Signs of Unhealth Weigh Heavy on America's Hospitals

If you and I were to apply a medical diagnosis to the nation’s hospitals and health care systems, according to current news reports, the ultimate costs as well as chances for full recovery would seem far from clear. And this holds true for both patients and practitioners.

Take for example the current state of resident doctors in training. They have finished medical school and are now living out their three to seven years of training at established teaching hospitals before they can practice independently. Their working conditions “had come under scrutiny long before the pandemic,” writes Kaiser Health News reporter Sarah Kwon. For them, logging 80 hours a week in the intensive care unit is not uncommon.

A call for better pay and benefits for residents is now emerging as many of these trainees are banding together around the country. “They join nurses, nursing assistants, and other health care workers who are unionizing and threatening to strike as staffing shortages, the rising cost of living, and inconsistent supplies of personal protective equipment … have pushed them to the brink,” writes Kwon. “Since March, residents at Stanford Health Care, Keck School of Medicine at the University of Southern California, and the University of Vermont Medical Center have unionized,” she notes. According to the report, more than 1,300 unionized residents and other trainees at three L.A. County public hospitals are currently locked in intense negotiations with the county.

Should the institution decide not to recognize the residents’ union (which they can do), the union can request that the National Labor Relations Board administer an election. “How far these unions will go to achieve their goals is an open question,” says Kwon. “Strikes are rare among doctors.” But the prospects and potential impact of one is a chilling thought.

According to a New York Times report, at the same time, research is showing that medical debt has risen sharply among older adults. “With some older people finding themselves unable to dig out from debt, such dilemmas threaten any notion of a comfortable retirement and have generated alarm among economists and other researchers,” writes Times reporter Paula Span.

“There’s a group of older people in financial distress,” says Annamaria Lusardi, an economist at the George Washington University. “They’re highly leveraged; they’re carrying high-cost debt. They’re being contacted by debt collectors. They’re not going to enjoy their golden years.” Using data from the University of Michigan’s Health and Retirement Study survey, Lusardi discovered that even in a relatively high-income group of 51- to 61-year-olds, when people are close to retirement and at the peak of their wealth accumulation, nearly one-quarter reported being contacted by bill collectors. The pressures are even stronger for older Americans with less income and education. For many of these folks, the debt pileup often comes as a surprise.

Reports NBC News, under the Hospital Price Transparency Law, which took effect in January 2021, hospitals are required to post prices for common procedures, yet few do. Says NBC, a study published recently in the Journal of the American Medical Association has added to mounting evidence that hospitals are largely ignoring the law.

“The law requires hospitals to list the cash prices for procedures on their websites in two forms: one that is easily accessible for patients and that includes a cost estimator for the 300 most common services, and another that is machine-readable — essentially a spreadsheet. That allows patients to know exactly what they should expect to pay and lets them compare the reduced cash prices with the prices they would pay if they went through insurance,” says a joint report by NBC’s Kaitlin Sullivan, Catie Beck and Lauren Dunn. “The report analyzed 5,000 hospitals nationwide and found that just 300, or fewer than 6 percent, were fully compliant with the rule,” they add. The report further revealed that hospitals with less revenue, in urban areas and in places with few health care clinics or other hospitals were more likely to be transparent. Among large institutions abiding by the law were Kaiser Permanente, the Cleveland Clinic and the Mayo Clinic.

“The new study illustrates a fundamental problem with a law meant to shield patients from opaque health care costs and unexpected medical bills,” says NBC. “Hospitals and insurance companies set their own prices for different procedures, but patients largely have no idea what those costs are until they get the bill.”

Charges Cynthia Fisher, founder and chairman of, “Hospital executives are putting profits over patients by being able to not comply with this rule.” That appears to be about to change.

Though the U.S. Department of Health and Human Services has raised the prescribed penalty, no hospital has yet been fined. Instead, the agency has issued hundreds of warning letters to those in noncompliance. That too has changed. According to NBC, on June 7, the Centers for Medicaid and Medicare Services acted on two Georgia hospitals by levying fines of more than $1 million for violating the price transparency law. More hospitals are likely to follow.

If you’ve encountered a hospital that isn’t complying with the Hospital Price Transparency Law, know that you have the option of filing a complaint with the Department of Health and Human Services.

Ishani Ganguli is a primary care physician and assistant professor of medicine at Harvard University. Like many of his colleagues, Ganguli has become increasingly concerned about what researchers are calling a “cascade of care” — the prevalence of an ever-increasing series of medical tests or procedures for which there is little to no benefit in the given clinical scenario. It is what is referred to as “low-value services,” or “low-value care.”

As reported by NPR’s Ryan Levi and Dan Gorenstein, “Over the past 30 years, doctors and researchers like Ganguli have flagged more than 600 procedures, treatments and services that are unlikely to help patients: Tests like MRIs done early for uncomplicated low back pain, prostate cancer screenings for men over 80 and routine vitamin D tests.” Such care is costly; according to one estimate, $75 billion to $100 billion annually.

“No one wants to deliver low-value care or receive it,” they write. “But in American medicine, the pressure to ‘just do one more test’ remains strong.