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"Why Is U.S. Healthcare So Expensive—Yet So Broken?"

 America spends more on healthcare than any other nation on Earth—over $4.5 trillion a year, nearly 20% of its GDP. And yet, by many global measures, the results are dismal. We have some of the highest rates of maternal mortality, medical bankruptcy, and chronic illness among developed nations.

So why is the most expensive system in the world also one of the most dysfunctional? Let’s break it down—without sugarcoating.

1. It’s Not the Care. It’s the System.

“We have the best doctors, the best nurses, the best hospitals. What we don't have is a functioning system.”
— Elisabeth Rosenthal, author of An American Sickness

The problem isn’t the medicine—it’s the business of medicine. Unlike most developed countries where healthcare is treated as a public service, the U.S. treats it as a for-profit industry. From hospital CEOs to insurance executives, healthcare here is engineered not for outcomes, but for revenue.

2. Price ≠ Quality

“We pay the world’s highest prices for some of the worst outcomes.”
— Wendell Potter, former Cigna executive turned whistleblower

Let’s be blunt: the U.S. ranks last among 11 high-income countries in access, equity, and health outcomes, according to The Commonwealth Fund. Yet a simple MRI that costs $100 in France might cost $2,000 in the U.S.—with no clinical difference in quality.

Hospitals often don’t publish prices, and even within the same hospital, costs vary wildly depending on your insurance, your negotiation skills (yes, really), and luck. This is not transparency. This is chaos.

3. Administrative Waste Is Bleeding the System

“Nearly a third of what we spend on healthcare—about $1 trillion—is pure waste.”
— Dr. Marty Makary, author of The Price We Pay

Makary’s research highlights how bloated the system has become. We’re not just paying for care—we’re paying for billing departments, prior authorizations, medical coders, and armies of administrators. For every physician in the U.S., there are 10 non-clinical workers.

That’s not a system focused on healing. That’s a system focused on billing.

4. Medical Debt Is a Feature, Not a Bug

“The number one cause of bankruptcy in America is medical bills.”
— Dr. Atul Gawande

In 2024, over 100 million Americans have some form of medical debt. In no other developed country does getting sick mean risking homelessness or financial ruin.

This is by design. Health insurance companies profit more when people don’t use care. Hospitals profit more when care is fragmented and opaque. The sick are often treated not as patients—but as profit centers.

5. Insider Game: Everyone’s Getting Paid—Except the Patient

CEO salaries in major health systems have soared. In 2023:

  • The CEO of UnitedHealth earned $20.9 million

  • Some nonprofit hospital executives took home 7-figure bonuses

  • Pharmaceutical CEOs continue to hike prices on insulin, inhalers, and chemo drugs, often without meaningful innovation

Meanwhile, nurses are overworked, rural hospitals are closing, and patients are left crowdfunding their surgeries on GoFundMe.

6. How Do We Fix This?

The solutions aren’t hypothetical—they exist.

  • Transparency laws: Mandating price disclosures and standardized billing

  • Global budgets: Used in systems like Canada’s to reduce waste and set caps

  • Primary care investment: Currently just 6% of U.S. healthcare spending

  • Non-profit care models: That reinvest into communities, not shareholders

But fixing it means unraveling the profit incentives that now drive the system. As Rosenthal says:

“Once you understand how the money flows, you understand why the care doesn't.”

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Final Dose:

The U.S. doesn’t have a healthcare system. It has a healthcare market—one designed to keep patients in debt, doctors burned out, and insurers rich.

But knowledge is the first step toward reform. If you're reading this, you're already part of the resistance.

Let’s stay curious. Let’s stay outraged. And above all, let’s stay human.



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