from setting drug prices The IRA as a 16-year Democratic push to repeal non-interference Why Tom calls the IRA price controls disguised as negotiations The Trump administration's focus on MFN and Globe Guard pricing 340B and the battle between manufacturers and covered entities The Chevron repeal's impact on drug pricing law HRSA's proposed rebate model and ongoing 340B litigation Why effective policy means competition, not controls Tom's work helping North Korean defectors and refugees Key Timestamps 1:51 Tom's background at HHS and CMS 2:30 The three pillars of Part D's success 5:10 Why Democrats wanted to repeal non-interference 5:55 Ted Kennedy's compromise and bipartisan votes 11:38 The IRA as a 16-year repeal attempt 12:03 What the IRA changed in Part D 15:02 IRA negotiations vs. real negotiations 16:25 How the excise tax makes it no real negotiation 21:32 Trump's focus on MFN and Globe Guard 25:37 340B's history back to 1991 28:45 340B as the second-biggest expenditure program 29:30 Manufacturer vs. covered-entity acrimony 33:18 The Chevron repeal's impact on pricing 34:54 HRSA's rebate model, the next step on 340B 35:40 The lawsuit over "patient" in 340B 38:18 Tom's advice: let competition work 39:30 Hepatitis C: competition drives prices down 40:34 Competition for gene therapies and CRISPR 41:36 Tom's work for North Korean defectors 44:49 Sponsoring Free North Korea Radio Medicare Part D, drug pricing policy, Inflation Reduction Act, non-interference clause, 340B program, MFN pricing, Globe Guard pricing, pharmacy benefit managers, covered entities, contract pharmacies, biosimilars, generics, federal drug pricing, government price controls, Tom Barker About the Guest Tom Barker is a partner at Foley Hoag in Washington, DC, and one of the country's top drug pricing attorneys. He served as acting general counsel of HHS and chief legal officer at CMS under the Bush administration, where he helped implement Part D from its inception. He is now a go-to expert on drug pricing, and helps North Korean defectors navigate US immigration law. Podcast: DC EKG with Joe Grogan Episode: 136 Guest: Tom Barker Sponsor: Survivors for Solutions - https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios - https://www.stayoncourse.studio

    47 min
  4. May 18

    Dr. Redfield's Warning: Hantavirus| Bird Flu| Long COVID and More

    In Episode 134 of DC EKG, former CDC Director Dr. Robert Redfield joins Joe Grogan to discuss his new book, Redfield's Warning, and break down three major threats to public health: Long COVID, Hantavirus, and bird flu. Dr. Redfield explains the persistent viral reservoirs in long COVID patients, the cognitive dysfunction and autonomic dysfunction that devastate these individuals, and why the federal government must partner with the private sector to develop meaningful treatments. He also walks through the current Hantavirus outbreak on a cruise ship, the human-to-human transmission of the Andes virus strain, and why bird flu is the most likely candidate for the next pandemic. Throughout, Dr. Redfield emphasizes the critical importance of antiviral development and the dangers of gain-of-function research. In This Conversation The current Hantavirus outbreak on a cruise ship and human-to-human transmission The Andes virus strain and why it differs from Sin Nombre and Four Corners Disease Two transmission routes: aerosolization and direct contamination Asymptomatic transmission and the intrinsic bias in testing Why has the US government not developed Hantavirus countermeasures in 70 years Bird flu is the most likely candidate for the next pandemic. Gain-of-function research and the public disclosure of dangerous genetic data Long COVID: viral reservoirs and the need for effective antiviral treatments Why antivirals should be the priority over vaccines for emerging viruses Operation Warp Speed and the importance of private sector partnerships The dismissal of long COVID patients as psychosomatic and the need for validation Key Timestamps 1:49  Details of the Hantavirus outbreak and cruise ship cases 3:00  Two methods of transmission: aerosolization and direct contamination 5:24  Asymptomatic transmission and testing bias 10:35  The Hantavirus family and why the Andes virus goes from human to human 12:35  How nervous should the public be 16:43  Shifting to bird flu and Redfield's Warning 19:00  Bird flu spread in US poultry and mammal populations 22:00  The four amino acids for bird flu to infect humans 23:30  The debate with Fauci over gain-of-function research 27:55  Unregulated gain-of-function research worldwide 33:35  Why antivirals should be the priority 37:55  Long COVID viral reservoirs and treatment gaps 42:37  The economic burden and need for solutions 43:57  The story of Joy and psychiatric misdiagnosis of long COVID 48:12  The solvability of long COVID and the importance of investing Hantavirus, Hantavirus transmission, Andes virus, Sin Nombre virus, Four Corners Disease, cruise ship outbreak, bird flu, avian influenza, gain of function research, Dr. Robert Redfield, CDC Director, antivirals, vaccines, long COVID, pandemic preparedness, infectious disease, virology, Redfield's Warning About the Guest Dr. Robert Redfield is the former Director of the Centers for Disease Control and Prevention. A trained virologist with decades of experience in infectious disease, he has been a leading voice on public health policy, pandemic preparedness, and biosecurity. He is the author of Redfield's Warning: What I Learned as CDC Director and What We Must Do to Be Prepared for the Next Pandemic, available on Amazon: https://www.amazon.com/Redfields-Warning-Learned-Couldnt-Might/dp/1510785051 Podcast: DC EKG with Joe Grogan Episode: 134 Guest: Dr. Robert Redfield, former CDC Director Sponsor: Survivors for Solutions –  https://survivorsforsolutions.org Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios –  https://www.stayoncourse.studio

