A record-breaking number of Americans now view their nation's healthcare system as being in a dire state, with spiralling costs identified as the single most urgent problem. According to a new poll from the West Health-Gallup Center on Healthcare in America, 29% of citizens pinpoint 'cost' as the paramount health issue facing the United States.
A System in Peril: Record Levels of Pessimism
The survey paints a stark picture of public sentiment. It found that a record 23% of Americans believe the US healthcare system is 'in a state of crisis', with an additional 47% concluding it has 'major problems'. Experts directly link this pervasive sense of crisis to the overwhelming concern over affordability. Emma Wager, a senior policy analyst at KFF, explained that healthcare is an unpredictable and unavoidable expense where consumers have little power to shop around, making cost fears particularly acute.
Timothy Lash, President of West Health, emphasised that rising costs are not an abstract policy issue but a direct assault on both wallets and health. 'When healthcare costs rise, it's a direct hit to the wallets of Americans and to their health,' he stated, noting that financial stress can itself lead to poorer health outcomes like hypertension.
The High Price of Care: Skipping Treatments and Regional Divides
The financial strain is forcing difficult choices nationwide. A landmark Gallup survey from November revealed that 30% of US adults have a family member who skipped a medical treatment due to high costs. The burden, however, is not evenly spread. The problem varies dramatically by state; while one in five adults nationally reported a household member unable to afford medication, that rate was three times higher in Mississippi than in Iowa.
Lash warned policymakers that the scale of forgone treatment should be alarming, noting that 'in the very best states, it's one in five'. This crisis of affordability is compounded by an ageing population, whose care demands are typically more expensive, and by broader economic volatility and inflation.
The Mental Health 'Feedback Loop' and Systemic Barriers
Since the Covid-19 pandemic, mental health has surged as a key area of public concern. David Radley of the Commonwealth Fund described a damaging 'feedback loop' connecting poor mental health and unaffordable care. Those experiencing the most mentally unhealthy days are also more likely to be unable to afford a doctor, yet the very care they need is often financially out of reach.
Radley highlighted a structural flaw: mental health services are frequently a 'carve-out' in insurance plans. Unlike standard preventive physical care mandated by the Affordable Care Act, patients often face unclear reimbursement processes and high out-of-pocket costs for psychotherapy. Dr Lisa Rosenthal, a psychiatry professor at Northwestern University, argues this separation of mental and physical health is a false and costly dichotomy. 'I think it's time to recognise the brain as just another part of the body,' she said, contending that integrating mental health into primary care could reduce overall system costs.
Rosenthal, who is working on a primary care screening initiative with the West Health Accelerator, placed the blame on policy choices: 'We have chosen to not pay for psychiatric treatments. We have chosen to not make them accessible to the vast majority of the population.' The poll's findings underscore a system under immense strain, where cost barriers are not just a financial concern but a fundamental threat to the nation's health.
