The Plague Within the Healthcare System

Insights and Pragmatic Solutions

Rising Costs, Rising Risk, and Care That Arrives Too Late… are not new issues but there is no doubt they have become magnified over the past decade. Regardless of who is in the White House or who controls congress, both parties are to blame for the disastrous situation we are faced with. The problem is that we keep electing the wrong people! We elect lawyers (no offense as there are some great ones, but boy are there some bad ones), career politicians (self-centered, egotistical, maniacal, narcissists, the occasional physician who has the best of intentions but is not prepared for the corruption of The Hill, and a slew of incompetents! Wake up America, we are dying and it’s by a thousand papercuts by our own hand!

America’s healthcare crisis is not one disease, one insurer, or one failed hospital. It is a systemic plague: a set of mutually reinforcing failures that makes care more expensive, more complicated, and often less accessible precisely when patients are most vulnerable.

The central problem is not that the United States lacks medical talent or advanced technology. It is that the system too often deploys both only after illness has become more severe, more expensive, and more difficult to treat.

In 2024, U.S. national health expenditures reached $5.3 trillion, or $15,474 per person, consuming 18.0% of gross domestic product. Health spending grew 7.2% that year, faster than the overall economy. The Centers for Medicare & Medicaid Services now project that health spending will rise to 20.6% of GDP by 2034.

Those figures reflect more than an economic trend. They reveal a healthcare system in which patients delay treatment, providers struggle to sustain operations, and administrative complexity consumes resources that should support care.

The Patient’s Experience: Care Is Not As Widely Available, And Often Not Affordable

For many Americans, health insurance does not eliminate financial insecurity. It changes the form of the problem.

Patients may have coverage but still face high deductibles, disproportionate copayments/coinsurance, uncovered medications, narrow provider networks, prior-authorization requirements, and bills that arrive long after an appointment or hospitalization. KFF data cited in public discussions of affordability indicate that nearly 44% of U.S. adults have difficulty affording healthcare costs, while more than one-third report skipping or postponing needed care because of expense.

The consequences are predictable. A patient postpones a primary care appointment because the deductible has not been met. A prescription is stretched, rationed, or never filled. Suspicious symptoms are monitored at home rather than evaluated. By the time care occurs, a manageable condition may have become an emergency.

Research involving adults with chronic conditions and multiple medical conditions underscores this dynamic: people with multimorbidity generally have greater healthcare utilization and out-of-pocket costs, and lack of insurance is associated with a greater likelihood of delaying care because of cost. High-deductible plans can compound that problem by making even insured patients reluctant to seek ongoing care.

Cost is not the only barrier. In 2022, 10.6% of U.S. adults delayed or did not obtain needed medical care because an appointment was unavailable when needed. Patients also reported difficulty finding providers who accepted their insurance, transportation limitations, and conflicts with work or family obligations.

Federal law recognizes at least one component of the network-access problem. Providers and facilities must maintain processes to provide timely directory information to plans and issuers, including when they enter or leave a network and when material directory information changes. 42 U.S.C. § 300gg-139(a).

A provider that improperly bills an enrollee more than in-network cost-sharing and receives that payment must reimburse the excess, plus interest. 42 U.S.C. § 300gg-139(b). These protections matter, but they do not solve the larger problem: patients still face a fragmented system that requires them to act as benefits specialists while they are trying to obtain medical care.

The Provider’s Experience: More Work, Less Margin for Error

Hospitals, physician groups, nursing facilities, and community clinics are operating in an environment of escalating costs, razor thin margins, and increasingly complicated payment rules. Total health spending is rising, but higher spending does not necessarily translate into financial stability for the organizations delivering care.

Hospital expenditures grew 8.9% to $1.63 trillion in 2024, while physician and clinical-service expenditures grew 8.1% to $1.11 trillion. Those national totals do not mean each provider is thriving. Hospitals must absorb rising labor costs, pharmaceutical costs, technology expenses, regulatory obligations, and uncompensated care demands. At the same time, payment depends on a billing and claims process in which a technical error, documentation dispute, coding question, or authorization denial can delay reimbursement for months.

