Tom Barker on The Truth About Drug Pricing Policy

Tom Barker on The Truth About Drug Pricing Policy

In Episode 136 of DC EKG, Joe Grogan hosts Tom Barker, a top drug-pricing attorney at Foley Hoag and former acting general counsel of Health and Human Services (HHS) under the Bush administration. Tom helped implement Medicare Part D and now advises drugmakers and policymakers on complex pricing issues. The episode traces 20 years of policy: what went right with Part D, what the Inflation Reduction Act (IRA) did, and what effective policy should look like. Tom explains that Part D's success rested on three pillars: private plans only, limited government control over benefit design, and a non-interference clause barring the government from intervening in negotiations among plans, pharmacies, and manufacturers. Competition worked and premiums stayed low, until the government asserted more control and weakened those pillars. The IRA, he argues, was a 16-year Democratic effort to repeal non-interference, creating price controls disguised as negotiations. The Trump administration has taken a different tack, focusing not on the IRA but on MFN and Globe Guard models pegged to other developed countries. Tom also breaks down the 340B program, now the country's second-largest expenditure program, and the fight between manufacturers and covered entities over contract pharmacies. His prescription is simple: let competition work. Speed FDA approval of generics and biosimilars, and trust the marketplace over price controls. He points to hepatitis C, where prices fell sharply once competition entered. In This Conversation The three pillars that made Part D successful for 20 years How non-interference kept government from setting drug prices The IRA as a 16-year Democratic push to repeal non-interference Why Tom calls the IRA price controls disguised as negotiations The Trump administration's focus on MFN and Globe Guard pricing 340B and the battle between manufacturers and covered entities The Chevron repeal's impact on drug pricing law HRSA's proposed rebate model and ongoing 340B litigation Why effective policy means competition, not controls Tom's work helping North Korean defectors and refugees Key Timestamps 1:51 Tom's background at HHS and CMS 2:30 The three pillars of Part D's success 5:10 Why Democrats wanted to repeal non-interference 5:55 Ted Kennedy's compromise and bipartisan votes 11:38 The IRA as a 16-year repeal attempt 12:03 What the IRA changed in Part D 15:02 IRA negotiations vs. real negotiations 16:25 How the excise tax makes it no real negotiation 21:32 Trump's focus on MFN and Globe Guard 25:37 340B's history back to 1991 28:45 340B as the second-biggest expenditure program 29:30 Manufacturer vs. covered-entity acrimony 33:18 The Chevron repeal's impact on pricing 34:54 HRSA's rebate model, the next step on 340B 35:40 The lawsuit over "patient" in 340B 38:18 Tom's advice: let competition work 39:30 Hepatitis C: competition drives prices down 40:34 Competition for gene therapies and CRISPR 41:36 Tom's work for North Korean defectors 44:49 Sponsoring Free North Korea Radio Medicare Part D, drug pricing policy, Inflation Reduction Act, non-interference clause, 340B program, MFN pricing, Globe Guard pricing, pharmacy benefit managers, covered entities, contract pharmacies, biosimilars, generics, federal drug pricing, government price controls, Tom Barker About the Guest Tom Barker is a partner at Foley Hoag in Washington, DC, and one of the country's top drug pricing attorneys. He served as acting general counsel of HHS and chief legal officer at CMS under the Bush administration, where he helped implement Part D from its inception. He is now a go-to expert on drug pricing, and helps North Korean defectors navigate US immigration law. Podcast: DC EKG with Joe Grogan Episode: 136 Guest: Tom Barker Sponsor: Survivors for Solutions - https://survivorsforsolutions.org [https://survivorsforsolutions.org] Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios - https://www.stayoncourse.studio [https://www.stayoncourse.studio]

