It’s Seconds to Midnight

America’s leadership in medical innovation has long been the envy of the world.

We develop the most advanced drugs, the most sophisticated diagnostics, the best practitioners, and many of the most successful biotech companies. Yet for all this achievement, our healthcare and insurance system is drifting toward structural failure. Costs rise far faster than incomes, primary-care access is shrinking, and American health outcomes trail those of other advanced economies. This reality requires the collective agency and coordination of both the public and private sectors to build on a history of collaboration to address what has become a crisis. Such collaboration should begin today.

To illustrate my points: World-leading national healthcare spending rose by more than 7% in 2024, to $5.3 trillion, or $15,474 per person, according to data released in 2026 by the Centers for Medicare & Medicaid Services. Primary care spending in recent years has comprised only about 5% of total healthcare spending. As of 2022, U.S. life expectancy at birth was 4.1 years shorter than the average of comparable countries including Australia, Canada, France, Japan, Switzerland, and the United Kingdom, a KFF study found. More than 8% of Americans do not have health insurance.

What’s more troubling is that Washington shows little sign of appreciating just how close we are to a breaking point. Politicians trade talking points about premiums, costs, and provider shortages, but the true scale of the underlying problem barely seems to register. The system isn’t just strained; it has become unsustainable.

No single headline will announce the system’s downfall, but the country’s inability to pay for and manage the system will show in reduced access to care, including care deserts, delayed and worsening care, consumer bankruptcies, and provider insolvencies. We can already see these trends happening, and they will accelerate.

Back in 2017, Warren Buffet noted that “healthcare costs are a tapeworm eating away at American economic competitiveness,” yet no one has seemed motivated to address the dysfunction. For some time, all the key players have followed what in game theory is referred to as “Nash’s Equilibrium,” where none of the players benefit from changing their strategy because they are all already implementing their optimal strategy. But now, the symptoms of a crisis are becoming obvious to everyone.

And the prognosis is only growing worse. Waiting to act will most certainly ensure financial and social disruption that Congress and the healthcare industry will not be able to control. With the national debt at $38 trillion and counting, our ability to fund infrastructure, defense, and education is already undermined. Medical debt and bankruptcies for families will increase, health inequality will grow, and overall economic sustainability will falter.

We can still act while the system functions, or we can wait until financial and operational pressures force decisions to be made in crisis, the result of which could include aggressive regulatory intervention, price controls, and changes in who has authority to take on risk between public versus private entities.

Incremental adjustments will not rescue a healthcare system whose decades-old design can no longer keep pace with today’s reality. Other nations with various political systems such as Switzerland, Germany, Singapore, and Australia have balanced innovation, affordability, and access. Australia in particular is a model for the United States to consider. Its public-private collaboration guarantees access and manages cost such that they spend just 10% of GDP on healthcare versus the U.S. spend of 18%.

The United States can, too, but not if policymakers keep treating healthcare as a partisan trophy rather than as a national economic and social threat.

What’s needed is a coordinated effort between lawmakers, industry, and public service leaders including heads of government agencies, public hospitals, and nonprofits who grasp the urgency of the moment. Working together, these stakeholders could leverage insurance and risk pooling, returning us to our roots as an industry. Whether focused on high-cost care or collaborated pooling, this type of partnership would capitalize on the law of large numbers, create capacity, and help to implement necessary reforms and innovation around the current fragmented pooling of health insurance.

We have seen this approach elsewhere and in the United States address catastrophic and low-probability costs while creating capacity for pricing to overcome market conditions.

One approach worth considering is a public-private partnership like the Terrorism Risk Insurance Act (TRIA), which was passed in 2002 after the terrorist attacks on 9/11 resulted in one of the largest cumulative claims payouts in global insurance history and more or less froze the terrorism insurance market. TRIA created a shared system of compensation between the federal government and private insurance industry for certain insured losses resulting from a certified act of terrorism. Since its initial enactment, TRIA has been revised and extended four times—the most recent reauthorization in 2019 is slated to expire on Dec. 31, 2027. While TRIA helped bring stability into the market, it has yet to be tested in terms of claims. In the almost 24 years since Congress approved the law, not a single act of domestic extremism, including the 2013 Boston Marathon bombing, has qualified as a terrorist event as defined by TRIA.

The 1972 End Stage Renal Disease Amendment to the Social Security Act extended Medicare for expensive treatment of that disease necessitating hemodialysis or a kidney transplant. This law prevented bankruptcies, drew in capital and caused the care ultimately to be routine instead of catastrophic. The same can be said of Medicare coverage for people living with amyotrophic lateral sclerosis (ALS).

We have also seen recent government collaboration around drug pricing with last year’s executive order regarding most-favored-nation prescription drug pricing. Among other things, the order directs the administration to “communicate most-favored-nation price targets to pharmaceutical manufacturers to bring prices for American patients in line with comparably developed nations.”

America’s healthcare doomsday clock is not at five minutes to midnight; it’s seconds away. Legislators and industry leaders can still act with collective agency, and we have examples from the past to use as a guide. But the window for incrementalism has closed.