By: Ngozika Egbuonu, MS, MA, DBH Student, Cummings Graduate Institute for Behavioral Health Studies
“Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.”- Dr. Martin Luther King, Jr, April 16, 1966
What Americans Were Promised
American health insurance did not begin as a billion-dollar machine. It began as a promise.
In 1929, a hospital payment plan created for Dallas schoolteachers offered a simple safeguard: affordable access to care when illness struck. It was not designed to enrich shareholders or expand corporate empires. It was designed to protect working people from the financial and physical consequences of unmet medical needs. That early model helped shape what would become Blue Cross and, eventually, the broader health insurance industry Americans have today.
Nearly a century later, that promise has been distorted beyond recognition.
How Insurance Became Industry
Today, the American patient is too often taught to confuse insurance with care, complexity with quality, and profit with innovation. We are told that the United States has the “best healthcare system in the world” because it spends the most, is powered by some of the world’s most brilliant clinical teams, uses advanced technology, and offers consumer choice.
Unfortunately, the outcomes tell another story.
Americans pay more for healthcare than people in comparable nations and still experience worse results, including the lowest life expectancy among high-income Western countries. We have built a healthcare economy that has made many people extraordinarily wealthy while leaving millions of patients underinformed, overbilled, and underserved.
That is not just policy failure. It is public miseducation.
The Burden Patients Were Never Meant to Carry
The problem is not simply that healthcare is expensive. It is that Americans have been conditioned to accept a system organized around financial extraction rather than human wellbeing.
Patients are expected to navigate deductibles, copays, coinsurance, provider networks, formularies, prior authorizations, surprise bills, and coverage denials while sick, scared, or caring for loved ones in crisis. This is not empowerment. It is administrative burden disguised as personal responsibility.
Research on health literacy makes clear how dangerous this burden is. Limited health literacy is associated with poorer health outcomes, lower use of preventive care, and reduced capacity to manage chronic illness. In a system as fragmented and bureaucratic as ours, confusion is not a side effect. It is a structural feature.
Patients are routinely expected to make “informed choices” in a landscape designed to obscure cost, restrict access, and shift accountability away from institutions and onto individuals.
Spending More, Living Less
The United States spends far more per capita on healthcare than peer nations, yet trails them on core outcomes. Despite unprecedented national spending, Americans die younger, experience more preventable illness, and face greater barriers to care.
Administrative waste alone consumes an enormous share of healthcare dollars, driven by the complexity of a fragmented multipayer insurance system that prioritizes billing, coding, utilization management, and reimbursement negotiations over seamless care delivery.
This is the great American contradiction: we have mistaken healthcare spending for healthcare success.
A Broken System Harms More Than the Poor
Some defenders of the healthcare status quo argue that the real problem is poverty, not the healthcare system itself. Poverty absolutely matters. So do race, geography, disability, and access to education.
But that explanation is no longer enough.
Recent evidence suggests that even wealthier Americans do not fare as well as their counterparts in Europe. In other words, this is not only a crisis for the poor. It is a crisis of system design. The problem is so deeply embedded that even people with relative advantage are harmed by it.
That should force a larger reckoning.
The Real Lesson Americans Have Been Taught
For too long, Americans have been taught to think of healthcare as an individual consumer issue rather than a collective public good. We are encouraged to shop for plans, compare networks, and negotiate bills, as though access to care were equivalent to selecting a phone carrier.
But healthcare is not a luxury market. It is a social necessity.
When a nation treats care as a commodity instead of a shared responsibility, the result is predictable: those with power profit, those without power struggle, and the public learns to normalize injustice.
This miseducation also shapes what patients believe is possible.
Many Americans do not realize that other wealthy nations achieve better outcomes with lower costs and simpler systems. Many do not know that coordinated primary care, integrated behavioral health, and community-based prevention can improve outcomes while reducing downstream costs. Many have never been invited to see healthcare reform as something they can shape, rather than something done to them by insurers, legislators, or hospital executives.
But they can shape it.
