How American Healthcare Became an Accidental System: The Untold History of HMOs, PPOs, and Academic Medicine

Ever wondered why healthcare in America feels so complicated? This episode reveals the surprising truth: nobody actually designed our current system.

We trace the fascinating origins of health insurance back to the Great Depression, when desperate hospitals invented prepaid plans just to survive. Discover how World War II wage controls accidentally created employer-based insurance, how a single tax code decision locked in this bizarre system, and why the "father of the HMO," Dr. Paul Ellwood, thought managed care would save American medicine.

In this episode, you'll learn:

• Why hospitals were going bankrupt in the 1930s and how the Baylor Plan became Blue Cross
• The forgotten history of prepaid group practice and why the AMA tried to crush it
• How WWII wage freezes accidentally created our employer-based insurance system
• The real difference between HMOs and PPOs—and who actually invented them
• Why academic medical centers nearly collapsed in the 1990s
• How "prior authorization hell" became the compromise nobody wanted

This is a story of path dependence. Each generation made rational choices to protect their own interests: hospitals stabilizing revenue, employers avoiding wage controls, politicians preserving the status quo. But those individual decisions accumulated into a system that serves nobody's original vision.

Whether you're a physician frustrated by prior authorizations, a patient confused by your insurance, or just curious about how we ended up here, this episode connects the dots between century-old decisions and today's healthcare chaos.

This is an AI generated podcast curated from publicly accessible sources.