Episode 76 | A System Made of Accidents: The Hidden History Behind U.S. Healthcare – Ragav Sharma, DO

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

Ragav Sharma, DO Ragav Sharma, DO is a Physical Medicine and Rehabilitation (PM&R) physician with training in interventional spine and musculoskeletal medicine. He formerly set powerlifting records and has also completed several races including ultramarathons. He is an avid proponent of resistance training and has coached others, obtaining a Certified Strength and Conditioning Specialist (CSCS) certification, for both general health and powerlifting goals. In this episode, Dr. Ragav Sharma breaks down the science and strategy behind resistance training — one of the most powerful tools for improving long-term health, performance, and longevity. We explore what the evidence says about strength training for muscle growth, fat loss, metabolic health, injury prevention, and healthy aging. If you’ve ever wondered how often to lift, what exercises actually matter, or whether resistance training is “safe,” this episode gives you the no-nonsense, research-driven answers.  Dr. Sharma's Social Media Instagram Link Show Notes What Is Resistance Training?Resistance training involves contracting skeletal muscle against external resistance to challenge strength and stimulate muscle growth. That resistance can come from:Bodyweight exercisesFree weights (dumbbells, barbells, kettlebells)Resistance bandsMachinesHousehold objects (backpacks, water jugs, cinder blocks)Strength training is not just for athletes or bodybuilders. It is one of the most potent therapeutic tools we have for improving overall function, mobility, and longevity — and it should be accessible to everyone.The Evidence-Based Benefits of Resistance Training1. Improved Body CompositionResistance training:Increases fat-free mass (muscle)Reduces overall and visceral fatHelps preserve muscle during weight loss or GLP-1/GIP therapyPredicts lower mortality independent of BMIMuscle is metabolically protective. Higher muscle mass is associated with a lower risk of chronic disease and death, even in those with a high BMI.2. Stronger Bones and Lower Fracture RiskBone density peaks around age 25–30 and declines after 40, especially in women. Walking alone does little for bone mineral density.Mechanical loading — squats, deadlifts, step-ups, weighted carries — is essential for:Increasing bone densitySlowing osteopenia and osteoporosisReducing fracture riskMaintaining physical function later in lifeOne of the strongest demonstrations is the Lift More Trial, where women 60+ with diagnosed osteoporosis safely performed heavy squats and deadlifts twice per week. They improved bone density significantly, with only one mild strain in over 2,600 sessions.3. Cardiovascular BenefitsMany people assume aerobics is the only way to protect the heart. The data tells a different story:Any resistance training → 19% lower cardiovascular mortalityImproves LDL, HDL, triglycerides, blood pressureEnhances functional capacity in heart failure patientsThe best results come from combining aerobic exercise with strength training — but strength training alone has a meaningful impact.4. Improved Metabolic HealthStrength training increases insulin sensitivity through GLUT4 upregulation and:Lowers HbA1c in both type 1 and type 2 diabetesReduces visceral fat, a major driver of insulin resistanceImproves metabolic flexibilityFor people unable to tolerate high-impact cardio, resistance training becomes even more important.5. Mental Health BenefitsThe psychological benefits are just as powerful:Significantly reduces anxiety symptomsLowers depressive symptoms in adolescents and adultsBenefits occur regardless of strength gainsSimply engaging in resistance training reliably improves mood and mental well-being.6. Reduction in Chronic PainMovement is medicine — and resistance training consistently reduces pain:Decreases chronic low back painImproves pain and function in knee osteoarthritisHelps patients with fibromyalgia reduce fatigue and tender...

Shounuck Patel, DO Join us for an inspiring conversation with Dr. Shounuck Patel, a leader at the forefront of interventional orthobiologics and musculoskeletal ultrasound. A proud alumnus of the Chicago College of Osteopathic Medicine (CCOM), Dr. Patel completed his residency at the prestigious Kessler Institute, followed by world-renowned fellowship training at the Orthopedic and Spine Specialists (OSS).Dr. Patel is a master instructor for the Interventional Orthobiologics Foundation, where he trains physicians globally in cutting-edge regenerative techniques. As the founder of the Patel Center for Functional Regeneration in Newport Beach, he has established a premier destination for patients seeking advanced, evidence-based musculoskeletal care.Internationally recognized for his expertise, Dr. Patel is a sought-after speaker on orthobiologics and ultrasound, sharing his knowledge at conferences and workshops around the world. He also serves as an associate clinical professor, mentoring the next generation of physicians at Western University and Touro College of Osteopathic Medicine.Passionate about education, Dr. Patel regularly shares practical insights and procedural pearls on Instagram and YouTube (@Regendrpatel), making high-level regenerative medicine accessible to clinicians and patients alike.Tune in to hear Dr. Patel’s journey, his approach to innovation in musculoskeletal medicine, and his commitment to teaching and advancing the field.  Dr. Patel's Social Media: Instagram Linkedin Show Outline/Transcript What does preventive medicine mean to you?What is regenerative medicine? Can it be used preventively to help regular folks and/or athletes injury free?How did your career progress to what you do now? What does your practice look like on a day-to-day basis?Do you think there is any merit to stem cell therapies found outside of the USA that people often use for biohacking or “reversing aging?"What does the future of regenerative medicine look like?If someone asks you how to get healthy? What do you tell them in 2 minutes?  Join our Mailing List HERE: Mailchimp

