For years, the U.S. has felt the impact of ever-rising health care costs while facing decreasing access, affordability, and worsening clinical outcomes, as compared to other countries. Multiple disruptive forces increasingly plague our health care system, our workforce and workplaces, health care facilities, health care consumers, and our economy.
2024 reports continued to confirm these worsening conditions, in what many are calling a failing health care system.
Now, recent events highlight an evolving economic non-sustainability crisis further threatening this failing system.
These events include:
Item 1: In 2025, the U.S. continues to accelerate as the most expensive health care system worldwide, but with the poorest outcomes of any industrialized country.
Item 2: A 2025 study notes that now 35 percent of Americans no longer can afford health insurance and cannot access adequate ongoing and preventative health care. This number is estimated by some to further rise to as much as 40 percent in 2026 due to changes in health care access laws.
These numbers are just 10 to 15 points shy of half of the entire American population.
But Americans still get sick and still need health care (though now even sicker with no ongoing preventative care), but increasingly cannot pay for these urgent/emergent medical bills.
Item 3: A 2024 report of 2022-2023 data notes that nationwide, patient collections fell to 47.8 percent. Non-payments are projected to accelerate in 2026, as insurance access and availability worsens.
Item 4: Now, the largest single reason for U.S. personal bankruptcy filings is for unpayable medical bills, reported to be upwards of 66.5 percent. These numbers accelerated in 2025 and are projected to continue to worsen.
Where does all this lead economically?
The crushing burden of almost half of the entire population of this country increasingly unable to pay their medical bills, but still requiring urgent/emergent medical access, is an insurmountable crush point destabilizing our health care delivery system.
What business can remain viable when almost half of its customers cannot pay their bills, but is still required, by law, to provide the service anyway?
What country can excel or even survive when half of its citizens cannot access ongoing health care and stay well and productive?
A bottom line
Not addressing this access and affordability issue will lead to, among other things, economic collapse of the system.
Are there solutions?
There are pathways to repair this system before it fails.
One option proposed by many, to better support the economic viability and health of the country, is to insure basic ongoing and preventative health care access for all Americans. This can be done through means other than increasing federal bureaucracy and taxpayer burden.
There are many other options also available. Even President Trump has recently weighed in on announcing possible alternatives to Americans’ current health care access system.
What is preventing repair?
The biggest single “sticking point” is continued inaction by our leaders.
Addressing health care delivery is a contentious and thorny issue. The current system encourages major stakeholders to oppositionally compete with each other for market share and profit, rather than working to repair the system. This continues while everyone seems to continue to believe that health care delivery is “Too Big to Fail,” so allowing leaders and other decision-makers to put it off and “Think about it Tomorrow,” thus not having to face the issue during their term.
Meanwhile, our system, our citizens, our patients, our economy, and our country continue to suffer and decline.
What happens if we do not act soon
The economics of the current system are now unsustainable, and if not addressed soon, will lead to continued accelerations in hospital closures nationwide and further reductions in patient resources and care access, further accelerations in escalating health care costs, and increasing collapse of further parts of the nation’s health care delivery system.
Harry Severance is an emergency physician.
