America’s health system is a paradox. The time and resources of its vast community of scientists, health professionals, and health insurers are supposed to be dedicated to healing the sick. Still, even though almost 18 percent of our GDP is spent on health, the average life expectancy in the US is nearly a decade lower than that of other developed countries, which typically spend 50 percent less.
According to a Commonwealth Fund report, the US ranks last among high-income countries in healthcare access, efficiency, and equity. Our health system has vast potential and can achieve Moonshot-like outcomes, but it still struggles to address people’s day-to-day needs.
The world’s largest health ecosystem comprises five fundamental stakeholders — patients, payers, product innovators, policymakers, and providers. And while they should work in harmony, they remain primarily disconnected, operating in silos with financial performance as the measure of success. With the fear of economic failure nipping its leaders’ heels, the system prioritizes fiscal responsibility over patients’ healthy longevity. It leads to a “sick-are” over healthcare strategic mindset.
A System Disconnected
While medicine is a “team-support,” the health industry positions its sectors like boxers — each pitted against the other. The concept of a fragmented health system is not new. Nearly 20 years ago, Dr. Alain C. Enthoven, a renowned health economist, argued that the US health sector suffered from a fundamental lack of coordination and misaligned incentives, leading to inefficiencies that primarily burden patients.
In her book Fragmented, Ilana Yurkiewicz, MD, illustrates the real-world consequences of this disconnect. Patients often find themselves bouncing between specialists dedicated to one piece of their patient’s anatomy, grappling with conflicting medical advice, and navigating a bureaucratic maze that often results in disparate, delayed, or denied care.
Economic pressures fueling consolidations and layoffs have led major players to go slow on much-needed ambitious health information initiatives. The much-heralded digital transformation, which promises AI-driven operational efficiency, seamless data exchange, and improved patient outcomes, remains unrealized.
Meanwhile, patients are finding themselves trapped in a complex, hard-to-navigate medical maze where medical records are often inaccessible, treatment plans are inconsistent, payer decisions feel opaque, and pricing remains elusive. The effect is profoundly dehumanizing.
The Patient is Out of the Picture
Financial pressures outweigh the fundamental goal of healing, and the loss of patient focus and a significant decline in empathy remain the system’s most glaring obstacles. This absurd reality is captured in a satirical moment from Yes Minister, where a lawmaker appointed by the UK Prime Minister visits an award-winning hospital — shockingly operating without patients. While comedic, the scene reflects an all-too-real aspect of modern health systems. Administrative structures, insurance approvals, and reimbursement models dictate operations, often sidelining the very individuals who seek care and healing.
As economic priorities continue to reshape industry, hospitals that once promised solutions struggle to sustain themselves, leaving patients increasingly marginalized. While improving patient outcomes should be the central focus of government policymakers, they too often become secondary considerations.
As the US Congress considers budget decisions, cutting Medicaid state subsidies does not mean economically struggling patients will be denied urgent care. Instead, when they seek treatment in the ER, hospitals will absorb the cost. This shifts the financial burden, further straining healthcare systems already operating on razor-thin margins.
Doctor Burnout: Primary Symptom of a Broken System
Physicians enter medicine purpose-centered with a desire to heal, yet the system relentlessly applies administrative and financial pressures that shift their attention elsewhere. Many doctors experience burnout, driven by excessive paperwork, prior authorization hurdles, and unrealistic patient quotas. According to a Mayo Clinic Proceedings study, nearly 63% of physicians report signs of burnout, including emotional exhaustion and depersonalization.
Designed to streamline care, electronic medical records (EMRs) are still a significant source of frustration. Physicians spend hours dealing with complex interfaces rather than engaging with patients. The demand to see more patients in less time — dictated by billing and reimbursement structures — further erodes the doctor-patient relationship, leading to dissatisfaction on both sides.
A 2023 survey by the Primary Care Collaborative and the Larry A. Green Center found that 62% of primary care physicians report not having enough time to adequately meet patients’ needs, which impacts treatment and preventive care discussions.
This dissatisfaction manifests as a breakdown in communication. While effective dialogue between providers and patients across specialties and within the broader health ecosystem is essential for treatment and prevention, patients and physicians struggle to find time to connect.
Burnout is not simply a professional hurdle; it’s a crisis that directly affects patient outcomes. Overworked, exhausted doctors are likelier to make errors, experience lower job satisfaction, and even leave the profession altogether. If the system fails to address professional despair and its causes, the shortage of health professionals will only worsen, limiting access and compromising care.
The Business of Health Over the Health of People
While business considerations shouldn’t take precedence over people, the financial structures underpinning the health sector drive decision-making that deemphasizes people’s health. The silos within the health ecosystem exacerbate this issue, preventing a shared understanding of economic and operational realities, limiting coordinated action and shifting the focus away from the patient.
Insurers prioritize cost control without recognizing the pressures this places on providers. Pharmaceutical companies innovate without fully considering how reimbursement models shape prescribing behaviors. Policymakers create regulations with a limited understanding of their clinical innovation impact. This lack of cross-sector awareness perpetuates fragmentation and inefficiency, and patients ultimately pay the price.
Digital health companies, once hailed as the future of care efficiency and effectiveness, are struggling with financial sustainability, forcing many to pivot or shut down entirely. Biopharmaceutical companies triage drug development pipelines, looking for future medicines with a high probability of regulatory success rather than encouraging research that may fail but illuminate a pathway to even more significant discoveries. Again, it is the patient who pays the price.
The Cost of Failing to Invest in Care and Caring
There is enough blame to go around, and we must stop looking for a convenient villain. If we attack one piece of the ecosystem rather than look at the totality of our problem, we will fail to make meaningful changes.
We can’t throw our health system out and start from scratch; we must find a way to work within and through it effectively. The primary lever that will drive reform of the health system and improve its functioning is bringing everything back into empathetic focus, with the patient at the center of care. Whether we are payers, product innovators, policymakers or providers, we must ask if our actions are built on a foundation of empathy — from heartfelt “care.” First and foremost, we must cooperate in the service of the patient.
The health sector is an industry, but it must be more than that. At its core, it should recognize that we are always people — only sometimes patients. Yet, financial pressures have overtaken its fundamental purpose: healing. This system-wide disconnect erodes trust, drives up costs, and leaves too many without the care they need. Until the key players in the health ecosystem realign around a unified, patient-centered mission, fragmentation will persist, outcomes will fall short, and lives will remain at risk. The stakes are too high to accept anything less.
Unless we build on a foundation based on “how would I feel” empathy, our system will not be built to last. It will be structured to fail.
