The critical decline of our nation’s health care delivery system

At a recent scientific conference address in Salt Lake City, I spoke about increasingly dire conditions within our health care system and how we are approaching a cliff — a precipice that we may soon be pushed over. 

Multiple, compounding disruptors have been allowed to persist, and have the potential to bring health care delivery and its related economics to their knees, while our leaderships and stakeholders continue to believe that health care is a system “too big to fail,” thus allowing them to delay in instituting any repairs, thus, “I’ll think about it tomorrow!” 

Though space does not allow discussion of a majority of the disruptors plaguing our system, I will discuss three interactively related disruptors (as I presented in my address) that, if not rapidly addressed, could themselves alone collapse health care delivery as we know it.

1. The disenfranchised, increasingly access-denied health care consumer-patient:

Today we see that the U.S. has the world’s most expensive health care system but among the worst health outcomes of any industrialized nation. Where each year our health care dollars buy less. Where confidence and trust in our health care system is at the lowest point ever recorded. Where the No. 1 reason for U.S. personal bankruptcy filings is for unpayable medical bills. Where, as of 2024, 35 percent of American citizens can no longer afford or access ongoing and regular, preventive health care (that is only 15 points shy of half of the entire U.S. population). Where, with the “Big, Beautiful Bill” legislation, federal subsidies for health insurance under the Affordable Care Act (ACA) are being allowed to expire at the end of 2025. Experts say these subsidy expirations will increase ACA “marketplace” insurance costs by 75 percent to 80 percent for most, to as much as 150 percent for some with special needs, making insurance unaffordable to an additional large group (one report notes up to 22 million Americans rely on these subsidies) of working Americans whose companies (including 2.7 million small and medium-sized companies) increasingly cannot afford the ever-escalating costs to provide health care employee benefits. This increase in those numbers of Americans who cannot access ongoing health care will then rise above half of all American citizens.

These impacts are occurring in an era where our U.S. population is aging (half of all Americans are now 40 or older), thus requiring more critical, ongoing preventative care to stay healthy. And, current studies now show that for more and more Americans (up to 52 percent) health care access and affordability has become one of their top three priorities (for over 25 percent, it’s their No. 1 priority), dominating their lifestyle and workplace choices, home life and financial decisions, and these escalating financial burdens are progressively impeding the quality of daily life for more and more Americans.

All this in a U.S. society, undergoing a cultural shift, that now increasingly views violence as an acceptable way to address perceived wrongs, and where increasing numbers of Americans find their access to affordable, preventive health care denied, while they watch with increasing outrage as their families, their friends, themselves, become sicker due to this growing lack of access. And, where Homeland Security warns of a rising tide of threats against the entire health care sector.

2. Thus: Health care as the most dangerous U.S. profession:

Studies now show that, due to the accelerating violence and assaults within our health care workplaces, health care is now the most dangerous profession of all U.S. jobs. Where you are five times more likely to be assaulted, injured or killed on the job because you work in a health care workplace, than any other job type in the U.S., including the police, non-combat military, etc.

Due to this unchecked, accelerating workplace violence, along with other workplace abuses, we see increasing numbers of doctors, mid-levels, nurses and other health care delivery workers abandoning health care for other safer, less abusive professions. As a health care career advisor/mentor, I see these departures on a daily basis. These are bright, knowledgeable people who have the capacity to take on new skill sets and redirect themselves, even in mid-career.

These departures are a significant part of the increasing shortfall in U.S. physicians, nurses and other care delivery workers. Recent estimates are that we will be over 86,000 physicians short by the next decade, and around 64,000 nurses short. During this same time period, the 76 million baby boomer population expansion bubble will be in ever-greater demand for increasing health care, placing ever more stress on health care delivery, and making the physician/nursing shortfall even more critical.

Even more telling for the tenuous future of health care delivery, our bright young minds, the future of health care, are increasingly turning away from health care delivery careers. In a 2023 study of over 8,000 medical and nursing students just under 25 percent (24.9 percent) of medical students said that they were going to leave medical school and seek a new career. Sixty-one percent of medical and nursing students stated that they would complete their degree program, but then will choose careers where they will never provide direct patient care.

I have also increasingly seen even younger bright minds also turning away from health care careers for options that are seemingly more lucrative and
less abusive.

3. Impact upon emergency departments and hospitals:

We already see increasing influxes of Americans without other access to health care into emergency departments (EDs) for their care needs. Due to lack of access to regular, preventative care, these patients are frequently sicker and require much more extensive (and expensive) interventions and more intensive in-hospital stays, that again, they cannot pay for. As the number of patients without health insurance continues to rise, these volumes will increasingly overwhelm already overcrowded, overburdened EDs. The financial burden of this accelerating uncompensated care will further overwhelm more hospitals’ economic bottom lines, and we will see more and more hospitals shut down beds and/or be forced to close.

In addition, as more and more doctors, mid-levels, nurses and other patient care workers leave clinical care, hospitals are finding it increasingly difficult to keep clinical service lines open, thus losing further revenue streams.

Nowhere is this impact being more immediately felt than in our rural hospital system, where uncompensated care losses are currently the highest (due in significant part to more frequent predominance of a Medicare/Medicaid and uninsured payer mix, thus losses are anticipated to further worsen), and where 759 hospitals (this number continues to rise) have failed financial stress tests and are at imminent risk of closure. With a total of around 1,800 rural U.S. hospitals, and with over 146 now already closed or converted to non-hospital services, that means just over half of all U.S. rural hospitals are facing imminent threat of closure, or already closed (759+146=905). But these impacts and closures are now also expanding to non-rural areas.

All this produces increasing denials or delays in access for health care consumers (with or without health insurance).

Results:

The results of these three interactive forces alone, if continued unchecked, can paralyze health care delivery and result in a vicious cycle of increasing consumer outrage, thus more violence, thus more clinician departures, thus further reduced access and more closures, and so forth. And, as previously noted, we have not yet added in the impact of the multiple other critical disruptors that are dragging down our health care system.

Solutions?

This evolving vicious cycle can be interrupted and the system repaired. There are pathways that I and others have outlined in other forums. But, this correction requires that all the major health care stakeholders — including Big Pharma, insurers, PBMs, government, corporate health care leaders, etc. — all come together collaboratively and work together to repair the system. Unfortunately, these stakeholders currently are more focused on wresting further profit and market share, thus appositionally battling one another for this bigger piece of the “pie.” Until these stakeholders begin to recognize that health care is not too big to fail, and stop putting off (“I’ll think about it tomorrow”) repairing the system, this system will continue to decline.

Meanwhile, no system is “too big to fail.”

About Dr. Severance:

Harry Severance is a nationally/internationally recognized health care strategist and analyst, named as a top 50 Healthcare Global Thought Leader & Influencer for the past three years by Thinkers360 land by HealthTech, with over 50 recent publications and presentations on health care workforce/workforce system and financial issues, who now consults and advises multiple organizations and companies on health care systems and delivery, preparedness and workplace/workforce clinical and economics issues.