    49 min
  5. May 4

    The European Union Explained with Christiaan Alting von Geusau

    In Episode 133 of DC EKG, Joe Grogan welcomes back Dr. Christiaan Alting von Geusau for Part 2 of their conversation, this time turning to the European Union. Christiaan walks Joe through the post-World War II origins of the EU as a peace initiative built around the Schuman Plan, the pooling of coal and steel between France and Germany, and the visionary leadership of Robert Schuman and Konrad Adenauer. He explains why understanding the EU's founding purpose is essential to understanding what has gone wrong since. Joe and Christiaan unpack the principle of subsidiarity, the rise of EU bureaucracy and over-regulation, the ideological capture of Brussels institutions, and the long detour into cultural battles that were never the EU's job to fight. They discuss Germany's strategic mistake of abandoning nuclear energy, the widening economic gap between the US and Europe, and why Friedrich Merz himself has called the EU the world champion of over-regulation. The second half of the episode looks at the US-EU relationship under President Trump's second term, including the Digital Services Act and free speech, decades of European free-riding on American defense, and the rise of bilateral engagement between Washington and individual European capitals. The conversation closes with a sharp discussion of the leadership vacuum across the West and Europe's growing economic dependence on China. In This Conversation How the European Union began as a Franco-German peace project Why the Schuman Plan and the pooling of coal and steel still shape Europe today The principle of subsidiarity and how Brussels has overstepped it Why Germany's abandonment of nuclear energy was a strategic disaster How EU institutions have been captured by ideology The Digital Services Act and the threat to free speech in Europe Why the US-EU relationship is under serious strain Whether Washington should deal with Brussels or with national capitals Europe's leadership vacuum and growing dependence on China Timestamps 0:00  Why Brussels has become the global champion of over-regulation 1:10  Joe welcomes back Christiaan for Part 2 1:32  Christiaan reintroduces himself and his background 3:00  Why the EU is misunderstood on both sides of the Atlantic 4:15  The historical origins of the EU and the Franco-German conflict 6:00  The Schuman Plan and the pooling of coal and steel 11:30  Truman, the Marshall Plan, and Dean Acheson 12:37  What went wrong with the EU 14:50  Bureaucracy, nuclear energy, and the German mistake 19:35  The principle of subsidiarity and why it matters 23:24  Cultural overreach by Brussels 26:44  Friedrich Merz on EU over-regulation 27:28  The widening US-EU economic gap 32:03  Free speech, the Digital Services Act, and Trump 38:33  European free-riding on American defense 44:07  Should Washington bypass Brussels 48:30  The rise of bilateral engagement 51:23  The leadership vacuum across the West 58:30  Europe's economic dependence on China 1:01:12  Wrap-up European Union, EU history, Schuman Plan, Franco-German conflict, subsidiarity, EU bureaucracy, EU overregulation, German nuclear energy, Digital Services Act, free speech Europe, US-EU relations, Trump and the EU, NATO defense spending, Europe-China dependence, transatlantic relationship, Christiaan Alting von Geusau, DC EKG About Our Guest Dr. Christiaan Alting von Geusau is a lawyer, professor, advisor, and host of the podcast The Educated Leader. Born in the United States and raised in the Netherlands, he studied law at Leiden University and Heidelberg University. He earned his doctorate in philosophy of law at the University of Vienna. He leads the International Catholic Legislators Network, serves as the principal of Ambrose Advice, and is the Rector emeritus and Professor of Philosophy of Law and Education at ITI Catholic University in Austria. Podcast: DC EKG with Joe Grogan Episode: 133 Guest: Dr. Christiaan Alting von Geusau Sponsor: Survivors for Solutions –  https://survivorsforsolutions.org Executive Producer: John “CZ” Czwartacki, DC EKG Podcast Producer: Stay on Course Studios –  https://www.stayoncourse.studio

