Host Nate Kaufman brings Rich Helppie back for a discussion about healthcare access.  A 30-day wait for a first oncology visit after hearing the word leukemia is not an edge case—it’s the new normal in a system where demand outpaces supply and incentives reward the wrong behaviors. Nate opens with a personal story that reveals how access feels when the stakes are life and death, then pulls back the lens to explain why it happens: a 12-year training pipeline for specialists, uneven reimbursement that pushes clinicians toward concierge and direct primary care, and payer tactics that encourage consolidation rather than capacity.

Kaufman and Helppie then get specific about the economics. Medicaid rates that barely cover overhead lead practices to cap panels, while insurers play separate groups against each other until they merge, gaining leverage but not necessarily improving availability. Primary care, which should function like a straightforward retail experience, is instead forced through insurance mechanics that add friction to simple, high-value services. The result is predictable: over 40 percent of ER visits come from Medicaid patients who couldn’t access timely outpatient care, and the most vulnerable pay the highest price in avoidable emergencies.

Their conversation wrestles with the big numbers and the real trade offs. Ten percent of patients drive more than 80 percent of spending across Medicare and commercial plans. Pharma’s incentives to expand lifelong demand clash with insurers’ incentives to deny care. The federal government, the largest health benefits organization in the world, changes leadership every few years, making long-term workforce planning and access expansion difficult. They outline pragmatic moves that can help now: secure continuity with direct primary care or concierge if possible, build a relationship with a PCP who can open specialist doors, and for complex care, shop outcomes rather than prices.

If you’ve felt the squeeze—months-long waits, denials, or a scramble for appointments—this conversation gives language, data, and practical options. Listen to understand why access is collapsing, what levers could ease the pressure, and how to protect your path to timely, high-quality care today. If the ideas resonate, follow and share, and leave a review with your own access story—what worked, what didn’t, and what needs to change next.

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