Healthcare Trailblazers

The episode contains a solid cluster of policy-specific data points and non-obvious mechanisms (incentive alignment in drug pricing, the PACs vs. EHR adoption contrast, prior auth cost estimates), but a significant portion of runtime is consumed by the host pitching his own company Careco, pleasantries, and explanatory background that any attentive healthcare operator would already know.

“Currently, they estimate that about 125,000 deaths a year are attributable to non compliance with medication. Um, and that non compliance is oftentimes informed by patients not being able to afford the medication.”

“we estimate that it costs about $2 billion a year in administrative time, uh, getting prior authorization for care that a, uh, doctor has prescribed for a patient.”

The sharpest original insight is the PACs-vs-EHR adoption comparison (market-driven universal adoption in 11 years vs. $30-50B mandated subsidy producing worse outcomes), and the counterintuitive point that insurance companies actually pay EHRs to carry drug-pricing data because it aligns incentives. Most of the rest is competent policy explanation rather than contrarian or first-principles thinking.

“This stands, by the way, in contrast to the adoption of PAC systems...The first PAC System debuted in 1989 at the University of Maryland. And basically by 11 years later, by the year 2000, they were completely universal...the reason that it was adopted so quickly is in the long run it was cheaper.”

“the insurance companies will actually not only provide this information to the electronic health record companies for free, they will actually pay the electronic health record companies to carry this information because it facilitates the efficient use of insurance.”

Dr. Keane is the sitting National Coordinator for Health IT at HHS, a practicing radiologist with 20+ years of clinical experience, and a longtime policy operator - a genuinely rare dual practitioner-policymaker with direct authority over the regulations and infrastructure he discusses. The host, however, repeatedly re-centers the conversation on his own startup, diluting the guest's airtime.

“in Trump 47, I was asked to uh, join as the national, uh, coordinator leading the agency that I previously worked at”

“when I'm at work here, I get to make policy and see other people make policy and then on the weekends or in the evenings or on my days off I go and I live with the consequences of those policies”

Strong on named programs, dollar figures, timelines, and regulatory citations: HITECH Act specifics, TEFCA volume trajectory, information-blocking fine structure, TrumpRx savings estimate, Project Hope outcomes, and the G10 API CFR citation all provide concrete anchors. Some figures are approximate or estimated, and a few numbers appear garbled in the transcript (e.g., '125 deaths' vs '125,000').

“In 2009 only about 15% of providers were using electronic health records. By 2015 that was over 90%...it provided, depending on how you count, between 30 and $50 billion to facilitate that adoption.”

“we are looking at 100 to 150 million document shares per month”

The host lands one genuinely sharp question ('What about functionality blocking?') that surfaces a real gap beyond the guest's prepared talking points, and frames the government-vs-market question well. However, he frequently interrupts the interview to pitch Careco at length, asks no follow-up challenges to any specific claim, and closes with extended praise rather than probing on hard topics like enforcement track record or actual TEFCA adoption gaps.

“What about functionality blocking?”

“where does government not belong?”