The U.S. health care system is a bit like a smartphone with 47 apps you didn’t download, three different chargers,
and a subscription you can’t cancel. It technically workssometimes brilliantlybut it also drains your battery,
your time, and occasionally your will to live (looking at you, “Explanation of Benefits” that explains nothing).
When people say “We must challenge the health care status quo,” they’re not being dramatic. They’re reacting to a
system that often rewards volume over value, paperwork over patient care, and crisis response over prevention.
Challenging the status quo doesn’t mean tearing everything down. It means being honest about what’s broken,
protecting what’s working, and redesigning the parts that cause everyday people to suffer unnecessarily.
Why the status quo is failing (even when the clinicians are heroes)
We spend a lotand still struggle with outcomes
The U.S. is famous for medical innovation. We pioneer therapies, develop lifesaving drugs, and run world-class
hospitals. And yet, as a country, we often lag behind other high-income nations on outcomes that matterlike
avoidable deaths and overall health. That disconnect is the first giant neon sign telling us the status quo needs
a makeover.
Part of the problem is that our system is optimized for “sick care” rather than “health care.” If you show up
with a heart attack, we can do incredible things. But if you need affordable preventive care, ongoing help for
diabetes, mental health support, or coordinated treatment for multiple chronic conditions, the experience can
feel like navigating an escape room designed by a committee of billing departments.
Administrative complexity is not a medical specialtyyet it runs the show
One of the most consistent critiques from clinicians and patients is the administrative burden: the billing,
coding, prior authorizations, coverage rules, and endless forms that multiply like rabbits. This is the “hidden
tax” of American health care, and it shows up everywhere: higher costs, delayed care, clinician burnout, and
patient confusion.
If you’ve ever received two bills for the same procedure, from two different entities, with two different phone
numbers, and neither of them can tell you what you actually owecongratulations, you’ve completed Level 1 of the
U.S. health care paperwork simulator. Level 2 is when the bill changes after you pay it.
Fragmentation turns patients into project managers
Many patients end up coordinating their own care: chasing referrals, repeating medical histories, tracking test
results, and carrying information between specialists who don’t share records seamlessly. That fragmentation is
more than annoyingit’s risky. When the system doesn’t communicate, important details get missed, duplicate tests
happen, and the patient is the only person forced to hold the full story.
What we should challenge, specifically
Incentives that reward quantity over quality
A big engine of the status quo is fee-for-service paymentpaying for each visit, test, and procedure. That model
isn’t inherently evil, but it naturally incentivizes volume. If we want better outcomes at sustainable costs, we
have to keep shifting toward care models that reward results: improved health, fewer complications, better
coordination, and real patient experience.
This is where value-based care comes in. In plain language: pay for what works, not just what’s done. Done right,
it encourages teams to prevent emergencies instead of profiting from them. It also nudges organizations to
coordinate care across settingsprimary care, specialists, hospitals, rehab, home healthso patients aren’t
constantly starting over.
Primary care treated like an afterthought (even though it’s the foundation)
Primary care is where prevention happens, chronic conditions get managed, medications get reconciled, and early
warning signs get caught before they become expensive disasters. Yet many communities struggle with access, and
the workforce pipeline remains strained.
If you want one practical way to challenge the status quo: make primary care easier to access and more rewarding
to practice. That means payment reform, team-based care (nurses, pharmacists, behavioral health, community health
workers), and smarter use of technology so primary care clinicians aren’t drowning in inbox messages and forms.
Mental health and substance use care still live in a separate universe
Americans have been loudly, clearly, consistently saying: mental health is health. And yet, access remains uneven.
Coverage rules can be stricter, networks narrower, and waits longer than for many medical services. Enforcement of
paritymaking sure mental health and substance use disorder benefits aren’t treated as second-classmatters because
“You’re covered” is meaningless if you can’t find a provider or your claim gets denied for reasons that would never
fly for a broken bone.
Challenging the status quo here looks like: stronger parity enforcement, better reimbursement so providers can
actually afford to be in-network, and integrated behavioral health in primary care so people can get help early.
