Podcast: The Power of the Physician’s Pen

Experts say that’s too simple a claim. Physicians make decisions that affect around 80-to-85 percent of every dollar spent on healthcare, and the medical necessity of those decisions isn’t always clear.

But getting physicians to change would require recalibrating the myriad pressures they face from employers, patients, payers, and themselves.

In episode 2 of our second season of Insight Unpacked, Kellogg professors Craig Garthwaite, David Dranove, and Paul Campbell walk us through the doctors’ role in the expense and complexity of the American healthcare system.

Listen to all available episodes of season two here.

Supplementary Materials

We’ve come a long way from the days where doctors used to perform often-experimental surgeries for an audience of peers and curious spectators, as was commonplace throughout the nineteenth century.

By the 1880s, medical schools were only just starting to require that prospective doctors practice surgeries and bandaging or have supervised experience working in operating rooms. Still, patients didn’t want to end up in these rooms, where walking out alive was lucky and evading postsurgical infection was even luckier.

Scientific advances and medical education changed all that. Surgical success rates went up. Vaccinations and other public-health advances shifted the focus from disease prevention to the promotion of individual health.

By the time the 60s rolled around, we were squarely in the era of “Marcus Welby medicine,” says David Dranove. Marcus Welby, M.D. was a fictional show about a really amicable family practice doctor who made house calls and even befriended his patients. It was a dramatized version of reality, at the time.

Regulatory, financial, and economic changes have since led to another shift for doctors—one of minutes-long appointment slots and mounting administrative requirements. This is the current reality. At a previous employer, Dr. Marco Palomo (who is featured in this episode of the podcast) recalled doctors feeling forced to “push RVUs through the system.” RVUs, or relative value units, are how Medicare calculates reimbursements.

American doctors are a well-compensated bunch, earning twice as much as their European counterparts, on average. Kellogg economist Craig Garthwaite says reducing that compensation would save the healthcare system some money, though it would also reduce the size and quality of the talent pool pursuing medicine. A medical license is granted at the end of a long, difficult, and expensive road.

Overall, doctor salaries tend to run the six-figure gamut, but primary care’s range generally hovers between $200,000–$300,000 (on the lower range). It’s a commonly cited reason for the shortage of primary-care physicians in America.

To alleviate some of the pressure left by the void of primary-care physicians, and maybe even save some money, states have introduced bills expanding the practice authority of nurse practitioners and physician assistants. The American Medical Association, a powerful doctors’ lobby, has fought these measures.

Scope expansions are just one crack at reforming American healthcare, but the pushback is worth noting because it demonstrates a common refrain when the profit or power of one group in the system is under threat from another: a tightened grip.

You can find additional sources for this episode hyperlinked in the podcast transcript below.

Podcast Transcript

Laura PAVIN: The 1960s and ‘70s were rosier times for patients and doctors.

David Dranove, one of our trusty healthcare management experts, calls this the era of “Marcus Welby medicine.”

David DRANOVE: Well, it was the number-one-rated television showing in the United States in the 1970s.

[fade up music and enter narrator]

NARRATOR: Examine the drama of today’s world in Marcus Welby, M.D.

[music fades]

Jessica LOVE: Marcus Welby, M.D., was a fictional show about a really amicable family practice doctor.

DRANOVE: And Marcus Welby kind of represented the way the ideal medical system of that time looked. You had your primary-care doctor who was selfless and tireless and did everything for you and referred you to all the specialists, got you into the hospital, went to the funeral of your loved one, et cetera, et cetera.

LOVE: Here’s Robert Young, the actor who played Dr. Welby, speaking to a child patient played by Barry Williams.

[Marcus Welby, M.D., clip]

Robert YOUNG (as Dr. Marcus Welby): Do you think I’ve lied to you?

Barry WILLIAMS (as Pancho McGurney): I figured that’s why my dad changed doctors, cause he couldn’t get ya to lie to me! And that’s why I tried to call you tonight. I figured you were the one person I could trust.

