American Healthcare Has Normalized The Abnormal

What’s something you once thought was abnormal in American healthcare that you’re now numb to?

The feedback was revealing—not because it highlighted unknown issues, but because it showed how accustomed we’ve become to these problems.

Respondents didn’t mention rare failures; they highlighted everyday issues: patients carrying their own records due to disconnected systems; inexplicable bills; delays that impact diagnoses; prior authorizations that undermine doctors; and jobs created just to bridge system gaps.

This discussion turned into a kind of diagnostic examination—not of patients, but of the American healthcare system itself.

The uncomfortable conclusion is clear: we have accepted the abnormal as normal.

We Have Turned Patients Into The System Integrators

Sherita Golden highlighted a fundamental issue in American healthcare: the daily lack of interoperability faced by patients.

She described how she must carry her “relevant medical documents” on her phone because “none of the electronic systems” her providers use are compatible. Her patients face the same challenge, a situation she termed an “unfortunate ‘normal’ that perpetuates fragmented care.”

This should be alarming.

In most areas of modern life, information follows us seamlessly. Banking, travel, retail, logistics—these systems generally know our identity, purchases, destinations, and future needs.

Yet, in healthcare, patients often become couriers.

They carry medication lists, repeat their medical history, upload the same lab results, recount previous medical advice, and serve as the integration point for a system that has invested heavily in digital technology without achieving reliable connectivity.

This is not patient-centered care. It is a system-centered burden shifted onto the patient.

We Have Made Price A Mystery Until After The Fact

Philip Louie identified another absurdity that has become routine: patients often learn the cost of care last.

“The patient is the only party in the transaction who never sees the price before agreeing to it,” he wrote. “The hospital knows the number, the insurer knows the number, the surgeon can find it out. The person actually paying the bill learns it last, usually after the care is already delivered.”

This is not how a functioning market or service industry operates. It certainly isn’t how a humane system should function.

Patrick Kennedy echoed this from the consumer’s viewpoint: people commit to a service without knowing the final cost, while someone else in the waiting room may pay a completely different price for the same service.

Abbie DuBois further emphasized the issue, noting that even with plain-language requirements and new AI tools, most people still struggle to understand EOBs, deductibles, coinsurance, balance billing, and cost-sharing exposure.

This is one of healthcare’s euphemisms. It’s called “benefit design,” but patients experience it as confusion.

Yet, we fault them for not being savvy consumers.

We Have Rebranded Delay As Access

Bob Hitson brought attention to wait times: why should anyone endure symptoms because “the schedule” is backed up?

This question is more profound than it first appears.

In healthcare, wait times are often seen as an operational issue. However, delays are more than inconveniences. They can be clinical events, progression, pain, anxiety, and missed diagnoses.

Ruchir Sinha pointed out that diagnoses and prognoses sometimes arrive months after the relevant event, rendering the information nearly irrelevant.

We have come to view this as normal. The specialist is unavailable, the referral takes weeks, the authorization is pending, the result is in the portal but no one has called, and the next appointment is months away.

But time is biology.

A system that makes people wait in ways that matter clinically cannot commend itself for eventual care. Sometimes, eventual care is too late.

We Have Made Clinical Judgment A Permission Slip

No topic resonated more than the issues of prior authorization and medical necessity.

Allison Silvers bluntly stated: we have accepted “someone other than you and your doctor deciding what is ‘medically necessary.’”

Jillian Shellabarger described a common scenario: an insurance company overriding a provider’s medical judgment by requiring a patient to try other medications before approving the one the clinician prescribed.

To clarify, healthcare resources have limits. Not every service is appropriate, nor does every intervention add value. Affordability constraints are real, and utilization management exists for a reason.

However, we must be honest about the patient experience.

Patients encounter a system where a doctor’s recommendation may not suffice. They face delays, confusion, and battles they didn’t choose, often when they are least prepared to fight.

When permission becomes a defining part of the care journey, it’s unsurprising that trust is eroded.

