Each program has its own rules, its own forms, its own lobbyists. Millions fall through the cracks.
Coordination isn’t a utopian idea; it’s a proven one.
History offers proof that coordination works. When Lyndon Johnson signed Medicare into law in 1965, hospital administrators warned it would bankrupt the nation. Half a century later, Medicare’s per-person cost growth is lower than that of private insurance. Canada’s single-payer system faced similar panic in the 1970s but stabilized within a decade, now covering everyone for roughly half the U.S. price.
If American health care is exceptional, it’s in how it protects its inefficiency. Hospital systems merge to gain leverage. Insurers merge to counter them. Drug makers lobby to extend patents. The result is a market where no one controls the system, yet everyone profits from its disorder.
When Martin’s bill finally arrives, it’s printed on thick paper with four pages of explanation and one that matters: Amount Due $167.00. The rest is a cloud of codes and disclaimers—CPT 99213, “established patient, fifteen minutes,” and, at the bottom, “This is not a bill. You may receive additional statements.”
He folds it once and sets it aside. The paper smells faintly of disinfectant, and he wonders if Anna’s clinic in Copenhagen even owns a printer.
Later that night, he tells his wife, “The high cost of health care is just another subscription I can’t cancel.” She laughs, but the joke lands hard. Every month, premiums, co-pays, and deductibles siphon a quiet tithe from their account. Behind each charge is a policy choice someone else made long ago.
If the country ever decides to rebuild its system, it will have to do more than trim waste. It will have to confront the industries that profit from confusion, invest in primary care that prevents illness instead of monetizing it, and accept that universal coverage is cheaper than its absence. Other nations have already proven that lesson.
The paper smells faintly of disinfectant — a small, sterile reminder of a system that could be clean, but isn’t yet.
Bibliography
1. Centers for Medicare & Medicaid Services. National Health Expenditure Data for 2023. CMS, 2024. Comprehensive federal dataset detailing total U.S. health spending, per‑capita averages, and GDP share.
2. Commonwealth Fund. Mirror, Mirror 2021: Reflecting Poorly. August 2021. Comparative analysis ranking the U.S. last among high‑income countries on access, equity, and outcomes.