Primary care receives only five cents of every health care dollar [ PODCAST ]

kevinmd.com · Mar 1, 2026 · Collected from GDELT

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Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes! Family physician and health benefits advisor Jonathan Bushman discusses his article “The 5 percent problem: the low value of primary care.” Jonathan contrasts the grueling decade of training and massive debt required to become a doctor with the thirty-minute process of obtaining a health insurance broker license. He reveals the shocking economic reality that both professions command roughly five percent of total health care spending, highlighting a system that values money movement as much as patient healing. The conversation explores his unique position straddling both worlds, arguing that bringing clinical insights into benefit design is the only way to lower costs and improve outcomes. Jonathan challenges the perverse symmetry of a market where a thirty-eight dollar license carries the same economic weight as a medical degree. Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let’s work together to tell your story. PARTNER WITH KEVINMD → https://kevinmd.com/influencer SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended Transcript Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jonathan Bushman, family physician and health benefits advisor. Today’s KevinMD article is “The 5 percent problem: the low value of primary care.” Jonathan, welcome back to the show. Jonathan Bushman: Thank you for having me. Appreciate it. Kevin Pho: All right, so tell us what led you to write this article and then about the article itself for those that didn’t get a chance to read it. Jonathan Bushman: Yeah, absolutely. What inspired me to write this was several years ago now. It has been about three years ago. I was looking into getting into the benefits space really as a consultant and as a collaborator. I had an opportunity to take a few smaller cases locally. Well, of course, that requires a license. I have been around benefits obviously, being a family physician. We have learned coding and billing and all that stuff for so long. But my first job out of high school was actually filing HCFA 1500 forms. I saw them in a neurosurgical practice. I was seeing the billed charges, the allowed charges, and the paid amounts. We were auditing EOBs. For a long time, I have been a part of that billing and benefits side, and I have always had lots of questions around it, but I have also had the education. When I decided to get this license, I literally logged in to the state insurance portal and scheduled a test for later that day at five o’clock when I finished up clinic. I logged in, took my test 30 minutes later, and for 38 dollars later, I am a licensed insurance agent. All right? I did see the humor in that at the time and how simple that seemed. Over time, I keep going back to it. I look over at my wall and I see this diploma sits there. You start thinking about how long it took me to get into the position of taking care of people. It is four years of undergrad, four years of med school, and three years of training. I got 11 years of my life. I sort of gave up my twenties, if you will. I dedicated my twenties to education and professional training. I had about 300,000 dollars in debt at the time to show for it in 11 years. Then as I was framing my insurance license is when it hit me. I put it up on the wall and I was like: “Holy crap, look at that. Thirty-eight dollars and 30 minutes versus 11 years and 300,000 dollars.” Then I started thinking broader because we have always heard primary care is just not invested in like it should be. We look at the nearly 5 trillion dollar health care system, and the estimate across the system is that primary care makes up about 4 percent. I did not know the economics getting into insurance. OK, I don’t have a large book of business. This isn’t a career replacement for me. This was an add-on because the opportunity arose and I see the value in doing it. But then when I get my first commission check and it is 5 percent of the total premium spend, not even just the claim spend, but the total premium spend, and I get 5 percent because I sold a product. That is kind of when it hit me that we have got a problem. My post and the article were not an insult to brokers. It was not an insult to insurance agents. Maybe it is an insult to the industry, and perhaps we have got it wrong regarding where we invest our money and how we reward those within the industry. I have had the opportunity to be a part of multiple conversations with advisors and brokers and have gone to multiple conferences now. I have gotten in the room and I will be honest, Kevin, sometimes I think I am probably the lowest net worth person in this room. They look at you and they ask what a physician is doing here. I say that I am working in the same space because I am trying to bring that clinical eye and clinical perspective to the discussion of purchasing benefits. I have realized that apparently I am a unicorn for that. Nobody sees the value in that. That to me is kind of the problem too for us as physicians. We are in the space all day long, but what do we know of the space? Do we know how this actually functions? Kevin Pho: Yeah. And that is like a whole field, right? Health economics isn’t traditionally taught in medical schools and residency, but it is such a big part of our lives, especially as outpatient physicians. Now there is still a misconception. You mentioned that story where you went into that room of insurance brokers and they were wondering what a physician was doing there. There is still that misconception that physicians have the fancy cars and the yacht, and that really doesn’t portray the reality of what primary care doctors are. Jonathan Bushman: No, absolutely. Kevin, I actually recently read an article about how physicians in many cases, particularly primary care physicians, are becoming right in the middle of the middle class anymore. Historically physicians were typically upper middle class. The wages have stagnated, the burdens of the job have increased, and they found themselves in a typical middle-class kind of income. I didn’t get into medicine specifically for the income, but it is kind of interesting. I think public perception is that we are very, very high income earners. It is not always the case. Again, that is not what we are in medicine for, but it is an interesting observation in primary care. Kevin Pho: As you know, across the board access is becoming more and more of a problem because students aren’t choosing to go into primary care. There are quite a few in the profession that would look at primary care as a dying breed. Jonathan Bushman: I actually think the value of primary care is high. If people aren’t recognizing it in today’s world, you give this another two, three, or four years. Just wait. When access becomes an even bigger issue, the value of primary care is actually going to go up. You cannot replace what primary care does in a health care system. You can measure any variable, and there is nothing that makes as dramatic a difference in the health of a population down to the individual level as primary care does. Kevin Pho: In your article, I just want to reiterate some of the statistics that you mentioned. Primary care accounts for 5 percent of health care spending, but handles 90 percent of the health care issues of our patients today. Then you of course equated that to your broker’s license, which you got in 30 minutes and you got 5 percent of the commission. Now, is this simply a matter of money? If we just threw more money at primary care, do you think that would solve the problem? Jonathan Bushman: I do not. However, the issue with money in primary care I think from a recruitment and workforce issue is a problem. A lot of people kind of joke that if you go into primary care, you know that you love people. One thing that we never have to question is if you went into primary care, you love people. From an economic standpoint, it doesn’t look like a great decision to make when you are in medical school. If you start looking around and looking at the income levels and also the burden of the work involved, you truly have to have the right mindset and the right heart in medicine to go into primary care. But I think it has got to be more attractive now. You can’t just throw money at it. It is more than that. So it comes down to literally what the day-to-day work looks like and what the influence is that we can have with our patients on a relational level. There is a lot more to it, but we have got to make primary care attractive again. We have to. Kevin Pho: So what are some of the ways that you suggest doing that? I know we have been talking about this for almost decades now. If you were in charge of our health care system, other than the money, how would you change the profession to make it more attractive to a new cohort of medical students? I have heard the same thing too. A lot of medical students who shadow primary care doctors see a lot of the burdens that they have to go through. Jonathan Bushman: Absolutely. Well, for one is the payment models. We know fee-for-service is broken. We just haven’t found the exact replacement across the board. Medicare has got multiple models to try. There are some definite positives coming from that, but there is not one perfect thing. What I have found is where I am in the benefits space, specifically working with employers. I am not working as much in a government-style program. But these are in many cases self-funded employers. Let’s talk about that for