The Accad and Koka Report

Latest Episodes:

Ep. 86 Tales of a Recovering Hospital CEO Jul 16, 2019

Show notes

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.”

GUEST:

John Chamberlain. Twitter

LINKS:

Citizen Health’s website

SUPPORT THE SHOW:

Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 85 Trump’s 6/24 Executive Order: A Turning Point for Direct Primary Care? Jul 11, 2019

Show notes

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.

GUEST:

Lee Gross, MD. Twitter

LINKS:

The White House. Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First

DPC Action’s website

Lee Gross. Direct Primary Care Can Rein In America’s Out-of-Control Healthcare Costs (in the Washington Examiner)

Epiphany Health: Dr. Gross’ practice website

Doc 4 Patient Care Foundation’s website

RELATED EPISODE

Ep. 49. Why Are We Insuring primary Care? (with Dr. Lee Gross)

SUPPORT THE SHOW:

Make a small donation on our Patreon page and join our discussion group or receive a free book.

Ep. 84 “You’ll Be Dead in a Year!” A Patient’s Journey Through the Healthcare System Jul 03, 2019

Show notes

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.

SUPPORT THE SHOW:

Patreon.com/accadandkoka

Ep. 83 The Faulty Economics of Health Insurance: Arrow Revisited (Pt. 2) Jun 28, 2019

Show notes

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.

GUEST:

Robert P. Murphy: Website and Twitter

LINKS:

Kenneth Arrow. “Uncertainty and the Welfare Economics of Medical Care” (1963, in American Review of Economics)
Bob Murphy. Choice: Cooperation, Enterprise, and Human Action (2015)
Bob Murphy and Doug McGuff. Primal Prescription: Surviving the “Sick Care” Sinkhole (2015)
Bob Murphy. The Politically Incorrect Guide to Capitalism (2007)

SUPPORT THE SHOW:

Patreon.com/accadandkoka

Ep. 82 The Economics of Healthcare: Market Failure or Faulty Models? (Part 1) Jun 21, 2019

Show notes

Robert P. Murphy, PhD

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?

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.

GUEST:

Robert P. Murphy: Website and Twitter

LINKS:

Kenneth Arrow. “Uncertainty and the Welfare Economics of Medical Care” (1963, in American Review of Economics)
Bob Murphy. Choice: Cooperation, Enterprise, and Human Action (2015)
Bob Murphy and Doug McGuff. Primal Prescription: Surviving the “Sick Care” Sinkhole (2015)
Bob Murphy. The Politically Incorrect Guide to Capitalism (2007)

Ep. 81 The Opioid Epidemic: Is Pharma To Blame? Jun 15, 2019

Show notes

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.

GUEST:

J.J. Rich: Profile and Twitter

LINKS:

J.J. Rich and Robert Capodilupo. “Examining the Lawsuit Massachusetts Filed Against Purdue Pharma About the Opioids Problem.” (Reason, May 15, 2019)
Michael H. Levy. Pharmacologic Treatment of Cancer Pain (New Engl J Med, 1996)

RELATED EPISODE:

Ep. 68 The Opioid Epidemic: A Solo Physician’s Hopeful Response (with guest Molly Rutherford, MD)

Ep. 80 How To Rollback Bad Health Care Laws Jun 03, 2019

Show notes

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.

GUEST:

Marcelo Hochman, MD: Website and Twitter

LINKS:

Coalition to Repeal CON. 501c-4 organization founded by Dr. Hochman to repeal CON laws.

RELATED EPISODE:

Ep. 18 A Doctor Fights Against CON Laws, with guest Gajendra Singh, MD

Ep. 78 In the Footsteps of Donabedian: The US News and World Report Hospital Ranking System May 16, 2019

Show notes

Ben Harder

Quality ratings of hospitals and physicians: help or hindrance? Surely, the general public demands and is entitled to an assessment of hospital quality based on sound methodology. And ratings coming from the private sector are far more likely to be unbiased and to adjust to an ever changing healthcare landscape than those coming from the government and public policy sector. But is there a downside to scrutinizing the healthcare enterprise?

We have a fascinating conversation with one of the most knowledgeable persons on the topic. Ben Harder is Chief of Health Analysis and US News and World Report and oversees the team of analysts and statisticians who produce the most recognized ranking of hospitals in the country. Ben holds a Bachelor of Science in Biological Anthropology from Harvard University and began his career in health and science journalism before taking the job of quality czar at US News and World Report and

GUEST:

Ben Harder Twitter

LINKS:

An Expert on Health Care Evaluate his Own Case. New York Times 2001 interview of Avedis Donabedian

Avedis Donabedian. Evaluating the Quality of Medical Care (1966, Milbank Quarterly)

Anish Koka. The High Cost of Public Reporting (2017, in The Health Care Blog)

Michel Accad. Key Problems for Report Cards (2018, Accad & Koka blog)

RELATED EPISODE:

Ep. 19 Public Reporting: Necessary Evil or Harmful Fake News? (with guest Robert Yeh, MD)