America spends trillions on healthcare while families struggle with medical bills, insurance premiums and long-term care. It’s time to question whether the system serves patients or the financial interests built around treating them.
ST. LOUIS, MO – October 23, 2026 (STL.News) The American healthcare system has become one of the world’s largest financial enterprises. Hospitals generate enormous revenues. Pharmaceutical manufacturers operate as multinational corporations. Insurance companies manage billions of dollars in premiums, and healthcare organizations employ armies of administrators, consultants, and billing specialists.
Yet millions of Americans struggle to afford medical treatment, health insurance, and long-term care.
Something is fundamentally wrong with a system that generates so much revenue while leaving so many families financially vulnerable.
The problem is not simply that healthcare is expensive. The financial structure of American healthcare often rewards more services, more procedures, and more treatments, without consistently rewarding illness prevention or patients’ long-term health.
America needs to reconsider the fundamental purpose of its healthcare system.
Healthcare should be a birthright, not a financial privilege.
That does not mean doctors, nurses, or medical researchers should work without compensation. It means access to essential medical care shouldn’t depend on a person’s financial circumstances, and the organizations providing that care should be accountable for both their prices and their results.
America Spends $5.3 Trillion on Healthcare
According to the Centers for Medicare & Medicaid Services, U.S. national health expenditures reached $5.3 trillion in 2024, representing approximately 18% of the nation’s gross domestic product.
That amounted to approximately $15,474 per person.
Spending included about $1.63 trillion for hospital care, $1.11 trillion for physician and clinical services, and $467 billion for prescription drugs.
Private health insurance financed approximately $1.64 trillion in healthcare expenditures. That financing category overlaps with spending on hospitals, physicians, and other services and should not be added to the provider categories as a separate total.
These figures should concern taxpayers, employers, workers and policymakers regardless of political affiliation.
The Organization for Economic Cooperation and Development has consistently reported that American healthcare spending per person substantially exceeds the average among its member countries.
Yet higher spending does not consistently translate into better population health outcomes.
American life expectancy declined sharply during the COVID-19 pandemic before recovering to a record 79 years in 2024, according to the Centers for Disease Control and Prevention. Nevertheless, U.S. life expectancy remains below that of many other wealthy nations.
America possesses extraordinary medical technology, advanced research institutions, and highly trained professionals. But technological sophistication and financial spending do not equal an effective, affordable healthcare system.
The public deserves to know what it gets for its money.
How Health Insurance Changed the Financial Incentives
In 1981, when I entered the health insurance business with my father, insurance looked considerably different from what Americans encounter today.
Traditional hospitalization policies often operated with scheduled benefits. The policy established specific amounts payable for covered hospital services, surgical procedures, and other medical expenses.
The insurer did not necessarily promise to pay whatever the provider charged.
I remember selling family health insurance policies for as little as $40 a month, with deductibles that would seem almost unimaginable today.
Those historical policies were not identical to modern comprehensive insurance. Coverage exclusions, benefit limits, and other differences make direct comparisons difficult.
Nevertheless, the transformation of insurance reimbursement deserves examination.
Major medical insurance, which existed before the 1980s, expanded the use of arrangements under which insurers paid a percentage of eligible expenses after deductibles and other conditions were satisfied.
I remember accompanying my father to an obstetrics and gynecology practice where physicians wanted to understand precisely how one of our policies worked.
Their questions centered on reimbursement.
Would the insurance company pay according to the contract even if the provider’s charges were substantial?
My father explained the terms, including the distinction between routine pregnancy expenses and covered complications.
That encounter stayed with me because it illustrated how medical providers could view insurance contracts as opportunities to increase revenue.
It did not establish that the physicians committed fraud. But it raised a question that remains relevant today: What happens when the person setting the price knows that a third party will pay most of the bill?
Over time, insurers introduced negotiated reimbursement rates, utilization reviews, provider networks, and other controls. Modern insurance generally does not pay whatever a physician charges.
Still, the underlying incentive problem remains.
When patients are insulated from the full cost of treatment, they may have less reason to question prices. When providers are paid based on the volume and complexity of services delivered, additional treatment can generate additional revenue.
The result is a system in which financial incentives do not always align with the patient’s interest in receiving only necessary, effective, and affordable care.
Would Americans Tolerate This in Any Other Industry?
Imagine taking a moderately used automobile to a repair shop.
You hand the mechanic the keys, sign a blank check, and tell the shop to perform whatever repairs it considers necessary.
You do not request an estimate. You do not ask which parts need replacement. You do not question the labor charges.
When the work is completed, you never receive a detailed invoice because a third party pays the shop directly.
Most consumers would consider that arrangement financially irresponsible.