YOUNG: You can.

[Marcus Welby, M.D., clip fades]

LOVE: Doctors were king. And health insurance paid for everything, except for maybe a really small copay. Line items went unquestioned.

PAVIN: Smash cut to today, and things could not be more different. Today, doctors barely get to spend any time with their patients, and the time they do get to spend with them is spent tirelessly documenting every bit of the interaction. They’re burnt out, and their practices are increasingly getting gobbled up by hospitals and other large corporations. The era of the family practice doctor who joins you for dinner? That’s long gone.

[music]

PAVIN: You’re listening to Insight Unpacked. I’m Laura Pavin.

LOVE: And I’m Jess Love.

PAVIN: Jess is going to join us for the rest of the series, by the way. Because she’s been on this reporting journey with me. Actually, Jess, what would you call this?

LOVE: An information-seeking, -distilling, and -communicating process, I guess? Anyway, today we give you episode 2 of our series on the misaligned incentives that make American healthcare so expensive and so confusing. In our first episode, we explained how healthcare megaproviders came to dominate the landscape and drive up costs. A lot of their bulking-up was an attempt to give themselves more power at the negotiation table with the government and insurance companies, who were trying to contain costs. Today, they account for a huge chunk of our healthcare spending. But megaproviders are only one of the players in this story of rising costs and misaligned incentives.

PAVIN: Right. This episode, we’re turning the lens on doctors, who are a somewhat more sympathetic bunch. Because, on the one hand, they’re at the mercy of their employers, who, more and more, are really large and powerful. But in a podcast about high healthcare costs, it’s hard to let them off the hook completely because, in fact, they make decisions that affect around 80-to-85 percent of every dollar spent on healthcare.

LOVE: But just how much can we blame them for the cost of care in this country? Are they really just pawns in a system that isn’t their fault? It’s complicated.

That’s next.

* * *

PAVIN: Marco Palomo was just a resident when it happened. He had a patient who got a mammogram, and she ended up having breast cancer.

On paper, the solution was simple: she should get surgery to remove the cancer.

But in practice, things weren’t simple, because this patient had an intellectual disability that made it difficult for her to give informed consent.

Marco PALOMO: And it was kind of a struggle trying to figure out, should we do surgery on a patient whom we are not 100% sure of their ability to consent and understand what is happening, knowing that they will be in pain postoperatively?

PAVIN: On the one hand, Palomo was worried that the pain and stress of the operation would severely affect the patient’s quality of life. On the other hand, he had to consider her right to full and equal access to medical treatment, as laid out in the Americans with Disabilities Act.

In other words, this patient’s case was really complicated: the kind of thing that medical ethicists spend entire careers thinking about. Palomo, the patient, and the patient’s family didn’t have that kind of time, so they reached a decision. They’d move forward with the surgery.

And unfortunately, the patient did really struggle with the post-operative pain. It was a really hard situation. Palomo still thinks about it.

LOVE: And we as patients would like to think that this is what our doctors are thinking about all the time: agonizing over these tough cases, trying to make the right decisions, consulting with their peers, learning as much as possible about the lives of the people they are caring for. You know, the kinds of things Dr. Marcus Welby would do.

Heck, if you ask doctors why they got into medicine in the first place, they’ll probably tell you that it was to do right by patients just like Palomo’s.

And a lot of them do. Every day.

But doctors are part of a system that doesn’t always allow for this kind of care. Healthcare is a business. Full stop. Like everyone else in the working world, doctors are pulled in a bunch of different directions, and sometimes, they might be so busy that they spend just a fraction of the time Palomo did on this case.

And this same system sometimes incentivizes them to push up spending on healthcare.

Dr. Palomo has seen that side of care, too.

PAVIN: Yeah. We talked to Palomo about that. We wanted to know what some of these monetary incentives looked like. He recounted his days as a medical resident for a large Chicago-area hospital—where he no longer works.

PALOMO: We saw medical leadership feel pressured to push RVUs through the system.

PAVIN: RVU?

