US Health Care Fails Due to Self Interest and Rising Costs

Trilliant Health just dropped a report that sounds less like a policy paper and more like a diagnosis of a broken machine. The core finding is blunt: the U.S. health economy is a textbook tragedy of the commons. This isn't a metaphor for lack of funding or bad luck. It is a structural failure where every stakeholder is incentivized to maximize its own revenue, and the predictable result is a system that delivers disproportionately little health for what it costs.

Allison Oakes, Ph.D., Trilliant Health’s Chief Research Officer, put it plainly in the release. The system is not designed to work together. It is designed for individual gain within a fragmented whole. The data behind this claim is drawn from hundreds of stories in Trilliant’s proprietary claims database, price transparency data, and Provider Directory, alongside government and industry sources. The conclusion is that the lack of shared purpose impacts how care is financed, delivered, and evaluated.

The report identifies six trends that support this thesis. The first is that the U.S. healthcare “system” does not function as a system. We have never resolved three foundational questions: what is healthcare, who is entitled to it, and who is obligated to pay? This lack of shared purpose is the root of the dysfunction. It is not a bug. It is the feature of a system that has never agreed on its own basic rules of engagement.

The Crisis Is Not New, But It Is Getting Worse

The public knows something is wrong. As of 2025, 70% of Americans believe the healthcare system has major problems or is in a state of crisis. That is not a fringe opinion. It is the majority view. The report links this widespread concern to the erosion of affordability, which has been a steady, grinding process rather than a sudden shock.

The numbers are stark. Employee deductibles and premiums have increased by 151.4% in recent years. Wages have grown by 73.2%. Inflation has risen by 55.3%. Healthcare costs are outpacing everything else in the economy. This is not a temporary squeeze. It is a structural divergence that is pushing the system further into the crisis zone that most Americans already believe they are in.

The System Is Not Built to Keep You Well

Trilliant Health points to a collective failure in handling population unwellness. Poor diet, physical inactivity, and social isolation are producing an increasingly unwell population. Yet the healthcare incentives remain focused on treating illness after it develops, not preventing it. This is the tragedy of the commons in action. No single stakeholder has an incentive to invest in prevention if the profit model is built on treatment.

The data on pediatric health is particularly alarming. Between 2019 and 2025, pediatric visits for pervasive developmental disorders increased by 117.1%. Visits for anxiety disorders increased by 72.4%. Over the same period, the number of children receiving an SSRI increased by 17.9%, and the number receiving an SNRI increased by 13.6%. In 2025, 6.4% of children were using five or more medications. This is not just a clinical trend. It is a sign of a system that is reacting to a population in crisis, not proactively supporting their well-being.

What This Means for the Future

The report does not offer a silver bullet. It offers a diagnosis. The tragedy of the commons is a well-known problem in economics and ecology. It happens when shared resources are depleted because individuals act in their own self interest. In healthcare, the shared resource is the health of the population. The depletion is the rising cost and the declining health outcomes.

Solving this requires a fundamental shift in incentives. It means moving away from a model where every stakeholder maximizes its own revenue and toward a model where the collective health of the population is the primary metric. This is not a small change. It is a structural overhaul. But if 70% of Americans already believe the system is in crisis, the pressure for change is no longer theoretical. It is a public mandate.