American Healthcare Has Normalized The Abnormal

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

The responses were clarifying—not because they revealed problems we didn’t know existed, but because they exposed how many of those problems we have learned to tolerate.

People didn’t point to exotic failures. They pointed to the ordinary ones: the patient carrying her own records because systems don’t talk; the bill no one can explain; the delay that becomes a diagnosis; the prior authorization that overrides a physician’s judgment; the job created solely because two parts of the system don’t connect.

The thread became a kind of diagnostic test—not of patients, but of American healthcare itself.

And the diagnosis is uncomfortable: we have normalized the abnormal.

We Have Turned Patients Into The System Integrators

Sherita Golden captured one of the most basic failures in American healthcare: the lack of interoperability that patients experience every day.

She wrote that she has to carry her “relevant medical documents” on her phone because “none of the electronic systems” her providers use communicate with one another. Her patients have had to do the same. She called it an “unfortunate ‘normal’ that perpetuates fragmented care.”

That should stop us cold.

In almost every other part of modern life, information moves with us. Banking, travel, retail, logistics—these systems largely know who we are, what we bought, where we are going, and what we need next.

But in healthcare, the patient is still too often the courier.

The patient carries the medication list. The patient repeats the history. The patient uploads the same lab results. The patient explains what the last doctor said. The patient becomes the integration layer for a system that has spent billions digitizing itself but has not reliably connected itself.

That is not patient-centered care. That is system-centered burden shifted onto the patient.

We Have Made Price A Mystery Until After The Fact

Philip Louie named another absurdity we have somehow made routine: the patient is often the last person to know the price.

“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.”

That is not how a functioning market works. It is not how a functioning service industry works. It is certainly not how a humane system should work.

Patrick Kennedy made the same point from the consumer’s perspective: people agree to pay for a service without knowing what they will end up paying, while the person sitting next to them in the waiting room may receive the same service and pay an entirely different price.

Abbie DuBois pushed the point further. Even with plain-language requirements and new AI tools, she noted, most people still do not understand EOBs, deductibles, coinsurance, balance billing, and cost-sharing exposure.

This is one of healthcare’s great euphemisms. We call it “benefit design.” Patients experience it as bewilderment.

And then we blame them for not being better consumers.

We Have Rebranded Delay As Access

Bob Hitson focused on wait times: why should anyone continue living with symptoms because “the schedule” is backed up?

That question is more profound than it sounds.

In healthcare, we often talk about wait times as an operational issue. But delay is not merely an inconvenience. Delay can be a clinical event. Delay can be progression. Delay can be pain. Delay can be anxiety. Delay can be a missed diagnosis.

Ruchir Sinha pointed to diagnoses and prognoses arriving months after the relevant event—sometimes so delayed that the information becomes almost moot.

We have learned to treat this as normal. The specialist is booked out. The referral takes weeks. The authorization is pending. The result is in the portal but no one has called. The next available appointment is months away.

But time is biology.

A system that makes people wait in clinically meaningful ways cannot congratulate itself for eventual care. Sometimes eventual care is late care.

We Have Made Clinical Judgment A Permission Slip

Few topics generated more resonance than prior authorization and medical necessity.

Allison Silvers put it plainly: we have normalized “someone other than you and your doctor deciding what is ‘medically necessary.’”

Jillian Shellabarger described a familiar version of this problem: an insurance company overriding a provider’s medical judgment by requiring a patient to try two or three other medications before approving the one the clinician actually prescribed.

To be clear, healthcare resources are finite. Not every service is appropriate. Not every intervention adds value. There are real affordability constraints, and utilization management exists for a reason.

But we should be honest about what the patient experiences.

The patient experiences a system in which the doctor’s recommendation is not always enough. The patient experiences delay. The patient experiences confusion. The patient experiences a fight they did not choose, often at the moment they are least equipped to fight.

When permissioning becomes a defining feature of the care journey, we should not be surprised that trust erodes.

We Have Built Jobs Around Broken Handoffs

Malik Haynes offered one of the most haunting observations in the entire thread:

“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 sentence should be printed and placed in every healthcare executive meeting.

Entire jobs exist because two processes don’t connect.

This is not a criticism of the people doing those jobs. Often, they are the only reason the system works at all. They are the fixers, navigators, coordinators, escalators, translators, and problem-solvers who help patients survive complexity.

But their necessity is also an indictment.

Leatha Melton made the deeper point. She wrote that she has become numb to the assumption that healthcare’s biggest challenges are operational. “I don’t think they are,” she said. “I think they’re architectural.”

That distinction matters.

Operational problems require better execution.

Architectural problems require redesign.

American healthcare too often responds to architectural failure with operational heroics. More people. More workarounds. More escalation pathways. More manual intervention. More meetings to coordinate what should have been connected in the first place.

We have confused activity with repair.

We Are Losing Trust—And Calling It Complexity

The most sobering responses were not about bills, forms, or portals. They were about resignation.

Amy Paez wrote that she has become numb to hearing one question over and over: “Who can I trust?” She called it “the saddest symptom of our healthcare system.”

Andrew Tsang described what he called healthcare’s real Great Resignation—not people leaving jobs, but people across the system becoming resigned to the idea that healthcare is fundamentally broken.

That may be the most dangerous normalization of all.

A bad form can be simplified. A broken directory can be fixed. A prior authorization process can be redesigned. A bill can be made understandable. A record can be made portable.

But resignation is harder.

Resignation is what happens when smart, decent people stop believing the system can change. It is what happens when complexity becomes an alibi. It is what happens when leaders describe moral failures in operational language.

We call confusion “health literacy.”

We call fragmentation “complexity.”

We call delay “access challenges.”

We call administrative burden “process.”

We call opacity “benefit design.”

And eventually, we stop seeing the abnormal at all.

We Learn After Harm, Instead Of Before It

Julian Holman made one of the most important points in the thread: “We’ve accepted learning after harm as normal.”

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

This is exactly right.

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 announce themselves earlier.

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

These are not annoyances. They are weak signals.

Leadership means taking weak signals seriously before they become harm.

The First Step Is To Stop Calling This Normal

What struck me most about the responses was not their anger. It was their clarity.

People know what is broken.

They know that patients should not have to carry their own records from doctor to doctor. They know prices should not be revealed after the service is delivered. They know delays are not merely scheduling problems. They know clinical judgment should not routinely become an administrative negotiation. They know entire layers of work should not exist simply because two parts of the system fail to connect.

The question is not whether we can see the problems.

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

Because normalization is one of the most powerful forces in healthcare. It dulls outrage. It lowers expectations. It teaches patients to blame themselves for not understanding. It teaches clinicians to work around dysfunction rather than challenge it. It teaches leaders to manage brokenness instead of fixing it.

A healthcare system does not fail all at once.

It fails through acclimation.

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. Outrage fades.

The opposite of numbness is leadership.

Leadership begins by naming things honestly. It begins by refusing to accept that the way things are is the way things must be. It begins with a simple question:

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

Because eventually, the patient will be someone we love.

And when that day comes, we will not want an alibi.

We will want a system that works.