PALOMO: Oh, so for each appointment we see, there’s an attached RVU. It’s called a relative value unit. It’s just how doctors get paid and how doctors can upcode [laughs] to get paid more. It’s still a 15-minute visit, but I can bill it five different ways—level one, two, three, four, five—and each level has a certain requirement of how many problems were covered, what was my physical exam, what was my review of systems? And levels one through five have an elevating RVU. The higher the complexity, the higher the RVU, the higher the revenue for that patient.

PAVIN: RVUs, these relative value units, are used by Medicare to reimburse doctors. Before there were RVUs, doctors pretty much just charged Medicare what they wanted for their services.

And then the federal government was like, okay, this is getting expensive. And RVUs were part of their solution. It standardized what doctors would get paid for different services.

People found ways to game that. Palomo saw it first hand. A system that was put in place to reduce costs was gamed at the hospital to increase costs. He didn’t like it.

PALOMO: There’s always a pressure like, “Okay, I have a 15-minute slot. How do I turn this into a level four so that I can maximize the revenue generation from that appointment?“

LOVE: Most patients aren’t wise to this RVU fee-for-service incentive structure, and how it affects their care. But Paul Campbell is a patient who is very aware of this. He’s a clinical associate professor of strategy at Kellogg. But, like all of us, he dons the hospital gown every now and then.

Paul CAMPBELL: Have I told you the story about my colonoscopy?

PAVIN: No [laughs], no.

CAMPBELL: So I promise there’s no pictures.

LOVE: Campbell hit the age when he needed to get a colonoscopy. His wife had already had one and said she liked the doctor who did it. So Campbell calls to schedule a colonoscopy with that doctor.

CAMPBELL: And the woman on the other side of the phone doing the intake said, “Okay, you need to come in and see the doctor.” And I said, “Well, I’m happy to do that, but why? I just got to visit with my primary-care physician. I don’t have any polyps. I’m just doing it for prevention because I’m 50. Why do I need to see the doctor?” She said, “Oh, no, you have to see the doctor. He has to visit with all of you before any procedure.” I’m like, “All right. He’s the doctor. I’m not.“

LOVE: Campbell goes in, and the doctor asks, “How did you find me? Like, was it online or a referral?” Campbell mentions his wife. And the doctor’s like, “oh yeah, I remember her.”

CAMPBELL: And then I’ll never forget the next thing he said to me, Laura. He said, “Had I known that, you wouldn’t have had to come in,” which means he didn’t really need to see me. Now, we went on to have the appointment, and he did two things. One is, he told me how important it was that I get a colonoscopy, which is: I called him, so I already sort of knew that. And then two, he basically walked me through the procedure, which could have been done by a nurse, a healthcare worker at a lower level of training. Could have been done virtually, could have been done with an asynchronous, get online and watch a video, and then answer these little quiz questions, right?

LOVE: There was a cheaper, easier way to do this. But there didn’t seem to be a ton of motivation or pressure for the doctor to offer the cheaper, easier option. Could that be because his employer nudged him to squeeze what he could out of each patient? Get some extra appointments in there because of the additional dollar signs attached to it? We don’t know for sure. But in this world of fee-for-service medicine and RVUs, we know it’s plausible.

PAVIN: To be fair, doctors aren’t the only ones that might be doing more for the sake of more. Sometimes even when doctors do try for the cheaper, easier option, patients get in the way.

PAVIN: We talked to someone about this.

PAVIN: Hello?

DOCTOR: Can you hear me?

PAVIN: Yes, I can.

DOCTOR: Sorry about earlier. I have no idea what happened. The call dropped and then I tried to join and I couldn’t join.

PAVIN: He asked us to keep him anonymous. But know that he’s a doctor by training and is now on the management side of things. Healthcare systems are his specialty.

And he says that, managing patient expectations? Not an insignificant part of what physicians do. Patients come into the exam room with a whole lot of ideas that come from many different places.

