Designed to Drain: US Healthcare System Works Exactly as Intended

US healthcare is in the toilet, even from the day-to-day side of things. The system seems designed to flush people down the tubes by draining all their finances before they die. And it does this while costing more than any other country on earth and delivering worse outcomes than most of them.

To put that in perspective: the United States spends nearly twice as much per capita on healthcare compared to similarly large and wealthy nations, yet has a lower life expectancy than all of them, and that gap has actually grown since the COVID-19 pandemic. (Peterson-KFF Health System Tracker, October 2025) The Commonwealth Fund’s 2024 “Mirror, Mirror” report compared the US to nine other high-income countries and found that Americans live the shortest lives and have the most avoidable deaths of any nation in the comparison. (Commonwealth Fund, September 2024) Unlike every other country in the study, the US hasn’t found a way to meet its residents’ most basic healthcare needs, including universal coverage. (Commonwealth Fund, September 2024)

That’s the macro picture. But who’s actually benefiting from all that spending? The seven largest publicly traded US health insurance companies reported a combined $71.3 billion in profits in 2024, a new record, while their CEOs collectively took home $146 million in compensation that same year. (NationofChange, August 2025) This while millions of Americans skipped medications and rationed insulin. The insurance industry’s core business model is, in plain language, collecting as much as possible in premiums and paying out as little as possible in actual care. Even after paying claims, the major insurers were still skimming between 8% and 13% of every premium dollar in overhead and profit, compared to Medicare’s 1.1%. (FAIR, November 2025)

Pharmaceuticals compound this. 94% of Americans agree that prescription drugs are costlier than they should be, and they’re right. (RetireGuide, March 2025) The US is virtually alone among developed nations in allowing drug companies to set their own prices without government negotiation, which means Americans routinely pay three to ten times what the same drug costs in Europe or Canada.

The consequences fall hardest on ordinary people navigating the system. Medical debt is responsible for 66.5% of all personal bankruptcies in the US, and roughly 500,000 families a year go bankrupt because of unpaid medical bills. (Self Financial, August 2022) Outside the US, medical bankruptcy is a fairly rare occurrence, with most developed countries financing healthcare through taxes. Meanwhile, 36% of US adults reported skipping or delaying needed care because of cost, including more than a third of people who technically had insurance. In the EU, only 3.6% of adults reported unmet medical needs due to cost, distance, or waiting lists combined. (North American Community Hub, December 2025)

Here’s what that looks like in one real life.

Consider one patient. An 88-year-old woman with vascular dementia has reached the stage where family can no longer manage her care around the clock. Three serious falls in the past year. Constant hospital visits, doctor’s appointments, physical therapy. She has Medicare and legacy insurance from her late husband, the kind of coverage you simply can’t buy today, and even that’s slowly whittled away year by year. A memory care facility costs around $9,000 a month at the low end. Her savings, if she sells everything she owns, might last eighteen months. She won’t qualify for Medicaid because her husband’s pension puts her just over the income limit. When the money runs out, her options are to move back in with family or have nowhere to go at all. The assets she spent a lifetime building, the ones her family might reasonably have expected to inherit, will be gone before the system offers any help. This isn’t unusual. Research from the Roosevelt Institute found that after the onset of long-term care needs, middle-class individuals face permanent wealth reductions to just 42% of their original levels, and that even upper-middle-class couples with lifetime earnings over $4.75 million will nearly half the time spend down to Medicaid if care is needed for five years or more. (Roosevelt Institute, April 2026) The system isn’t just failing the patient. It’s severing the financial thread between generations.

That family has already been managing her care at home for three years, watching her decline. She can no longer navigate stairs. The family home is full of them, and there’s no money for ramps.

At the care facility, medication protocol is governed by liability rather than by the patient in front of the nurses. Without a doctor’s order in the system, staff must administer the dose from the most recent written prescription, even if the physician has verbally updated it with the family’s medical power of attorney. A regular adult dose of Miralax runs straight through a frail 88-year-old woman. A child’s dose is appropriate, but that was always managed at home by the family, so nothing in the paperwork reflects it. The family requests a temporary dose adjustment, which is permitted for five days. The facility is then unable to receive the updated doctor’s orders in time, and after five days she’s put back on the original dose. Because that’s the law. This same problem repeats across several of her medications, some with considerably more serious consequences than a laxative. No one’s technically at fault. It’s all about liability. Meanwhile the care staff are stretched thin, underpaid, and burning out, and there’s no way to know how many other residents are falling through the same cracks.

Then she falls again. The facility sends her to the emergency room, which is doing its best under conditions that have become standard: overwhelmed, understaffed, and backed up for hours. She spends ten and a half hours in a wheelchair before a doctor can see her. The diagnosis is serious bruising and lacerations, no internal bleeding, no broken bones. She’s discharged. Had the family taken her home before she was formally seen and released, they’d have been liable for up to $50,000 in emergency services that insurance wouldn’t have covered. So they waited. Not because it was the right thing for a confused, exhausted, injured elderly woman, but because the alternative was financial ruin.

This is what the numbers look like in a real life. An 88-year-old woman with decades of work and savings behind her will likely be financially wiped out before her condition runs its course, because a system that spends nearly $15,000 per person per year has decided that the most efficient place to put the risk is on the patient. The insurance companies post record profits. The pharmaceutical companies set their own prices. The nursing home has to balance care against payroll, and the staff pays the price along with the residents. And somewhere in the middle of all of it, a family’s arguing with a care facility about Miralax dosages because the paperwork didn’t come through in time.

That’s not a broken system. A broken system fails by accident. This is a system working exactly as designed, for the people who designed it.