What happens when the person publicly criticizing the government’s pandemic strategy is summoned to the Oval Office—and asked to help run it?
In this week’s episode of Good Medicine, I was thrilled to sit down with Dr. Ashish K Jha. You likely remember him as the White House COVID-19 Response Coordinator in 2022, or as the former Dean of the School of Public Health at Brown University.
We began with his time in government, where he experienced the federal government at both its most powerful and most constrained. A place where an idea debated in the morning could become national policy before lunch—but also one where public service sometimes meant defending decisions you found problematic. Hearing how a physician and public health expert navigated power, politics, and compromise for the first time was an important lesson for anyone charged with turning expertise into influence.
Recently though, he’s turned his sights towards tackling the cost problem in American healthcare. In a remarkably practical 10-part series for The Boston Globe, he offers a bipartisan agenda for lowering spending—one designed not to satisfy an ideology, but to align the incentives of all stakeholders towards better patient care at lower cost.
This is a conversation about power: what it can accomplish, where it fails, and how we might use it more intelligently.
Here are three ideas that stayed with me:
1. The Next Great Threat: Engineered Pandemics
While we learned a lot from COVID-19, like how to rapidly build mRNA vaccines and deploy national wastewater surveillance, Dr. Jha warns that we are ignoring a massive, looming threat. The convergence of artificial intelligence and synthetic biology has drastically increased the risk of engineered pathogens. Dr. Jha shares his concerns that we are not building the comprehensive, AI-driven biodetection infrastructure needed to identify these synthetic threats before they spiral out of control. He also offers a sobering assessment of how, despite our experience with COVID-19, our preparedness for the next pandemic needs a lot of work.
2. Stop Looking for Healthcare “Villains”
When it comes to the ballooning costs of U.S. healthcare, Dr. Jha refuses to cast hospitals, private equity, or insurers as simple villains. Instead, he argues we must target bad behaviors and misaligned incentives. For example, he is a strong proponent of “site-neutral payments”, meaning we shouldn’t pay a hospital significantly more than an independent clinic for delivering the exact same service. He also argues that hospital non-profit status shouldn’t be automatic; it must be rigorously earned by demonstrating tangible community benefit.
3. The $200 Billion Administrative Fix
Administrative waste is a huge weight around the neck of the American healthcare system. Dr. Jha points out that the sheer variability in how insurance claims are processed creates massive, unnecessary costs. He advocates for a centralized, standardized national billing platform, similar to how the banking system operates, or how countries like Germany and the Netherlands handle claims. By streamlining this infrastructure, paying out claims faster, and rapidly auditing a percentage of claims to ensure accuracy, we could potentially save hundreds of billions of dollars a year.
Also in this episode:
- The surreal vetting process and Oval Office meeting that led to him joining the Biden administration.
- Why capping commercial hospital prices at 300% of Medicare could rein in the worst market-power abuses.
- Why the solution to our medical workforce shortage isn’t necessarily 150,000 more doctors, but a radical reimagining of how we use AI and expand the scope of practice for pharmacists and NPs.
- His favorite D.C. restaurants and the mentor who helped him navigate his identity as an Indian American.
If you are interested in the inner workings of government, the future of biosecurity, and practical solutions to make healthcare affordable, please join us for this great conversation.
If you’re a US-based physician, continue the conversation with Dr. Jha on Roon!
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