Support for the Nocturnist comes from the California Medical Association.

At the Nocturnist, we are careful to ensure that all stories comply with health care privacy laws.

Details may have been changed to ensure patient confidentiality.

All views expressed are those of the person speaking and not their employer.

You're listening to the nocturnous conversations.

I'm Emily Silverman.

We are living in an era of medical breakthroughs.

Curative treatment for hepatitis C, the sweeping impact of GLP1 drugs, groundbreaking cancer therapy.

But beneath the surface, there's a different story.

The healthcare system is more expensive, inefficient, and impersonal than ever, driven largely by misaligned incentives and a tangled web of businesses that extract wealth while consuming an

ever-growing share of our nation's GDP. Physician, health policy expert, and New Yorker writer

Drew Kular calls this The Gilded Age of Medicine, an era where dazzling innovation masks a deep

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 health care, and why frontline clinicians

must stay engaged in the health policy debate.

Dr. Kular is a physician and associate professor of health policy and economics at

Weil 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,

focuses on value-based care, health disparities, and medical innovation.

In my conversation with Drouve, we talk about how private equity is buying up hospital systems,

...