DOCTOR: What they hear in the media, what’s being directly marketed to them, their personal experiences, family experiences, what their neighbor is saying; they are now coming in with a lot of, some accurate, some inaccurate, insights, but from their vantage point, it’s all accurate.

PAVIN: He says that this outside information becomes a problem when patients ask their doctors to do something about it.

PAVIN: Did you ever experience this firsthand when you were practicing?

DOCTOR: Oh, yeah. All the time, you know. There was a patient who was seeing a naturopathic clinician, or doctor of naturopathy, and they wanted a lot of these tests done, and they wanted me to check their selenium and copper. And selenium and copper deficiencies exist, but not at a population level without any underlying issues, right? So, they were like, “well, symptom x could be related to selenium deficiency.” Well, sure, a selenium deficiency is essentially only present in a subset of patients that are getting total parenteral nutrition or have GI issues. You don’t have those things. “Well yeah, doc, but can you just check it?” No, but I’m not doing it.

PAVIN: For the most part, this doctor says, he’s been able to stand his ground. But that’s for a very important reason: his compensation wasn’t tied to how satisfied his customer—the patient—was. He says that that’s not the case for all doctors who do have the threat of a bad review looming over their head.

DOCTOR: So there are organizations where they tie compensation to it, and then that changes the physician’s behavior incentives. If I get paid more, if somebody’s happy with me, then I’m just going to do whatever they need me to do and call it a day, right? It’s like, all right, I’m going to recommend what I need to do. If the patient doesn’t listen, then I’ll just do, if it appeases them, so that they’re happy and I get paid. Does that make sense?

PAVIN: If you’re a doctor whose compensation is tied to patient satisfaction scores, you might now give some weight to a patient demanding a blood test, however dubious their reasons, because hey, a blood draw isn’t really harming anyone, right? And the patient seems okay with incurring this extra cost. Maybe they have really good insurance anyway, and they don’t care one way or the other.

LOVE: Doctors, they’re just like us: driven by the fear of an unhappy customer.

PAVIN: [laughs] I mean, yes and no. Not all doctors have their compensation linked to patient satisfaction. Some do. And even for this subgroup of doctors, it’s one metric—not the end-all-be-all determinant of their salary.

But what I will say is that, whether it’s tied to their income or not, patient satisfaction is probably hard for doctors to outright ignore. They’re reviewed on Yelp, ZocDoc, Healthgrades, and a slew of other ratings sites, and patients look at that when deciding on a doctor. The fairness of these ratings is definitely a question mark—sometimes patients base their rating on how the people at the front desk treated them—but either way, online reviews are sending some kind of signal to patients looking around for a doctor. And doctors know that.

What this means is that, if we’re really being honest here, it’s sometimes the patient who ends up pushing the doctor to behave in more expensive ways. Because in America, the patient is a consumer who can either be a satisfied customer or an unhappy one. And what’s a doctor without patients?

* * *

LOVE: So, patient pressures could have some bearing on the way doctors behave. And that way isn’t always cheap. Another physician we talked to said there was another issue that she thought contributed to the expense of our healthcare system: she had no idea what anything cost at all.

This doctor, who also wanted to be anonymous, said that making decisions about patient care often felt like ordering from a restaurant menu with no prices. Like, yeah, the 40 oz Tomahawk Chop sounds really great, and I would totally order that. But would I order it if I knew it was $250? I would not.

She said it would be meaningful to know exactly what certain procedures, or even lab work, could cost patients, because it might change her opinion on how necessary certain things are.

PAVIN: But one big reason it’s hard for clinicians to track prices is that it all depends on who is paying those prices.

PAVIN: Here’s the earlier doctor we spoke to—the one who didn’t want to do unnecessary blood work for his patient who was seeing the naturopath.

DOCTOR: There are different payers in the country,—Medicare, Medicaid, commercial, HMO, PPO—that want different things. But all of this is channeled through the clinician. And sometimes it’s like, every different plan has their own different benefit design, this and that or whatnot, and different costs. It is impossible for a clinician to keep those things in mind, period.

