Episode 76 | A System Made of Accidents: The Hidden History Behind U.S. Healthcare – Ragav Sharma, DO
Wed Nov 26 2025
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 CoveredHow employer-based insurance began by accident during WWII wage freezesThe rise of fee-for-service and how early insurance models locked in volume-based paymentMedicare and Medicaid’s structural influence on cost and system designHow technology and specialization shifted the system toward high-cost acute careWhy the ACA unintentionally accelerated consolidation among insurers and hospital systemsHow misaligned incentives across hospitals, payers, physicians, and patients drive today’s dysfunctionWhy U.S. healthcare prioritizes volume, pricing power, and market share over actual health outcomesWhat You’ll LearnWhy the system behaves exactly the way it doesHow economic incentives—not clinical priorities—shaped U.S. healthcareWhy costs continue to rise regardless of reform effortsWhy consolidation amplifies prices and reduces competitionThe historical context needed to understand meaningful solutionsIdeal ForCliniciansHealth policy professionalsStudents in medicine, public health, or health economicsAnyone trying to understand why U.S. healthcare feels so broken
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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. Ragav's Social Media: Instagram Link Show Notes Key Topics CoveredHow employer-based insurance began by accident during WWII wage freezesThe rise of fee-for-service and how early insurance models locked in volume-based paymentMedicare and Medicaid’s structural influence on cost and system designHow technology and specialization shifted the system toward high-cost acute careWhy the ACA unintentionally accelerated consolidation among insurers and hospital systemsHow misaligned incentives across hospitals, payers, physicians, and patients drive today’s dysfunctionWhy U.S. healthcare prioritizes volume, pricing power, and market share over actual health outcomesWhat You’ll LearnWhy the system behaves exactly the way it doesHow economic incentives—not clinical priorities—shaped U.S. healthcareWhy costs continue to rise regardless of reform effortsWhy consolidation amplifies prices and reduces competitionThe historical context needed to understand meaningful solutionsIdeal ForCliniciansHealth policy professionalsStudents in medicine, public health, or health economicsAnyone trying to understand why U.S. healthcare feels so broken Join our Mailing List HERE: Mailchimp