Policymakers, business leaders and medical societies are all busy counting metrics like insurance subsidies, premiums and enrollment numbers. These details matter but they miss the larger issue: medicine’s invisible gorilla.
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In the late 1990s, Harvard psychologists Daniel Simons and Christopher Chabris ran a now-famous experiment. Students watched a short video of six people passing basketballs and were told to count the number of passes made by the three players in white.
Halfway through the film, a person in a gorilla suit walks into the frame, beats its chest and exits. Amazingly, half of viewers — both then and in multiple recreations of the study — never notice the gorilla. They’re so focused on counting passes that they miss the obvious event happening right in front of them.
The authors call this “inattentional blindness.” And you don’t need to visit a research lab to see it. It’s everywhere in American healthcare.
Policymakers, business leaders and medical societies are all busy counting their own pass equivalents: metrics like insurance subsidies, premiums and enrollment numbers.
These details matter but they miss the larger issue: medicine’s invisible gorilla. That gorilla is the $5.6 trillion our nation spends on healthcare each year, a figure that exceeds the total economic output (GDP) of every nation except China.
As a country, we need to stop counting passes long enough to observe how the gorilla negatively impacts people everywhere: in Washington, in boardrooms, in workplaces and in rural communities. Only then can we confront the gorilla head on.
1. The Gorilla In Washington
In Congress, lawmakers spent more than a month debating how to reopen the government. The fight centered on whether to continue funding the enhanced premium tax credits that have made coverage more affordable for roughly 20 million lower-income Americans who purchase coverage through the online health exchanges.
Democrats argued that ending those payments in 2026 would cause premiums to spike and make care unaffordable. Republicans warned that continuing them would add nearly $400 billion to the federal deficit over the next decade. Both believed they were protecting Americans from financial harm. And both were right. If the cost of providing medical care isn’t reduced, neither the federal government nor the average family will be able to afford it.
According to the Peterson Center, the United States spends $14,885 per person each year on medical care while the next highest-paying nation, Switzerland, spends $9,963 per person with far better clinical outcomes.
If the U.S. could cut the spending gap between American and Swiss healthcare in half, our nation would save $700 billion annually. Those savings could help maintain ACA subsidies, lower out-of-pocket costs for families and reduce federal deficits.
But the gorilla inflicts financial damage far beyond just the ACA exchanges. Between federal funding cuts and eligibility changes, analysts warn that millions of Americans enrolled in Medicaid will become uninsured starting in 2026. Meanwhile, because federal law limits Medicare payment growth to the rate of inflation, hospitals make up lost revenue by charging private insurers and their enrollees more (already about 250% of Medicare rates). Ultimately, employers and workers will pay the price.
2. The Gorilla In Corporate America
America’s C-suite leaders are conducting the business equivalent of counting passes. Instead of confronting the cost of medical care itself, they’re focused on comparing premiums, raising deductibles and choosing plans with narrower physician networks.
But without major changes in how care is delivered, no plan will remain affordable.
The average cost of family health coverage will approach $30,000 next year, with employers paying about $24,000 and workers responsible for the rest. A projected 9% premium increase means employers and employees together will spend roughly $2,500 more next year per worker — limiting wage growth, hiring and investments in innovation.
America doesn’t have an insurance problem. It has a medical cost crisis.
3. The Gorilla In The Workplace
While workers focus on wages, benefits and job security, the same cost crisis threatening businesses and government is about to hit them hard.
More than half of U.S. adults receive health insurance through an employer. But as medical costs rise, companies are turning to automation and generative AI to reduce their expenses.
More than 1 million U.S. jobs have already vanished in 2025 and even more are set to disappear in 2026.
Amazon offers a vivid example: the company eliminated 14,000 office and professional roles and announced plans to combine robotics with generative AI to replace as many as three-quarters of its warehouse workforce. New, higher-skill jobs will be created to maintain the robots, but far fewer (and not for the same people who were displaced).
When workers lose employer-based insurance, they don’t stop getting sick. They turn to Medicaid or subsidized exchange plans. That strains government budgets, lowers hospital reimbursements and pushes insurers to raise commercial premiums even higher.
Unless the cost of medical care drops dramatically, the gorilla’s impact will reverberate throughout society.
4. The Gorilla In Rural Hospitals
The cost crisis is devastating people everywhere, but perhaps nowhere more than in rural America. Over the past two decades, 150 rural hospitals have closed or stopped offering inpatient services. Another 700 facilities (nearly one-third of those remaining) are at risk of shutting down.
With small patient populations and high fixed costs, many rural hospitals can no longer provide inpatient care. But instead of reducing the high cost of care delivery, most communities pursue short-term relief: emergency grants, temporary bailouts and added Congressional funding.
These efforts can delay closure, but they don’t change the math. Even when hospital beds are empty, the buildings must be staffed, heated, insured and maintained, turning every day into a financial loss.
To survive, the model will have to change, and painful sacrifices will be necessary.
3 Solutions For Addressing The Gorilla Everywhere
To avoid a systemwide collapse, our nation will need to tackle healthcare’s invisible gorilla: the $5.6 trillion cost of care delivery. Structural reform, not minor tweaks, will be required to cut $700 billion a year in medical spending. The good news? Three already exist:
A Leaner Hospital Footprint
America has too many inpatient facilities providing duplicate services at high fixed costs. A more sustainable system would consolidate low-volume hospitals and eliminate overlapping specialty programs in crowded markets. It would create regional centers of excellence that deliver superior outcomes at half today’s cost and transition small rural hospitals into 24-hour emergency and urgent-care hubs supported by telemedicine and reliable, low-cost transportation systems connected to larger facilities.
For more on these gorilla-busting solutions, check out:
Preventing Diseases Before They Happen
According to the CDC, more effective control of chronic disease could reduce healthcare spending by up to $1.8 trillion by preventing as many as half of all heart attacks, strokes, cancers, and kidney failures.
Three pragmatic opportunities stand out:
Expand the primary-care workforce.Allow the government to negotiate drug prices for all medications, including GLP-1 compounds.Use generative AI tools to empower patients and expand home monitoring.
Every life-threatening complication avoided is a hospital admission, ICU stay or surgery that never happens — and is never billed. For more on these solutions:
Paying For Value, Not Volume
Today’s fee-for-service system rewards hospitals and clinicians for doing more, not doing better. Capitation — payments made directly to physician groups and hospitals — incentivizes providers to prevent disease, avoid complications and maximize patient safety.
When healthcare organizations receive a fixed amount to care for a population, they benefit most financially by keeping patients healthy. Under capitation:
Prevention is rewarded, not ignored.Chronic diseases are managed earlier and better, before complications develop.Care shifts to the most effective, efficient settings, including centers of excellence and low-cost, convenient virtual platforms.
Capitation at the delivery-system level creates a virtuous cycle: healthier patients, fewer complications and dramatically lower cost. For more:
No single group — elected officials, businesses, insurers, clinicians nor patients — can fix our nation’s healthcare. Success will require all stakeholders to overcome their inattentional blindness and confront the gorilla together. The only question is how much worse things must become before they do.