    1h 2m
  6. Apr 30

    Hungary Election After Orban with Christiaan Alting von Geusau

    In Episode 132 of DC EKG, Joe Grogan sits down with Dr. Christiaan Alting von Geusau for a timely discussion on Hungary’s election, Viktor Orbán’s loss, and what comes next under Peter Magyar. Christiaan explains why the size of the election wipeout surprised even seasoned observers, why the mainstream narrative about democracy in Hungary misses key facts, and why the new Hungarian parliament remains entirely on the right side of the political spectrum.  Joe and Christiaan break down the structure of Hungary’s political system, the collapse of Orbán’s long-running coalition, the rise of Peter Magyar out of a political scandal, and the challenge of governing with a brand new party full of political newcomers. They also discuss whether Western media is misreading the result as a rejection of conservatism and why the more important question may be whether the new government has the experience to govern effectively.  The second half of the episode turns to Hungary’s position on Russia and Ukraine, the country’s cultural conservatism, the future of its relationship with the European Union, and the dangers of revenge politics after a major political transition. This is a wide-ranging conversation on democracy, power, media narratives, and the future of Hungary in Europe.  In This Conversation What happened in Hungary and why Orbán lost so badly Who Peter Magyar is and why his rise shocked the political class Why Hungary’s new parliament is still entirely right of center What the election means for democracy and conservatism Hungary’s position on Russia Ukraine and the European Union Why the competence of the new government may matter more than ideology The risks of revenge politics after a major political transition Timestamps0:00 Is Hungary’s election really a repudiation of conservatism0:55 Joe welcomes Christiaan Alting von Geusau1:14 Christiaan’s background and his dual US Dutch perspective4:00 Why Hungary matters and what makes its politics unique5:30 What happened in Hungary and why the wipeout was so large10:06 How Hungary’s electoral system magnified the result11:48 What happened to Fidesz and the Christian Democrats12:37 Why the new parliament is still entirely right of center16:00 The scandal that changed Hungarian politics18:20 Peter Magyar’s rise and political comeback20:00 Who Peter Magyar is and what he believes22:50 What changes Peter Magyar is likely to make24:00 The risks of governing with political newcomers28:50 What this means for Russia Ukraine and the EU34:33 Will Hungary remain culturally conservative36:34 Are Western media misreading the result41:06 Has Christiaan’s view changed since election night43:24 The economic challenges facing the new government44:04 Why revenge politics can damage a country48:03 Outro Hungary election, Viktor Orban, Peter Magyar, Christiaan Alting von Geusau, Fidesz, Christian Democrats, Hungary politics, European Union, Russia Ukraine war, democracy, conservatism, revenge politics, cultural conservatism, political transition, DC EKG About Our GuestDr. Christiaan Alting von Geusau is a lawyer, professor, advisor, and host of the podcast The Educated Leader. Born in the United States and raised in The Netherlands, he studied law at Leiden University and Heidelberg University and earned his doctorate in philosophy of law at the University of Vienna. He leads the International Catholic Legislators Network, serves as principal of Ambrose Advice, and is Rector emeritus and Professor for Philosophy of Law and Education at ITI Catholic University in Austria. Podcast: DC EKG with Joe GroganEpisode: 132Guest: Dr. Christiaan Alting von GeusauSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Stay on Course Studios – https://www.stayoncourse.studio

    49 min
  7. Apr 21

    Obamacare, HSAs, and Reference Pricing with Dr. John Goodman

    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

    46 min
5
out of 5
27 Ratings

About

Join former White House policy expert Joe Grogan as he cuts through the complexities of healthcare legislation and its real-world implications. Each episode of DC EKG aims to demystify the policies shaping our healthcare system, uncovering how these changes impact patients, providers, and payers across the country.

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