Episode 294- Inside America’s Access Crisis And Why Wait Times Keep Rising. With Rich Helppie.

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.

Transcript

Welcome And Purpose

SPEAKER_01 0:00

Welcome to this episode of the Healthcare Bridge, where we explore the vital connections shaping our healthcare landscape. Hosted by Nathan Kaufman, Managing Director of Kaufman Strategic Advisors, the Healthcare Bridge is dedicated to improving healthcare delivery by strengthening the strategic and financial performance of healthcare providers. As part of the Common Bridge family, our focus is on fostering insightful, nonpartisan conversations that drive meaningful change in the healthcare industry. We invite you to join us as we build bridges toward a healthier future. The show is available on Substack, YouTube, and your favorite podcast platforms. Search for the Common Bridge and stay connected.

Defining Access Beyond Buzzwords

SPEAKER_00 0:37

This is Nate Kaufman from the Healthcare Bridge, part of Rich Elpey's Common Bridge podcasts. And we're here today talking to the one and only Rich Elpey about healthcare access. So what usually happens in these podcasts is while I am the host, Rich begins to ask most of the questions. So we'll start with you, Rich. What do you want to know about access?

A Leukemia Scare Reveals The Wait

SPEAKER_02 1:02

Well, Nate, I've found that these little 15-minute quick hitters are very popular. People stop me and go, that was really informative, what you did about Medicare disadvantage, for example, and wife drug prices are so high. And uh, you know, you and I talk about the triple aim, right? Of cost, quality, and access. And, you know, people can get their heads around what cost is and what quality is. We know it when we see it. But what about access? So, you know, from a healthcare point of view, how would we tell an audience that is not familiar with healthcare, not from the inside, what would we tell them that access is and why it's important?

Shortages And Maldistribution

SPEAKER_00 1:40

So let's talk about my friend. My friend had an infection in his arm, and he went to his primary care physician who did a bunch of blood tests, and he said to my friend, there's a chance here that you may have leukemia. Well, when you hear that, the next day you want to be in with a hematologist, oncologist to find out if in fact you do. Well, the next appointment he could get was about 30 days away. And he called me and I was able to get him in by that Friday, and sure enough, he does have leukemia. But the average person, when they find out they have a particular problem, access to specialists, neurologists, it's 40 days for your first appointment. Just another fun fact, it almost takes an entire year for a hospital or a physician group to recruit an oncologist when they know they need one to go into their practice. The net result is that we are seeing a maldistribution of specialists, especially out of rural areas and into urban areas. And even in urban areas, the problem is not whether those specialists have enough patients, it's that they have too many patients. So the real challenge that I see out there today is what are we going to do with this physician shortage that nobody is dealing with?

SPEAKER_02 3:02

It's beyond specialists. It's just, you know, access to primary care, access to obstetrics, you know, labor and delivery maldistributed as well. And the painful part of this, of being a data guy, because your friend said, Yeah, I'll take that next available appointment, even though it's a scary 30 days away, that would be coded as no weight. And lay media outlets would report that as we're very, very efficient and nobody's waiting for care. And if he was in other systems like the VA, it would be a year out, but it would be coded the same way. So I caution people about reading summary statistics. But here's the way I think of this, Nate. We have a population that wants healthcare services, particularly with the graying of America. We need more old people like us. We also have an amazing amount of diagnostics and treatment facilities. We have lots of doctors and nurses and allied health professionals, and yet we can't seem to get them in the same place. So I think it bears discussing a little bit, and maybe let's use coffee, for example. In my little town here, there is a Starbucks, there is a local chain called Big B's, and there is at least one really good quality, independent coffee place. So they know that there's demand out there for people that want to buy coffee and they want their doors open, and they would not look at a long line of people waiting as a good thing. But the situation you just described with your friend, that long line out the door, nobody's really concerned about it inside because our appointment calendars are full. Am I on the right track or is this not a great analogy?