What Patients and Communities Can Do Now
Real change begins when patients stop seeing themselves as passive recipients of a broken system and start acting as stakeholders in a public one.
Locally, that means supporting leaders and institutions that prioritize Medicaid expansion, transparent pricing, behavioral health integration, strong primary care networks, and community-based care models. It means showing up at school board meetings, county hearings, hospital advisory councils, and state legislative forums. It means asking hard questions about who is being left out of care and who benefits when access is delayed or denied.
Nationally, it means advocating for policies that reduce administrative waste, regulate insurer overreach, simplify coverage, and expand access to affordable, evidence-based care. It means rejecting the false choice between economic sustainability and human dignity.
A healthcare system that prioritizes people over profit is not unrealistic. It is overdue.
The Role of Doctors of Behavioral Health
Doctors of Behavioral Health (DBHs) have an especially important role in this movement.
DBHs are trained at the intersection of behavioral health, medical systems, care coordination, and population health. That training positions us to do more than treat symptoms. It prepares us to help redesign healthcare systems.
In a healthcare environment where patients are often bounced between siloed services, DBHs can lead efforts to integrate behavioral health into primary care, strengthen interdisciplinary communication, improve screening and referral pathways, and center whole-person care.
That work matters because the failures of the American healthcare system are not purely medical. They are behavioral, structural, and social. Patients do not experience depression, diabetes, trauma, housing instability, substance use, food insecurity, or chronic stress in separate compartments. Their lives are interconnected, and yet our systems remain unsustainably fragmented.
DBHs help close that gap by building models of care that reflect how people actually live.
Professionally, DBHs can support reform by helping organizations reduce barriers to access, improve patient engagement, address social drivers of health, and translate evidence into practice and policy. They can lead system redesign efforts that make care more understandable, more coordinated, and more equitable. They can also serve as advocates in clinical, administrative, and legislative spaces. DBHs are well equipped to insist that healthcare institutions measure success not only in revenue and utilization, but in the institution’s ability to encourage and support more trust between patients and their care teams, improve treatment access, advance better health outcomes, and increase a person’s sense of dignity.
A Better Healthcare Future Is Possible
The miseducation of the American patient has never only been about health insurance. It has been about unfair expectations.
Americans have been taught to expect confusion, to tolerate inequity, and to mistake survival within a broken system for evidence that the system works. We have been told that complexity is inevitable, that better outcomes are unaffordable, and that patients should be grateful for coverage even when coverage fails to deliver care.
We should firmly and collectively reject that lesson.
Healthcare was never meant to be a maze. It was meant to be a safeguard. A nation as wealthy as the United States can build a system that is simpler, fairer, and more humane. It can choose coordinated care over fragmentation, prevention over crisis, and people over profits.
That future will not and cannot emerge from silence. It will require patients, clinicians, advocates, and leaders willing to confront what has been normalized and demand something better.
The American patient does not need more confusion packaged as choice. The American patient needs truth, dignity, and a healthcare system worthy of public trust.
Call to Action – What to Do NOW
The next chapter of American healthcare should not be written by insurers, lobbyists, and shareholders alone.
It should be shaped by patients, families, communities, and professionals committed to health equity and whole-person care.
Ask questions. Attend meetings. Support integrated care. Challenge policies that place profits above people. Vote for leaders who understand that healthcare access is not a privilege for the few, but a public obligation to all.
The more informed the American patient becomes, the harder it will be for the system to remain unchanged.
About the Author
Ngozika Egbuonu is a Doctor of Behavioral Health (DBH) candidate whose work sits at the intersection of analytical insight and strategic communication. With advanced degrees in Psychology and Medical Humanities and Bioethics, she brings a distinctive dual perspective to roles that demand both quantitative rigor and creative, human-centered thinking. Her experience spans project management, fundraising, event coordination and planning, program direction and leadership, research, and volunteer leadership, equipping her to drive initiatives from conception through execution. Passionate about fostering inclusive environments and empowering teams, Ngozika thrives on leveraging data, storytelling, and collaboration to deliver meaningful impact to patients, communities, and all in need.
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