Episode 23 · Aug 23, 2026 · A Healthy Conversation
with Dr. Sam Zager · Family Physician & State Representative
About this episode
Dr. Lisa Belisle and Dr. Jeff Barkin are joined by Dr. Sam Zager, a Portland family physician and Maine House of Representatives member for District 116, who serves on the Health and Human Services Committee. His path to that dual role ran through the United States Naval Academy, a master's at Oxford, Harvard Medical School, a family medicine residency at Maine Medical Center, and eleven years of Navy service. Zager reflects on what it means to bring clinical training into a legislative body, arguing that good legislating, like good medicine, begins with listening and demands humility about the limits of one's own perspective. He notes that his committee achieved unanimity on roughly 83 percent of its votes, a figure that complicates the common assumption that Augusta operates in a state of constant partisan deadlock.
A substantial part of the conversation focuses on the state of primary care in Maine and nationally. Zager draws on a major National Academies of Sciences, Engineering, and Medicine report concluding that strengthening primary care is the foundation for improving health outcomes across the system, and he and the co-hosts examine why family medicine struggles to attract physicians, pointing to the difficulty of conveying its rewards in a short rotation, the administrative burden of prior authorization, inadequate compensation structures, and high staff turnover. Barkin describes prior authorization as a daily drain on clinical time, and Zager frames these pressures as symptoms of a system that treats health care as a market commodity rather than a public good, drawing an analogy to national security functions that society does not leave to private insurance. Both co-hosts and Zager discuss what incremental steps Maine can pursue on prior authorization reform and primary care pipeline development while broader structural questions remain at the federal level.
The episode also moves into questions of leadership, institutions, and what it means to carry responsibilities that shape other people's lives. Belisle, who trained alongside Zager at Maine Medical Center's family medicine residency under her father, Dr. Charlie Belisle, draws out Zager's thinking on upstream determinants of health: housing, education and economic opportunity as conditions that shape whether clinical care ever has a chance to work. Zager uses a-ha's 2017 acoustic rendering of their 1985 song 'Take On Me' as an illustration of how perspective and temperament deepen over a lifetime, arguing that effective leadership requires the same kind of accumulated reflection. He closes by encouraging listeners to consider civic participation, up to and including running for office, as one way of contributing to the health of shared institutions.
From this episode
“The health of a legislature and the wisdom of legislative decisions really rests on a diversity of opinions and experiences. So I see myself as one of many, one person who brings the things that I've learned from my patients, from my training and experiences, to the decisions that we make together.”
“I think the way I'm gathering is just because their lives have been different, their lives have become richer, deeper, more meaningful, and more contemplative. I feel like I've had a similar trajectory.”
“I guess I approach legislating and my conduct and manner in the legislature in the same way that I approach being a doctor. It's a tremendous and humbling privilege to be invited into somebody's life as a physician to help them, guide them, or to be an advisor as they're essentially the captain of their ship.”
“I feel like part of my responsibility is to be true to the evidence. Even when I sometimes have to tell friends that the evidence isn't there to support what you are suggesting. That has to happen too. And that's part of being committed to where the evidence is going.”
“I believe we fundamentally have the wrong approach to providing healthcare in this country. We are treating it like a commodity rather than a public good. Can you imagine if national security or local security, fire and police protection and so forth, were provided by your insurance policy that you got through your employer?”
“Primary care is the only specialty that has been shown over and over again to have a health benefit. For every primary care doctor that's in a catchment area of 100,000 people, the life expectancy of those people is associated to improve by about two months, almost 60 days. That's profound.”