Who Decides What Healthcare Is Worth? with Andrew Tsang | LOF #138

A healthcare claim is more than a bill. It is an assertion someone else can contest. If technology makes that exchange faster, who decides what the care is worth? Andrew Tsang joins Lucas Ferrer Cardona and Miguel Montero to follow the money through American healthcare, from the front desk to the insurance appeal and from employer premiums to clinical care. His diagrams turn an abstract system into something you can see. The harder question is what those lines reveal about the choices we have made together. Andrew describes roughly 15 years of consulting across providers, payers, and pharma, along with work in Medicaid policy. At the time of this conversation, he had stepped away from that career to write about healthcare economics and was working on a book. He publishes Health is Other People, combining analysis of healthcare institutions with questions about what we owe one another. For physicians, this conversation reaches beyond billing. Andrew traces the administrative work around a patient encounter: eligibility checks, prior authorization, coding, claims, denials, and payment. Lucas connects that burden to the freedom to build an independent practice. Miguel asks what Andrew would change if he could rewrite the system. The answer pushes past a quick political fix toward incentives, shared values, and the people caught between institutions. YOU'LL HEAR • Why revenue cycle may shape more of the patient experience than its name suggests. • How administrative scale can change the playing field for independent practices. • What AI agents can accelerate, and which disagreements remain unresolved. • Why a healthcare claim is different from a settled transaction. • What the UK and Germany reveal about the values behind financial flows. • How a confusing chart becomes a story about patients, families, and hospitals. • Why Andrew keeps returning to education, agency, and collective change. Innovation has a real place in healthcare. CHAPTERS 00:00 Who decides what care is worth? 00:53 Life of Flow intro 01:07 Welcome to Andrew Tsang 02:14 From consulting to writing about healthcare 03:35 Revenue cycle: where care meets commerce 06:33 The work before and after the patient visit 10:43 Can words change the healthcare conversation? 16:56 What do other systems say about shared values? 20:13 Independent practice and room to innovate 23:44 Why scale changes the administrative burden 25:37 AI agents, claims, and unresolved disagreement 28:14 The magic-wand reform question 32:24 The human cost of fighting over payment 35:32 Education and us against the problem 37:35 Seeing change and making systems legible 40:20 Mapping the healthcare financing flows 42:13 Taxes, premiums, and the choices inside the chart 45:29 Every line represents a human life 47:23 Costa Rica and reasons for optimism 48:35 Where to follow Andrew and closing thoughts GUEST & RESOURCES Andrew's writing, Health is Other People: https://blog.healthisotherpeople.com/ The financing-chart essay discussed, An Abominable Creature: https://blog.healthisotherpeople.com/p/an-abominable-creature JOIN LIFE OF FLOW YouTube: https://www.youtube.com/@LifeofFlowPodcast Instagram: https://www.instagram.com/lifeofflowpodcast/ X: https://x.com/vascularpodcast LinkedIn: https://www.linkedin.com/company/65882426/ Subscribe for candid conversations about independent practice, clinical judgment, and building a life in medicine. Share this episode with someone who has tried to make sense of a denial, a reimbursement rule, or a healthcare financing chart. Music: Life of Flow house theme; the cold open uses the existing instrumental production asset. This conversation offers education and personal perspectives. Examples, policy references, and figures reflect the recording; they are not individual medical, legal, or financial advice. Andrew’s answer separates speed from resolution: AI may accelerate the claims workflow, while people still disagree about coverage and the value of care.