My wife underwent major surgery in December 2025. She remained 10 days in a Charlotte, NC, hospital and was then for several weeks supported at home by visiting nurses, a physical therapist, and a dietician. We just saw the bill: The hospital and participating doctors submitted bills of $120,000 to Medicare and to Tricare (family health insurance for military service veterans like me).

The 21 years that I served as a U.S. Air Force officer have turned out to be the smartest investment I ever made, despite the occasional hardships those years created for my family in multiple relocations. The Air Force also paid for my two graduate engineering degrees along the way, a major factor in my increased income when I chose to retire in 1988 rather than accept promotion to Colonel.

The hospital and caregivers, of course, were not paid the full $120,000. If I am reading their invoices correctly, they were actually paid about a fifth of their billed cost. But still, I must ask what people do in medical emergencies when they cannot afford to replace insurance provided by an employer who lays them off in bad economic times.

The cost of care

A lot of them go broke. Medical bills or medically related issues contribute to roughly two-thirds of all personal (non-business) bankruptcies in the United States. Major loss of income in medical emergencies is considered to be one of those issues.

U.S. Medicare covers about 67 to 69 million people, roughly 18 to 19 percent of the entire U.S. population. The large majority are retired adults like me, age 65 and older. Medicaid (at state level) covers about 70 to 71 million people total as of 2025, roughly 15 percent of them U.S. adults. A similar percentage or a somewhat larger percentage of those covered are children.

A system of inequality

There are some overlaps between these systems. However, overall, for all adults of ages over 18, recent data show an uninsured rate around 11 percent, with many of the uninsured concentrated among working-age adults (around 19 to 64). What this means is that 29 million of us are one accident or major illness away from bankruptcy, or perhaps homelessness.

I am the first to acknowledge that my family and I are fortunate to have the prosperity we have, partly by good planning and partly by simple luck and timing. But what about people who face the impacts of budget cuts by the second Trump administration? It is estimated that around 10 million people could lose medical insurance coverage nationwide, due to Medicaid work requirements, the lapsed Affordable Care Act subsidy cliff, and narrowed eligibility for lawfully present immigrants in Medicare and Medicaid programs.

How many of those people may lose their homes also?

The wealth gap

We live in very turbulent times, with an uncertain economy around us. Stock markets are very volatile and clearly engaging in speculative short-term trading. Sectors of the U.S. economy associated with artificial intelligence seem poised for major growth, but those sectors employ only a fraction of the best-educated Americans, while potentially reducing demand for new entry-level college graduates in many other sectors. Moreover, increasing wealth concentration among the top 1 percent of wealthy families and reduction of the incomes of the bottom 50 percent have continued long-standing trends of the past 50 years.

Necessary fairness

We are becoming a nation of the super-rich and the homeless. And health care costs are a factor in that inequality. Reducing these costs at the margins is not a solution for the mess we find ourselves in. We must also be prepared to restructure our tax system and embrace as national policy, the reduction of our growing wealth inequality.

Some people might call this reality “socialism.” I call it necessary fairness. Whatever we call it, we must soon begin to rebalance both our health care costs and our wealth. That, or we will founder as a society.

Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.