Dr. Mark McClellan on How FDA and CMS Should Work Together

Dr. Redfield's Warning: Hantavirus| Bird Flu| Long COVID and More

In Episode 134 of DC EKG, former CDC Director Dr. Robert Redfield joins Joe Grogan to discuss his new book, Redfield's Warning, and break down three major threats to public health: Long COVID, Hantavirus, and bird flu. Dr. Redfield explains the persistent viral reservoirs in long COVID patients, the cognitive dysfunction and autonomic dysfunction that devastate these individuals, and why the federal government must partner with the private sector to develop meaningful treatments. He also walks through the current Hantavirus outbreak on a cruise ship, the human-to-human transmission of the Andes virus strain, and why bird flu is the most likely candidate for the next pandemic. Throughout, Dr. Redfield emphasizes the critical importance of antiviral development and the dangers of gain-of-function research. In This Conversation The current Hantavirus outbreak on a cruise ship and human-to-human transmission The Andes virus strain and why it differs from Sin Nombre and Four Corners Disease Two transmission routes: aerosolization and direct contamination Asymptomatic transmission and the intrinsic bias in testing Why has the US government not developed Hantavirus countermeasures in 70 years Bird flu is the most likely candidate for the next pandemic. Gain-of-function research and the public disclosure of dangerous genetic data Long COVID: viral reservoirs and the need for effective antiviral treatments Why antivirals should be the priority over vaccines for emerging viruses Operation Warp Speed and the importance of private sector partnerships The dismissal of long COVID patients as psychosomatic and the need for validation Key Timestamps 1:49  Details of the Hantavirus outbreak and cruise ship cases 3:00  Two methods of transmission: aerosolization and direct contamination 5:24  Asymptomatic transmission and testing bias 10:35  The Hantavirus family and why the Andes virus goes from human to human 12:35  How nervous should the public be 16:43  Shifting to bird flu and Redfield's Warning 19:00  Bird flu spread in US poultry and mammal populations 22:00  The four amino acids for bird flu to infect humans 23:30  The debate with Fauci over gain-of-function research 27:55  Unregulated gain-of-function research worldwide 33:35  Why antivirals should be the priority 37:55  Long COVID viral reservoirs and treatment gaps 42:37  The economic burden and need for solutions 43:57  The story of Joy and psychiatric misdiagnosis of long COVID 48:12  The solvability of long COVID and the importance of investing Hantavirus, Hantavirus transmission, Andes virus, Sin Nombre virus, Four Corners Disease, cruise ship outbreak, bird flu, avian influenza, gain of function research, Dr. Robert Redfield, CDC Director, antivirals, vaccines, long COVID, pandemic preparedness, infectious disease, virology, Redfield's Warning About the Guest Dr. Robert Redfield is the former Director of the Centers for Disease Control and Prevention. A trained virologist with decades of experience in infectious disease, he has been a leading voice on public health policy, pandemic preparedness, and biosecurity. He is the author of Redfield's Warning: What I Learned as CDC Director and What We Must Do to Be Prepared for the Next Pandemic, available on Amazon: https://www.amazon.com/Redfields-Warning-Learned-Couldnt-Might/dp/1510785051 Podcast: DC EKG with Joe Grogan Episode: 134 Guest: Dr. Robert Redfield, former CDC Director Sponsor: Survivors for Solutions –  https://survivorsforsolutions.org [https://survivorsforsolutions.org] Executive Producer: John "CZ" Czwartacki, DC EKG Podcast Producer: Stay on Course Studios –  https://www.stayoncourse.studio [https://www.stayoncourse.studio]

The European Union Explained with Christiaan Alting von Geusau

In Episode 133 of DC EKG, Joe Grogan welcomes back Dr. Christiaan Alting von Geusau for Part 2 of their conversation, this time turning to the European Union. Christiaan walks Joe through the post-World War II origins of the EU as a peace initiative built around the Schuman Plan, the pooling of coal and steel between France and Germany, and the visionary leadership of Robert Schuman and Konrad Adenauer. He explains why understanding the EU's founding purpose is essential to understanding what has gone wrong since. Joe and Christiaan unpack the principle of subsidiarity, the rise of EU bureaucracy and over-regulation, the ideological capture of Brussels institutions, and the long detour into cultural battles that were never the EU's job to fight. They discuss Germany's strategic mistake of abandoning nuclear energy, the widening economic gap between the US and Europe, and why Friedrich Merz himself has called the EU the world champion of over-regulation. The second half of the episode looks at the US-EU relationship under President Trump's second term, including the Digital Services Act and free speech, decades of European free-riding on American defense, and the rise of bilateral engagement between Washington and individual European capitals. The conversation closes with a sharp discussion of the leadership vacuum across the West and Europe's growing economic dependence on China. In This Conversation How the European Union began as a Franco-German peace project Why the Schuman Plan and the pooling of coal and steel still shape Europe today The principle of subsidiarity and how Brussels has overstepped it Why Germany's abandonment of nuclear energy was a strategic disaster How EU institutions have been captured by ideology The Digital Services Act and the threat to free speech in Europe Why the US-EU relationship is under serious strain Whether Washington should deal with Brussels or with national capitals Europe's leadership vacuum and growing dependence on China Timestamps 0:00  Why Brussels has become the global champion of over-regulation 1:10  Joe welcomes back Christiaan for Part 2 1:32  Christiaan reintroduces himself and his background 3:00  Why the EU is misunderstood on both sides of the Atlantic 4:15  The historical origins of the EU and the Franco-German conflict 6:00  The Schuman Plan and the pooling of coal and steel 11:30  Truman, the Marshall Plan, and Dean Acheson 12:37  What went wrong with the EU 14:50  Bureaucracy, nuclear energy, and the German mistake 19:35  The principle of subsidiarity and why it matters 23:24  Cultural overreach by Brussels 26:44  Friedrich Merz on EU over-regulation 27:28  The widening US-EU economic gap 32:03  Free speech, the Digital Services Act, and Trump 38:33  European free-riding on American defense 44:07  Should Washington bypass Brussels 48:30  The rise of bilateral engagement 51:23  The leadership vacuum across the West 58:30  Europe's economic dependence on China 1:01:12  Wrap-up European Union, EU history, Schuman Plan, Franco-German conflict, subsidiarity, EU bureaucracy, EU overregulation, German nuclear energy, Digital Services Act, free speech Europe, US-EU relations, Trump and the EU, NATO defense spending, Europe-China dependence, transatlantic relationship, Christiaan Alting von Geusau, DC EKG About Our Guest Dr. Christiaan Alting von Geusau is a lawyer, professor, advisor, and host of the podcast The Educated Leader. Born in the United States and raised in the Netherlands, he studied law at Leiden University and Heidelberg University. He earned his doctorate in philosophy of law at the University of Vienna. He leads the International Catholic Legislators Network, serves as the principal of Ambrose Advice, and is the Rector emeritus and Professor of Philosophy of Law and Education at ITI Catholic University in Austria. Podcast: DC EKG with Joe Grogan Episode: 133 Guest: Dr. Christiaan Alting von Geusau Sponsor: Survivors for Solutions –  https://survivorsforsolutions.org [https://survivorsforsolutions.org] Executive Producer: John “CZ” Czwartacki, DC EKG Podcast Producer: Stay on Course Studios –  https://www.stayoncourse.studio [https://www.stayoncourse.studio]