Coffee Analogy For Capacity

Training Lag And Rising Demand

SPEAKER_00 4:47

No, it's a good analogy because there's a big difference between, you know, like a Starbucks and a hematology practice, and it's it takes 12 additional postgraduate years to make the hematologist. While we've seen hematology oncologists increase in terms of supply, there's 25% more than there was maybe a bunch of years ago. The demand is 40% up. And then what's happened is many physicians, especially in primary care, say Medicare and Medicaid are not paying us sufficiently. We're going concierge. Okay, we'll have less busy practice of people paying us more money. And by the way, I recommend that if you can possibly afford it, either get a primary care physician who's got a concierge practice, or they now have these things called direct primary care where you pay a small monthly fee for membership, but lock your primary care doctor in. Otherwise, um, I just don't know where people are going to find primary care physicians in the future.

Concierge And Direct Primary Care

SPEAKER_02 5:53

Well, I can tell you this. We have a provider that recently decided to leave Medicare and Medicaid, said, I don't get paid enough, the paperwork's too high, I've got enough patients that can pay. But we know the problem is that if providers say they're not taking Medicaid patients by way of example, people that are on that end of the socioeconomic strata aren't going to get care. They're not going to have access, they're going to become sicker, and when they become sicker, then they're going to end up in the ER and they're going to be treated for the most dreadful of conditions in the highest cost place possible at a cost that is far exceeded what the preventive care of a primary care doctor could do. So I think it's imperative on us as a just society to make sure that people can get to a doctor when they want to.

Medicaid Math And ER Overuse

SPEAKER_00 6:46

Right. But and it's no surprise, by the way, that over 40% of all emergency visits are from Medicaid patients. But to give you an example, I mean, a Medicaid patient may pay a doctor$70, Medicaid may pay them$70 a visit. Well, after the overhead, paying for the nurse and everything, there may be$10,$20 left for that physician to take responsibility for that person's care. And that's just not enough. And so what's happened, the other thing that's happened, which is a conspiracy theory, but is not true, is because of Medicare and Medicaid underfunding physician services, the physicians have gone to the health systems and said, you benefit from our surgeries and our referrals. You need to improve my compensation so I can make a living after spending 12 years uh postgraduate to get this degree. And oh, by the way, we're in short supply, so if you don't want to do it, we'll just go to your competitor. So there's this arms race that's going on. One other thing about my friend, so the next question is okay, so you probably have leukemia and you may need a bone marrow transplant. Now, do you think he's looking for the cheapest bone marrow transplant when there's under best circumstances the survivability rate is maybe 75%? And where do you get that data on where should you go for a bone marrow transplant where you have the best chance of success? I mean, the system is just so broken. And the healthcare policymakers, nothing that they're saying is making any sense to me, at least, because they're not recognizing the fact that we have people in our system that make up the cost, and these people expect to be compensated well, and nobody's willing to take a cut and pay.

Arms Race And Market Consolidation

SPEAKER_02 8:38

You just summed it up right there. The demand is there. It takes 12 years of additional training. I want to be paid for that if I've gone through that 12 years. As a patient, I want the best and brightest. I want people that are going into that field to compete for that role and be highly qualified. And I want them to be highly compensated so they're not worried about their car payment while they're doing a bone marrow transplant. All right. You don't want that. But let's go back to the coffee analogy. People want to buy coffee, they're willing to spend several dollars for fancier coffees, and there can be an arms race, but you're going to expand capacity. And now watch this. I don't go into my neighborhood coffee store and they go, Well, who's your coffee plan with? I don't pay a third party$10 so that I can go into my coffee shop and instead of paying the coffee shop$5, they only pay four and they charge me$10 to this third party. But that's where we're at with primary care. Primary care is basically a retail business. And by having it under insurance, it's a distortion of what the word insurance is. Insurance is an unanticipated, financially catastrophic event like leukemia. Let's insure for that. But insuring for primary care is insane. All it does is enriches, once again, that insurance company. Am I right about that or wrong?

Insurance Distortion Of Primary Care

SPEAKER_00 10:10

No, I don't think you're wrong. I think the issue is let's go back to your coffee analogy. You have three different coffee shops in town. Um, what happens if this is oncology? Is there's three different oncology groups in town, and the insurance companies play one off against the other to say, okay, we'll send all your patients to you if you give us a better rate. And eventually the oncologist said, This is crazy. Let's join up and create one oncology group. We don't have to work as hard and we can demand better rates because we are the only group in town. And so, again, you know, this whole idea that we're going to get cost down under our current system, I just don't see it. Keep in mind that 10% of the population consumes over 80% of the cost of health care. And that's not just Medicare, that's in the commercial as well. And so unless we address that issue and focus on those people and reduce the care from those people, we're not going to get the cost down. And in addition, what we're doing is we're burning out and driving physicians to either practice concierge medicine, go part-time, or look for an administrative job. And now we have an access crisis.