PAVIN: Providers have different contracts with different payers—something we’ll be talking more about next episode. And these contracts aren’t simple. Whole teams of people are dedicated to the billing side of things.

LOVE: But maybe, a solution here could be this: find a way to make it easier for doctors to track what a patient’s plan covers. If doctors have access to that information, they could plausibly have those money talks with patients. That feels like a good incentive that would help lower the cost of care in America.

We ended up talking to Dr. Deborah Clements about that.

Deborah CLEMENTS: I think that’s an interesting perspective.

LOVE: She’s at Northwestern’s Feinberg School, and she’s a doctor of family medicine at Northwestern Medical Group. She agrees that being blind to what patients can afford costs the system.

And get this: Clements told us that there are actually apps she can use to see what a prescription will cost, and she is up front with patients about that. “Is this something you’ll be able to afford?” she asks them. It’s an approach that feels like the best of both worlds: good for the patient’s pocketbook and good for the amount we spend on healthcare as a whole.

PAVIN: But Clements doesn’t see this way of practicing as a silver bullet for our system, because there are downsides to doctors thinking about price too much.

CLEMENTS: The balance is, we also don’t want people making care decisions on the basis of costs, because that’s when inequities happen. And so we prefer that people are actually kind of blind to that, so that they choose the right thing and not the thing that they think the patient can afford.

PAVIN: So when you talk about inequities, you mean who gets the best care then depends on their ability to …

CLEMENTS: Who can pay for it, right?

PAVIN: Right.

CLEMENTS: Exactly. And that’s certainly not the route we want to go.

LOVE: If doctors base care decisions on ability to pay, we get unequal care. That feels like a pretty big downside to talkin’ money with your doctor.

PAVIN: And, for what it’s worth, I’m not sure those conversations would go very far, anyway. Hospitals aren’t always upfront about what they’ll charge for their portion of the bill.

That’s the case despite a federal rule that hospitals be more transparent about their prices. A report last year found that more than three-quarters of the biggest hospital systems were not in compliance with that.

The point is, systematically making doctors think about costs is harder than it sounds.

[music break]

LOVE: So doctors are in a bind. When they consider an individual patient’s ability to pay, they may be doing them a favor or discriminating against them. Or, they just don’t have all the information to give them a proper estimate.

But collectively, our economists say, they do need to have some degree of price sensitivity. Otherwise, what you get is a system that’s unsustainable. Here’s David Dranove.

DRANOVE: Look, I think, like, if it was what’s best for my patients, my patient would get everything no matter what it costs, and that would bankrupt the system. If they only do what’s best for the system overall, well that boggles the mind as to how we would even imagine what that would be. So now that we know that physicians are going to respond to incentives, the question is, what are the incentives that we’re putting in place? And just how far removed from what’s right for patients in the healthcare system are the incentives that we currently have in place.

* * *

PAVIN: I have to say, after talking to our professors and several doctors, I do not envy the position MDs are in. They have to balance what their employer wants with what the patient wants, which can sometimes be separate from what the patient needs. They’re burnt out. Physician burnout has been called a “workforce crisis.”

LOVE: That’s right. But Kellogg healthcare economist Craig Garthwaite says, “Sorry! We can’t let them off the hook for rising healthcare costs.”

Craig GARTHWAITE: I think we’d have a much better conversation if we admit that healthcare reform that strips money out of the system is going to cost physicians some money as well.

LOVE: Just like every other player in healthcare, physicians, as a group, have made decisions that helped to bring us to the system we have today, and they do benefit from it in an important way: financially.

GARTHWAITE: So physicians are all about healthcare reform until you suggest that one thing we’ll do is we’ll lower physician salaries, and they’re like, “Well, hold on. I went to Med school for so long, and I could do this, like my salary is not the problem.” And it’s not. I mean, it’s not clearly the problem. But it’s not nothing, right? We do pay a lot for physician wages in this country.

LOVE: We do. Across the board, U.S. doctors earn more money than their European counterparts—twice as much, on average.

