The Root Cause of America’s Healthcare Crisis

A response to Anna Eisenberg’s “Deep Dive” Eisenberg’s six-part Deep Dive into the U.S. healthcare system is a well-researched and timely summary of the urgent challenges we face. Many of her points are well-known but bear repeating:

• The U.S. spends nearly twice as much on healthcare as other advanced nations, yet our outcomes are worse. Meanwhile, 10–15% of Americans remain uninsured. Experts have long warned that the Fee-For-Service (FFS) payment model drives up costs and fragments care. As the article notes, “FFS is the primary driver of both high costs and fragmented care.”

• The leading alternative, Value-Based Care (VBC), has seen limited uptake and hasn’t fundamentally changed the system.

• Administrative burden is crippling healthcare. It costs over $1 trillion per year—roughly 25% of total U.S. healthcare spending—and is a key source of provider burnout. The main culprit is our convoluted medical coding system.

• Chronic illness, driven largely by lifestyle choices (e.g., a 42% obesity rate—double that of other advanced nations), continues to rise, particularly among the elderly.

• Medicare faces insolvency by 2033, compounded by the aging population—the so-called “Silver Tsunami.”

• U.S. policy has prioritized specialization and innovation over essential care. As Eisenberg writes, “The U.S. excels in high-tech services… but fundamental services like Primary Care… are underfunded and understaffed.”

• Medicare Advantage, the private-sector alternative to Medicare, is under federal investigation for care denials and costs 22% more per enrollee than Traditional Medicare—again due to manipulation of the coding system used to set premium payments.

Eisenberg also touches on possible reforms:

• “The future of America’s healthcare will be decided on a political battlefield… Powerful lobbying forces defend a profitable status quo.”

• “The financial trajectory is unsustainable.”

There is growing consensus around a new social contract for healthcare. Encouragingly, public support for serious reform is rising. But one central issue receives too little attention: coding.

Look closely at the reasons for our primary care shortage, fragmented system, rising costs, physician burnout, Medicare Advantage overpayments, and insurers’ ability to deny care—all roads lead to coding. This system was designed to measure and pay for care, but it has instead become an engine for inefficiency, fraud, and burnout. It rewards volume over value and creates a bureaucratic nightmare for providers and patients alike.

We must move toward simpler, outcomes-focused payment models—ones that reward actually caring for patients, not maximizing code entries. Likewise, we need new methods for adjusting insurance premiums that don’t depend on coded data games.

Viable alternatives exist. To learn more about healthcare reform that prioritizes people over paperwork, visit www.thejourneys-end.org.