Healthcare in the United States is largely designed for reimbursement based on medical interventions that are not necessarily linked to creating health. Though the nation has excellent critical and specialty care facilities, the system fails to adequately account for critical factors impacting health including environmental, socio-economic, and access to care. These are fundamental contributors for health, but the hectic and excessively expensive health system of the U.S. doesn’t include them in most metrics of performance. The message is that the nation has chosen to treat late-stage chronic disease, provide for critical care, and accept mortality rates that are some of the worst in the industrialized world for suicide, gun deaths, and maternal deaths.
For example, the maternal mortality rate in the United
States is four times as high compared to European nations. And this metric has
not improved in over a decade. Women die because of complications from
childbirth, which is largely preventable, and most of these deaths occur after
discharge from the birthing facility. The Commonwealth Fund, a Massachusetts
nonprofit health systems research group published a maternal mortality report
in 2024 confirming the areas where the US is an outlier in maternal health.
|
Maternal Mortality Metrics |
Best Nation |
USA Rank |
|
Maternal
Deaths per 100,000 live births |
Norway-less
than 1 death per 100,000 live births |
22 per
100,000 live births |
|
Number of
C-sections |
Norway-160
per 1,000 live births |
320 per 1,000
live births |
|
Access to pre-
and post-natal care |
Korea
provides home post-natal visits for up to 2 years for vulnerable families |
Healthcare
system does not guarantee maternity coverage, based on the state Medicaid
plans and private insurance standards |
|
Number of OB
Gyns |
Germany-27
per 1,000 mothers |
12 per 1,000
mothers |
|
Number of
Midwives |
Chile-80 per
1,000 mothers |
4 per 1,000 mothers |
|
Federally
Mandated Paid Maternal Leave |
Norway-86
days paid leave |
None, 25% of
women have private employer paid leave |
Examples of how the health system does not align with
creating health
Financialization of Healthcare Without Requirements to
Generate Health
The financialization of healthcare by hedge funds to
maximize profits without actually delivering care. This is the opposite of what
public goods should do. Health should be a goal for our nation’s people and the
most efficacious way to identify methods to improve health should be a mandate,
not merely an option for investors. The hedge funds purchasing include; behavioral
health facilities, medical devices, biotechnology, and physician practices.
Hedge funds are buying healthcare-delivery assets, to make profits, not to
generate health. In fact, if more people are chronically overweight, depressed,
addicted, there will be more customers to buy their weight loss medicine, take
the wonder drugs, enroll in specious behavior modification programs, and require
medical interventions, which will add revenues to their medical device
companies and specialty practices which generate lots of profits in targeted
surgeries. Never mind that these procedures may be costly for patients and the
health system and the health results short lived.
Purchasing healthcare assets may cause disruption in
services, for example, treating the delivery of health care as a commodity,
rather than a public health property can reduce the availability of care when
physician practices are consolidated. This is rarely to the advantage of
patient care but is marketed as an improvement to regulators. For example, when
Harrison Hospital was purchased by a Catholic hospital group, the first thing
it did was expand urgent care clinics and facilities in wealthier areas and
ultimately close the hospital in Bremerton, Washington, which provided care for
many veterans, low-income residents, and persons with mental health and addiction
issues.
Nonprofit Hospitals Which Have Converted to For-profit
First, why is shaving money off the top for shareholders a
good technique for improving health care, and how will this contribute to
affordability? The most affordable health care program in the U.S. is Medicare,
a government run program for seniors and disabled persons, which has the lowest
administrative cost (6%) of any program public or private. Steward Hospitals is
an example of a private equity deal from the purchase of the nonprofit hospital
Caritas Christi in Massachusetts. The hedge fund then sold off the assets of
the hospitals (land) and created a second company for lease revenues from the
hospitals which now paid rent to the hedge fund owners. True to form, those
investors made all of their money in the first three years and spun off Steward
to a physician group and walked away with leaseholds. The physician group, made
up of some of the original members of the hospitals, started to lose money and
within a decade the hospitals were auctioned off to other entities, but two
failed to survive, Carney Hospital and Nashoba Valley Medical Center. The
patients in rural Massachusetts and inner-city Boston have had to scramble to
find care.