Maternal health outcomes and disparities we should not accept
Maternal care is one of the clearest examples of why the status quo is unacceptable. The U.S. has persistent
maternal mortality challenges, and outcomes can vary dramatically by geography and demographics. Access gaps in
rural communities, closures of maternity units, and uneven prenatal care all add risk where we should be reducing it.
A system that can perform robotic surgery should also be able to ensure timely prenatal visits, safe deliveries,
postpartum follow-up, and respectful care for every personregardless of zip code.
Modern tools that can helpif we use them like grown-ups
Price transparency that actually helps people shop (not just spreadsheets nobody reads)
Price transparency rules are a step toward sanity: people deserve to know what something costs before they
receive it. But transparency only matters if it’s usableclear estimates, patient-friendly formats, and real
accountability for compliance. “We posted a 10-gigabyte file of codes” is not transparency. That’s a scavenger hunt.
The goal should be simple: if a patient can compare flights, they should be able to compare shoppable health
servicesespecially when the price range can be wildly different across facilities.
Surprise billing protections: fewer financial ambushes
Surprise medical bills have been a defining horror story of U.S. health careespecially in emergencies, when
patients can’t exactly ask, “Excuse me, are you in-network while I’m actively having a crisis?” The push to reduce
surprise billing and take patients out of disputes between plans and providers is a meaningful challenge to the
status quo. It’s a reminder that financial chaos is not a medically necessary service.
Interoperability: your records should follow you, not the other way around
Health information should move securely where the patient needs it: between clinicians, across systems, and to the
patient. When information gets stuckbecause of outdated systems, business incentives, or intentional “information
blocking”care becomes slower, riskier, and more expensive.
Challenging the status quo means treating interoperability as a basic expectation, not a “nice-to-have.” Patients
should be able to access their results easily. Clinicians should not have to fax things in the year 2026 like it’s
a retro hobby.
Telehealth: not a magic wand, but a powerful lever
Telehealth exploded during the pandemic and proved a simple truth: for many needs, you don’t have to be in the
same room to get good care. Virtual visits can reduce travel barriers, make follow-ups easier, and expand access
for people with mobility issues, caregiving responsibilities, or limited local providers.
The future isn’t “telehealth versus in-person.” It’s hybrid care: the right visit type for the right situation.
A medication check-in might work perfectly on video. A new abdominal pain probably deserves a real exam. The goal
is better access without lower standards.
Health is shaped outside the clinic, so the system can’t ignore social needs
Housing instability, food insecurity, transportation barriers, and other health-related social needs can push
people into preventable emergencies. Models that strengthen clinical-community linkagesscreening for social needs
and connecting people to resourceschallenge the status quo assumption that medicine begins and ends with a
prescription.
This isn’t about turning clinicians into social workers. It’s about acknowledging reality: if someone can’t afford
food, “eat healthier” is not a plan. If someone can’t get a ride, “schedule a follow-up” is not access.
What “challenging the status quo” looks like in practice
For health systems and clinicians
- Design care around patients: fewer handoffs, clearer instructions, smoother transitions after hospitalization.
- Reduce low-value care: stop doing things “because that’s what we do” when evidence says otherwise.
- Invest in team-based models: let everyone practice at the top of their licenseespecially in primary care.
- Make administrative work smaller: streamline prior auth, standardize billing processes, and remove redundant documentation.
- Measure what matters: outcomes, equity, patient experiencenot just throughput.
For employers and insurers
- Build networks for access, not optics: a directory that lists unavailable therapists is not a network.
- Pay for prevention: benefit designs can make primary care, chronic care, and mental health easier to use.
- Use transparency to reduce price games: reward high-quality, fair-priced providers.
- Cut denial friction: make appeals navigable and ensure medical necessity decisions are clinically grounded.
For patients and families
You shouldn’t need a law degree to get care, but while we’re fixing the system, a few moves help:
- Ask for an estimate: for scheduled care, request a good-faith cost estimate and clarify what’s included.
- Keep a simple health file: meds, allergies, diagnoses, recent tests, and key contactsespecially for caregivers.
