Enforcement, Arbitration, and the Fight to Keep Independent Medicine Alive

Original Substack Release Date:  August 29, 2025

🎯 Why Listen

Heard “surprise billing” blamed on doctors? This episode shows how insurers shaped the narrative, how the No Surprises Act (NSA) was meant to protect patients, why weak enforcement broke it, and what Rep. Greg Murphy’s No Surprises Enforcement Act could fix.

👥 Co-Hosts

• Dutch Rojas – Founder, Bliksem Health
• Anthony DiGiorgio, DO, MHA – Neurosurgeon, UCSF; health policy researcher
• Anish Koka, MD – Cardiologist; healthcare policy commentator
• Dan Choi, MD, FAAOS – Orthopedic spine surgeon; healthcare advocate
• Sanat Dixit, MD, FACS – Neurosurgeon; Faculty, Vanderbilt; entrepreneur

📌 Episode Overview

The insurer-made “surprise billing” label and how network design boxes out small practices.

• NY arbitration (market-based, patient kept out) vs CA benchmarking (median in-network → narrower networks).
• The gap: doctors win arbitrations; insurers don’t pay. Murphy’s bill adds deadlines and penalties.
• Plus: FDA leadership, gene therapy tradeoffs (safety vs efficacy, tiny trials, huge prices), and a quick take on homelessness policy and harm reduction.

💬 Notable Quotes

• “‘Surprise billing’ was insurer spin for an insurer problem.”
• “If you can’t charge fair market rates, you can’t stay independent.”
• “Science doesn’t have a left or right—only signals to read.”

📚 What You’ll Learn

• How network contracting disadvantages small practices.
• Why arbitration design changes insurer behavior.
• How enforcement determines whether NSA works.
• The real-world costs and evidence hurdles of gene therapies.
• Ways practicing physicians can still shape policy.

⏱ The Episode (Timestamps)

• 00:00–03:30 Order vs. healthcare chaos
• 03:30–09:30 Why clinicians wade into policy
• 10:00–13:30 In-network vs. out-of-network
• 13:30–19:00 “Surprise bills” demystified
• 19:00–23:45 NY arbitration vs. CA benchmarking
• 26:30–33:15 The NSA enforcement problem & Murphy’s fix
• 33:15–41:30 FDA, Vinay Prasad, Duchenne gene therapy
• 56:00–1:04:00 Homelessness policy: housing-first vs. institutional care

🔗 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