Healthcare was carrying the economy. Any commentary on why that’s failing?
Contracts were heavily affected by cuts in federal programs that are critical to some rural regions, and uncertainty caused by inconsistent messaging about the future of such programs. Some areas are very dependent facilities that can only survive with public funding.
For example in nursing categories, CNOs (Chief Nursing Officers) would be requesting more staff, but CFOs would block those requests due to changing budget forecasts. The unpredictability of the fed is causing chaos downstream.
There is also a continuing trend to "realign" staff levels post-COVID, but that now is much easier to forecast for compared to the political chaos. In 2026 healthcare, that would not be a reason for attrition at these levels.
https://www.kff.org/medicaid/implementation-dates-for-2025-b...
It looks like some of the big ones landed Jan 1 2026.
I ran the team that maintained our business analytic data, and was also on weekly calls where feedback from our clients about the situation was discussed. There was direct correlation between uncertainty and both a decline in new job postings, as well as a lack of renewing existing job contracts.
When comparing our numbers to those of our publicly traded competitors, all the data showed the same trends.
The thing is, bad and expensive health issues can literally come upon you over night. You can get hit by a vehicle or get beaten up with no perpetrator to be held accountable, you can develop an aneurysm, get food poisoning, get pregnant unexpectedly (with all the risk that comes with, including healthcare not being accessible because of anti-abortion BS), or you can simply fall over a step in your own house.
Aneurin Bevan
Absolutely, but there are lots of working, existing models that are better than ours in practice, so this isn't much of an excuse.
For one example there are some positive aspects to the Japanese system in that they achieve good outcomes (on average) at lower costs. But that's partly due to the "Metabo Law" aka "fat tax" which voters in other countries might see as punitive or discriminatory. I'm not necessarily arguing for any particular approach to lifestyle-related health conditions but any choice involves trade-offs.
https://www.telegraph.co.uk/news/2023/12/07/japan-solved-obe...
Is it? An existence proof multiple times over actually seems extremely important in debates about the future of healthcare in the US.
So, if health insurers want to start charging premiums I suggest they send their bills to Superfund sites first, then to regular toxic cities like Flint, Camden, Hinkley or Picher, then to producers of known-carcinogenic substances (like Chrome-6 or Roundup), and then to advertisers of known-harmful products like alcohol or tobacco. Only when they run out of those targets can we have a discussion on individual lifestyle choices.
There's very little tobacco advertising anymore so we're not going to squeeze many dollars out there.
https://www.fda.gov/tobacco-products/products-guidance-regul...
Realistic in this administration? No. They will keep taking and taking from the working class and pitting them against one another. There's no solution there when the government is actively looking to sabatoge the system.
Arguing over tobacco premiums is pennies on the dollar. Pretty much every other civilized country has figured something out with regards to universal healthcare. I'm sure there's dozens of solutions out there to choose from. The only real steps to take right now is to have Americans stop licking the boot and actually push for something that helps them.
For example Some people want to see a specific doctor they know in a private session to discuss life and family stresses. Others only go to urgent clinics if they need an immediate medication.
The only way this can make sense mathematically is if you're including children, seniors, and/or the ill—populations who are unable to work. What is your reference?
These numbers are incommensurate in a way that may not be obvious.
7% of the population doesn't tell you what population fraction is covered by such policies.
36% coverage is even harder—every child in the US is eligible for Medicaid, and such children may not always need it, or may move states after using Medicaid, in a way that makes them doubly counted.
80% of the working population is also less clear; is that 80% of policy-holders get their own policy through their own job? Or 80% of working-age people have a policy through some workplace, even if they are not working?
What I think we have now is the most non-market like sector of the economy, with 1/3 of all citizens already receiving government funded healthcare.
There has to be SOME point where the constant muggings aren't worth it vs the risk, otherwise they would simply demand all our money, knowing we won't say no with our life on the line.
Realistically catastrophic revolving temporary insurance plus managing what you can in Mexico, plus occasionally paying out of pocket would mitigate the vast majority of yours risks while keeping expense relatively low.
They'll only treat you until you're stabilized, though. They won't give you chemo or routine care. If you need to be admitted you're also not covered by the EMTALA.
All emergency medicine, not just that triggered by the EMTALA, is 5-6% of all healthcare spending in the US, so while it contributes, it's not collapsing the healthcare system.
The real problems with it are that it's an unfunded mandate by Congress, just adding to the financial tangling of the healthcare system, and that it's way too often used to treat things that could have been much more cheaply treated in a clinic, but then there are no clinics nearby that take Medicaid and are actually open, so instead, like with so much of our health care system, we choose to solve it the stupid way instead.
Thus solving the problem.
I know the economic idea, but it is not a good mechanism for society.
So that part could just be a blip. The rest seems on-trend.
The fact that it's such big part of the economy is a really bad thing because it's "overhead" or "broken windows" for the most part.
And it's falling because people are stretched thin so they're not going to the engaging healthcare unless they truly NEED it. Even if you have "great" insurance contacting that system still costs you money if not every time then on average.
For instance, I could live with allergies, and all my ancestors just had to, but I have the option to spend money on allergy testing services, medicines, treatments, etc. People spend money on in-home professional care to get better treatment than going alone or relying on family, or spend money on care facilities as appropriate for their circumstances.
We have medicines for depression, anxiety, restless leg syndrome, ADHD, birth control, acne, weight loss, low testosterone, ED, poor sleep, eczema, psoriasis and a million other issues which people in the past, or people in developing countries today, simply had to live with that we have the privilege of having access to treatments for to improve our quality of life.
I know people who are affluent and outwardly "healthy" who spend thousands of dollars per year in the "healthcare" category that's entirely discretionary, but lets them keep looking young and playing tennis at 70 years old, or helps them juggle work, family and fitness at 40.
Humans weren't designed to last forever, and it's inefficient to push against that constraint, you run into fast diminishing returns, and it leads to maladies and stratification when done at a societal scale. It doesn't matter how much we spend on health care, we're not going to live forever.
It’s both. Like transportation and construction. And whether you think it’s a profit or cost center doesn’t change that it contains paying jobs.
I'm getting more benefit than the cost of that healthcare (I'm asserting that this is true, I feel a lot better with the medicine) and that ends up feeding into the economy.
I reckon I'm trying to think about the dependency graph of necessity. I suspect you are too.
A monetary economy has productive sectors and non-productive sectors. Most healthcare is non-productive from the point of view of an economy. Healthcare for workers and future workers is economically productive (from an economy's point-of-view). Maybe my conceptual cleaving is poor (black n white binary splits are usually misleading).
Of course ultimately most of what an economy delivers to us individually is monetarily uneconomic (is art or entertainment necessary?). Me confused.
Now I feel bad that I've wandered off into philosophy (which I usually find interesting but non-useful).
[1] https://www.beckershospitalreview.com/hr/31000-kaiser-worker...
Workers on strike are classified as not employed, so yeah we should ignore that category
I'm probably missing something here, but those seem quite unrelated categories, and I'm not sure why anyone would pay for private education these days when we all have access to free AI private tutors?
The parents that stuck their kids in front of a TV in the 80s or handed them an iPad to shut them up in the 2010s think this is a great idea today. Namely, it’s not an AI tutor. It’s an AI babysitter. That’s fine. Parents need breaks, particularly ones who can’t afford childcare. But branding it as anything but a way to mindlessly occupy one’s child is dishonest.
https://www.penguinrandomhouse.com/books/172835/the-diamond-...
I know human teachers aren't perfect, but they seem much better than these things.