Dr. Ashish Jha on how to Actually Fix Healthcare and the Future of Medicine

Dr. Ashish Jha on how to Actually Fix Healthcare and the Future of Medicine

Are we any more prepared for the next pandemic than we were in 2019? In this episode of Good Medicine, Dr. Rohan Ramakrishna sits down with Dr. Ashish Jha — the former White House COVID-19 Response Coordinator and former dean of the Brown University School of Public Health — for a candid conversation about the risks we're ignoring and the health system we can still fix. Jha recalls the phone call from President Biden, explains why he left academia to build an AI-powered biodetection system against engineered pathogens, and warns what US withdrawal from the WHO really costs. Then he unpacks his ten-part Boston Globe series on bending the health care cost curve: hospital consolidation and site-neutral payments, capping commercial prices, nonprofit hospital status, prior authorization, administrative waste, value-based care, GLP-1s, and expanding scope of practice. Along the way he makes a deliberately bipartisan case designed to annoy everyone a little. A conversation about medicine, public health, AI, and affordability. New episodes are released monthly, wherever you get your podcasts. For more from Roon, visit: https://www.roon.com/ Sign up for our substack: https://rohanramakrishna.substack.com/ Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care. (00:00) Intro (00:26) Getting the call to join the White House (03:15) What he loved and found hard about government (06:21) Defending policies he personally disagreed with (07:33) Are we ready for the next pandemic? (09:46) CDC cuts and leaving the WHO (10:50) Building AI-driven biodetection (13:16) The Boston Globe series: why he wrote it (17:18) Is rising health care spending actually a problem? (19:33) Hospital consolidation and market power (22:20) Site-neutral payments (23:48) Should hospitals lose nonprofit status? (26:34) Medicare, Medicaid, and capping commercial prices (29:28) Making sure savings reach patients (31:30) Insurance across state lines and vertical integration (34:39) What makes value-based care actually work (37:08) Prevention, GLP-1s, and long payoff timelines (39:13) End-of-life care and marginal therapies (42:59) Prior authorization and administrative waste (45:07) Fixing the broken claims and billing system (47:43) The future of independent physicians (49:50) Regulation and its unintended effects (51:46) Scope of practice and the physician shortage (55:39) AI, malpractice, and physician-level care (57:09) Quick Hits: restaurants, books, and mentors

Dr. Ashwin Vasan on Public Health as a Moral Endeavor

What happens when a doctor trained to fight HIV in rural Uganda takes charge of public health for the largest city in America? In this episode of Good Medicine, Dr. Rohan Ramakrishna sits down with Dr. Ashwin Vasan, the 44th Health Commissioner of New York City, whose path ran from trailing his immigrant neonatologist mother through Chicago's ICUs to delivering AIDS treatment alongside mentors Paul Farmer and Jim Kim. Vasan reflects on the WHO, PEPFAR, and the real promise of ending AIDS in our lifetime, then turns to the hardest years of his career: leading the NYC Health Department through the pandemic's backlash, launching HealthyNYC to reverse falling life expectancy, confronting Black maternal mortality, and building TeenSpace for youth mental health. He also makes a candid case on the MAHA movement, nutrition, and taking on the corporate food system. A conversation about medicine, public health, AI, and why health is fundamentally a moral project. New episodes are released every other week, wherever you get your podcasts. For more from Roon, visit: https://www.roon.com/ Sign up for our substack: https://rohanramakrishna.substack.com/ Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care. (00:00) Intro (03:02) Trailing his mom through Chicago's ICUs (05:05) The immigrant physician's contribution to American medicine (08:41) From development economics to public health (12:54) Partners In Health in Uganda, Rwanda, and Lesotho (14:31) The beat-up Camry and a Jay-Z playlist (16:30) Building trust with patient communities (18:45) Inside the WHO and the case for reform (22:52) Can global health delivery survive US funding cuts? (26:35) PEPFAR, lenacapavir, and ending AIDS in our lifetime (29:42) Why public health is a moral endeavor (31:57) The call from Mary Bassett to join NYC Health (35:49) What surprised him as Health Commissioner (38:57) Protesters at home and his daughter's wisdom (41:31) Launching HealthyNYC and a life expectancy North Star (48:03) Confronting Black maternal mortality (51:35) Why healthcare affordability is a public health issue (53:16) Hospital price transparency and medical debt (56:12) TeenSpace and the youth mental health crisis (01:01:53) AI as prevention infrastructure (01:04:14) Modernizing public health data systems (01:07:46) MAHA, nutrition, and where medicine dropped the ball (01:13:14) Would he work with RFK Jr.'s HHS? (01:15:41) Quick Hits: mandates, mentors, and book picks (01:18:19) Why a physician community like Roon matters

