By Russell R. Barksdale, Jr.
The cumulative attributes that once established the United States as a global leader in healthcare—groundbreaking medical innovation, world-class physician training, and timely accessibility—remains threatened. Once revered as the standard-bearer for medical excellence, the U.S. healthcare system faces a mounting crisis defined by institutional closures, delayed accessibility, inconsistent quality, and rising disparities in care delivery.
In 2024 alone, 25 hospitals across the country shuttered their doors. Even more concerning, over 400 hospitals are currently identified as “vulnerable to closure” due to persistent negative operating margins. This isn’t just a rural hospital problem—urban safety net hospitals, community institutions, and even longstanding regional facilities are at risk, destabilizing access across the continuum of care providers. Similarly, the number of skilled nursing facilities has steadily declined, despite an aging population with increasing long-term care needs. In 2023, over 500 nursing homes were projected to close or reduce capacity nationwide, driven by staffing shortages and financial constraints.
While hospital closures are the most visible sign of distress, the underlying erosion of healthcare quality is perhaps more insidious. The distinctions among providers—those that set benchmarks in clinical outcomes, patient safety, and experience—continue to grow exponentially. Even within elite institutions, glaring inconsistencies exist across departments and subspecialties. A world-renowned academic center may boast a top-ranked oncology program while simultaneously struggling with quality metrics in orthopedics or maternal care.
What was once a universally accepted standard of care has diminished at a time when the U.S. healthcare system faces unprecedented demand from a rapidly aging population and a surge in complex, chronic conditions such as diabetes, cardiovascular disease, and dementia. It is tempting to search for a single root cause, but there is no common explanation for this systemic decline. Many critics point to the for-profit healthcare model, in which financial capital is redirected toward investor returns rather than reinvested into patient care, clinical innovation, or staffing infrastructure. Indeed, the rise of private equity ownership in hospitals and physician practices has raised concerns. A 2023 study found that private equity-acquired hospitals were associated with a 25% increase in charges and a decline in certain quality measures compared to non-acquired facilities.
But the problems go far beyond ownership models. Unsustainable pharmaceutical pricing continues to drain public and private resources, while restrictive managed care practices limit provider choice and create bureaucratic bottlenecks. Preauthorization requirements, narrowed provider networks, and low reimbursement rates—particularly from Medicaid and Medicare Advantage plans—can delay timely care and burden providers with administrative complexity.
On the public health front, the U.S. continues to struggle with chronic disease prevention and health maintenance. Our healthcare system remains largely reactive—focused on treating illness rather than preventing it. Cultural overreliance on pharmacologic interventions instead of promoting sustainable lifestyle changes has become the norm. Rising obesity rates, poor dietary habits, work-life imbalances, and environmental stressors have contributed to an increase in preventable diseases.
A recent JAMA report revealed a disturbing increase in avoidable deaths in the United States, reinforcing that our healthcare system is not just lagging—it is deteriorating compared to peer nations. In fact, the U.S. now ranks near the bottom among OECD countries in terms of preventable mortality, maternal health outcomes, and life expectancy.
This decline has not occurred overnight, nor is it the direct result of recent federal restructuring efforts within agencies like the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), or the Department of Health and Human Services (HHS). Instead, it reflects years of misaligned incentives, underinvestment in healthcare infrastructure, and a regulatory environment that often rewards mediocrity rather than excellence.
For example, the CMS star ratings system—intended to guide consumer choice—is based on a bell-curve model, meaning that only a fixed number of facilities can achieve 5-star status regardless of how many actually meet high-quality criteria. This structure disincentivizes true excellence and encourages institutions to chase benchmarks rather than pursue continuous, self-defined improvement.
In contrast, high-performing organizations understand that healthcare excellence is not a destination but a relentless pursuit. Renowned systems continue to innovate by reinvesting in their workforce, leveraging data to refine care pathways, and setting internal standards that surpass state and federal requirements.
These organizations invest not only in cutting-edge diagnostic and therapeutic technologies but also in the development of their staff. From nurse residency programs and physician continuing medical education (CME) to cross-disciplinary case reviews and team-based care models, these institutions understand that proficiency is born from collaboration, mentorship, and repetition.
Moreover, the rapid growth of concierge and direct-pay medical practices signals a consumer shift toward personalized, immediate-access care. While these models offer improved care coordination and quality for those who can afford it, they also underscore a deepening two-tiered system—where wealth, not need, increasingly dictates care quality and speed of access.
Proficiency in healthcare is not simply a function of education or licensure; it is the result of deliberate practice, continuous learning, and a culture that prioritizes outcomes over appearances. It is refined through data transparency, patient engagement, interdisciplinary accountability, and a shared mission to elevate care delivery.
The path forward requires bold differentiation—not imitation. State, federal, and private payers must take the next step and go beyond simply reporting quality. They must reward it. This means higher reimbursement for top-tier institutions and performance-based incentives that encourage investment in staff development, technology, and patient-centered care. The CMS Compare tool (www.medicare.gov/care-compare/) offers a public framework, but financial alignment must follow.
For a Medicare Advantage plan or commercial insured network to admit a provider solely based upon their acceptance of a discounted rate structure only reinforces diminished standards and rationing of care. To restore leadership in healthcare, sustainable increases in quality outcomes must also be financially rewarded. Only then will our region, state, and nation rise to meet the growing demands of a complex population and fulfill the promise of our profession.
Russell R. Barksdale, Jr., PhD, MPA/MHA, FACHE, is President and CEO of Waveny LifeCare Network. With over 25 years of healthcare leadership, he guides the organization’s mission to deliver high-quality, compassionate senior care across a full continuum of services.
