In modern times, we frequently encounter messes in our public life. This seems particularly true in American health care, and it is certainly true in our politics. But few citizens seem to put the two issues together sufficiently to effectively demand change. Putting them together is what this article is about.

According to the nonprofit public interest group Open Secrets, individuals and political action committees spent a record $4.5 billion in 2024 to influence United States House and Senate elections. More than half of that spending came from groups that do not fully disclose the sources of their funding. For just the top 15 candidates, including presidential candidates, the visible total contribution was $1,867,906,976.

The U.S. Supreme Court decision in Americans for Prosperity Foundation v. Bonta (2021) made it harder to trace dark money in politics. This decision struck down California’s requirement for nonprofits, including those involved in political activities, to disclose major donors’ identities to state officials on Internal Revenue Service (IRS) Schedule B forms.

Specifically with regard to U.S. health care policy and practice, the amounts are also staggering. In 2024, total contributions to House and Senate health care-related committee members for health amounted to $758,459,804. Much of this money was focused on chairs and ranking members of key committees.

• Senator Bill Cassidy (R): $1,313,974 by health care professionals, $712,504 by pharmaceutical companies, and $496,667 by health maintenance organizations (HMOs) in 2019 to 2024.
• Senator Bernie Sanders (D): $885,848 from health care professionals in 2019 to 2024.
• Representative Ron Wyden of Oregon (D): $1,214,999 from 1990 to 2024.
• Representative Mike Crapo (R) of Idaho: $945,434 from 1990 to 2024.

Note: Multiple data sources; figures may overlap.

The consequences of political spending on health care

With this amount of money being spent to buy the legislative policies of the U.S. government, is it any wonder that American health care is a mess and doctors are burning out in large numbers? 18 percent of U.S. gross domestic product (GDP) is spent on health care. However, the U.S. ranks poorly in key international health measures despite high spending. It often places last or near the bottom among high-income nations in life expectancy, avoidable deaths, and access equity. U.S. life expectancy lags peers by about 4 years (78.4 vs. 82.5 years average in 2023). Globally, we rank around 46th for males and 47th for females out of more than 200 countries. Poor lifestyle habits in diet, smoking, alcohol use, and exercise are significant contributors to this low performance.

Administrative costs, including payment collection and billing, consume a substantial portion of U.S. health care spending. Billing and insurance-related (BIR) activities alone account for about 15 to 25 percent of total expenditures. Recent estimates peg total administrative costs at 25 to 31 percent of health care spending, or up to $950 billion in 2019. These amounts have doubtless risen above $1 trillion in the 7 years since.

It is not hard to guess which organizations want to continue this sad state of affairs. These are the same health care companies and associations that are buying our legislators to avoid single-payer insurance systems.

Prominent organizations lobbying against single-payer health care systems in the U.S. primarily represent insurance, pharmaceutical, hospital, and business. For instance, Pharmaceutical Research and Manufacturers of America (PhRMA) deployed 27 lobbyists against Medicare for All in 2019; this group leads opposition from drug makers. The U.S. Chamber of Commerce used 26 lobbyists to actively fight single-payer as a “job killer” in states and federally. The American Medical Association (AMA) fielded 21 lobbyists. The AMA has been historically opposed despite internal debates.

American health care in crisis

At present in the U.S., health care-related costs are a major contributor to personal bankruptcies. Republican-proposed cuts to Medicare and Medicaid, primarily through the One Big Beautiful Bill Act (OBBBA) passed by the House in 2025 and signed into law on July 4, 2025, are projected to result in 11.8 to 17 million Americans losing health coverage by 2034. The same bill will result in tax reductions for the top 1 percent of wealthy American families that amount to approximately $4.5 trillion over 10 years. These reductions are major drivers in the pending insolvency and potential collapse of the U.S. Medicare system.

It can be argued, as the author has in multiple published papers, that American health care corporations, and indeed large parts of the U.S. government itself, seem to fit the legal definition of Racketeer Influenced and Corrupt Organizations under U.S. law. Likewise, even though we must acknowledge that American health care costs are much too high, our most fundamental problem is not doctors. It is legislators who have allowed themselves to be bought off by wealthy corporations and contributors who want to become wealthier, no matter how many millions they must hurt or kill to do so.

To reduce these distortions, it may not be necessary to “kill all the lawyers,” as a character in Shakespeare’s Henry VI, Part 2 proposes. But it will almost certainly be necessary to vote a large number of legislators out of office in every election for at least the next 10 years, until the message is heard: “We are a nation in pain, and we will not be silenced!”

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.