In 2007, healthcare reform felt inevitable. The American public had grown restless. Employers were drowning in rising insurance costs. Even major CEOs were questioning the private sector's stranglehold on the system. With Democrats in control of Congress and a presidential election on the horizon, momentum was building toward change.
In the years since, the crisis has deepened. Americans still face denial of life-saving care. Employers remain trapped by skyrocketing costs. Public trust in the system has cratered. For all the political noise, the fundamental problems remain, and the cost of inaction has grown incalculably.
What makes the American system so uniquely inefficient is its insistence on maintaining a fragmented, profit-driven model while pretending that competition alone will yield better outcomes. In reality, this arrangement creates massive administrative bloat. By 2007, private health insurers were spending more than five times as much on administration as Medicare. Former American Airlines CEO Robert Crandall summed it up bluntly: "I want to put everyone on Medicare. Medicare works."
Despite being underfunded, America's single-payer programme for seniors manages to deliver care more efficiently than the private sector ever has. If scaled up and properly resourced, it could have served as the foundation for universal healthcare. Instead, policymakers pursued convoluted reforms that preserved private profits while failing to solve the core problems.
The cost of this failure is not just borne by the sick and uninsured. American businesses, large and small, remain shackled to a system that undermines competitiveness, inflates costs, and drains resources. In countries like Canada or the UK, businesses do not shoulder the burden of employee health coverage. In the United States, however, employers provide 60% of health insurance, a system that not only distorts the labour market but leaves workers vulnerable when they change jobs or fall ill.
In 2007, even companies like UPS had begun experimenting with preventative "health coaching" programs to mitigate these costs. However, these were workarounds, expensive and uneven, not solutions. As employers tried to take control of their employees' health outcomes, they essentially stepped into the role of healthcare providers, not because they wanted to, but because they had no choice.
Even retail giants like Costco began offering insurance plans to small businesses, trying to plug gaps left by the government. These efforts, while well-intentioned, amounted to treating symptoms, not curing the disease.
For all the corporate frustration, the true victims remain ordinary Americans. Stories of denied care are the system working as intended. Insurance companies have a legal obligation to maximize shareholder returns. Every denied treatment, every delayed procedure, every bureaucratic hurdle is part of that equation.
Critics of public healthcare often point to these flaws, but they miss the point. A British citizen may grumble about waiting for a non-emergency surgery, but they never face the existential terror of being uninsured. No parent in France wonders whether their child will be denied life-saving medication because the insurer found a technicality. No cancer patient in Germany delays care because of a rejected pre-authorization form.
The American healthcare crisis has not gone unnoticed by the private sector. Many firms have stepped in to "disrupt" the system, a term that often conceals as much as it reveals. Some startups genuinely seek to improve access or reduce inefficiencies. Others see a broken system as a business opportunity.
Healthcare technology companies promise solutions to billing complexity, treatment delays, and data silos. Nonetheless, these innovations often exist to navigate or monetize the dysfunction. Meanwhile, insurers rebrand themselves as health partners, all while continuing to deny coverage and raise premiums.
At some point, the United States must confront an uncomfortable truth: either it is falling behind, or the world is catching up. What once seemed unthinkable, the global marginalization of American leadership in healthcare, is now happening in real time.
It is easy to despair. The scale of the American healthcare crisis makes reform feel impossible. But meaningful change requires political will, public understanding, and a refusal to accept the status quo.
Reform must begin with the acknowledgment that healthcare is a right, not a privilege. Medicare already works. It is efficient, trusted, and popular. Expanding it gradually, but deliberately, would offer the most direct route to universal coverage. Investment in preventative care must follow, not only because it saves money, but because it respects human dignity.
Voters must demand better, not just through outrage, but through sustained engagement. Healthcare should not be a political football. It should be a national priority.