Ninety percent of private equity deals in the health care
sector are never reviewed for public interest or unintended consequences. Private
equity funds are short-term profit driven and not geared to long-term
investments in healthcare infrastructure. In 2022, according to DealBook, there
were 863 healthcare deals in private equity. Only Oregon and Massachusetts have
state laws which monitor private equity healthcare transactions.
Reimbursement policies mostly geared toward volume and
not quality of health produced
Medicare Demonstration Projects have attempted to include
quality metrics and reimbursement incentives linked to procedures for health
measures, especially in the realm of cardiac care, stroke treatment, and
reduction in hospitalizations from improved patient care for infection control.
The Patient Protection and Affordable Care Act attempted to invigorate
preventive care and wellness through mandated annual physical and well-child-care.
However, the ability of middle-class people to afford medical insurance is
tenuous, the reimbursement policies vary by state and insurance plan, and
immigrants without permanent residency status are denied access to the
federally subsidized health insurance programs. Several states have elected to
change their Medicaid plans under 1115 waivers, which affords greater
flexibility in benefit design and program allocation. Washington State is
designing a Medicaid program that provides additional nutritional food support,
housing assistance coordination, and medical transportation services.
Because the U.S. healthcare system is geared to insurance
reimbursement, many of the other factors that contribute to health are often
not included in performance metrics. For example, adequate nutrition for
children is a fundamental necessity in their physiological development, yet the
Trump Administration has chosen to minimize funding for a Supplemental Food
Program for families, at the same time, making tax cuts for billionaires
permanent. This makes no sense at all for a nation which has an embarrassment
of food stocks, where farmers are paid not to grow certain crops, and
agribusiness receives all kinds of subsidies. Further, this cruel decision is
exacerbated by the administration’s decision to limit funding for school
lunches. There are literally silos of unused food in the country going to
waste.
Removal of Scientific Data from Public Resources About
Environmental Problems
Another important aspect of health is an environment which
is safe and free from poisons, yet the Trump Administration has defunded the
Environmental Protection Agency and ceased to report on environmental hazards
which impact public health, like forever chemicals[RW1] .
Why is it even a political decision to reduce harmful substances that endanger
our health- there should be a national mandate for this. The first rule of a
nation is to do no harm to its people, especially to the vulnerable.
Health and welfare of our children is being ignored by
short-term public policy decisions
An aspect of health is safety is the provision of reliable
affordable childcare, without this people choose not to have children, and the
country will not be able to support its aging population. For many families,
children are unsupervised for long periods of time. This problem was recognized
in the eighties while I served as the finance chair for a Campfire group, where
we made the decision to sell the camp property and set up a fund to support the
Latchkey Program, which was a recognition of the dearth in childcare in the
country. This was a resource targeted for school-age children who were home
after-school for extended periods before their moms came home from work. I
remember my son, in second grade, shivering on the steps of our home, while I
trudged up the hill from the bus stop. After that, we came up with a plan where
he would push the garbage can against the back gate, open it, go to the back
door, and open the door with the key under the mat. I raised him to survive in
a world where we were on our own. The travesty is this was our best recourse in
a wealthy city in America.
Discriminatory Policy Decisions Which Harm Families and
Contribute to The Unaffordability of Health Care
Further, those of us who have medical insurance, are still
stuck with co-insurance liabilities that are completely unaffordable, $13,000
for co-insurance after deductibles per year? The annual burden for medical
insurance for a family in the U.S. is $27,000 according to the nonprofit Kaiser
Family Foundation.
Lack of regard for the mental and emotional health of the
nation’s people
The U.S. has one of the highest suicide rates in the
industrialized world, especially for children and youth. Suicides outnumber
homicides 2 to 1. A Harvard study found that states with fewer gun restrictions
have higher suicide rates and Wyoming has the nation’s highest rate at 28
people per 100,000 lives. The global suicide rate is 8.9 deaths per 100,000
people and the U.S. has the highest rate of all industrialized countries, 14.2
suicides per 100,000 people.