Payer Tactics And Group Mergers

SPEAKER_02 11:25

We do have an access crisis, and it's not just specialists, it's geographic, it is cultural, it is, of course, financial. We need to create supply and make it accessible to the people that need it. But here's our system today, Nate. You and I have talked about the pharmaceutical empires and those businesses. So you have one big for-profit arm trying to create demand to sell you stuff for the rest of your life, whether you really need it or marginally don't need it. On the other side, you have this big for-profit insurance business whose job is to deny you care and not buy any of the stuff from the pharma company and not let you go to the doctor or the hospital. Coming back to the coffee analogy, I can't go to the counter at Big B and them saying, hey, sorry, but your your coffee plan was denied. You don't get any coffee today. It's like, no, I'm here. I got money in my hand. I want to see, I want a cup of coffee. We need to make that available to all people for primary care. But because of the way that we've tax subsidized the insurance companies, they're scraping billions for the purpose of not letting people get to the doctor. And when they get to the doctor, paying the doctor less money. And you've just illustrated it in the example with the oncologist playing one off the other. And I've demonstrated on the primary care side. Until we get reformed to deal with that, I think we're going to suffer this access problem.

High-Cost Patients Drive Spending

SPEAKER_00 13:07

And you know, and so we should probably leave this with this concept. It's not going to get solved. And the reason it's not going to get solved is the biggest health care benefit company in the world is the United States government. It's the biggest health care benefit company in the world. It spends$1.8 trillion on healthcare. And every four to eight years, the entire executive team is wiped out and a new executive team comes in, and they may or may not have the competencies to deal with the healthcare crisis that we have. And so I don't see us making a lot of progress. I see change happening, but the impact of change, as Thomas Sowell says, there are no solutions, only trade-offs. Is if we get costs down, we're going to have an access crisis. If we get costs uh up, people aren't going to be able to afford healthcare. And nobody has come up with a solution.

Pharma, Insurance, And Denial Incentives

SPEAKER_02 14:09

Well, you and I have. We have uh come up with it uh a couple of times. And maybe we ought to shoot a short segment on the insanity at the federal level. I'll just leave with the teaser. You remember we reformed healthcare 15 years ago. You can keep your doctor if you like your doctor, and you're going to save$2,500. We called it out at that time that that was not going to happen. And here we are today in desperate need of reform.

SPEAKER_00 14:34

So our advice is if you can, lock yourself into at least the concierge or a direct primary care physician, because when you need one, they may not be accessible to you. So good luck.

SPEAKER_02 14:49

And if you're not possessing the resources to get into a concierge of medicine, still try to develop a relationship with a primary care physician that will take your insurance. There are providers out there, they are fewer and further between. But uh just understand you're suffering from the crisis of access. It's a healthcare segment, Nate. So do you want to read us out?

SPEAKER_00 15:10

Oh, sure. This is Nate Kaufman and Rich Helpie ranting about healthcare again. Access is a problem. Make sure you try to get a provider that you can depend on. And by the way, if you get sick, like my friend did, you don't want to focus on the cheapest care. You want to look for outcomes. And the only way you find out who are the best is you have to find an insider. And that's one of our jobs to provide an insider's perspective on healthcare. So signing off with Rich Helpie. Thanks a lot, Rich. Thanks, Nate.

Government Scale And Policy Trade Offs

SPEAKER_01 15:42

Thank you for joining us on this episode of the Healthcare Bridge. We hope you gained valuable insights into how strategic and financial analysis can transform healthcare delivery. Remember, building stronger connections in our healthcare system is a collective effort, and we're honored to be part of that journey with you. Be sure to subscribe and stay tuned for more conversations that aim to bridge gaps and create a healthier future for all. You can find all your healthcare bridge episodes at the Common Bridge on Substack, YouTube, and your favorite podcast platform.