Health Care Hits Different
By Craig B. Garner
Founder
Garner Health Law Corporation
Original Publish Date: June 17, 2025
"Logic: The art of thinking and reasoning in strict accordance with the limitations and incapacities of the human misunderstanding." -- Ambrose Gwinnett Bierce
Do not blame republicans, democrats or even private equity in the demise of health care reform. To be sure, hospitals continue to close around the nation, and President Trump’s One Big Beautiful Bill Act may prove to be the Affordable Care Act’s death knell, especially if the next budget eviscerates Medicaid and the health insurance exchanges. Health insurance circa 2026 may soon resemble its ancestry circa 2009, but the past 180 months were not a total loss. The survival of health care and hospitals is not dependent upon the fate of the Affordable Care Act nor the degree to which private equity remains involved. Indeed, for the 340 million people who call the United States home, life most likely will continue to begin and end within the four walls of the local hospital.
Health care hits different, and its timeline has never been linear. Medicare, for example, generally provides comprehensive reimbursement to providers, sometimes expeditiously, reserving civil and even criminal audits for a later date. Likewise, providers must consider the payer when calculating compensation timing. Health care covets the provider who commands fee schedule payments made before services rendered. The hospital, health care’s preeminent institution, continues to assess profitability based upon its fractional collection of each dollar, oftentimes months after it delivers patient care. While standalone hospitals sometimes find such economics unsustainable, private equity has kept an unknown number of struggling institutions open through consolidation and capital infusion.
Health care in the twenty-first century remains a game of numbers. With or without reform, health care still commands $1.8 Trillion of the 2025 Federal budget, although this behemoth amount often fails to make providers whole. Health care’s unsustainable path resembles the railroad industry in the 1840s, automobiles in the 1900s, television in the 1940s and the dot-com bubble during the late-1990s. Such historical events resulted in dispensation of available venture capital and the rapid growth of valuations. The resulting crash which follows such historical cycles hardly signals the end of an industry, although provider participants may continue to fail and shut down. Not gonna lie, without such events the list of billionaires according to Forbes and Generation Alpha would not be the same. Given the institutional instability and a tenet focusing on life and death, that anyone, including private equity, still wants a seat at the hospital board table remains as remarkable as the discovery of penicillin.
Chad Alphas Cornelius Vanderbilt, Henry Ford, Bill Gates and Elon Musk have no functional equivalent in health care, especially when society measures hospital success by the number of Medicare beneficiaries who bypass the morgue and go home. Such an unremarkable standard exists without regard to sus industry financial statements typically devoid of generally accepted accounting principles. Nevertheless, the intermittent spikes and dips health care experiences in any fiscal year should not detract from what it once was, and what it can possibly be when Medicare turns seventy-five. Both sides of the political party line should just put the fries in the bag. Instead, ignore health care’s catastrophic increase in expense as it becomes less affordable to more people each year, and focus instead on a preeminent national program equipped with elite providers empowered by cutting edge innovation and technology beyond the imagination of most science fiction. Accessibility can catch up later.
The firmament under which health care exists bears little resemblance to traditional markets in a capitalistic society or democratic state. The trillions spent each year must comply with the baffling fraud, abuse and waste laws. Health care must also protect the anticipated 47% increase in the ranks of Americans 65 years and older between 2022 and 2050, which includes deployment of not just geriatric medicine, but also geriatric psychology for one quarter of the population in today’s simulation. At this rate, the contemplated work requirement for Medicaid may give way to the “get out of bed today” condition.
Delulu partisan politics most likely will continue to debate the efficacy of vaccinations, the origins of autism, and whether or not COVID-19 accidentally escaped from a laboratory. Should the next Federal budget send health care back to the stone age of 2009, however, even deployment of the Tricorder throughout the nation and around the flat Earth will fail in the absence of a functional infrastructure within which to flourish. Indeed, health care does not belong in a box next to Schrödinger’s cat.
Health care needs its own differential diagnosis, which the doctor may employ when symptoms match more than one condition and additional tests are necessary. To be fair, some Medicaid beneficiaries should work, although others may be unable to answer the phone due to the brain’s prefrontal cortex, hippocampus, amygdala, and thalamus. One size does not fit all, especially when genetics, environmental factors and underlying health conditions may bear just as much blame as overeating and a sedentary lifestyle. Before society can decide if natural selection is the panacea to widespread stupidity, society must first ensure its network connectivity remains intact, lest privilege replaces fitness.
To be sure, the nation’s ability to fund health care never disappears from the ongoing debate. While technological advances may someday replace practical considerations, today at least the United States must fix its broken health care system. The three primary participants in health care, patients, providers and payers, must find common ground rather than pushing culpability on each other. Private equity probably despises all three, but savvy investment bankers received an advance copy of SimCity: Hospital years ago. Zang, health care does hit different, and until such time as it no longer commands nearly 18% of the gross domestic product in the United States, elected officials may need to bolster their understanding of the system before unraveling things more. While it is difficult to break that which is already broken, it is even harder to fix that which is patently misunderstood.
Craig Garner is the founder of Garner Health Law Corporation, as well as a healthcare consultant specializing in issues pertaining to modern American healthcare. Craig is also an adjunct professor of law at Pepperdine University School of Law. He can be reached at craig@garnerhealth.com.