We tackle issues that matter to doctors

Ep. 89 From Fortress to Frontier in American Health Care, with Bob Graboyes

Robert Graboyes, PhD

According to our guest, American health care is stuck in a fortress mentality that stifles innovation, constrains medical advances, and yield low quality care.  That fortress was erected more than 100 years ago but, in many ways, is being circumvented by creative actors who are seizing opportunities to make changes outside of the political process.

Bob Graboyes is Senior Research Fellow at the Mercatus Center at George Mason University.  He holds a PhD in Economics from Columbia University and has held a number of academic positions in higher education in Virginia.  He is the author of “Fortress and Frontier in American Health Care,” a booklet which offers many examples of individuals adopting a risk-tolerant frontier attitude to compete with insiders and pave the way to the future without having to rely on political reform.  Prior to focusing his career on health care, Bob Graboyes was regional economist/director of education at the Federal Reserve Bank of Richmond.

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Ep. 88 The Stupidity of the American Healthcare Consumer?

Dr. G. Keith Smith

The Affordable Care Act was allegedly passed thanks to “the stupidity of the American voter.”  The economist who made that claim—and who is also considered to be one of the architects of the law—has recently published a working paper that examines whether better informed patients make better healthcare decisions.  He and his colleagues conclude in the negative.

To help us gain a better perspective on that paper we’ve invited Dr. Keith Smith back to the show.  Dr. Smith is the co-founder of the Surgery Center of Oklahoma, a pioneering institution in free-market medicine.  As such, he has direct knowledge of the behavior of healthcare consumers and offers us his insights on the chasm that exists between the way healthcare policy makers conceive of medical practice and how ordinary patients actually seek the best possible healthcare value for themselves.

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Ep. 87 Trump’s 7/10 Executive Order: A Turning Point for Nephrology?

Joel Topf, MD

President Trump’s July 10, 2019 Executive Order on Advancing American Kidney Health may represent a major turning point in regard to how patients with chronic kidney disease are treated.  We have the pleasure of having as our guest Dr. Joel Topf.  Dr. Topf is a nephrologist in private practice and a popular blogger and leader in medical social media.  He is an adviser to the American Society of Nephrology and was present at the signing or the executive order.  He joins Anish Koka to share his insights on the good and bad of the executive order and on the state and future of kidney disease in the United States.

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Ep. 86 Tales of a Recovering Hospital CEO

John Chamberlain

Hospital executives with a conscience may have a tough time navigating the corrupting waters of our healthcare system.  Mr. John Chamberlain is a self-described “recovering” hospital CEO with over 35 years of experience as a hospital and physician practice executive.  In this interview with Anish Koka, he relates how his attempts to do right by the patient became increasingly arduous.

Mr. Chamberlain eventually saw the light of free market medicine and currently serves as Chairman for Citizen health, an organization dedicated to “rebuilding healthcare for the next generation.”

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Ep. 85 Trump’s 6/24 Executive Order: A Turning Point for Direct Primary Care?

Lee Gross, MD

President Trump’s June 24, 2019 Executive Order on health care transparency contains a key provision regarding direct primary care.  We have the pleasure of having back on the show Dr. Lee Gross.  Dr. Gross and colleagues in the DPC movements were instrumental in getting the White House to clarify a prior ambiguity regarding how direct primary care membership fees ought to be considered from a tax standpoint.  Dr. Gross will be telling us about this effort and about the implications of that change for the growth of the direct care movement.

Dr. Gross is a family physician in North Port, FL.  He is a pioneer and a leader in the DPC movement.  He is a health care consultant to physician practices, medical organizations, insurance groups, hospitals and private businesses. He founded and serves as President of the Docs 4 Patient Care Foundation and he is chairman of a new lobbying organization called DPC Action.

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Ep. 84 “You’ll Be Dead in a Year!” A Patient’s Journey Through the Healthcare System

Anish Koka, MD

What can we learn from the experience of a 90-year-old patient who is told point-blank “You’ll be dead in a year!” and who survives to tell the story?

This is a first of its kind in the annals of the Accad and Koka Report.  The episode starts with a 15-minute interview conducted by Dr. Koka of a patient of his, about her journey through the healthcare system.  After the interview, we have an in-depth conversation, prompted by the patient’s testimony, about what to take into consideration when making decisions for elderly patients who contemplate expensive and risky procedures.