- Use your “why” question: “What are we trying to accomplish with this test or medication?”
- Appeal when something doesn’t make sense: denials get overturned more often than people realize.
Big shifts that would move the needle
Make care easier to navigate
Navigation should not be a luxury service. The system can build default supports: clear referrals, real-time
scheduling, transparent coverage guidance, and care coordination for people with complex needs.
Align payment with outcomesand protect against unintended consequences
Value-based care can reduce fragmentation and focus attention on prevention, but it must be built carefully. Good
models adjust for patient complexity so organizations aren’t punished for caring for sicker or more vulnerable
populations. Metrics should be meaningful, not just checkboxes. And patients should retain choice and trust.
Invest upstream
A system that mostly pays after people get sick will always feel expensive and reactive. Investing in prevention,
primary care, mental health, maternal health, and social supports won’t solve everything, but it changes the
trajectory. It’s cheaper to keep a roof from leaking than to replace the ceiling every year.
Conclusion: the status quo isn’t neutralit’s a choice
“The status quo” sounds like a passive thing, like weather. But it’s not weatherit’s design. It’s a set of
incentives, rules, workflows, and habits. And because it’s designed, it can be redesigned.
Challenging the health care status quo means refusing to accept avoidable suffering as normal. It means valuing
primary care like the engine it is, protecting people from financial ambushes, treating mental health as real
health, building systems that share information, and paying for outcomes that patients actually care about:
staying healthy, functioning well, and living longerwithout going broke or getting buried under paperwork.
We don’t need perfect solutions to start. We need better defaults, clearer accountability, and a relentless focus
on making care simpler, fairer, and more human. The goal is not a “health care system” that wins awards. The goal
is a system that works on an ordinary Tuesday.
of experiences that show why the status quo has to change
Here’s what “the status quo” feels like in real lifenot as a policy debate, but as a Tuesday at 2:17 p.m.
You finally get an appointment, but it’s in six weeks, during the exact hour your boss schedules the meeting that
“can’t be moved.” You take it anyway because you’ve learned that rescheduling is basically a new referral. You
show up early, fill out the same forms you filled out online, and then repeat your medical history like you’re
auditioning for a role called “Patient #3.” The clinician is kind, sharp, and clearly trying to helpbut the
visit feels rushed because the schedule is packed tighter than a budget airline seat.
Afterward, the testing begins. Not just medical testingbilling testing. A statement arrives that looks like a
bill but isn’t a bill. Then a bill arrives that looks like a scam but isn’t a scam. You call the number and the
automated voice tells you your “estimated wait time is greater than… time.” When you finally reach a human, they
explain you owe an amount that doesn’t match anything you’ve seen. You ask why, and they say, “That’s what
insurance says.” You call insurance and they say, “That’s what the provider billed.” You realize you are now the
unpaid mediator in a financial argument between two organizations that both have your money.
Meanwhile, your symptoms don’t pause while everyone sorts out codes. You try to be responsibleeat better, move
more, sleep morebut your work schedule, your childcare schedule, and your bank account form a powerful alliance
against your wellness goals. You get told to “manage stress,” which is hilarious, because the health care process
itself is a stress-management obstacle course. You’re not resisting healthy choices; you’re drowning in logistics.
If your need is mental health care, you learn a new phrase: “We’re not accepting new patients.” You hear it so
often it becomes background music. If you’re pregnant or postpartum, you realize how much depends on geography:
some places offer coordinated care and support; others feel like you’re doing this on hard mode. If you live in a
rural area, telehealth can be a lifelineuntil the rules change, coverage shifts, or broadband turns your visit
into a frozen screenshot of your worried face.
And yet, you also meet the best part of the system: the nurse who follows up because they actually care, the
primary care clinician who catches a serious issue early, the pharmacist who explains your meds without judging
you, the therapist who helps you put your life back together. These moments are proof that we don’t have a “people
problem.” We have a design problem. Challenging the health care status quo is how we protect the human magicand
stop wasting it on unnecessary friction.
