Ep. 116: Anthony DiGiorgio & Anish Koka on the Rules That Undermine Independent Medicine and Misaligned Healthcare Incentives from Practitioners’ Perspectives

Niklas sits down with Dr. Anish Koka, a practicing cardiologist, and Dr. Anthony DiGiorgio, a neurosurgeon and academic, co-hosts of The Doctor’s Lounge. It’s a dense conversation about why the US healthcare system is structurally built to favor consolidation, bureaucracy, and large hospital systems, rather than independent doctors or patients.

They break down specific rules working against independent practice, like Stark Law, which bars doctors from referring patients to equipment they own while hospitals face no such restriction, and Certificate of Need laws in over 35 states, which require government approval to open a new healthcare facility, often granted by boards run by existing competitors.

The conversation traces how these incentives, not bad intentions, produced the consolidation defining American healthcare today, and looks at early state-level experiments, including Montana’s rollback of Certificate of Need, as a possible blueprint for reform.

→ Listen to their podcast episode with Niklas on The Doctor’s Lounge

More about Anish Koka’s work:

* Anish on X

* Anish’s Substack

More about Anthony DiGiorgio’s work:

* Anthony on X

* Anthony’s website