I assume most neurosurgeons just care about neurosurgery.
Period.
They fix brains, they fix spines, they save lives and they go home to their very nice houses in the suburbs.
Dr. Anthony DiGiorgio probably does all that too.
But he also spends his free time studying Medicaid policy. He testifies before Congress about healthcare reform.
He respectfully addresses the concerns of his obnoxious internet trolls on X.
He writes papers with titles like: "Medicaid Insurance is a Predictor of Prolonged Hospital Length of Stay After Traumatic Brain Injury”
And for a long time, I’ve wondered:
Why would a surgeon who will always have a job, will always make good money and will always be essential to the healthcare system care so deeply about family medicine, poor people and about how patients pay for healthcare in general?
I had to know, so I asked.
I actually first 'met' Anthony through his writing, his research and his relentless advocacy for making sure that people in need have real access to care.
And with the recent passing of the One Big Beautiful Bill and the lively, sometimes aggressive, surrounding discussion regarding changes to Medicaid, I thought it would be a great time to have him on to discuss.
His analysis changed a lot about what I thought I knew about the most vulnerable patients in our system.
I think you'll enjoy the conversation, and benefit from his insights as I have.
The problem hiding in plain sight
Every week, Dr. DiGiorgio sees patients who need follow-up care.
Not brain surgery or spine surgery - just regular primary care. The kind of care that can help patients manage non-surgical conditions or prevent bigger problems down the road.
"The wait list is six plus months long just to get a primary care appointment," he told me.
Six months.
Think about that for a second. If you're seen by any specialist or discharged from the ER and need to see a family doctor to make sure you're healing properly, you can't.
The earliest appointment is in six months.
And by then, a small problem becomes a big problem. A big problem becomes a catastrophe. A catastrophe becomes... well, another trip to the emergency room, where the cycle starts all over again.
This isn't a bug in the system. This IS the system.
DiGiorgio is in a position to see it clearly- and is one of the few who is doing something about it, often against significant resistance.
Is Medicaid a ‘safety net’ or has it become something else entirely?
DiGiorgio said something that completely reframed how I think about Medicaid reform.
He compared fixing Medicaid to... food stamps.
(I know, I know. But stay with me here)
"Food stamps work so well because it's a cash equivalent," he explained. "There's minimal involvement of a third party, which means the beneficiary receives most of the benefit. They're accepted at almost every food establishment."
When you have food stamps, you're not forced to shop at the "poor people grocery store." You go to the same store as everyone else.
But when you have Medicaid? You get a card that half the doctors won't accept.
You get shuffled to the "poor people clinic" for second-class healthcare after an extended wait at a first-class price.
The huge sums of money spent doesn't seem to be resulting in adequate access for patients or come with reasonable terms for physicians.
Here's what DiGiorgio understands that most people don't:
Medicaid isn't failing its purpose because it doesn't spend enough money. It's failing because of how it spends money.
About 60% of Medicaid spending now goes to people who weren't originally supposed to be on Medicaid. The program was designed for disabled individuals, elderly poor, poor children, and poor pregnant women.
Now it covers healthy adults, and in some states, people making up to 400% of the poverty level.
That means the people who truly need a safety net are competing for resources with people who could potentially be served other ways.
Meanwhile, the truly vulnerable: the homeless patient with schizophrenia, the elderly woman with dementia, the child with cerebral palsy- are lost in the shuffle.
DiGiorgio sees these patients every day. A quarter of his patients are homeless. And he's fighting for them in ways that would surprise you.
His solution? More choice.
His approach is refreshingly simple: "As Milton Friedman says, the problem with poor people is they don't have any money. So give them a cash-based equivalent so they can get into the private market."
When people pay directly for routine care- like the $60 per month direct primary care he mentions- they get better access and doctors can focus on patients instead of paperwork.
"If physicians, instead of taking an early retirement, instead go into this direct primary care model, then you have physicians practicing longer and you're alleviating the physician shortage," he explained.
The key insight?
When there are fewer middlemen between you and your doctor, doctors are happier, stay in practice longer, costs go down and access goes up.
Why this gives me hope.
Here's what still gets me about DiGiorgio: he has nothing to gain from fighting these fights.
He'll always have patients. He'll always have a good income. He could easily focus on surgery and ignore the policy discussion entirely.
Instead, he's chosen to be a voice for people who don't have voices.
Homeless patients, medicaid patients, and people trapped in a system that doesn't work for them.
He's not doing this because it's good for his career or because it’s easy. He's doing it because it's right.
And he's not just complaining about problems, he's proposing solutions.
Real, practical, evidence-based solutions that could make life better for all of us.
What it means for you.
Even if you have insurance, or an alternative like CrowdHealth, this affects you.
When emergency rooms are clogged with people who can't get primary care, your wait time goes up.
When hospitals are full of patients who can't discharge to appropriate facilities, your surgery gets delayed.
When the system is inefficient and wasteful, everyone pays more and everyone suffers.
We're all in this together, whether we like it or not.
But here's the hopeful part: DiGiorgio sees change happening.
More people are choosing direct primary care even when they have insurance. More physicians are staying in practice longer by getting out of the insurance-based system.
"I think the culture is starting to shift," he told me.
We need more people like Anthony DiGiorgio.
Not necessarily more neurosurgeons (though we need those too), but more people who are willing to look beyond their own immediate interests and fight for a new paradigm that will work for everyone - especially the people who need it most.
Not through virtue signaling, name calling or moral arguments, but through thoughtful reform that goes beyond the status quo.
If we’re honest, it’s clear that throwing money into a broken system hasn’t ‘solved’ anything at all. It’s made things worse.
His message isn't complicated: give people choices, remove barriers to care and create direct payment options and real access instead of a bureaucratic maze.
It's not about politics. It's about people.
And it's about time we listened to someone who actually knows what he's talking about.
Want to hear the full conversation? DiGiorgio explains the research, the policy solutions, and why he's optimistic about the future of healthcare.
Follow Dr. Anthony DiGiorgio here:
Healthcare Comic: offlabelideas.com
And a BIG thank you to CrowdHealth!
If you’re ready to experience healthcare differently? Visit joincrowdhealth.com. Use code “Liberty Lab” for $99/month for the first 3 months.
Until next week yall!
Tiffany
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