Yet American healthcare often operates in circumstances where patients have little advance knowledge of prices and limited ability to evaluate the necessity of individual services.
There are important differences. Emergency medical treatment cannot always wait for price comparisons, and patients cannot reasonably be expected to possess the knowledge of trained physicians.
But those differences make transparency and professional accountability even more important.
Patients should receive clear explanations of medical recommendations and their associated costs whenever possible.
They should also have practical access to itemized billing information and meaningful procedures for challenging questionable charges.
Insurance should never eliminate the expectation of financial accountability.
The Insurance Premium Problem Begins With Medical Spending
Americans often complain about health insurance costs without examining the medical expenses insurance is designed to cover.
In 2025, the average annual premium for employer-sponsored family health coverage reached $26,993, according to KFF.
Workers contributed an average of $6,850 directly toward those premiums, with employers paying the remainder.
Employers absorb substantial insurance expenses, but those costs are part of overall compensation and operating expenses.
Insurers also have administrative costs, reserves, and profit considerations. They are not merely passive intermediaries. Nevertheless, rising medical claims are an important driver of premiums.
Lowering the cost of necessary medical care could therefore benefit patients, employers, taxpayers, and insurance purchasers.
The fundamental question should not be how Americans can continue financing ever-higher medical bills.
It should be why those bills are so high in the first place.
Healthcare Fraud Is a National Financial Problem
Federal healthcare fraud investigations demonstrate that the problem extends far beyond occasional billing disputes.
On June 23, 2026, the Department of Justice announced its National Health Care Fraud Takedown, involving charges against 455 defendants, including 90 doctors and other licensed medical professionals.
Federal prosecutors say the cases involved more than $6.5 billion in alleged fraudulent claims and related schemes.
Those are allegations, not findings that every defendant committed a crime. All defendants are presumed innocent unless proven guilty.
Still, the scope of the enforcement action raises serious questions about how vulnerable healthcare payment systems are.
The Trump administration’s 2026 enforcement actions, including the nationwide takedown, warrant close examination for their potential to deter fraud and recover taxpayer money.
But healthcare fraud enforcement is not new. Federal authorities have investigated fraudulent billing, kickbacks, unnecessary services, and prescription schemes under multiple administrations.
The larger question is whether enforcement can be accompanied by structural changes that make fraud harder to commit.
The Department of Health and Human Services Office of Inspector General has separately identified substantial improper payments in federal healthcare programs.
Improper payments are not automatically fraud. They can also result from errors, inadequate documentation, or other violations of payment requirements.
That distinction matters. But so does the public’s right to demand accurate accounting.
When taxpayer-funded programs pay for services that were never delivered, medically unnecessary procedures or fraudulent claims, the consequences extend beyond the immediate financial loss.
Money intended for legitimate patient care is diverted, and confidence in the entire system suffers.
Medical Education Does Not Guarantee Ethical Conduct
Americans are taught to respect physicians, and medical professionals deserve recognition for the years of education and training required to practice.
But professional credentials do not prove personal integrity.
Doctors are human beings. Like professionals in banking, insurance, law, and other industries, they can face conflicts of interest and financial incentives.
Most importantly, they should be subject to independent accountability.
Patients should not be discouraged from asking why a treatment is necessary, whether alternatives exist, what risks are involved, or how much it will cost.
The appropriate response to a patient’s question is an explanation grounded in medical evidence, not an appeal to professional status.
A physician who cannot explain a recommendation in understandable terms has failed an important responsibility to the patient.
At the same time, disagreements over treatment do not automatically establish negligence or fraud. Medical decisions often involve uncertainty, and unsuccessful treatment is not necessarily inappropriate treatment.
The answer is better documentation, independent review, meaningful informed consent and transparent financial relationships.
Why Prevention Must Become a Financial Priority
The Centers for Disease Control and Prevention reported that 40.3% of American adults had obesity during the August 2021-August 2023 survey period.
Obesity increases the risk of several serious conditions, including hypertension, Type 2 diabetes, heart disease, and stroke.
Those figures should prompt a national discussion about prevention.
Regular physical activity, improved nutrition, appropriate weight management and early intervention have established health benefits.
Yet the healthcare payment system can make procedures and repeated clinical services easier to reimburse than sustained preventive support.
This does not mean medications are unnecessary. Many drugs save lives, prevent complications, and allow patients with chronic conditions to live longer and healthier lives.
Nor does it mean obesity results simply from individual choices. Genetics, income, food availability, working conditions, and other factors influence health.
But a healthcare system committed to prevention should make evidence-based lifestyle support readily available rather than treating it as an afterthought.
Medical professionals should be evaluated partly on measurable patient outcomes, preventive care, and the quality of their treatment decisions.
