US Healthcare System is a House of Cards; Could it Collapse?

The country is perched on the precipice of a financial healthcare disaster, and far too few Americans know it.

Ominous forces are coalescing: more than 100 million Americans — including 41 percent of adults — have significant medical debt, and nearly 20 percent have debt in collections. Meanwhile, inflation is rising, economists are warning of recession, our country is more divided than at any time in recent memory, and this pandemic isn’t over.

Half a million healthcare workers have left healthcare for other occupations between 2020 and 2021, and this exodus continues, with many of these workers citing harassment, fear of physical assaults and overwhelming stress in the healthcare workplace as reasons for their exodus. Now our healthcare system is critically short of healthcare workers — especially ‘front-line’ workers.

To add to this burden, The cost of healthcare in the U.S. is now 2–3 times greater for the same services versus countries with comparable economies and healthcare systems. Costs for all US healthcare services are soaring, with more and more Americans facing massive emergency department and hospital bills for single critical or catastrophic events such as an acute illness or injury. Also, costs for new drugs have risen by an average of 11 percent every year from 2008 through 2021. Many, many Americans are now having to make critical life decisions such as whether to put food on the family table or pay for medications — increasingly not being able to do both. Yet organizations such as Medicare are not currently allowed to negotiate for volume drug pricing

In plain terms: our U.S. healthcare system is now a house of cards. A significant further disruption, such as a re-emerging pandemic, a social upheaval (such as now being seen in US politics), a significant recession, or other forms of unrest or rapid shift, could — like a domino chain, crash the whole or a great part of the system, thus bringing other systems down with it! We have recently seen how interconnected and inter-dependent all our economic and social systems have become (ex: supply chain, war, fuel crisis, COVID-19 pandemic, drought).

But, is collapse avoidable? Are there steps that can be taken to prevent this progression?

Yes — here are some initial questions that could begin the process of moving us forward in healing our healthcare system:

1. Why is our healthcare system so much more costly than equivalent systems in countries with similar economies and standards of living?

2. Why is the cost of medication prescriptions so much greater in the US than for the same medicines in other countries?

3. Will Congress allow Medicare to negotiate for volume drug pricing?

4. Are there better ways that the working poor and the working middle class can be better protected and covered from overwhelming or at least catastrophic medical debt?

5. Will new surprise billing laws really do much to reduce severe medical debt?

6. Why do healthcare workers continue to exit our healthcare system for other careers, and what can be done to reverse this process?

There are certainly many more questions to answer, but this is a good starting point if we want to begin to heal our increasingly fragile healthcare system and avoid a potential catastrophic collapse.

Harry W. Severance is an adjunct assistant professor in Duke University’s Department of Medicine



Duke University Opinion and Analysis

Duke University is home to more than 15,000 undergraduate and graduate students and a world-class faculty helping to expand the frontiers of knowledge.