Dr. Jim Kim on Bending the Arc of Global Health

What if the impossible is just an argument waiting to be lost? Dr. Jim Kim — co-founder of Partners In Health alongside Paul Farmer, former president of the World Bank, former president of Dartmouth College, and former head of HIV/AIDS at the World Health Organization — joins Dr. Rohan Ramakrishna and Vikram Bhaskaran for a sweeping conversation that traces the birth of the modern global health movement. From his childhood as the son of Korean refugees in a small Iowa farming town, to smuggling sputum samples through Miami customs, to the landmark Gates Foundation grant that cracked open multidrug-resistant tuberculosis treatment for the world's poorest, Dr. Kim shows how a handful of stubborn idealists bent the arc of history and saved millions of lives. He also reflects on what anthropology taught him about power, why the fight to treat HIV in Africa mattered, and how the dismantling of USAID and the rise of anti-science sentiment are forcing a new generation of physicians to scheme, plot, and reclaim their role as the natural attorneys of the poor. New episodes released wherever you get your podcasts. For more from Roon, visit: ⁠https://www.roon.com/⁠ Sign up for our substack: ⁠https://rohanramakrishna.substack.com/⁠ Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care. -- (00:00) Intro (03:32) Welcome to Good Medicine, Dr. Jim Kim (04:22) Korean refugee parents and a childhood in Iowa (09:17) Muscatine, civil rights, and an early sense of justice (11:30) Quarterback of a 56-game losing streak (12:20) Summer science camp and finding his tribe (14:34) Look in the mirror — his father's reality check (17:19) Anthropology, Arthur Kleinman, and the MD-PhD path (19:59) What anthropology taught him about every room (22:25) The village idiot among economists at the World Bank (24:39) His mother, Zhu Xi, and a friendship with Xi Jinping (28:06) Meeting Paul Farmer and founding Partners In Health (33:18) From Haiti to a squatter settlement in Lima (35:25) An MDR-TB outbreak nobody wanted to admit (38:19) Why the global health establishment pushed back (42:30) The sputum mule and the Massachusetts State Lab (46:46) If we fail, this will be off the table (47:45) Bill Foege, Bill Gates, and the $45 million grant (50:00) HIV is next — and the Lazarus effect (52:00) Fighting the same battle to treat HIV in Africa (54:00) Pool purchasing, ACT UP, and the path to PEPFAR (56:35) Winning the WHO and launching 3 by 5 (1:00:28) The new crisis in global health funding (1:01:42) The arc of history doesn't bend on its own (1:08:24) How young physicians can get started today (1:10:25) Mental health, cancer care, and Rwanda (1:14:16) Why Roon could be world-changing (1:19:06) Lightning round: books, leaders, one wish (1:22:19) Physicians as the natural attorneys of the poor

Dr. Anthony Fauci: A Lifetime of Service and Impact

What does it look like to be in the room — and sometimes at the center of the fire — for every major public health crisis of the last 50 years? Dr. Anthony Fauci, former Director of the National Institute of Allergy and Infectious Diseases and advisor to seven U.S. Presidents, joins Dr. Rohan Ramakrishna for a sweeping conversation that spans a Brooklyn pharmacy, the first AIDS wards, the Situation Room, and the front lines of COVID.Dr. Fauci traces the unlikely arc from delivering prescriptions on a Schwinn bike in Bensonhurst to architecting PEPFAR — the most successful global health program in history, credited with saving 26 million lives. He reflects candidly on his famous adversarial-turned-collaborative relationship with activist Larry Kramer, how that changed the way clinical trials are run in America, and why the scientific community needs a louder collective voice. He also addresses the Great Barrington Declaration, the vitriol of the COVID years, and what it means — as both a physician and a public servant — to tell the truth when people don't want to hear it. And he shares his deep concern about what's happening right now to the institutions he spent a lifetime building.New episodes are released every other week, wherever you get your podcasts. If you’re a US-based physician, continue the conversation with Dr. Fauci on Roon, visit: www.roon.com Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care -- (00:00) Intro (02:54) Welcome — Dr. Anthony Fauci (03:12) Growing up in Brooklyn: A family pharmacy and a calling (05:52) The Classics, the Jesuits, and a philosophy degree (07:43) Why he chose the NIH over private practice (10:38) Early career: Vasculitides and the bench-to-bedside approach (11:05) How treating rare autoimmune disease shaped his HIV work (13:41) The first AIDS patients at the NIH (1981) (15:07) Pivoting his career entirely to HIV/AIDS (18:06) Becoming director of NIAID — a job he didn't want (20:31) Advising seven presidents: The feeling of the Oval Office (21:30) The moment Bush commissioned PEPFAR (22:59) PEPFAR: 26 million lives saved (24:41) The contrast with today's global health commitments (27:06) The Godfather, Bethesda, and the secret PEPFAR meeting (31:16) PEPFAR's uncertain future under the current administration (34:12) Can other countries fill the U.S. funding gap? (36:20) Larry Kramer and the HIV activist community (39:00) Listening instead of running: The decision that changed everything (40:40) How activism permanently changed clinical trials and the FDA (44:33) Is an HIV vaccine possible? (46:30) The tools we already have to end the epidemic (48:34) COVID: How quickly mRNA became the obvious platform (50:41) Lessons from Operation Warp Speed (52:59) Buying doses before knowing if the vaccine worked (53:53) What the Great Barrington Declaration got fundamentally wrong (57:15) Handling years of personal attacks and vitriol (1:00:05) Did the broader medical community let him down? (1:01:40) The need for doctors to speak up — measles as a warning (1:02:38) An impassioned defense of the NIH (1:04:21) Quick Hits: Book recommendations (1:05:47) Most impactful mentor: Sheldon Wolff (1:06:29) Most inspiring leader: Nelson Mandela (1:07:16) Closing

