‘A state of crisis’: record number of Americans are pessimistic about US healthcare system | US healthcare

A record 23 percent of Americans think the U.S. health care system is “in a state of crisis” and 47 percent think it has “major problems,” according to a recent poll from the West Health-Gallup Center on Healthcare in America.

The poll also found that a record 29% of Americans view “cost” as the most pressing health care issue facing the United States. Experts note that these two perceptions – that the healthcare system is in crisis and that costs are a pressing healthcare issue – are linked.

The American health care system has long been criticized by members of the medical community and those outside it. Among the industry’s biggest problems are how U.S. health insurance giants often cause life-threatening delays in life-saving medical procedures and care, rapidly rising drug prices and doubt among those who oversee U.S. health care in the current administration. This last question particularly concerns the US Secretary of Health, Robert F. Kennedy Jr, who has been repeatedly criticized for spreading false information and calls for his resignation.

Emma Wager, senior policy analyst for the health policy organization KFF which tracks health care affordability, said the results of the latest Gallup poll “make a lot of sense, because health care is something that people don’t get to choose how much they will buy, nor how much they can actually buy in most circumstances. It’s an unpredictable expense and one that we all face.”

Wager attributes these perceptions to the fact that many Americans are living longer and fluctuations in the economy.

“As the population ages, people become more expensive. Their care becomes more expensive. Most of the money spent in the U.S. health care system goes to people 55 or older,” Wager said.

“Inflation also contributes. Although we’ve seen this kind of fluctuation, whether or not it’s increasing more or less than overall health care costs. It’s been difficult to tell in recent years because inflation has been very volatile.”

Timothy Lash, president of West Health, an organization focused on aging and health care affordability, said it’s important to emphasize that the cost of health care directly affects health.

“We often talk about health care outcomes and costs separately,” Lash said. “But the reality is that when health care costs rise, it’s not an abstract insurance issue, or even a political debate. It’s a direct hit to Americans’ wallets and to their health.”

Lash added that politicians should pay attention to the fact that “we are at an unprecedented level in terms of concern about the current state of health care affordability,” which itself affects overall health because it can add to stress and anxiety — potentially lending itself to other health problems, like high blood pressure. Rising healthcare costs may also cause more people to skip treatments.

A first-of-its-kind Gallup survey released in November compared health care affordability, quality and access across states and found that many Americans forgo needed treatments and prescriptions, but that these issues varied widely by region.

For example, nationally, one in five adults reported having a member of their household who could not afford a prescription drug. But that figure was three times higher in Mississippi than in Iowa. Thirty percent of American adults said a family member had skipped medical treatment because of high costs. In Mississippi, nearly half of those surveyed had a family member who skipped treatment they couldn’t afford.

Lash said it should be of particular concern to policymakers that so many people are skipping treatment in some states and that “in the best states, it’s one in five people.”

Americans also view mental health as a greater concern since the Covid-19 pandemic. David Radley, senior health system monitoring scientist at the Commonwealth Fund, said health care costs and mental health are linked. According to the 2025 State of Mental Health in America Survey, adults who experienced 14 or more days of mental health problems in a month were also more likely to not be able to afford to go to the doctor.

Radley described the relationship between poor mental health and unaffordable health care as a “feedback loop,” because as mental health care becomes more difficult to access, mental health outcomes also deteriorate. At the same time, those most in need of mental health care will likely struggle to afford it, as factors such as poverty and employment can contribute to anxiety and depression.

Cost may also be a bigger barrier when it comes to mental health, because psychotherapy and other mental health services are often considered an “exclusion” from health insurance plans, Radley says. Rather than having a standard co-pay, patients often have to pay out of pocket for such treatments and then wait to find out how much their insurer will reimburse them.

When it comes to physical health, the Affordable Care Act says some preventative care must be covered, but “mental health services don’t get the same type of treatment,” Radley said.

Dr. Lisa Rosenthal, a professor of psychiatry at Northwestern University, says part of the problem is the misperception that physical health and mental health are separate. She noted that she doesn’t like the term “behavioral health” because it implies guilt for differences in the brain.

“Caries is behavioral,” Rosenthal said. “The pandemic is actually a good example of this. There is a direct impact of Covid on the brain,” adding that many types of infection and inflammation can cause psychiatric changes, “I think it’s time to recognize the brain as just another part of the body.”

Rosenthal believes that the overall cost of health care will actually decrease if mental health is included in the primary care curriculum. She is working on an initiative with the West Health Accelerator to screen for mental health issues in primary care settings, in the same way that blood pressure and cholesterol are routinely screened.

“We keep saying that mental health care is too expensive or that there is a shortage of mental health professionals… But I think we created this situation and could easily change it, and we choose not to,” she said.

“We have chosen not to pay for psychiatric treatment. We have chosen not to make it accessible to the vast majority of the population.”