Over the past several years, each time a periodic U.S. hospital closures report is released, the number failing financial stress tests and at extreme risk of closing rises. The number now approaches 800 nationwide.

Meanwhile, many project that the just-passed One Big Beautiful Bill will rapidly increase these closures and further degrade health care access for American citizens.

Touted reasons for accelerating hospital closures, especially impacting rural and other disadvantaged locales, are several, and include: Inadequate reimbursements to meet expanding expenses, lower reimbursement rates selectively paid to rural and other disadvantaged hospital settings, decreasing ability to attract/retain doctors, nurses and other health care workers.

Yet, these same hospitals are the very backbone of critical access, safety net health care facilities that are an only access option for increasing numbers of Americans, especially in these rural and other disadvantaged areas such as inner cities.

All this in an era when U.S. health care has become the most expensive worldwide, but with the poorest outcomes, where now over 35 percent of American citizens can no longer afford or access ongoing health care. Where health care consumer confidence and trust in this system are at their lowest point ever, leading to, among other consequences, increased health care workplace violence. Where hands-on health care is now classed as the most dangerous job of all U.S. professions, due to violence and assaults, resulting in ongoing defections out of hands-on health care delivery for safer, less abusive careers, and where many more critical disruptors dominate. In 2023 I published a 2-part article thumbnailing 18 critical disruptors impacting our health care system. There are now many more.

But this is also a time when our political and health care business leaders and stakeholders who, though very aware of these expanding issues impacting health care delivery, choose to look the other way and focus on what they say are more pressing and important time-sensitive economic, national-global geopolitical, warfare, and other crises and needs.

Perhaps in great part, this willingness to look away evolves out of a belief permeating leaderships that altruism and a “calling” in health care will keep those who still attempt to deliver hands-on patient care in their trenches and continue to soldier on, even under steadily worsening conditions, and the system itself (altruistic and too big to fail?) will find some way to make it work. Thus, paradoxically, these beliefs allow leaders to believe they have the time to focus on other issues and return to health care delivery when it’s more timely and convenient. And, in truth, no one seems to be able to even imagine this country without a seemingly intact health care delivery system, thus, “I’ll think about it tomorrow.”

What history tells us: Hubris among leadership is a pathway to demise.

It may be a poor analogy, but this look the other way and deal with it later phenomenon driving U.S. political, economic and health care business leaderships in their dealings with health care has a critical connection with similar decision pathways leading to the Titanic disaster, where there were up to 17 or more purported issues, each contributing to this sinking and great loss of life.

The critical point in this progression to disaster is that the Titanic leadership, well aware of these issues, chose to look the other way. Their belief that the Titanic was unsinkable and too big to fail led them to view other issues, such as speed records and increasing profits, as more urgent and deserving of immediate attention.

Will health care delivery suffer a similar fate? No system is too big to fail.

The opinions expressed are mine alone and do not necessarily represent the opinions or stances of my employers or affiliates.

Harry Severance is an emergency physician.