A “Perfect Storm” in the American healthcare system is developing, driven by mounting structural failures and stupid political decisions. The core issues include severe physician shortages, government cutbacks on Medicare and preventative services, looming loss of ACA marketplace subsidies, and major reductions in public health and child nutrition programs, all combining to reduce access, quality of care, and affordability of care on a State and national level.
Physician Shortage and the ‘Employment’ Paradox
There is a critical and worsening shortage of physicians, especially in Kent and Sussex. The U.S. is projected to be short up to 86,000 doctors by 2036, with primary care and internal medicine among the hardest-hit fields. This is already leading to much longer wait times for appointments and limiting access.
The aging physician workforce and increased retirements, coupled with pandemic burnout and poor working conditions, are major contributors to this gap.
With the shift from private practice to hospital employment, there has been a clear cut reduction in physician productivity coupled with marked increased in costs. The shortage has resulted in increased emergency room utilization, dramatically increasing costs!
Cutbacks on Medicare and Preventative Care
Congress has allowed a 2.83% across-the-board Medicare physician payment cut for 2025, the fifth consecutive year of such reductions (and note hospitals got a 3% increase!) This has eroded provider participation, especially in private practices and pushed doctors to leave medicine.
Proposed federal budgets would slash funding to the CDC by more than half, directly eliminating dozens of public health, prevention, and chronic disease programs. Reductions in vaccine utilization will raise morbidity, mortality and costs.
Medicare coverage and cost-assistance programs that support low-income seniors are being weakened and ACA preventive care mandates have recently survived a legal threat, but continued political challenges remain.
Loss of ACA Subsidies
Proposed and ongoing legislative changes threaten ACA market subsidies, which help more than 22 million people obtain insurance. Loss of these credits and the creation of stricter sign-up windows risk a sharp rise in the uninsured population, making access to care even more precarious amid already-high costs.
Cuts to Child Nutrition and Support
Federal cuts and budget clawbacks are taking billions out of child nutrition, SNAP (food stamps), and other support programs, making food insecurity worse for children, families and people with disabilities. SNAP faces major reductions, with states expected to either cut eligibility or risk terminating the program entirely if they cannot fill the funding gaps, putting millions at risk for worse health outcomes.
The Collapse of the System
The convergence of these has created a “Perfect Storm”. With costs outpacing growth, critical coverage and prevention programs gutted, and a shrinking medical workforce, many experts warn the system is approaching the point of collapse, with implications of severe declines in quality, safety, and accessibility, with particularly acute suffering among vulnerable populations and in public health responses.
Dr Bob, Brain Mechanic 