Broken and Failing: A Rural Physician's Plea for Healthcare Reform in America

As a rural family medicine physician, this latest report from The Commonwealth Fund is both eye-opening and disheartening. It underscores a reality I witness daily: our healthcare system is chronically underperforming, especially in areas where it should thrive—access, equity, and health outcomes. The U.S. is not just an outlier in how much it spends on healthcare but also in how poorly it meets the basic needs of its population. This is not just a statistic—it’s a reflection of the painful, lived experiences of patients across rural America, including my own community.

In rural areas like mine, the deficiencies outlined in this report hit especially hard. Access to care is an ongoing struggle, driven by financial barriers and a shortage of healthcare professionals. Many of my patients face staggering out-of-pocket costs, and those without adequate insurance delay or avoid care until their conditions become dire. It’s not uncommon to see patients in my clinic with preventable conditions that have worsened simply because they couldn’t afford timely treatment. This is a daily reality for rural healthcare providers, who not only deal with patients’ medical concerns but must also navigate the labyrinth of insurance claims, billing disputes, and administrative red tape. The administrative inefficiencies highlighted in the report detract from the time we can dedicate to patient care, which is already stretched thin.

Equity and health outcomes are areas where the U.S. ranks last—and this resonates painfully with my experience. In my practice, I see the impact of these disparities every day. Rural and low-income patients, especially those from underserved populations, face significant gaps in healthcare access. The report confirms what I already know: there is a stark divide in the quality of care between the wealthy and the poor. Too many of my patients are forced to make impossible choices—between filling a prescription and paying rent, between visiting a doctor and putting food on the table. These are choices that no one in a country as wealthy as the United States should have to make.

The Current State of U.S. Healthcare

The U.S. healthcare system is, frankly, unsustainable and unjust. We are failing in our most basic obligation as a society—to ensure the health and well-being of all our citizens. It’s infuriating to see a system that prioritizes profit over people, where access to essential healthcare is determined by one’s ability to pay. Despite being one of the wealthiest nations in the world, we leave millions of people—many of them from the most vulnerable populations—without access to the care they desperately need. The complexity and inefficiency of our system place a tremendous burden on both patients and healthcare providers, diverting time and resources away from care and toward navigating bureaucracy. It’s heartbreaking to witness the unnecessary suffering that comes from preventable and treatable conditions because the system is simply too expensive or too inaccessible.

Three Ways We Can Improve

Expand Access to Universal Healthcare Coverage:

We need to move toward a system of universal healthcare coverage. Countries like Australia and the Netherlands—both of which perform significantly better than the U.S.—show that universal coverage removes financial barriers and improves health outcomes and equity. If we want to address the deep inequalities in our system, we must ensure that every American has access to healthcare, regardless of their financial situation. Universal healthcare would prevent patients from avoiding care due to cost and ensure that everyone has the opportunity to live a healthier life.

Invest in Primary Care and Rural Health Infrastructure:

The shortage of primary care providers in rural areas is one of the biggest challenges we face. We need more investment in primary care, particularly through better compensation, loan forgiveness programs, and incentives for physicians to practice in underserved areas. Strengthening the primary care workforce would not only improve access but also reduce the need for expensive emergency care. Additionally, expanding telemedicine options for rural communities can make a real difference in ensuring that patients get the care they need without having to travel long distances.

Streamline Administrative Processes and Reduce Costs:

The U.S. healthcare system is burdened by administrative inefficiencies that waste time and resources. Simplifying insurance claims, reducing the complexity of billing, and adopting standardized practices would allow providers like myself to spend more time caring for patients and less time dealing with paperwork. Regulating healthcare costs—particularly the exorbitant prices charged by hospitals and pharmaceutical companies—would also help make care more affordable and prevent patients from falling into financial hardship due to medical bills.

A Call for Urgent Reform

The U.S. healthcare system is at a breaking point, and without comprehensive reform, the situation will only worsen. We need to expand access, reduce costs, and make significant investments in primary care—especially in rural areas. The data from The Commonwealth Fund report is clear: we are falling behind other developed nations, and the consequences are deadly. People are dying younger, more people are dying from preventable causes, and the inequities in care are deepening.

It’s time to prioritize the health and well-being of the American people over the interests of the healthcare industry. We cannot continue down this path where profit is prioritized over human lives. Every person, regardless of income, geography, or background, deserves access to quality healthcare. As the report highlights, the U.S. is spending more than any other nation on healthcare, yet we are seeing some of the worst outcomes. This is not just a policy failure—it’s a moral failure.

If we truly want to improve, we must take bold steps to lower costs, expand access, and ensure that healthcare is a right for every American, not a privilege for those who can afford it.

Reference

David Blumenthal et al., Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System — Comparing Performance in 10 Nations (Commonwealth Fund, Sept. 2024).