Profits Before Patients

Structural Incentives and Their Impact on U.S. Healthcare Spending and Outcomes

Abstract

The United States spends nearly twice as much per capita on healthcare as any other
developed nation, yet consistently ranks near the bottom on critical health outcomes, from life
expectancy to chronic disease burden. Americans pay more for hospital visits, physician
services, and prescription drugs—not because care is more effective, but because the system is
engineered to charge more. This contradiction is not incidental; it is systemic. The Iron Triangle
of healthcare—cost, quality, and access—illustrates that optimizing one pillar often requires
trade-offs with the others. Yet the U.S. manages to compromise all three. In pursuit of profit, it
delivers a system that is simultaneously unaffordable, inaccessible, and often underperforming.
Unlike nations with universal or public healthcare systems designed to promote population
health, the American model is fragmented, opaque, and driven by market logic. Insurance
companies, pharmaceutical corporations, hospital networks, and medical device manufacturers
all operate within a framework that rewards revenue generation over patient outcomes. This
paper argues that the root cause of the nation’s healthcare crisis is not inefficiency or lack of
innovation—but a profit-centered architecture that treats health as a commodity. In such a
system, administrative complexity is rewarded, pricing is unregulated, and the human need for
care becomes subordinate to quarterly earnings. To build a just and sustainable healthcare
future, we must confront a hard truth: profit and patient care do not—and cannot—share equal
priority.