Don't Normalize "Less"

Why is it that in almost every industry, “more” is considered good service—more communication, more clarity, more personal attention—yet in healthcare, asking for more gets you treated like you’re being unreasonable?

In this episode of The Talking Rehab Podcast, Dr. Fred Bagares breaks down why the traditional insurance-based system consistently delivers less: less time, less access, less personalization, and less continuity. And more importantly—what patients can actually do about it.

You’ll hear a relatable story of a patient who followed all the rules and still ended up with delays, fragmented opinions, a surprise bill, and barely eight minutes of face-to-face time. Not because anyone involved was unkind, but because the system isn't built around people. It’s built around billing, risk management, and volume.

Dr. Bagares explores:

• Why “less” has become normalized in healthcare
 • The service-industry comparison that makes the problem impossible to ignore
 • How delays, gatekeeping, and rushed visits are baked into the insurance model
 • Why the system won’t fix itself—and what proactive patients can do now
 • Five practical paths for reclaiming clarity, access, and personalized care
 • How direct care rebuilds medicine around you, not billing protocols

If you’ve ever felt rushed, unheard, or confused after a medical visit, you’re not imagining it—and you’re not expecting too much. There are better options.

For clarity guides, diagnostic tools, and resources that help you understand your body and next steps, visit FredBagares.com or MSKDirectVB.com.

