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Original Substack Release Date: Â June 14th, 2025
🎯 Why Listen
When the New England Journal of Medicine claims that direct primary care threatens the “common good,” four practicing physicians step into the ring. This episode isn’t just a rebuttal, it’s a full-throated defense of medical freedom, patient choice, and the future of primary care. If you want to understand how Medicaid has morphed from a safety net into a subsidy machine—and why academics and policymakers are terrified of patients controlling their own dollars—this episode is essential.
Co-Hosts
- Dutch Rojas – Founder, Bliksem HealthÂ
- Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
- Anish Koka, MD – Cardiologist, Philadelphia; healthcare policy commentator
- Dan Choi, MD, FAAOS – Orthopedic spine surgeon, Long Island; healthcare advocate and social media voice
- Sanat Dixit, MD, FACS – Neurosurgeon, Huntsville, AL; Faculty, Vanderbilt University; healthcare entrepreneur
Episode Overview
- The NEJM op-ed that sparked outrage: framing DPC as a social harm while ignoring why doctors are leaving the insurance system.
- Why direct primary care isn’t boutique medicine—it’s an economic correction to price-fixing and burnout.
- The Medicaid industrial complex: how states and managed care organizations profit while patients wait for access.
- Real numbers: Centene makes ~$18,000 per member annually, while primary care doctors earn less than plumbers.
- State-level gaming: double enrollment, lax verification, and taxpayer waste.
- A better alternative: DPC + catastrophic coverage + HSAs at less than $7,000/year.
- The hypocrisy of policy academics: designing broken payment systems, then blaming practicing physicians for opting out.
Notable Quotes
- “Primary care doctors are getting paid less than plumbers—and somehow they’re the ones being blamed.” - Dr. Dan ChoiÂ
- “If Medicaid were truly a safety net, why are insurers profiting like it’s Wall Street?” - Dr. Dan ChoiÂ
- “The moment patients control the money, the system collapses—and that’s what terrifies them.” - Dr. Dan ChoiÂ
What You’ll Learn
- Why the NEJM perspective on DPC gets the economics wrong.
- How Medicaid expansion shifted from safety net to subsidy scheme.
- The real cost of managed Medicaid—and who profits most.
- Why HSAs and direct primary care offer a scalable, patient-centered alternative.
- How academic medicine fuels policy myths that widen access gaps.
The Episode (Timestamps)
- 00:00 – Opening banter and NEJM op-ed overview
- 02:00 – The ideology behind calling primary care a “common good”
- 06:00 – Economics of primary care and why DPC emerged
- 10:00 – Medicaid’s expansion: safety net or single-payer on training wheels?
- 20:00 – State-level gaming and provider tax loopholes
- 29:00 – DPC + catastrophic plan + HSA: a viable alternative
- 38:00 – Manage
đź”— Connect with the Hosts:
• Dutch Rojas on X
• Dr. Anthony DiGiorgio on X
• Dr. Anish Koka on X
• Dr. Dan Choi on X
• Dr. Sanat Dixit on X