We Have Built Jobs Around Broken Handoffs

Malik Haynes made a haunting observation:

“The number of people doing work just to compensate for broken handoffs somewhere else in the system. Entire jobs exist because two processes don’t connect.”

That statement deserves attention in every healthcare executive meeting.

Entire jobs exist because two processes don’t connect.

This isn’t a critique of the people in those roles. Often, they are the only reason the system functions. They are the fixers, navigators, coordinators, escalators, translators, and problem-solvers who help patients navigate complexity.

Yet, their necessity is also an indictment.

Leatha Melton made a deeper point, expressing numbness to the idea that healthcare’s biggest challenges are operational. “I don’t think they are,” she said. “I think they’re architectural.”

This distinction is significant.

Operational problems require better execution.

Architectural problems necessitate redesign.

American healthcare often addresses architectural failures with operational heroics. More people. More workarounds. More escalation pathways. More manual intervention. More meetings to coordinate what should have been connected initially.

We have mistaken activity for repair.

We Are Losing Trust—And Calling It Complexity

The most sobering feedback wasn’t about bills, forms, or portals. It was about resignation.

Amy Paez shared that she often hears the question: “Who can I trust?” She deemed it “the saddest symptom of our healthcare system.”

Andrew Tsang described healthcare’s real Great Resignation—not people leaving jobs, but individuals across the system resigning themselves to the belief that healthcare is fundamentally broken.

This might be the most perilous normalization of all.

A problematic form can be simplified. A faulty directory can be fixed. A prior authorization process can be redesigned. A bill can be clarified. A record can be made portable.

But resignation is harder to address.

Resignation occurs when capable individuals stop believing in the possibility of change. It happens when complexity becomes an excuse. It happens when leaders frame moral failures in operational terms.

We label confusion as “health literacy.”

We call fragmentation “complexity.”

We refer to delays as “access challenges.”

We term administrative burden as “process.”

We describe opacity as “benefit design.”

And eventually, we stop recognizing the abnormal altogether.

We Learn After Harm, Instead Of Before It

Julian Holman made a crucial point: “We’ve accepted learning after harm as normal.”

Healthcare has world-class systems for investigating incidents but lacks systems for systematically capturing weak signals before harm occurs. “Prevention should begin long before an event reaches an incident report.”

This observation is spot on.

We wait for the grievance, the adverse event, the lawsuit, the sentinel event, the viral post, the newspaper story, the regulator, the congressional hearing.

But most failures provide early warnings.

The confused patient, the delayed referral, the repeated call, the missing record, the inexplicable bill, the incorrect provider directory, the clinician spending more time with the computer than the patient.

These are not mere annoyances. They are weak signals.

Leadership involves taking weak signals seriously before they result in harm.

The First Step Is To Stop Calling This Normal

What stood out most about the responses was not their anger but their clarity.

People understand what is broken.

They know that patients shouldn’t need to carry their own records between doctors. They know prices should be clear before services are rendered. They know delays are more than just scheduling problems. They know clinical judgment shouldn’t become an administrative negotiation. They know entire layers of work shouldn’t exist because two parts of the system don’t connect.

The question isn’t whether we can identify these problems.

The question is whether we still have the courage to be unsettled by them.

Because normalization is a powerful force in healthcare. It dulls outrage, lowers expectations, teaches patients to blame themselves for not understanding, encourages clinicians to work around dysfunction, and prompts leaders to manage brokenness instead of repairing it.

A healthcare system doesn’t collapse suddenly.

It fails through gradual acceptance.

One workaround at a time. One delayed appointment at a time. One unexplained bill at a time. One patient-carried medical record at a time. One “that’s just how it works” at a time.

The opposite of numbness is not outrage, as outrage fades.

The opposite of numbness is leadership.

Leadership starts by naming things honestly. It begins by rejecting the notion that the current state is inevitable. It starts with a simple question:

Would we accept this if the patient were someone we loved?

Because eventually, the patient will be someone we love.

And when that day arrives, we won’t want an excuse.

We will want a system that functions.