Episode 29 · Sep 13, 2026 · A Healthy Conversation
with Jeff & Lisa
About this episode
Dr. Lisa Belisle and Dr. Jeff Barkin open by mapping the scale of the problem: the United States spends roughly 18 cents of every dollar on healthcare, about half again what comparable wealthy nations spend, yet ranks far down in health outcomes. Both co-hosts draw on personal experience to make that abstraction concrete, noting that high deductibles, rising premiums, and copayments have turned a trip to the doctor into a financial calculation for many Maine households. Barkin describes the deductible as a structural perversity: insurance that technically exists but withholds coverage until a patient has already absorbed thousands of dollars in out-of-pocket costs, precisely when illness makes them most vulnerable. Belisle adds that coverage gains seen a few years ago have since eroded, leaving more Mainers without consistent access to preventive care.
The co-hosts then work through the main cost drivers in detail. Administrative overhead, estimated at roughly a third of every healthcare dollar, draws particular attention: Belisle notes that clinicians spend close to two hours on electronic health record documentation for every hour of direct patient care, and that the average clinician completes dozens of prior authorizations each week, a process both identify as the leading source of professional burnout. Hospital pricing receives equal scrutiny, with Barkin noting the stark difference in what an insurer pays for the identical service depending on whether it is delivered in a physician's office or a hospital facility. Belisle pushes back on framing hospitals as profiteers, citing the 2025 closure of Northern Light Inland Hospital in Waterville and the loss of labor and delivery services at multiple rural facilities as evidence that many Maine hospitals are operating at a loss, squeezed between rising costs and low reimbursement rates. Drug costs round out the discussion, with the co-hosts examining the opacity of pharmaceutical pricing, the growing expense of newer drug classes, and the role of negotiated formularies in Medicaid programs as a model for broader cost control.
The final segment turns to what individuals and policymakers can do. Barkin describes his experience negotiating drug rebates on behalf of multiple state Medicaid programs, arguing that removing the profit motive from that process and returning savings directly to states produced better coverage for more patients at lower cost. On the consumer side, the co-hosts encourage listeners to compare prices before filling prescriptions, noting that the same medication can vary dramatically in price from one pharmacy to the next, and to review their explanations of benefits carefully for billing errors. Belisle points to CompareMaine.org as a state resource for comparing estimated costs and quality across healthcare settings. Throughout, both co-hosts frame the conversation not as a partisan debate but as a practical accounting of why people in Maine are struggling to access the care they need, and what structural changes might begin to close the gap.
Mentioned in this episode
Also mentioned: Community Health Options · CompareMaine · Dr. Sean McCloy on this show · GoodRx
From this episode
“Who invites somebody to a dinner party whose job it is to make sure nobody else gets to eat? And that's what the health insurance companies do.”
“How did we get to this crazy place where getting sick is the reason that people lose their homes? That's not a statistic, that's just a fact.”
“To be sick, to be fighting cancer, and to be fighting denials is frightening.”
“Don't just assume that when you get your explanation of benefits back in your mailbox that what has been given to you is correct. Go through it, try to understand what you were charged for, what this means. Because people are human and are creating these, and there are errors that occur.”
“When people don't have as much coverage, we know that they're not going to utilize preventive services. They're not going to be seeing their physician, their nurse practitioner, their physician associate on a regular basis. So the balance is we're paying more, we're getting less, and we're not going in to see our clinician.”
“The American Medical Association estimates that clinicians spend nearly two hours on electronic health record documentation for every one hour of direct patient care time. In family medicine in Maine, that translates to roughly 13 to 15 hours a week of work that is not reimbursable and is not visible to the patient.”