PAVIN: But stop right there! Before you start thinking we need to scale doctor salaries back to make our whole healthcare system less expensive, you need some context. The U.S. has the longest and most expensive path towards becoming a doctor. You’ve got a 4-year bachelor’s degree, and then 4 years of medical school, and then 3 to 7 years of a residency. And it costs a whole lot of money.

Emily MUSCAT: Taking the MCAT to apply. I think the MCAT was like three or four hundred dollars.

LOVE: Emily Muscat is in her fourth year of medical school at the University of Illinois College of Medicine here in Chicago. She says things start adding up the minute you take the MCAT, the exam you have to take for medical school.

MUSCAT: And it’s a hard test, so if you want to do well, you really need to study a lot. A lot of people will, if they’re able to afford it, will not work for a couple of months. So that’s the MCAT. But then to submit an application, it’s like $100, and that’s to get your app into the portal.

LOVE: Once your application is in this portal, she says, you pay fees for each of the medical schools you’re applying to, and if you land yourself an in-person interview, you pay for your own travel and lodging.

MUSCAT: And then when you get in, there’s usually a fee you have to put down that’s like six or seven hundred dollars, and then there comes tuition which is insanely expensive. I get in-state tuition at UIC. Tuition is like $45,000 or $50,000 and then with living expenses, it’s close to like $70,000 or $75,000 a year for 4 years. So I’m gonna be like $300,000 in debt once I graduate.

PAVIN: $300,000 in the hole. Despite all the help she got from her parents, she says. Parents, she adds, who are also physicians.

MUSCAT: Being a physician is not a good way to build generational wealth in the U.S.

LOVE: Muscat’s impending debt load isn’t unusual. Many grads have between $200,000 to $400,000 in outstanding student loans by the time they enter the workforce.

So money is an incentive for doctors, a somewhat justified one, when you think about all they’ve invested in becoming a doctor. So, if we paid them less, that could have some unintended consequences. Garthwaite again.

GARTHWAITE: So if we want to pay doctors less, and I don’t necessarily want to pay them less, but if we do want to pay them less as a source of savings, they then become less-highly, you know, compensated relatively in American society. Which then over time means that smarter people who have lots of options might choose to not become physicians.

PAVIN: Actually, there might be a case to pay U.S. doctors more money. Well, one type of doctor. The primary care physician, or the PCP.

NBC NEWSCASTER: Across the country, a growing crisis.

Max THOMPKINS: Hi, I was wondering if I could sign up for a primary care physician?

NEWSCASTER: People are struggling to find a primary care doctor.

THOMPKINS: It’s disheartening.

NEWSCASTER: In Los Angeles, Max Thompkins has been looking for a year. And he’s not alone. The health resources and services administration is saying the nation is more than 17,000 primary-care physicians short. The number is projected to grow up to 48,000 by 2034.

LOVE: There’s a shortage of primary-care physicians in the U.S. Some of it is because of burnout, but there’s another reason. The pay.

PAVIN: As a group, doctor salaries tend to run the six-figure gamut. But primary care generally hovers between $200,000 and $300,000.

LOVE: Yeah, and this is significantly less than what specialists earn. In 2023, specialists were making an average of 37 percent more than primary care physicians. Neurosurgeons, among the highest paid specialists, sit in the high $700,000’s. So, like, I’ll speak for myself here, but of course there’s a shortage.

And it kind of gives you a peek at what you get when you pay less in this system. You get less. And having fewer primary-care doctors looking out for us feels like a pretty bad thing for everyone.

LOVE: So, if paying them less isn’t necessarily what we want, then what can physicians do to lower the cost of care? No one is entirely sure. But what is clear is that any attempt to change how they do their job, for the sake of saving money or any other reason, will probably need their stamp of approval first. Because they have a strong lobby.

PAVIN: There’s been a lot of talk about giving nurse practitioners and physician assistants more power to do some of the more-routine tasks that doctors usually get paid to handle. To save money, perhaps, but also to bring down wait times. Remember that shortage of primary care physicians? And so, for this reason, some states introduced bills to expand what these medical professionals could do. The American Medical Association pushed back against that. Real hard.

