Episode 76 | A System Made of Accidents: The Hidden History Behind U.S. Healthcare – Ragav Sharma, DO
Description
Ragav Sharma, DO
In this episode, we break down the surprising and often overlooked history of how the U.S. healthcare system came to be—not through strategy or design, but through a series of accidents, policy compromises, and economic incentives that spiraled into today’s crisis.
We explore the roots of employer-based insurance, the rise of fee-for-service reimbursement, the unintended consequences of Medicare and the Affordable Care Act, and how hospitals, insurers, and physicians evolved into the fragmented landscape we live with today. From the explosive growth of consolidation to the misaligned incentives driving costs, access issues, and burnout, this episode explains why American healthcare works exactly as it does—and why fixing it requires understanding its origins.
Whether you’re a clinician, policymaker, administrator, or simply a curious listener trying to understand why U.S. healthcare is so complex and costly, this deep dive uncovers the structural forces that still shape the system. You’ll learn how major policy decisions, market power, and historical quirks created the misaligned incentives that fuel skyrocketing prices, consolidation, administrative waste, and persistent inequities.
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Show Notes
Key Topics Covered
How employer-based insurance began by accident during WWII wage freezes
The rise of fee-for-service and how early insurance models locked in volume-based payment
Medicare and Medicaid’s structural influence on cost and system design
How technology and specialization shifted the system toward high-cost acute care
Why the ACA unintentionally accelerated consolidation among insurers and hospital systems
How misaligned incentives across hospitals, payers, physicians, and patients drive today’s dysfunction
Why U.S. healthcare prioritizes volume, pricing power, and market share over actual health outcomes
What You’ll Learn
Why the system behaves exactly the way it does
How economic incentives—not clinical priorities—shaped U.S. healthcare
Why costs continue to rise regardless of reform efforts
Why consolidation amplifies prices and reduces competition
The historical context needed to understand meaningful solutions
Ideal For
Clinicians
Health policy professionals
Students in medicine, public health, or health economics
Anyone trying to understand why U.S. healthcare feels so broken
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