Dr. Mandy Cohen on Fixing the Broken Systems of Public Health

What does it actually take to fix a broken health system — and what happens when the progress you've built starts to unravel? Dr. Mandy Cohen, former CDC Director, former Secretary of the North Carolina Department of Health and Human Services, and longtime leader at the Centers for Medicare and Medicaid Services, joins Dr. Rohan Ramakrishna for a wide-ranging conversation on what it means to lead at the intersection of medicine, policy, and operations. Dr. Cohen traces her journey from accidental operator during the HealthCare.gov crisis to architect of one of the country's most ambitious social determinants of health programs in North Carolina — and ultimately to the helm of the CDC during its most consequential rebuilding effort in decades. She speaks candidly about the promise and limits of value-based care, the systemic importance of primary care–led ACOs, and why she's deeply concerned about the current state of vaccine infrastructure. She also shares her framework for building public trust — transparency, relationships, and results — and why getting the payment models right is the only way AI will actually improve health outcomes rather than just optimize revenue. New episodes are released every other week, wherever you get your podcasts. For more from Roon, visit: ⁠https://www.roon.com/⁠ [https://www.roon.com/%E2%81%A0] Sign up for our substack: ⁠https://rohanramakrishna.substack.com/⁠ [https://rohanramakrishna.substack.com/%E2%81%A0] Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care -- (00:00) Intro (03:15) Welcome — Dr. Mandy Cohen (03:37) Why she went into public service (06:06) Discovering she was an operator: The HealthCare.gov crisis (08:30) The limits of ambition in government (10:40) Coalition building as a leadership tool (11:51) The origins of value-based care and CMMI (13:45) The case for primary care-led ACOs (16:31) Physician-led vs. hospital-led value programs (17:22) The complexity problem in programs like TEAM (19:10) Blood pressure control as a key intervention (20:25) Day one as NC Secretary of Health and Human Services (22:15) Rebuilding culture before setting priorities (23:30) Working across the aisle in North Carolina (25:11) The Healthy Opportunities Pilot: Social determinants at scale (26:53) Navigation as the highest-impact intervention (28:57) Behavior change and the limits of education programs (30:39) Coalition building for social determinants policy (33:26) Lessons that other states have learned from NC (34:13) Arriving at the CDC post-COVID (36:10) Modernizing siloed data systems (38:00) Rebuilding the CDC's lab infrastructure with private sector (40:01) Where pandemic preparedness stands today (42:55) The return of measles — and what it means (43:58) How Dr. Cohen rebuilt public trust during COVID (46:30) Trust in three parts: Transparency, relationships, results (49:05) Advising health systems on AI (51:00) Payment models and the AI trap (52:54) AI tools she's excited about (55:13) How health systems should evaluate AI vendors (58:31) Does Epic have too much power? (1:00:20) Paying for outcomes, not activity (1:03:22) Doctors building their own tools (1:04:42) Leadership philosophy for change management (1:08:30) Making hard calls that will upset people (1:10:54) Communicating under uncertainty (1:13:58) What the medical community should have done differently (1:17:17) Quick Hits: Mentors, books, and inspiring leaders (1:20:08) Guest recommendation for Good Medicine (1:20:39) Closing