Providers expend enormous effort to obtain payment for services already rendered. Revenue-cycle departments must verify eligibility, secure preauthorization, submit claims, appeal denials, correct coding edits, respond to payer requests, and pursue patient balances. This work is essential to keeping the doors open, but it does not diagnose, treat, comfort, or prevent illness.

Every dollar spent untangling a claim is a dollar unavailable for bedside staffing, behavioral-health access, care coordination, or preventive outreach.

The problem is especially acute for rural hospitals, safety-net institutions, independent practices, and providers serving patients with complex medical and social needs. These organizations may treat the sickest populations while carrying the least financial flexibility to withstand denials, delayed payment, staffing shortages, or a cyberattack.

Workforce Shortages: Human Infrastructure Is Fraying

Healthcare depends on people. Yet the workforce is under sustained strain.

Physicians, nurses, pharmacists, behavioral-health clinicians, medical assistants, technicians, and administrative professionals confront growing patient volume, complex documentation requirements, long shifts, and moral distress when they cannot provide the care patients need. Burnout is not simply an employee relations issue; it is a patient safety and access-to-care issue.

An aging clinical population and retirement of experienced personnel intensify the challenge. When a hospital cannot recruit nurses, it may reduce staffed beds. When a community loses a primary-care physician, patients may travel farther or wait longer for appointments. When behavioral-health services are unavailable, emergency departments become default care settings for crises they were not designed to manage.

The result is a dangerous cycle:

• Staffing shortages increase workload for remaining clinicians.
• Higher workload increases burnout and attrition.
• Attrition reduces access and continuity of care.
• Delayed care produces sicker patients with more complex needs.
• Greater complexity further increases workload and cost.

This is not a workforce problem that can be solved solely by asking clinicians to work harder. It requires investment in training, retention, team-based care, mental-health support, flexible scheduling, and technology that reduces rather than adds to administrative burden.

Cybersecurity Vulnerabilities: A Digital Threat to Physical Care

Healthcare has become one of the most attractive targets for ransomware attacks and data breaches. Hospitals hold highly valuable personal information, rely on interconnected digital systems, and often cannot tolerate prolonged downtime without jeopardizing patient care.

A cyberattack can disrupt electronic health records, prescription processing, laboratory operations, imaging, scheduling, communications, and claims submission. In practical terms, it can force clinicians to use paper records, delay procedures, divert ambulances, or postpone treatment.

The danger is not limited to privacy. It is operational.

When clinical information is inaccessible or unreliable, providers lose time, patients face delays, and medical decision-making becomes more difficult. A system already strained by staffing shortages and thin operating margins may be particularly vulnerable when its digital infrastructure fails.

Healthcare organizations therefore need to treat cybersecurity as part of patient safety. That means maintaining tested backup systems, segmenting networks, training staff against phishing threats, managing vendor risk, and developing downtime protocols that protect continuity of care.

Administrative Waste: Complexity Has Become Its Own Industry

The American healthcare system spends extraordinary sums on administration. The problem is not that healthcare requires records, billing, quality measurement, or oversight. Those functions are necessary. The problem is duplication, fragmentation, and complexity without corresponding clinical value.

A single patient encounter can trigger separate processes for eligibility verification, coding, prior authorization, claim submission, denial review, patient billing, collections, quality reporting, and compliance documentation. Different insurers may apply different coverage rules, formularies, network standards, authorization forms, and appeal procedures to the same medical service.

Electronic health records were meant to improve coordination and safety. Too often, however, clinicians experience them as tools that require excessive clicking, duplicate data entry, and after-hours documentation. When technology is poorly designed or poorly integrated, it does not reduce administrative work. It moves it to the physician, nurse, or front-desk staff member already responsible for patient care.

