A record 23 % of Americans believe the United States healthcare system is “in a state of crisis” and 47% think it has “major problems,” according to a recent poll from the West Health-Gallup Center on Healthcare in America.
The poll also revealed that a record 29% of Americans see “cost” as the most urgent health problem facing the US. Experts note that these two perceptions – that the healthcare system is in a state of crisis and that costs are an urgent health problem – are related.
The US healthcare system has long been criticized by those within the medical community and those outside it. Some of the sector’s biggest issues include how US health insurance giants often cause deadly delays to vital medical procedures and care, the rapidly rising cost of drug prices and the dubiousness of those overseeing US health in the current administration. The latter issue most notably centers on the US health secretary, Robert F Kennedy Jr, who has been repeatedly lambasted for spreading misinformation and called upon to resign.
Emma Wager, a senior policy analyst for the health policy organization KFF who tracks healthcare affordability, said the results of the latest Gallup poll “definitely makes sense, because healthcare is something that people can’t choose how much they’re going to buy, or how much they can really price-shop in most circumstances. It’s an expense that is unpredictable and that we all face.”
Wager attributes these perceptions to many Americans living longer and fluctuations in the economy.
“As the population ages, people just become more and more expensive. Their care becomes more expensive. Most of the money that gets spent in the US healthcare system is spent on people who are 55 or older,” Wager said.
“Inflation is also contributing. Although we’ve seen that sort of fluctuate, whether or not it’s rising higher or lower than healthcare costs overall. It’s been difficult to say for the past couple of years, because inflation has been so volatile.”
Timothy Lash, president of West Health, an organization focused on ageing and healthcare affordability, said it’s important to highlight that the cost of healthcare directly affects health.
“We often talk about healthcare outcomes and costs separately,” Lash said. “But the reality is when healthcare costs rise, it’s not an abstract insurance issue, or even a policy debate. It’s a direct hit to the wallets of Americans and to their health.”
Lash added that politicians should be paying attention to the fact that “we’re at all-time highs in terms of concern around the current state of healthcare affordability”, which itself affects overall health because it can add to stress and anxiety – potentially lending itself to additional poor health outcomes, such as high blood pressure. Rising health costs can also lead more people to skip treatments.
A first-of-its-kind Gallup survey published in November compared healthcare affordability, quality and access across states and found that many Americans are foregoing necessary treatments and prescriptions, but that these problems varied widely in different regions.
For example, nationally, one in five adults reported having a household member who was unable to afford a prescription medication. But that number was three times higher in Mississippi than in Iowa. Thirty per cent of US adults overall said a family member had skipped a medical treatment due to high costs. In Mississippi, nearly half of respondents had a family member who skipped a treatment they couldn’t afford.
Lash said it should be especially concerning to policymakers that so many people are skipping treatment in some states, and that “in the very best states, it’s one in five”.
Americans have also rated mental health as a greater area of concern since the Covid-19 pandemic. David Radley, senior scientist for health system tracking at the Commonwealth Fund, said healthcare costs and mental health are connected. According to the 2025 State of Mental Health in America survey, adults who experienced 14 or more mentally unhealthy days in a month were also more likely to be unable to afford to go to the doctor.
Radley described the relationship between poor mental health and unaffordable healthcare as a “feedback loop”, because as mental health care becomes harder to access, mental health outcomes also worsen. Meanwhile, people who are most in need of mental health care are likely to struggle to afford it, as factors such as poverty and employment can contribute to anxiety and depression.
Cost can also be more of a barrier when it comes to mental health because psychotherapy and other mental health services are often considered a “carve-out” in health insurance plans, Radley says. Rather than having a standard copay, patients must often shell out for such treatments out of pocket and then wait to find out how much their insurance provider will reimburse.
When it comes to physical health, the Affordable Care Act dictates that certain preventive care must be covered, but “mental health care services don’t get that same kind of treatment”, Radley said.
Dr Lisa Rosenthal, a psychiatry professor at Northwestern University, believes part of the problem stems from the false perception that physical and mental health are distinct. She noted that she dislikes the term “behavioral health” because it implies culpability for differences in the brain.
“Cavities are behavioral,” Rosenthal said. “The pandemic was actually a great example of this. There’s 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 healthcare will actually decline if mental health is included as part of the primary care package. She is working on an initiative with the West Health Accelerator to screen for mental health conditions in primary care settings, similar to how blood pressure and cholesterol are routinely screened.
“We keep saying that mental health care is too expensive, or that there’s a shortage of mental health professionals … But I think we’ve created that situation and that we could easily change it, and we choose not to,” she said.
“We have chosen to not pay for psychiatric treatments. We have chosen to not make them accessible to the vast majority of the population.”
