Healthcare keeps getting more expensive, less accessible, and harder to navigate, and the part that drives you crazy is that it also feels familiar. We sit down with Lou Shapiro, former CEO of Hospital for Special Surgery, to talk candidly about what changes and what never changes in the U.S. healthcare system after four decades inside hospitals, consulting, and executive leadership. If you’ve ever wondered whether healthcare is really a commodity, why “cheaper” care can cost more in the long run, or why consolidation keeps happening even when it doesn’t fix the fundamentals, this conversation goes straight at it.

We dig into what makes quality actually vary in musculoskeletal care, orthopedics, and complex clinical services, and why outcomes depend on who treats you and how the organization is built to support great teams. Lou shares the leadership principles he’d give a rising hospital operations leader: keep learning, leave the office, build teamwork over individual performance, and make contributions that still show up years after you’re gone. We also get into affordability and why the system is structured to produce the results it produces, which helps explain why so many “value-based care” nudges feel small compared to the problem.

Then we shift to the “shoves” that might matter, especially redesigned primary care. We explore direct primary care models for self-insured employers, how multidisciplinary teams can reduce friction, and why primary care access may be the foundation for better cost control and better patient experience. Finally, Lou opens up about stepping away from the CEO seat, the dark stretch he didn’t expect, and his “We Me Work” framework for building a next chapter that fits real life.

If this sparked something for you, subscribe, share the episode with a colleague, and leave a review. What part of healthcare needs a shove where you live?

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AI is pushing America into a new infrastructure era, and it’s bigger than potholes and bridges. When Professor Rick Geddes from Cornell joins us, we zoom out and connect the dots between infrastructure policy, infrastructure finance, and “infretech” the technology that makes civil and social infrastructure run smarter, safer, and more efficiently. Along the way, we clear up a confusion that trips up even experienced leaders: the difference between infrastructure funding (who ultimately pays) and infrastructure financing (how projects get built and repaid), plus why operation and maintenance is where reliability is won or lost.

We also get practical about why projects stall. Environmental permitting and stakeholder engagement can protect communities, but they can also become slow, redundant, and expensive when timelines stretch for years. We talk about what states are doing to move faster, why design-build and progressive design-build procurement can reduce friction, and how AI could help agencies review applications, spot gaps early, and cut repeat work without cutting standards.

Then the conversation turns to the fastest-growing infrastructure in the country: data centers. The demand for AI compute drives massive needs for electricity and cooling water, putting real pressure on the grid and local utilities. From Micron’s semiconductor expansion in upstate New York to cybersecurity threats like pipeline hacks and even drone risks, the line between “civil infrastructure” and national security keeps fading. We close with a hopeful look at reliable power options, including small modular nuclear reactors and earth source heating, and why infrastructure careers offer something rare: tangible impact.

Subscribe, share this with someone who cares about how the country actually works, and leave a review with your biggest local infrastructure win or failure.

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Palm Beach County gets portrayed as sunshine and wealth, but that picture leaves out the families choosing between rent and groceries, seniors stretched by HOA hikes, and working parents who cannot keep up with prices. I sit down with Ruth Mageria, executive leader at Cros Ministries, to talk about the real mechanics of hunger and food insecurity and what it takes to keep neighbors fed with healthy food, not just something to fill a stomach.

We dig into how a community food pantry actually works, why a food bank is different, and how USDA emergency food assistance and local donations move through a supply chain of trucks, warehouses, volunteers, and distribution sites. Ruth shares what Cros sees on the ground: rising demand that now tops the COVID era, first-time visitors during government shutdowns, and the quiet embarrassment people feel when they never imagined needing help. We also address tough questions about nonprofit accountability, audits, board oversight, and the common misconception that “a nice car” means someone is gaming the system.

Then we widen the lens to Cros’s Caring Kitchen hot meal program, homebound meal delivery, and gleaning, recovering fresh Florida produce that would otherwise go to waste. If you care about hunger relief, community partnerships, healthy nutrition, and practical solutions that scale, this conversation will give you both clarity and a path to action. Subscribe, share this episode, and leave a review, and tell us what your community is doing to close the gap.

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