A Costly Paradox: More Spending, No Better Health. - Dr. Elliott Fisher

Healthcare Reframed

Is more healthcare always better healthcare?

Dr. Elliott Fisher has spent decades uncovering why high-spending regions fail to deliver better care or longer lives — and what this means for patients and policymakers.

In this episode of Healthcare Reframed, Fisher shares the inside story of how one 1973 paper shook the medical world, why towns with the same people and same hospitals have 10× differences in surgery rates, and what it really takes to align incentives so care becomes safer, kinder, and more affordable.

🧐 You'll learn

• Why spending more often leads to worse outcomes
• How the idea of Accountable Care Organizations (ACOs) was born (literally by "stopping the presses")
• Why the U.S. wastes 20–30% of healthcare dollars on unnecessary care
• The "balloon problem" of squeezing costs in one area only to see them pop up elsewhere
• The most important leadership question: "What do you stand for?"

Whether you're a policymaker, healthcare worker, or a patient trying to understand why medical bills keep rising, this conversation will change how you see the system.

📖 Chapters

1. 00:00 – Introduction to Healthcare Spending and Outcomes
2. 01:03 – Elliott Fisher's Background and Early Insights
3. 05:28 – Personal Motivations and Family Influence
4. 08:33 – Early Research on Variations in Medical Practice
5. 12:21 – Challenges and Skepticism in the Medical Community
6. 13:22 – Shared Decision-Making and Patient Preferences
7. 16:47 – Physician–Patient Interaction in the Early 1980s
8. 19:01 – Treatment Decisions and Patient Advocacy
9. 21:28 – Choosing Wisely and Understanding Risks
10. 23:05 – The Value of Time in Diagnosis
11. 24:05 – Global Spread and Impact of Variation Research
12. 25:16 – From Research to the Dartmouth Atlas
13. 27:50 – Why the Research Was Unique & National Impact
14. 29:38 – Four Decades of Progress in Healthcare
15. 31:47 – Spending, Outcomes, & Hospital Utilization
16. 37:04 – Policymaker Reactions and Political Context
17. 38:41 – Development of Accountable Care Organizations (ACOs)
18. 44:56 – Effectiveness and Challenges of ACOs
19. 48:47 – Insurance Trends & High-Deductible Plans
20. 52:12 – Reflections & the Need for All-Payer Models
21. 54:31 – Quality Improvements & Remaining Gaps
22. 56:08 – Case Study: Intermountain Healthcare's Success
23. 58:19 – Pathways to Reform & Leadership
24. 60:38 – Barriers to Change in Health Systems
25. 62:40 – Hospital vs. Physician Roles in Care Delivery
26. 63:37 – Medical Pricing & Systemic Reform
27. 69:10 – Regulatory Models & Public Utility Commissions
28. 69:44 – Financialization of Healthcare & Consequences
29. 72:57 – Oversight & Competition in Healthcare Markets
30. 74:12 – Controversies Around Competition & Choice
31. 77:13 – Purpose & Leverage Points for Improvement
32. 81:20 – Empathy, Compassion & the Future
33. 82:14 – Measuring Success in Healthcare Reform