Hungary Election After Orban with Christiaan Alting von Geusau

In Episode 132 of DC EKG, Joe Grogan sits down with Dr. Christiaan Alting von Geusau for a timely discussion on Hungary’s election, Viktor Orbán’s loss, and what comes next under Peter Magyar. Christiaan explains why the size of the election wipeout surprised even seasoned observers, why the mainstream narrative about democracy in Hungary misses key facts, and why the new Hungarian parliament remains entirely on the right side of the political spectrum.  Joe and Christiaan break down the structure of Hungary’s political system, the collapse of Orbán’s long-running coalition, the rise of Peter Magyar out of a political scandal, and the challenge of governing with a brand new party full of political newcomers. They also discuss whether Western media is misreading the result as a rejection of conservatism and why the more important question may be whether the new government has the experience to govern effectively.  The second half of the episode turns to Hungary’s position on Russia and Ukraine, the country’s cultural conservatism, the future of its relationship with the European Union, and the dangers of revenge politics after a major political transition. This is a wide-ranging conversation on democracy, power, media narratives, and the future of Hungary in Europe.  In This Conversation What happened in Hungary and why Orbán lost so badly Who Peter Magyar is and why his rise shocked the political class Why Hungary’s new parliament is still entirely right of center What the election means for democracy and conservatism Hungary’s position on Russia Ukraine and the European Union Why the competence of the new government may matter more than ideology The risks of revenge politics after a major political transition Timestamps0:00 Is Hungary’s election really a repudiation of conservatism0:55 Joe welcomes Christiaan Alting von Geusau1:14 Christiaan’s background and his dual US Dutch perspective4:00 Why Hungary matters and what makes its politics unique5:30 What happened in Hungary and why the wipeout was so large10:06 How Hungary’s electoral system magnified the result11:48 What happened to Fidesz and the Christian Democrats12:37 Why the new parliament is still entirely right of center16:00 The scandal that changed Hungarian politics18:20 Peter Magyar’s rise and political comeback20:00 Who Peter Magyar is and what he believes22:50 What changes Peter Magyar is likely to make24:00 The risks of governing with political newcomers28:50 What this means for Russia Ukraine and the EU34:33 Will Hungary remain culturally conservative36:34 Are Western media misreading the result41:06 Has Christiaan’s view changed since election night43:24 The economic challenges facing the new government44:04 Why revenge politics can damage a country48:03 Outro Hungary election, Viktor Orban, Peter Magyar, Christiaan Alting von Geusau, Fidesz, Christian Democrats, Hungary politics, European Union, Russia Ukraine war, democracy, conservatism, revenge politics, cultural conservatism, political transition, DC EKG About Our GuestDr. Christiaan Alting von Geusau is a lawyer, professor, advisor, and host of the podcast The Educated Leader. Born in the United States and raised in The Netherlands, he studied law at Leiden University and Heidelberg University and earned his doctorate in philosophy of law at the University of Vienna. He leads the International Catholic Legislators Network, serves as principal of Ambrose Advice, and is Rector emeritus and Professor for Philosophy of Law and Education at ITI Catholic University in Austria. Podcast: DC EKG with Joe GroganEpisode: 132Guest: Dr. Christiaan Alting von GeusauSponsor: Survivors for Solutions – https://survivorsforsolutions.org [https://survivorsforsolutions.org]Executive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer: Stay on Course Studios – https://www.stayoncourse.studio [https://www.stayoncourse.studio]