Reimbursement is a major determinant of how medicine is

Host:
The room smelled faintly of antiseptic and coffee. Beyond the glass wall, the hospital corridor glowed with pale fluorescent light, the kind that turns everything—faces, walls, even hope—slightly grey. It was past midnight, the hour when hospitals start to hum differently, when machines whisper secrets to one another and footsteps sound like apologies.

Inside a small doctor’s lounge, Jack sat slumped in a vinyl chair, still in his scrubs, his name tag bent, his stethoscope coiled on the table beside him. Jeeny, wrapped in a long coat, leaned against the counter, hands clasped around a paper cup, watching him. On the wall behind them, a muted TV played a health policy debate no one was really listening to.

Between them lay a folded medical journal, opened to a quote underlined twice in pen:

“Reimbursement is a major determinant of how medicine is practiced. When reimbursement changes, so do medical practice and medical education.” – Dean Ornish

Jeeny:
(softly, almost reverently)
Dean Ornish said that. And he’s right. It’s strange, isn’t it? The way healing bends to money.

Jack:
(dryly, without looking up)
Not strange. Predictable. Medicine’s supposed to be about care, but it’s just another market. Patients are customers. Doctors are salespeople with licenses.

Host:
His voice was low, steady, but there was a shadow behind it—an exhaustion that didn’t come from sleepless nights, but from knowing too much of how the system really worked. The clock on the wall ticked too loudly.

Jeeny:
It shouldn’t be like that. A life shouldn’t be worth more depending on the insurance it comes with.

Jack:
(leans back, rubbing his temples)
Tell that to the reimbursement codebook. It decides what gets treated, who gets seen, and how long they’re worth listening to.

Jeeny:
(sits across from him)
You sound bitter.

Jack:
(half-smiles, weary)
I sound awake.

Host:
Outside, a gurney rolled past, the squeak of its wheels echoing faintly. Somewhere down the hall, a nurse laughed, then coughed, then fell quiet again.

Jeeny:
Do you ever wonder what would happen if money wasn’t the first question in every consultation? If medicine could just—breathe again?

Jack:
(looks at her, expression unreadable)
That’s not medicine. That’s idealism. And idealism doesn’t bill well.

Jeeny:
Maybe not. But doesn’t it feel wrong? That reimbursement—not research, not compassion—dictates what’s “worth” doing?

Jack:
(nods slowly)
Yeah. That’s the irony. The system teaches you how to treat disease, but not how to value life.

Host:
A soft buzz from the fluorescent light filled the silence between them. Jeeny’s fingers tightened around her cup, her eyes searching his face.

Jeeny:
Then why stay? Why keep doing this if it hurts you that much?

Jack:
(quietly)
Because the patients aren’t the system. They’re the reason I haven’t walked out yet. Every once in a while, someone looks at you with that kind of fragile gratitude—the kind that reminds you this is supposed to be about healing, not billing.

Jeeny:
(softly)
So you fight it from inside.

Jack:
I try. But every time a reimbursement rule changes, it rewrites how we practice.
(he gestures vaguely toward the journal)
That’s what Ornish was talking about. You want to focus on prevention, on nutrition, on long-term healing—but prevention doesn’t pay. Surgery does.

Jeeny:
So the system rewards fixing, not preventing.

Jack:
Exactly. There’s no code for empathy, Jeeny. No line item for listening.

Host:
The TV flickered briefly, a headline scrolling past about “health reform” and “cost containment.” The words felt sterile, bloodless—bureaucratic echoes in a room full of human fatigue.

Jeeny:
I read once that the average doctor gets fifteen minutes per patient. Fifteen minutes to understand a lifetime of pain.

Jack:
(grim smile)
Less if the patient can’t pay.

Jeeny:
That’s obscene.

Jack:
It’s normalized.

Host:
He said it flatly, but something in his eyes betrayed him—a flicker of quiet grief, the kind that belongs to people who’ve seen both miracles and their price tags.

Jeeny:
(after a pause)
You know, when Ornish says “medical education changes,” it scares me. What kind of doctors are we teaching the next generation to be?

Jack:
(leans forward, elbows on knees)
Efficient ones. Profitable ones. Ones who know how to navigate insurance portals better than human hearts.

Jeeny:
And you call that medicine?

Jack:
(shakes his head)
It’s maintenance. Of systems, not people.

Host:
The rain began again, light against the windows, the sound steady and rhythmic, like a pulse trying to remind the world it still beats. Jeeny stared at the droplets racing down the glass, her reflection fractured among them.

Jeeny:
What if it changed, though? What if reimbursement started rewarding compassion? What if listening was as valuable as prescription-writing?

Jack:
(smiling faintly)
Then maybe I’d finally get paid for what actually heals.

Jeeny:
And maybe medicine would remember its first promise—do no harm.

Jack:
(sighs)
You’d think that’d include emotional harm too.

Host:
The lights buzzed louder, then quieted again. The room felt smaller now, more intimate. Jack looked tired, but lighter—as though speaking the truth had loosened something in his chest.

Jeeny:
You know, Ornish once said that love and connection are the most powerful medicines. Maybe that’s what he meant here. The real health crisis isn’t lack of care—it’s lack of care that cares.

Jack:
(nodding, thoughtful)
Yeah. Healing isn’t just science. It’s presence. But that doesn’t fit on an invoice.

Jeeny:
(smiling faintly)
Maybe it doesn’t have to. Maybe the proof of healing isn’t in what you bill—it’s in who gets better.

Jack:
(after a long pause)
You sound like a believer.

Jeeny:
(softly)
I am. In people, not systems.

Host:
The rain outside began to slow. The corridor lights dimmed to night mode, the world beyond their small room growing still.

Jack closed the journal, setting it aside. Jeeny stood, placed her cup down, and walked toward the door, stopping for a moment to look back at him.

Jeeny:
You know, maybe medicine isn’t just about curing. Maybe it’s about remembering that every heartbeat is a story, not a statistic.

Jack:
(quietly, smiling)
That’s the kind of medicine I’d still believe in.

Host:
She left, her footsteps fading into the corridor. Jack sat alone for a moment longer, listening to the faint hum of the machines and the steady rhythm of the rain. Then, slowly, he rose, slung the stethoscope around his neck, and walked back toward the ward—where stories, not numbers, waited.

The door swung shut behind him.

And for a moment, in the quiet between duty and doubt,
the truth of Ornish’s words lingered like an echo:

That when we change how we value care,
we don’t just change medicine—
we change what it means to be human.