The economic stakes are substantial. In 2024, out-of-pocket spending alone reached $556.6 billion, while private health insurance spending reached $1.64 trillion. Yet patients and providers continue to devote enormous effort to determining what is covered, what is owed, and who must pay.

The “Sick Care” Problem: Treating Crisis Instead of Preventing It

The most fundamental failure may be the system’s emphasis on reactive care.

The United States excels at trauma care, complex surgery, specialty medicine, and advanced pharmaceuticals. But it is far less consistent at ensuring that patients receive affordable primary care, preventive screenings, nutrition support, behavioral-health treatment, chronic-disease management, and early intervention.

This is “sick care”: a system that mobilizes its greatest resources after a person becomes ill enough to need them.

Consider the difference:

Preventive care is not limited to annual checkups. It includes controlling blood pressure before stroke, treating depression before crisis, managing diabetes before kidney failure, providing prenatal care before complications, and addressing transportation, food insecurity, housing instability, and medication access before they become medical emergencies.

The Patient Protection and Affordable Care Act expanded access to insurance and established important consumer protections, including requirements that many individual and small-group plans cover essential-health-benefit categories. But coverage alone does not guarantee usable care. A person may technically have insurance and still be unable to afford the deductible, locate an in-network clinician, obtain a timely appointment, or navigate a denial.

A Better Standard: Care That Is Timely, Affordable, and Understandable

The healthcare system should be judged not merely by how much it spends or how sophisticated its treatments are. It should be judged by whether patients can obtain needed care before preventable illness becomes catastrophe.

Meaningful reform should prioritize:

• Affordability: Reduce cost-sharing that causes patients to delay essential care, medications, and chronic-disease treatment.
• Primary and preventive care: Invest in early intervention, behavioral health, maternal care, and long-term chronic-care management.
• Workforce retention: Reduce administrative overload, improve staffing conditions, and support clinicians before burnout drives them from practice.
• Simplified payment systems: Standardize prior authorization, claims processes, network information, and denial appeals.
• Cybersecurity resilience: Treat digital-security preparedness as a core patient-safety obligation.
• Meaningful transparency: Give patients understandable information about network participation, expected cost-sharing, and treatment options before care is delivered.
• Accountability for outcomes: Reward systems that improve health, access, continuity, and patient experience rather than simply delivering more billable services.

Conclusion

The plague within American healthcare is not a lack of money. The nation spends more than ever, and spending is projected to grow faster than the economy for the next decade. The plague is a system in which financial barriers, workforce instability, cyber risk, administrative waste, and reactive treatment models reinforce one another.

Patients should not have to choose between treatment and financial security. Clinicians should not have to sacrifice their well-being to keep an overloaded system functioning. Hospitals should not have to devote scarce resources to fighting avoidable denials and billing complexity instead of improving care.

A healthcare system worthy of its name must do more than treat illness after it has taken hold. It must prevent harm, remove barriers, support its workforce, and make care accessible when people need it most.

Sources

• Exploring the U.S. Healthcare System, Cost of Care (discussing healthcare spending, prescription-drug spending, Affordable Care Act coverage requirements, and access barriers).
• Centers for Medicare & Medicaid Services, National Health Expenditure Fact Sheet (2024 historical expenditures and 2025-2034 projections).
• National Center for Health Statistics, Sociodemographic Differences in Nonfinancial Access Barriers to Health Care Among Adults: United States, 2022, Nat’l Health Stat. Reps., No. 207 (Aug. 1, 2024).
• Delayed Healthcare Due to Cost Among Adults with Multimorbidity in the United States, PMC (discussing cost-related delayed care, multimorbidity, insurance status, and high-deductible plans).
• Centers for Medicare & Medicaid Services, National Health Expenditures 2024 Highlights.
• 42 U.S.C. § 300gg-139.