The U.S. healthcare system suffers from misaligned incentives, where stakeholders prioritize individual revenue over collective well-being, according to a new analysis by Trilliant Health. Their review of claims data, price transparency records, and industry sources identifies six systemic issues that worsen this dysfunction. Trilliant Health’s Chief Research Officer, Allison Oakes, describes the system as a “tragedy of the commons,” where actors focus on profit rather than health outcomes. As a result, no single group takes responsibility for improving care—only for maximizing earnings.
Cost pressures are pushing affordability to a breaking point. Seventy percent of Americans now see the healthcare system as flawed or in crisis, with expenses outpacing wage growth and inflation. For employees, deductibles and premiums have become a top financial burden, surpassing housing, utilities, and groceries. Oakes emphasizes that workers are struggling to keep pace. Meanwhile, behavioral health visits for children with developmental and anxiety disorders rose sharply between 2019 and 2025. By 2025, 6.4% of children were prescribed five or more medications, while opioid prescriptions from multiple providers exceeded 10% in 11 states. These patterns reveal systemic failures in prevention, where financial incentives reward treatment over early intervention.
The gap between healthcare demand and supply is growing. By 2038, the U.S. physician workforce is expected to meet just 87.7% of demand, with adult psychiatrists and primary care doctors facing shortages of 49.8% and 80.4%, respectively. Between 2019 and 2025, demand for advanced imaging and behavioral health visits outpaced primary care growth. Consumers are responding by adopting self-testing and alternative care models, often bypassing traditional providers. The report suggests these changes reflect both unmet needs and frustration with access barriers. Without systemic reforms, these workarounds may become permanent.
Current quality measures from the Centers for Medicare & Medicaid Services (CMS) include over 800 active metrics, but only 27% directly link to patient outcomes. Hospital pricing data shows little connection between cost and quality, higher rates do not ensure better survival rates. This misalignment means financial incentives frequently override efforts to improve care delivery.
Profit-driven models also contribute to fraud, waste, and abuse. Between 2019 and 2024, for-profit hospices expanded by 11.2%, while nonprofit hospices shrank by 2%. In 2023, for-profit hospices reported a Medicare margin of 13.7%, compared to a 1.3% loss for nonprofits. The data suggests these models may exploit gaps in care standards. Additionally, new medications like GLP-1 agonists and SGLT2 inhibitors are altering revenue streams. Their adoption coincides with declines in certain high-volume procedures, indicating that drugs may increasingly replace costly interventions. This shift disrupts the traditional healthcare economy, which has long depended on procedure volumes for profitability.
