In Part I, I named the uncomfortable truth: capitalism didn’t accidentally fail at care—it was never built for it. Now in Part II, we discuss the measurable inputs and outputs of this system and what a care-based approach might look like.
When Design Choices Become Measurable Harm
According to the U.S. Census Bureau, more than 35 million Americans live in poverty, and tens of millions lack continuous health insurance coverage — conditions long associated with delayed care, poorer health outcomes, and higher mortality.
https://www.census.gov/newsroom/press-releases/2025/income-poverty-health-insurance-coverage.html
Long-term mortality data from the Centers for Disease Control and Prevention shows that age-adjusted death rates remain stubbornly higher in underserved, often poorer rural communities, and have remained so for decades.
https://www.cdc.gov/nchs/products/databriefs/db417.htm
These are not disparate phenomena.
They are features of a system that treats care as ancillary to revenue, throughput, and administrative compliance.
And then there are the people on the front lines.
The ones reminded daily to come to work with compassion.
To treat each patient as if they were a grandmother, an uncle, a child.
To absorb grief, fear, and urgency with steadiness and grace.
A study published in the Journal of the America Medical Association, JAMA, examined rates of poverty, food insecurity, and housing instability among U.S. healthcare workers. The findings were stark:
1 in 10 lived below the poverty line.
Nearly 25% experienced food insecurity.
Roughly 13–14% reported housing instability.
https://jamanetwork.com/
Let that sit.
The people tasked with delivering care, cleaning infected wounds, holding the hands of the dying, preventing infection room by room, are themselves living with profound instability.
And what feels most aligned with the current capitalist scope of our nation is not just these numbers, but the gap they reveal: the widening distance between administrative compensation and frontline labor.
Not everyone can be a leader. True.
But not everyone can clean a fourth-degree infected wound.
Not everyone can calmly sit at the bedside as a life ends.
Not everyone would choose to do embodied, repetitive, emotionally taxing workday after day so others can survive.
Yet our system compensates proximity to power far more generously than proximity to suffering.
This is not an accident.
It is a value statement.
Burnout is not the problem. It is the signal.
We hear constant concern about healthcare “shortages.”
There are not enough workers to sustain our healthcare needs.
But people do not leave because they suddenly stopped caring.
They leave because burnout is what happens when a system extracts compassion without providing stability. Burnout is not a personal failure — it is the body and spirit responding logically to unsustainable conditions.
And here’s the deeper contradiction: the United States is not under-spending on healthcare.
According to the Peterson-KFF Health System Tracker, the U.S. spent $13,432 per person in 2023, nearly twice as much as other wealthy nations — yet with worse outcomes and persistent workforce instability.
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
Much of this excess spending goes not to prevention, not to workforce stability, not to keeping people well — but to higher prices, administrative complexity, and revenue-driven care models.
So, the question is not whether we have resources.
It’s what we choose to value.
What would it mean to design healthcare around care again?
In Part I, I asked who gets to decide whose life is worth saving.
In Part II, I want to be explicit about the alternative.
Designing healthcare around care would mean investing upstream and human centered. As opposed to the current model based over simplifying human efficiencies, financial targets, and technology over connection.
A care-centered investment strategy would look like this:
Education & Prevention First
Pay for prevention like it matters. Chronic disease prevention, tobacco cessation, hypertension control, and early intervention reduce suffering before crisis ever arrives. Education for everyone on how these bodies work, what healthy looks and feels like, and how to prioritize health.
Primary Care as the Foundation
Build primary care systems that allow time, continuity, and relationship. Not rushed throughput. Prevention, behavioral health, and care coordination belong at the center, not the margins. Give providers education on how to build connections with their patients.
Community & Navigation Support
Fund community health workers and patient navigators as core care. People who help patients access, understand, and sustain care in real life, not just on paper should be seen as first responders and treated with dignity.
Home-First Care Models (Done Right)
Expand safe, well-staffed home-based care and hospital-at-home models with strong clinical oversight, real staffing, and caregiver support. Keep care where people are, without shifting risk onto families. Train everyone on at home primary care techniques and reinforce alternative care options.
Workforce Stability as Patient Safety
Pay living wages for direct care roles. Protect staffing ratios. Reduce administrative burden. Provide mental health support. Treat workforce sustainability as a patient safety strategy, not a cost center.
Redirect Money from Complexity to Care
Reduce administrative waste and price inflation so dollars flow to people — patients and caregivers — rather than systems that extract without healing.
Burnout is telling us something.
So are workforce shortages.
So are the outcomes.
If we are willing to listen, they are pointing us toward the same truth:
Healthcare will not heal until it is designed to care —
for patients,
for workers,
for communities —
with dignity, responsibility, and heart.
Light returns not because we ignore the darkness,
but because we face it.
In Part III, I’ll be centering the voices of people living inside this system. Less data and more about how these experiences are affecting the patients and clinicians. If you have an experience you’re willing to share — as a patient, clinician, or leader — you can reply to this post or message me privately. Anonymity will be respected.
If this resonated, consider sharing it with someone who works in healthcare — or someone who’s been harmed by it.
These conversations don’t spread through algorithms alone. They move person to person.