A serious illness in America means a war on two fronts. One is the disease. The other is the bill. The first is nature’s doing. The second is ours, and it is the one we could end.
The numbers show the second front. The U.S. spent 17.2 percent of its economy on health in 2024, against 11.2 percent in comparable wealthy countries. Per person that was $14,775, nearly twice their average. What it buys is a shorter life: 79.0 years at birth, 3.7 below the peer average. Brand-name drugs cost 4.2 times what they cost in 33 other countries, though generics are cheaper here.
The patient pays for the gap. KFF estimates that about 14 million adults owe more than $1,000 in medical debt, and 3 million owe more than $10,000. Together Americans owe at least $220 billion. Hundreds of hospitals sue patients or threaten their credit. They include for-profit chains, nonprofit Catholic systems, and public university hospitals, so the problem is not one kind of owner.
Barbara and John Ehrenreich named the medical-industrial complex in 1969, after Eisenhower’s warning about its military cousin. In 1980 Arnold Relman, then editor of the New England Journal of Medicine, warned of care run as a business. Care is one of the goods that distorts when treated as a product. The buyer is sick, scared, and in no position to shop. The market’s usual discipline, walking away when the price is wrong, is the one thing a patient cannot do.
So the second front is a choice of rules, not a law of nature. Other rich countries spend about half as much per person and live longer, under many different systems. The 2025 Medicaid cuts moved the other way. A sick person should only have to fight the disease.