John Whyte, MD Dr. John Whyte is a nationally recognized physician leader, public health communicator, and healthcare innovator. He currently serves as the Chief Executive Officer and Executive Vice President of the American Medical Association (AMA), where he leads the organization’s mission to advance the art and science of medicine and improve the health of the nation.A board-certified internist, Dr. Whyte earned his MD from the University of Pennsylvania and his Master of Public Health from Harvard University. His distinguished career spans leadership roles across some of the most influential healthcare institutions in the United States. He has served as a Director at the U.S. Food and Drug Administration (FDA), as well as positions at the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS).Prior to his role at the AMA, Dr. Whyte was the Chief Medical Officer at WebMD, where he became a trusted voice for evidence-based health information and patient education, reaching millions through his accessible communication style and media presence.Known for his ability to bridge clinical medicine, public policy, and health communication, Dr. Whyte has dedicated his career to helping people make informed decisions about their health — embodying the rare combination of leadership, compassion, and clarity that defines the very best of medicine.  Dr. Whyte's Social Media: Instagram Linkedin Outline/Transcript What does preventive medicine mean to you?Can you tell us a little bit about the overarching mission of the AMA and who it functions to serve?How does the AMA promote preventive medicine?What does the AMA identify as the biggest challenges physicians face in today’s world?How does the AMA enact change in healthcare policies? What does the process look like for reflecting and enacting the changes physicians want?What actions is the AMA taking to combat misinformation and the ongoing dismantling of evidence-based healthcare in the current political situation?Insurance is becoming more expensive and seems to cover less and less with more barriers. What is the AMA’s involvement in trying to improve the situation?What benefits do physicians have in getting involved in the AMA? How can individual physicians make a difference?If someone asks you how to get healthy, what do you tell them in 2 minutes?   Join our Mailing List HERE: Mailchimp

Boyd Burns, MD Dr. Boyd Burns is a distinguished leader in academic medicine and healthcare administration, currently serving as the Interim Dean of the Oklahoma University School of Medicine. He also holds dual leadership roles as Chair of the Department of Emergency Medicine and Chief of Staff at Hillcrest Healthcare System, where he plays a pivotal role in shaping clinical excellence and medical education across the region. A former residency program director, Dr. Burns has trained and mentored countless physicians, emphasizing clinical rigor, leadership, and service to the community. Beyond his institutional roles, he remains deeply engaged in the broader landscape of emergency medicine, contributing to the leadership and governance of multiple professional organizations. Dr. Burns’ career reflects a lifelong commitment to advancing patient care, medical education, and healthcare systems through innovation, collaboration, and evidence-based leadership.   Outline/Transcript: What does preventive medicine mean to you?How did your career evolve towards becoming so heavily involved in medical education and leadership?How has the practice of emergency medicine evolved over your career and where do you think it’s headed?Can you tell me about your role in educating medical students and their involvement in the community with the SCM Institute?How do you think physicians and medicine can help create bridges to the community in order to assist those with lower SES?What is the responsibility of physicians and hospital systems vs. that of the local, state, and national governments in assisting those who require the most assistance?If someone asks you how to get healthy, what do you tell them? Dr. Boyd Burns is a distinguished leader in academic medicine and healthcare administration, currently serving as the Interim Dean of the Oklahoma University School of Medicine. He also holds dual leadership roles as Chair of the Department of Emergency Medicine and Chief of Staff at Hillcrest Healthcare System, where he plays a pivotal role in shaping clinical excellence and medical education across the region.A former residency program director, Dr. Burns has trained and mentored countless physicians, emphasizing clinical rigor, leadership, and service to the community. Beyond his institutional roles, he remains deeply engaged in the broader landscape of emergency medicine, contributing to the leadership and governance of multiple professional organizations.Dr. Burns’ career reflects a lifelong commitment to advancing patient care, medical education, and healthcare systems through innovation, collaboration, and evidence-based leadership.

Ragav Sharma, DO The podcast is back! I took time off of the podcast during residency to focus on really mastering my craft, and now that I am a fellow physician, feel it is the right time to start bringing back the message of prevention! In this episode, I go over the history of the show, re-introduce myself, talk about current big topics in preventive medicine, things I find interesting in the world of preventive medicine right now, and talk about what to look forward to.    Ragav's Social Media: Instagram Link Show Notes Join our Mailing List HERE: Mailchimp