GARTHWAITE: They’re like, well, hold on here, a doctor should be doing that.

PAVIN: So they lobbied.

Todd UNGER: Hello and welcome to the AMA video and update podcast series. Today we’re bringing you an update on our work so far this year to combat inappropriate scope of practice expansions.

PAVIN: This is a podcast from the American Medical Association, a powerful national doctors’ group. In July, they interviewed their senior attorney, Kimberly Horvath, about how the lobby was going.

Kimbery HORVATH: Overall, it’s been really successful. We’ve been pretty much successful in defending the practice of medicine against those inappropriate scope expansions, and in fact some states have actually defeated all of their scope bills. States like Texas hit 132 bills this year on scope of practice. Mississippi defeated all of their bills. South Dakota, Indiana as well …

[fades out]

PAVIN: To be fair, some of these “scope expansions” might not be appropriate. But Garthwaite thinks that some of the pushback is coming from physicians who want to preserve the status quo for their own reasons. And he argues that we currently put too much emphasis on doctors being the only ones who can give great care.

GARTHWAITE: There’s a lot of, you know, it takes a lot of training to be a nurse practitioner, to be a PA. There’s a lot of great care they can give. And so this focus on only the physician is the person who can provide care, I think, also implicitly drives up some of the spending as well.

LOVE: Wherever you land on the debate over non-doctors doing previously reserved-for-doctor tasks, that’s just one crack at trying to fix the problems borne of misaligned incentives.

There are plenty of others. And David Dranove seconds the point that physicians should be more actively involved in exploring those. Because, physicians still directly and indirectly control up to 85 percent of all healthcare spending. And as a group, he says, they aren’t trying hard enough to bear the fiscal weight of that responsibility.

DRANOVE: Physicians control most healthcare spending. Physicians, when they make a medical decision, have some consequences.

PAVIN: In his view, even doctors who don’t like where healthcare is headed and really want to put patients first, and there are a lot of them, they’re nonetheless letting the system, and all of its different business models, happen to them.

DRANOVE: The problem isn’t that doctors want to do things one way and they don’t see the business side of things. Doctors would believe the business case if they could trust you, that you’re making a business case that looks out for the patient’s interest and not just the corporate interests. And don’t view the doctors as stubborn enemies.

LOVE: So what can be done to make the business side more trustworthy? Dranove sees the solution here as bringing more doctors into the upper levels of management throughout the healthcare system, getting them up to speed on where the money comes from and where it goes. Because with more people throughout the system who understand both the financial aspects of medicine and, you know, the medicine part, we might just get to a healthier system.

[music]

LOVE: Next time on Insight Unpacked: You probably don’t think twice about it, but it is indeed weird that here in America, our health insurance is tied to employment. We take a fun little trip into the past to find out why our insurance is structured this way and what that means for all of us today.

PAVIN: And we look at what really incentivizes health-insurance companies these days. We also hear what it’s like to get insurance on the infamous exchanges, straight from a guy whose job it is to help people with that.

DAVERN: It’s so confusing. I don’t know how the hell they expect people to do it on their own. It wasn’t supposed to be like this, but that’s why I have a job, I guess.

* * *

CREDITS

PAVIN: While you’re waiting for our next episode, you can check out links, supplementary materials, and images for this episode at kell.gg/unpacked.

This episode of Insight Unpacked was written by Laura Pavin and edited by Jess Love. It was produced by the Kellogg Insight team, which also includes Fred Schmalz, Abraham Kim, Maja Kos, and Blake Goble. It was mixed by Andrew Meriwether. Special thanks to Craig Garthwaite, David Dranove, Dr. Deborah Clements, Dr. Marco Palomo, and Emily Muscat. As a reminder, you can find us on iTunes, Spotify, or our website. If you like this show, please leave us a review or rating. That helps new listeners find us.