Transcript

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You know what's interesting In almost every part of life when a company gives you more, that's considered good service, more communication, more transparency, more options that actually make sense. But there's one industry where more has somehow become the problem. We're asking for more time and direct contact with the person treating you gets you treated like you're being difficult. I'm talking about healthcare, and today we're gonna explore why that is, what it costs patients And ultimately what you can do about it. So let's start with a simple question. Why do consumers get more value everywhere else but less in healthcare? Think about the last time you had a great customer service Maybe it was a hotel that upgraded your room without you asking, or an airline that texted you gate changes in real time. Maybe it was a retailer that let you return something three months later without any questions asked. In those moments, what made it great wasn't the outcome. It was that they gave you more than you expected. They were being flexible and being respectful of your time. Now think about the last time you tried to navigate healthcare. I'm willing to bet the experience was completely different. And here's what we're going to impact today. We'll explore where more actually matters, where healthcare systematically withholds it, and why you should normalize it. I'm Dr. Fred Begar and this is The Talking Rehab Podcast. Before we dive in, if this show has ever made you see your body or your recovery in a new way, hit that subscribe button. It's free, it's quick, and it tells me these conversations matter to you. Thanks for being a part of this movement. Now let's get into it. Let's establish a baseline When you travel, you see the price up front. You know what's included. If something goes wrong, they tell you immediately and often compensate you for the inconvenience. In retail, it's a fairly simple transaction. You pay by a credit card, cash or check free returns within a certain time window. Perhaps they have loyalty programs that reward you for coming back and being a good customer. They want to make the process so easy that you want to come back. let's say you wanna work with a personal trainer, what is the very first thing that they ask you? What are your goals? They ask you this so they can design a program to meet your expectations. It's not some generic template. They want to see you succeed and hit your goals. Here's the pattern. In most service industries, they value their customers and exceeding their expectations is how they differentiate themselves from their competitors. It is clear who they're serving, and this is how they earn your trust. It ultimately keeps you coming back for more. Because I've done such a great job, you've come to expect it. It's not a luxury. It's not the baseline experience. Now, let me tell you about a patient I worked with recently. She came in with shoulder pain that had been going on for months. Nothing debilitating, but just persistent and annoying. But ultimately was getting worse. She had already talked with her primary care physician twice about it and was finally referred to see an orthopedist. It took five weeks for that appointment. The orthopedist ordered an MRI that took three more weeks to actually get it scheduled. Then another two weeks to get back in to review the results. When she finally got back in the orthoped, spent maybe eight minutes with them, looked at the MRI images for 30 seconds, said, looks like a rotator cuff issue. Let's try physical therapy. If that doesn't work, we can talk about surgery. All of this with their hand on the door handle. The assistant came back in with a script for physical therapy and she was told to schedule a follow-up in six weeks and they were out of the door before they could ask any questions. And here's the thing, she wasn't being difficult. She wasn't necessarily being demanding. She just wanted what you'd expect from any other service in 2025. That seems totally reasonable to me. Unfortunately, the bar for healthcare is very low. The patient or customer experience is met with gatekeepers, delays, more referrals. A surprise bill for the MRI that insurance only partially covered conflicting opinions from the physical therapist and orthopedist about what she should and should not be doing now. I would be surprised if anyone listening can describe a different experience. As a matter of fact, this may be considered a good experience. Let's call this what it is. Healthcare is one of the few businesses where less service or not improving the patient experience is considered the norm. You get less time with your provider. The average primary care visit in the US is now under eight minutes, and that's total visit time, including getting your vitals and waiting for the doctor to finish charting. Try calling them directly, texting them a question, getting an email back the same day. You get less personalization. Treatment plans are built around billing codes and insurance protocols not around you as an individual with specific goals, you get less continuity, so you see whoever's actually available. No one seems to have the time to read the previous notes, so you have to repeat yourself over and over and over. I think you kind of get the point. Now, here's what I need you to understand. The unfortunate truth is that this experience is only going to get worse. The healthcare industry isn't suddenly going to simplify. Insurance companies aren't going to reduce bureaucracy. The system isn't going to magically start giving you more time, more access. If anything, it's going to get more complicated. In this past year, insurance companies have been quite vocal about using AI to initiate prior authorizations. Physicians have been dropping insurances because of poor reimbursement. The cost of insurance premiums just went up to an average of$26,000 per year. There is now more administrative burden pushed onto the patients, more consolidation of hospital systems that reduces your choices and increases prices. The system is not broken. It's working exactly as it's designed. It's just not designed around you. It is designed around billing, compliance, and risk management. And no matter how good your individual doctor is, no matter how much they care, they're trapped in that system too. So here's what I want to encourage you to do. Look for other options. Do you have more options than you think? And the best strategy might be to engage with the traditional system as little as possible. Let me walk you through what this actually looks like. The best healthcare system is the one you don't need to use. I know that sounds obvious, but think about how much time, energy, and money people spend navigating the healthcare system compared to how much they invest in actually staying healthy. What if you took a portion of the money that you're spending on insurance premiums that you barely use and redirected some of it toward things that actually move the needle? A gym membership, you'll actually use a nutrition coach, maybe a standing desk, perhaps cutting out caffeine and screen time at nighttime to encourage better sleeping habits, maybe stress management, incorporating a movement practice on a day-to-day basis that keeps your joints healthy and your body resilience. This isn't about becoming a biohacker or, or obsessing over optimization. It's about recognizing that the traditional healthcare system is designed for crisis management, not health creation. The less you need the system, the less you have to engage with it. Option number two. Here's something that most people don't realize. Not everything needs to be seen by a physician first. That shoulder pain, that nagging back issue. You can go straight to a physical therapist, you can go to a sports chiropractor, you can see a massage therapist. These are folks who routinely deal with orthopedic issues. And here's why that matters. Early intervention prevents the need for the system's, quote unquote solutions. Most musculoskeletal issues don't need MRIs, specialists, injections, medications, or even surgery. They need movement strengthening and proper loading strategies. Working with musculoskeletal providers early before you're in crisis mode Keeps you out of the messy and chaotic system that we call healthcare option number three. Taking a preventative approach is how you avoid the current system. The traditional healthcare system is set up for finding diseases and initiating some sort of medical treatment. insurance doesn't reimburse for, I want to make sure I don't develop problems it reimburses for. I have a problem. Let's give it medication or surgery. So if you're waiting for your annual physical to address prevention, you're already behind. Real prevention looks like addressing movement dysfunction before it becomes pain. Managing stress before it becomes anxiety, insomnia, fixing your workspace, ergonomics before you develop neck or shoulder issues. Strengthening your body before you injure it. The system unfortunately will not guide you here. You have to take ownership of this yourself. If you're going to have insurance and it's an option, make it a high deductible health plan paired with an HSA. Here's why. HSAs you save pre-tax dollars that you can use for healthcare expenses. You control how those dollars are spent, not the insurance company. Want to use HSA funds to pay for direct care. You can want to use them for PT without a referral. maybe a physical therapist that's out of network. When you have HSA funds, these are definitely options. A high deductible plan often has a cheaper premium, which means you're paying less into a system you're trying to avoid anyway. An HSA gives you financial flexibility to access the kind of care that actually works without waiting for insurance approval. You're essentially opting out of the micromanagement while keeping catastrophic coverage in place of true emergencies. Option number five, direct care. Because here's the reality, this healthcare system is designed to give you the bare minimum. Unfortunately, this isn't an exaggeration. It is just simply how the incentives of this system work. The less time your doctor spends with you, the more patients they can see. The more the system makes, the less access you have and the fewer unnecessary touch points, the less clarity you get, the faster they can move to the next patient. Bare minimum isn't a bug. It's the feature of the system. With direct care, you remove these incentives and rebuild around what actually matters. You the patient, because the current system in place is not designed to give you more. In the end, less care isn't great care. It's just simply less. So let's come back to where we started. Healthcare is one of the few services where average to below average care is the norm. How many times have you returned to a restaurant where the food was average or even bad? Let's say you want to give them one more chance, but they raise their prices and the food is not any better. Maybe it's even worse. Why would you go back there? Most consumers would find another restaurant or learn to cook on their own. However, consumers of healthcare seem to go back to the same restaurants settling for below average food. There is no magic solution. This is your opportunity to be proactive in your own healthcare, move more, eat healthier, address problems sooner, and maybe you can stay away from the average healthcare experience. However, maybe you decide to invest in your health and go outside of the insurance network to work with someone that aligns with your goals And no matter who you choose to take care of, you do not normalize. Less, less time is in grade care, even if the physician is amazing. It's just less time, less access isn't a sign that your provider is in high demand. It's just less access. I'll leave you with one of my favorite quotes by Warren Buffet. Price is what you pay, values what you get. Think about that the next time you hand over your copay. If you've been frustrated by the less is normal approach in healthcare, you're not imagining it and you're not asking for too much. If you want more clarity, accuracy, or partnership in your care, visit fred bagis.com or msk direct vb.com. I've got clarity guides, diagnostic tools and resources to help you understand what's actually going on and what your next best step should be. Thanks again for listening. I'll see you next time. Thank you for listening to The Talking Rehab podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.