Kevin Walter, MD is a board certified pediatric sports medicine physician that specializes in helping children with various sports and musculoskeletal related problems. He is the medical director of pediatric and adolescent sports medicine at Children's Hospital Wisconsin, an associate professor at the Medical College of Wisconsin, has published several papers on concussions in children, and is avidly active in advocacy for safety in youth sports.  Show Notes What does preventive medicine mean to you and how do you apply that to pediatrics? Pediatric sports medicine is a pretty niche field until your kid breaks a bone or gets involved in sports. What led you to this field? What are the biggest differences between adults and children when it comes to sports medicine? Summer is coming, whats the best way to keep kids out of your exam room? What’s the deal with concussions. What are they? How many can you have as a kid? Does this mean you won’t be as smart in the future? Kids these days are in a hypercompetitive sports environment and find themselves playing a single sport year round so they can become the next tiger woods or michael phelps. What do you think about specialization at such an early age when it comes to sports? How early is too early to start thinking about organized sports? If there was one thing you wanted listeners to take away from this podcast? What would it be? Join our Mailing List HERE: Mailchimp

This is a re-cast of an episode originally aired in June of 2020. This was an incredible episode that deserves to be heard by all new listeners! In this episode we discuss the role of resistance training for both patients and as a prescription by providers, the evidence behind various practices in prevention, the harms of over-screening, and much more!. Whether in the hospital inpatient floors or his clients in the gym, Dr. Baraki brings evidence-based information and suggestions to help those he works with. Dr. Baraki is board certified in Internal Medicine, an assistant professor of medicine, and well known for his role with Barbell Medicine.  Dr. Baraki's Social Media: Instagram Twitter Link Show Notes Question 1:  What is Barbell Medicine, why did you decide to get involved and what are it's goals? Question 2: Why did you decide to go into Internal Medicine given your athletic history and interest in exercise? Question 3: What do you think other physicians that do not lift weights can learn from Barbell medicine, should they attend your seminars? Question 4: Does the population of those attending your Barbell Medicine seminars trend more towards physicians or healthcare professionals? Question 5: There are many silly ideas surrounding preventive medicine and other aspects regarding medicine, can you speak to the use of evidence when it comes to recommendations in preventive health? Question 6: What does preventive medicine mean to you? Question 7: Why is the allure of more screening with regards to preventive care problematic? Question 8: How do you balance limiting the allure of physicians to use screenings widely as a way to "check-off" preventive care and patients that desire screening based on false notions of prevention? Question 9: How do you communicate to patients who come in wanting to get unneeded screening such as a whole-body scan to determine all potential problems? Question 10: Why is it important that patients are educated and develop a level of self-efficacy? Question 11: Do you think helping patients develop a positive self-narrative is beneficial in the scope of preventive medicine? Question 12: Do you think we do a poor job of letting our patients know that they should be striving to develop a more robust exercise program based on the current guidelines? Question 13: How do we bridge the gap between personal trainers and physicians in bringing exercise programs and nutritional counseling to patients? Question 14: In 2 minutes what do you tell someone who asks you "how do I get healthy?" Join our Mailing List HERE: Mailchimp

It's 2023. It's time we separate our weight from our health. Everywhere we look, health and weight has been synonymous leading to body dysmorphia, poor relationships with food, and many other issues. Well, there's many more benefits to eating well and physical activity!  In this podcast, I go over some of the highlights from the podcast for the last year, some of my life events from 2022, podcast goals for this year, and then dive into dividing out health from fitness and nutrition. Ragav's Social Media: Instagram Twitter Link Show Notes Top Episodes Links:  Dealing with Burnout, and ICU Physician Tells All - Jeremy Topin, MD: https://thepreventivemedicinepodcast.com/episode-58/ The Dogma of Diets and Nutritional History - Alan Flanagan, MsC: https://thepreventivemedicinepodcast.com/episode-57/ Are We Really in Control of Our Diet? - Stephen Guyenet, PhD: https://thepreventivemedicinepodcast.com/episode-56/ Article Suggestions:  The Beginner Prescription by Barbell Medicine  Health Priorities by Barbell Medicine Join our Mailing List HERE: Mailchimp

If you listen to this podcast, you likely pay some sort of membership fee either for coaching, the gym, or another health related item. You get access to the facility, time with the coach, and whatever else is included in the fee. What if medicine was practiced the same way? Enter concierge medicine. Dr. Ari Levy is a serial entrepreneur and physician who founded SHIFT which is a concierge medicine practice focused on integrating all aspects of health under one roof. In this episode we discuss what SHIFT is, what concierge medicine is, how Dr. Levy's vision seems to be the gold standard when it comes to being mindful of prevention, and lastly the pitfalls of concierge medicine.  Go check out: https://shiftlife.com/ for more information on SHIFT and to see if you would like to make the SHIFT!  Episode Outline What does preventive medicine mean to you? What is SHIFT and what inspired you to start this practice? What differentiates it from what people usually think of as their doctor? Do you think physicians should get involved with advising patients on lifestyle modification or should we just focus on the medicine? What results have you seen with the “life” package through SHIFT? Do people take advantage of their resources? How does the model of concierge medicine work? Does this mean members don’t need insurance at all? What does it take to have these kinds of services available for those of lower socioeconomic standing? How do you keep it all evidence based when you hire for different positions? If you were waiting for your coffee at Starbucks and someone who recognizes you asks “how do I get healthy,” what do you tell them in the 2 minutes you have? Join our Mailing List HERE: Mailchimp