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Ep. 83 The Faulty Economics of Health Insurance: Arrow Revisited (Pt. 2)

Robert P. Murphy, PhD

It is commonly believed that healthcare is a sector plagued by “market failure.” A heavy dose of government intervention is therefore necessary to optimize the needs of society. A paper most commonly cited in support of that view is one published in 1963 by Nobel Prize winner Kenneth Arrow, one of the giants of economic theory in the 20th century, and titled “Uncertainty and the Welfare Economics of Medical Care.”

But how does economic theory arrive at the concept of market failure and how do economists conceive of health care when they apply their theoretical models to medical practice?

To help sort this out, we have as our guest Robert P. Murphy, economist, teacher, and author of many books.  Dr. Murphy obtained his PhD from NYU and is Senior Fellow at the Mises Institute.  He is co-host, with Tom Woods, of the popular podcast Contra Krugman and he is also host of The Bob Murphy Show, “a podcast promoting free markets, free minds, and grateful souls.”

The episode in in 2 parts.  In the first part, we reviewed the theoretical framework that forms the background to Arrow’s paper.  In this second part, we delve into the paper itself, discuss how economists conceive (or misconceive) of medical care, and what the implications have been for the US healthcare system as a whole.

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Ep. 82 The Economics of Healthcare: Market Failure or Faulty Models? (Part 1)

Robert P. Murphy, PhD

It is commonly believed that healthcare is a sector plagued by “market failure.” A heavy dose of government intervention is therefore necessary to optimize the needs of society. A paper most commonly cited in support of that view is one published in 1963 by Nobel Prize winner Kenneth Arrow, one of the giants of economic theory in the 20th century, and titled “Uncertainty and the Welfare Economics of Medical Care.”

But how does economic theory arrive at the concept of market failure and how do economists conceive of health care when they apply their theoretical models to medical practice?

To help sort this out, we have as our guest Robert P. Murphy, economist, teacher, and author of many books.  Dr. Murphy obtained his PhD from NYU and is Senior Fellow at the Mises Institute.  He is co-host, with Tom Woods, of the popular podcast Contra Krugman and he is also host of The Bob Murphy Show, “a podcast promoting free markets, free minds, and grateful souls.”

The episode in in 2 parts.  In this first part, we review the theoretical framework that forms the background to Arrow’s paper.  In the upcoming second part, we will delve into the paper itself, discuss how economists conceive (or misconceive) of medical care and what the implications have been for the US healthcare system as a whole.

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Ep. 81 The Opioid Epidemic: Is Pharma To Blame?

J.J. Rich

The Commonwealth of Massachusetts’ lawsuit against Purdue Pharmaceuticals exemplifies a common narrative that lays a large part of the blame for the opioid epidemic at the feet of the manufacturer of prescription opioids for manipulating physicians into prescribing the drugs more liberally.  Is there merit to that story?

To examine that question, we have as our guest Jacob James Rich, a policy analyst at Reason Foundation.  Mr. Rich holds master’s degrees in economics and mathematics from Eastern Michigan University.  Prior to joining Reason, he conducted research for the Cato Institute focused on opioids and the drug war.

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Ep. 80 How To Rollback Bad Health Care Laws

Marcelo Hochman, MD

Is the healthcare mess so hopeless that physicians should either leave it or wait for it to collapse?  Are there legislative steps that doctors can take to tangibly improve the practice of medicine?  And, if so, how should physicians act within the problematic framework of “organized medicine” to bring about such changes?

Our guest is Dr. Marcelo Hochman, who is sharing with us some hopeful successes in introducing important legislation by working in conjunction with his local and state medical societies.   The 3 issues he has focused on are 1) a repeal of certificate-of-need laws, 2) a ruling against “non-compete clauses” in physician contracts, and 3) a tax deduction for charitable work provided by physicians.  All 3 issues appeal to the notion that expanding the settings in which physicians can be free to practice will benefit both doctors and society.

Dr. Hochman is an independent solo pediatric facial plastic surgeon who practices in Charleston, South Carolina.  He has specialized in the treatment of congenital vascular anomalies.  He is a recipient of the Order of the Palmetto, South Carolina’s highest civilian award, and of other national and local professional and community honors. He currently serves as the President of the Charleston County Medical Society, as Chair of the Coalition to Repeal  CON (Certificate of Need),  and as Director of The Hemangioma Treatment Foundation.

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