Any incentive system would also need safeguards against avoiding seriously ill patients or withholding necessary services merely to reduce costs.
The objective should be better health, not simply fewer medical bills.
The Financial Burden of Long-Term Care
The crisis becomes particularly visible when families must arrange long-term care for aging parents.
A family paying $9,000 monthly for nursing home care faces an annual expense of $108,000.
Over five years, that amounts to $540,000, assuming no further increases.
For many American families, these expenses can deplete retirement savings, force asset sales, and create enormous financial pressure.
Long-term care facilities have legitimate operating expenses, including staffing, supervision, meals, regulatory compliance, and specialized services for residents with dementia.
But families should receive understandable explanations of charges, changes in care levels, and the services included in their monthly fees.
When prices increase, facilities should be prepared to explain why.
And when residents cannot independently question their care because of cognitive impairment, strong oversight becomes even more important.
The financial vulnerability of elderly Americans should never become an opportunity for exploitation.
Should Healthcare Become a Publicly Funded Service?
The United States should seriously examine whether essential healthcare should be financed primarily as a public service rather than through a fragmented mix of private insurance, employer benefits, government programs, and individual payments.
Under such a model, qualified medical professionals could receive competitive compensation while healthcare organizations operate under budgets, quality standards, and independent oversight.
The objective would be to provide medically necessary care without exposing families to devastating financial obligations.
This would not make healthcare free to society. Hospitals would still need funding, physicians would still require compensation, and taxpayers would bear the costs through public financing.
Public funding would not automatically eliminate fraud, bureaucracy, shortages, or poor management.
Those problems can exist in government-run systems as well.
However, public financing could provide a framework for controlling prices, simplifying payment administration and separating access to essential care from employment and personal wealth.
Countries have adopted different approaches, including public insurance with private providers, predominantly publicly operated services, and mixed systems.
America could examine those models without assuming it can copy any one country’s structure wholesale.
The goal should be a system designed around measurable health outcomes, financial sustainability, and universal access.
Transparency and Accountability Must Come First
Structural reform will take time. But several changes deserve immediate consideration.
Patients should have practical access to clear medical bills and explanations of the services they received.
Hospitals should disclose meaningful prices for scheduled services, except in emergencies and other circumstances where advance estimates are impractical.
Federal hospital price transparency requirements already exist. CMS requires hospitals to publish standardized pricing information, and new requirements effective in 2026 strengthened disclosures involving actual allowed amounts.
The effectiveness of those rules depends on compliance, enforcement, and whether ordinary consumers can actually use the information.
Independent oversight should also examine patterns of unnecessary procedures, improper billing and conflicts of interest.
Healthcare professionals who report wrongdoing should be protected from retaliation.
Patients should have accessible mechanisms to dispute charges and seek independent review of disputed treatment decisions.
And medical organizations should be measured by more than revenue, patient volume, and expansion.
Quality of care, patient safety, preventable complications, affordability and long-term outcomes must matter.
America Must Decide What Healthcare Is For
The United States has built an extraordinary healthcare economy.
It supports hospitals, medical practices, pharmaceutical manufacturers, insurers, research institutions, investors, and countless other businesses.
Many of those organizations provide valuable products and services. Medical innovation has saved lives and transformed the treatment of diseases once considered untreatable.
But those achievements do not excuse excessive prices, fraudulent billing, unnecessary treatment or failures of accountability.
Nor should the healthcare industry’s financial success be confused with the health of the American population.
The public has every right to ask whether the system’s incentives are producing the results Americans need.
Healthcare should not operate like a blank check handed to an auto repair shop.
Patients deserve to understand what is being done, why it is necessary, and what it will cost.
Doctors deserve fair compensation for their expertise. They do not deserve immunity from questions or oversight.
Hospitals deserve the resources required to deliver quality care. They should also be accountable for their pricing and performance.
Pharmaceutical companies deserve reasonable returns on legitimate innovation. Their financial interests should not override patient safety or public access to necessary treatment.
And government has a responsibility to protect the public from fraud, waste, and financial exploitation.
The ultimate objective should be straightforward: A healthier America, not simply a more profitable healthcare industry.
After decades of rising expenditures, the country should question healthcare’s financial structure.
Because if Americans continue measuring the industry’s success primarily by the money it generates, they may never adequately confront the question that matters most:
Are we paying to make Americans healthier, or are we simply paying more to treat them?
We praise the healthcare fraud that the current administration is pursuing. Just hope it continues.
Editorial disclosure: This article is an opinion and analysis piece advocating healthcare financing and accountability reforms. Personal historical observations reflect the author’s experiences and are not presented as independently verified findings of misconduct. Healthcare spending and population health figures are attributed to federal and other published sources. Criminal allegations do not establish guilt.
