The Broken Economics of American Health Care

November 2, 2026 - 12:16

The economics of the U.S. health care system are broken, writes Paul Markovich, president and CEO of Ascension. In his view, the numbers tell a story that should alarm anyone paying attention. The United States spends far more per person on health care than any other wealthy nation, yet it consistently posts worse outcomes on measures like life expectancy, infant mortality, and preventable deaths. That gap between spending and results is not a minor inefficiency. It is a structural failure.

Markovich argues that the problem is not simply how much money flows into the system but how that money moves. Prices are opaque, incentives reward volume over value, and administrative overhead consumes a large share of every dollar spent. Patients rarely know what a service costs before they receive it, and providers are often paid for procedures rather than for keeping people healthy. Insurers, hospitals, drug makers, and intermediaries all operate within a framework that rewards cost shifting instead of cost reduction.

The consequences reach beyond balance sheets. Rising premiums and out of pocket costs push families to delay care, skip prescriptions, and take on debt. Employers face mounting expenses that limit hiring and wage growth. Meanwhile, rural hospitals close and access shrinks in communities that can least afford it. Markovich contends that incremental fixes will not be enough. Real reform requires confronting the underlying incentives, making prices transparent, and aligning payment with outcomes rather than activity. Without that shift, the economics will remain broken, and the people who depend on the system will keep paying the price.