For every dollar invested in wellness, through nutrition,
maternal and child health services, and environmental cleanup, we save over $5
per person. In 2008, The Trust for America’s Health found an investment of $10
per person in community-based health programs would save $5.60 in medical
expenses per head.
|
State |
Potential Annual Savings |
Return on Investment |
|
Alabama |
$250
million |
5.6
to |
|
Alaska |
$47 million |
7.2 to 1 |
|
Arizona |
$242
million |
4.2
to 1 |
|
Arkansas |
$139 |
5 to 1 |
|
California |
$1.7
billion |
4.8
to 1 |
|
Colorado |
$232 million |
5 to 1 |
|
Connecticut |
$231
million |
6.6
to 1 |
|
Delaware |
$57 million |
7 to 1 |
|
Washington,
D.C. |
$57
million |
9.9
to 1 |
|
Florida |
$1 billion |
6.2 to 1 |
|
Georgia |
$426
million |
4.8
to 1 |
|
Hawaii |
$70 million |
5.6 to 1 |
|
Idaho |
$62
million |
4.5
to 1 |
|
Illinois |
$708 million |
5.6 to 1 |
|
Indiana |
$343
million |
5.5
to 1 |
|
Iowa |
$165 million |
5.6 to 1 |
|
Kansas |
$155
million |
5.7
to 1 |
|
Kentucky |
$248 million |
6 to 1 |
|
Louisiana |
$234
million |
5.2
to 1 |
|
Maine |
$98 million |
7.5 to 1 |
|
Maryland |
$332
million |
6
to 1 |
|
Massachusetts |
$476 million |
7.4 to 1 |
|
Michigan |
$545
million |
5.4
to 1 |
|
Minnesota |
$316 million |
6.2 to 1 |
|
Mississippi |
$150
million |
5.2
to 1 |
|
Missouri |
$334 million |
5.8 to 1 |
|
Montana |
$51
million |
5.5
to 1 |
|
Nebraska |
$102 million |
5.8 to 1 |
|
Nevada |
$115
million |
5
to 1 |
|
New Hampshire |
$76 million |
5.9 to 1 |
|
New
Jersey |
$543
million |
6.3
to 1 |
|
New Mexico |
$88 million |
4.7 to 1 |
|
New
York |
$1.3
billion |
7
to 1 |
|
North Carolina |
$473 million |
5.6 to 1 |
|
North
Dakota |
$39
million |
6.2
to 1 |
|
Ohio |
$685 million |
6 to 1 |
|
Oklahoma |
$183
million |
5.2
to 1 |
|
Oregon |
$193 million |
5.4 to 1 |
|
Pennsylvania |
$791
million |
6.4
to 1 |
|
Rhode Island |
$73 million |
6.8 to 1 |
|
South
Carolina |
$233
million |
5.6
to 1 |
|
South Dakota |
$42 million |
5.5 to 1 |
|
Tennessee |
$351
million |
6
to 1 |
|
Texas |
$1 billion |
4.7 to 1 |
|
Utah |
$89
million |
3.7
to 1 |
|
Vermont |
$43 million |
7 to 1 |
|
Virginia |
$385
million |
5.2
to 1 |
|
Washington |
$343 million |
5.5 to 1 |
|
West
Virginia |
$124
million |
6.9
to 1 |
|
Wisconsin |
$337 million |
6.2 to 1 |
|
Wyoming |
$29
million |
5.8
to 1 |
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These wellness programs included education and resources for
improved nutrition, smoking cessation, and increased exercise. Not very sexy,
but low-cost interventions that do provide long term benefits, including
reductions in strokes, heart bypass surgeries, incidence of type II diabetes,
and several types of cancers. Not to mention a reduction in kidney failure,
neuropathy, and other chronic disease comorbidities. Another example of the positive impact of
preventive healthcare is in Hawaii. The Hawaii State Medical plan conducted an
economic study of 166,000 members over a four-year-period was found to save
$350 in healthcare treatment for every investment of $10.
