Doctors were told to ignore cost. Patients are paying for it.

A retired Korean War veteran with Medicare and a secondary plan told his doctor he could not fill a $500-a-month inhaler. Narinder Singh Parhar, a physician of nearly 40 years across primary care, hospital care, and intensive care, says a moment like that is not an accounting problem, it is a moral one. He argues doctors were trained to be blind to what care costs, and that the training helped build the bill patients now cannot pay.

⏱️ Chapters:
0:00 Introduction
0:31 Why affordability kept coming up in an affluent practice
1:20 The Korean War veteran who could not fill a $500 prescription
2:17 The four wounds he says are damaging health care
2:35 Why cost is a moral failure, not an economic one
3:50 Where the money goes in a top-heavy system
4:20 The basic health habits nobody teaches patients
5:07 Why the money and the talent should move to primary care
6:20 The 30-minute visit that put him behind schedule
7:32 What a doctor can do in the room to lower a bill
8:02 How to hold asthma down without another prescription
9:15 Why nothing in health care changes without physicians
10:03 The lesson that taught doctors to ignore the price of care
10:29 The referral, the MRI, and the brand name you can skip
12:14 Take home messages

About this episode:
Narinder Singh Parhar practiced for nearly 40 years in primary care, hospital care, and intensive care, and he says the affordability question kept surfacing even in an affluent community where patients had worked their whole lives and carried both primary and secondary insurance. His KevinMD article, "Health care affordability is now a moral crisis," grew out of a retired Korean War veteran who could not fill a $500-a-month steroid bronchodilator near the end of the year. Parhar puts affordability alongside accessibility, polypharmacy, and microbial drug resistance as the four wounds he believes are damaging the health care model. He argues the system has grown top-heavy, with money flowing to hospitals, imaging, procedures, and specialty care while primary care is left underfunded and under-respected. His proposal moves both financial and intellectual resources toward primary care, and asks primary care to teach patients the basics of muscle preservation, joint preservation, balance, sleep, nutrition, and regular exercise. He describes spending 20 or 30 minutes with patients on that work and falling behind schedule for it, which he uses to argue the reimbursement structure itself has to change. For physicians who feel powerless, he makes the sharper claim: doctors were told to be blind to the cost of care, that blindness helped costs rise, and nothing in health care moves without the consent of the physician community. He closes by asking clinicians to care for their own health, their families, and the cost of every test, referral, and prescription they order.

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