The Gilded Age of Medicine

with Dhruv Khullar, MD

CONVERSATIONS

We’re in a golden age of medical innovation—curing Hepatitis C, revolutionizing obesity treatment, and advancing cancer care. But beneath the breakthroughs lies a broken healthcare system: rising costs, misaligned incentives, and corporations extracting wealth at the expense of patients.

Physician, health policy expert, and New Yorker writer Dhruv Khullar calls this The Gilded Age of Medicine—an era where dazzling innovation masks dysfunction and mounting frustration among the general public.

In his latest piece “The Gilded Age of Medicine is Here,” he unpacks how private equity, Medicare Advantage, and consolidation are reshaping healthcare—and why frontline clinicians must stay engaged in the health policy debate.

Dr. Khullar is a physician and associate professor of health policy and economics at Weill Cornell Medical College. He serves as Director of the Physicians Foundation Center for the Study of Physician Practice and Leadership and Associate Director of the Cornell Health Policy Center. His research, published in JAMA and The New England Journal of Medicine, focuses on value-based care, health disparities, and medical innovation.

In our conversation, Dhruv and I discuss:

• How private equity is buying up hospital systems, leading to cost-cutting, ER staffing shortages, and even hospital closures

• The dark side of Medicare Advantage and the financial incentives that drive upcoding

• Why hospitals—especially nonprofit ones—aren’t always the heroes they appear to be

• How data has become the "oil" of healthcare—powering innovation, driving profits, and creating new vulnerabilities, like the 2024 cyberattack that crippled hospitals, disrupted patient care, and forced UnitedHealth to pay a $22 million ransom.

Dhruv has a rare talent for making complex health policy accessible to the public—so much so that I could easily see him running for office one day.

I hope you learn as much from this conversation as I did.

Give this episode a listen: The Gilded Age of Medicine.

Warm regards,

Emily and The Nocturnists Team

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