US Spends More Money Than Any Other Nation-Where Does the
Money Go
Using data for 2023 from the Centers for Medicare and
Medicaid and other government agencies, these charts show where the healthcare
dollars are spent by sector, who actually pays for the services, and how it
looks on the consumer- end, by health services purchased. United States
healthcare consumed 4.9 trillion dollars in 2023. These tables show who paid for
it.
|
Source |
|
Centers for Medicare & Medicaid |
|
Notes |
|
The RX or prescription drug budget
is for retail scripts, not infusions or other applications |
|
Other health care includes care
through schools, residential treatment facilities for mental health, drug
treatment, and community centers |
|
Nondurable medical means-retail
healthcare products, like surgical dressings, blood pressure cuffs, over the
counter medicines |
|
Durable Medical products
means-contacts, eyeglasses, hearing aides |
|
Other Professional Services means
optometry, podiatry, chiropractic |
|
Unspecified miscellaneous may
include: weight loss counseling, ayruvedic health care, acupunture, massage,
health retreats |
|
Mental health care estimates
includes; all behavioral health intervention according to the Substance Abuse
and Mental Health Services Administration |
The United States spends more than any other nation on
health care, but it doesn’t generate better health outcomes than nations which
spend 40% less. In 2024, the average industrialized nation spent $7,371 and the
United States spent $14,885 per person for health care.
One of the reasons for the disparity is the U.S. spends far
more on administering it’s terribly inefficient 50-states standards for private
and government run health plans. Other nations use the money collected from
taxes and private payers to actually pay for services. For example, long term
care administration in the U.S. cost $1,079 versus $339 in France in 2023.
The United States of America, a nation for which my
grandfather fought in the Revolutionary War to create, is failing to generate
health for our children and those who work to pay for it. Yet, the Trump
Administration is systematically gutting medical research, tax subsidies for
the Affordable Care Act, government reporting on quality measures, and oversite
for government and private sector agencies. A nation which starves its people
is a nation in decline. If you aren’t familiar with the robber baron era, look
it up, for the current administration wants to make us serfs in lifetime penury
to the ultra rich.
And this is the healthpolicymaven signing off encouraging you not to sign blanket releases for inpatient procedures, do stipulate that for which you agree and decline. This article was written by independent journalist and healthcare analyst, Roberta Winter, who received no compensation from anyone in healthcare.
References
(n.d.).
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(2024, December 16). Private Equity's Appetite For Hospitals May Put Patients
At Risk. Harvard, TH Chan School of Public Health. Retrieved November
3, 2025, from
https://hsph.harvard.edu/news/private-equitys-appetite-for-hospitals-may-put-patients-at-risk/
Joan Stephenson,
P. (2022, July 22). Rate of First Time Cesarean Deliveries On The Rise In The
U.S. JAMA Health Forum, 2022;3;(7):e222824.
doi:doi:10.1001/jamahealthforum.2022.2824
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Foundation. (2024, October 9). Annual Family Premiums for Employer
Coverage Rise 7% to Average $25,572 in 2024, Benchmark Survey Finds, After
Also Rising 7% Last Year. Retrieved November 5, 2025, from Kaiser Family
Foundation-Health Affairs:
https://www.kff.org/private-insurance/annual-family-premiums-for-employer-coverage-rise-7-to-average-25572-in-2024-benchmark-survey-finds-after-also-rising-7-last-year/
Munira Z. Gunja,
E. D. (2024, June 4). Insights into the U.S. Maternal Mortality Crisis: An
International Comparison. The Commonwealth Fund Issue Brief. Retrieved
November 9, 2025, from
https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison
Peter G. Peterson
Foundation.org. (2025, October 7). How Does the U.S. Healthcare System
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Steven M.
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The Growth of
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https://nihcm.org/publications/the-growth-of-private-equity-in-us-health-care-impact-and-outlook
Trust for
America's Health.org. (2008). Prevention for a Healthier America. Trust
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Washington State
Healthcare Authority. (2025, November 9). Section 1115 Medicaid
Waiver-Foundational Community Supports Program. Retrieved from Washington
State Healthcare Authority:
https://www.hca.wa.gov/about-hca/programs-and-initiatives/medicaid-transformation-project-mtp/foundational-community-supports
Winter, R. E.
(2016, September 3). Hospital Closures and the Impact on Health Services. Straight
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(2022, August 26). Pregnancy in the US Just Got More Dangerous-Post Dobbs
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https://healthpolicymaven.blogspot.com/2022/08/pregnancy-in-us-just-got-more-dangerous.html
[RW1]I
will provide a citation here
