Healthcare’s Staffing Crisis is Not a Crisis, It’s a Business Model
- Jun 11
- 7 min read
Angie West, MSN, RN, is an ICF-credentialed coach, speaker, herbalist, and founder of Genuine Growth LLC, bringing 15 years of healthcare leadership experience to her work on moral injury, psychological safety, and brave culture change.
The United States spends nearly $15,000 per person on healthcare, almost double what comparable countries spend. Its nurses are exhausted, its physicians are silenced, and its outcomes trail the developed world. This is not a system in crisis. This is a system producing exactly the results its financial architecture was designed to produce.
What is really driving the healthcare workforce crisis?
In May 2026, actor Noah Wyle led more than 400 doctors, nurses, and medical students to Capitol Hill. His mother, Marjorie Speer, a registered nurse of 50 years, stood with him. They were there to ask Congress for tax credits for healthcare workers in shortage areas and mental health funding for clinicians.
Four hundred healthcare workers could not get that room on their own. They needed a television actor to open the door. That fact alone tells you something about where healthcare workers stand in the political power structure of American medicine.
The rally was hosted by FIGS, a publicly traded healthcare apparel company that has built an advocacy platform alongside its business. FIGS developed the Healthcare is Human Act, a bipartisan bill that would provide up to 6,000 dollars in annual tax credits for healthcare professionals serving in federally designated shortage areas and committed 1 million dollars to medical debt relief. These are meaningful actions. FIGS is also a for profit company whose advocacy is also brand strategy. Both things are true and both deserve to be named, because the people living inside this system deserve the full picture.
What happens when a healthcare worker speaks up
In January 2025, Dr. Elisabeth Potter, a Texas plastic surgeon, was in the middle of a breast reconstruction surgery for a cancer patient when a call came into the operating room. UnitedHealthcare. Urgent. They needed to speak with her immediately.
She scrubbed out mid surgery to take a call from an insurance representative who, by her account, wanted to know whether the patient’s overnight hospital stay was “justified” and who did not even know the patient had cancer.
She posted a video about it on TikTok. It reached nearly 6 million views. Then UnitedHealthcare hired Clare Locke, the defamation firm behind a nearly 800 million dollar settlement against Fox News for Dominion Voting Systems. They sent a six page letter demanding that she delete her videos and post a public apology. They called her video “dangerous misinformation.” They accused her of “jeopardizing patient safety for social media clout.” She says they then refused to bring her clinic into their network, which she believes is deliberate retaliation that could bankrupt her practice.
UnitedHealthcare disputes her account. They say they did not ask a physician to interrupt patient care and that the decision not to bring the surgery center into network had already started prior to the video. What is not in dispute is this. A 200 billion dollar company deployed one of the most powerful defamation law firms in the country against one surgeon who posted a video about her patient. That is the power differential healthcare workers are operating within.
Dr. Potter named the dynamic plainly. There is a subculture in healthcare where you will get fired, disciplined, or labeled if you speak up about insurance.
What the numbers reveal about the business model
A report from the National Association of Insurance Commissioners shows that health insurers posted 9 billion dollars in total profit in 2024. That sounds almost modest. Here is what it actually means. Health insurers collected nearly 1.2 trillion dollars in premiums last year. Nine billion dollars in profit on 1.2 trillion dollars in revenue is a 0.8 percent margin, thinner than a grocery store.
The money did not disappear. It moved into hospitals, into pharmaceutical companies, into record high utilization driven by a system so fragmented and delayed that by the time people finally get care, they are sicker than they needed to be. Insurers lost money on Medicaid and Medicare lines. They stayed profitable only because 13.9 billion dollars in investment income bailed out a nearly 1.3 billion dollar underwriting loss. The system is not profitable because it is efficient. It is surviving because it is enormous.
Now consider executive compensation. Two hundred seventy five healthcare CEOs collectively earned 3.6 billion dollars in 2024. That averages 13 million dollars per person. Not the other C suite members. Not the board. Just CEOs. Nonprofit hospital CEO compensation grew a median of 23.4 percent over a recent five year period. Researchers found strong correlations between executive pay and hospital revenue. There was no meaningful correlation between executive pay and quality of care. We are not paying for outcomes. We are paying for scale.
How U.S. healthcare spending compares to the rest of the world
According to data from the Organisation for Economic Co-operation and Development, the United States spent 14,885 dollars per person on healthcare in 2024. Switzerland, the second most expensive country in the world, spent 9,963 dollars. The OECD average among wealthy peer nations was 7,371 dollars.
We spend twice as much as most comparable countries. We have lower life expectancy than the OECD average. Canada’s population is measurably healthier than ours, with longer life expectancy and better health adjusted life years, despite spending roughly half what we spend per person. The difference is not clinical skill. It is not technology. It is how care is financed, how prices are negotiated, and what we have decided to treat as a market versus a public good.
In the United Kingdom, the CEO of NHS England, the executive responsible for the entire National Health Service, earns roughly 270,000 dollars a year. A large NHS hospital trust CEO might earn 175,000 to 350,000 dollars. No stock options. No performance bonuses tied to margin. Here, a single hospital system CEO can earn 30 million dollars. We accept it as normal.
Why regulators and legislators are finally naming the problem
In January 2026, the Joint Commission replaced its long standing National Patient Safety Goals with a new framework called National Performance Goals. Fourteen goals total. One of them, NPG number 12, states that a hospital must be staffed to meet the needs of the patients it serves and that staff must be competent to provide safe, quality care.
The Joint Commission has had staffing standards for decades. But elevating adequate staffing to a named, measurable goal on par with reducing surgical infections or preventing medication errors is an institutional acknowledgment that staffing is not an operational inconvenience. It is a patient safety crisis.
On March 12, 2026, Senator Chris Murphy introduced S. 4086, the Patient Safety and Whistleblower Protections Act. The bill would prohibit healthcare facilities from retaliating against any practitioner who raises a patient safety concern, including concerns about staffing levels, denial of care, and quality of services. It would make any contractual provision designed to silence clinicians null and void. Non disparagement clauses, gag provisions in employment contracts, all of it.
The bill also creates what is called a rebuttable presumption. If a hospital or health system takes any adverse action against a clinician within 180 days of that clinician speaking up, the institution must prove it was not retaliation. The burden shifts. For the first time, it would allow practitioners to go to the press if internal reporting does not result in corrective action within 90 days. Right now, in most of the United States, a nurse who raises a patient safety concern internally and gets nowhere has almost no legal protection if she then calls a journalist. This bill would change that.
The bill has not passed. It may not. But the fact that a senator put it on paper means the conversation has shifted.
Why better legislation alone will not fix a system built on profit
The legislation being pressed in 2026 addresses real things. Understaffing, mental health support for healthcare workers, tax credits for clinicians in shortage areas. These matter. Anyone who has worked a 16 hour shift understaffed knows they matter in the body.
But we are not yet asking the deeper question. Why does the most expensive healthcare system in the world produce exhausted nurses, silenced clinicians, and outcomes that trail countries spending half as much? We are treating the symptoms. Staffing ratios, mental health resources, administrative burden, the legal exposure of speaking up. Without yet confronting the design.
The design is the problem. A system organized around revenue generation, executive compensation, and shareholder return will always, eventually, sacrifice the people inside it, both the workers and the patients. Not because of malice. Because of math. Margin pressure flows downhill. It lands on the nurse at the bedside. It lands on the surgeon who scrubs out mid operation to argue with an insurance representative. It lands on the patient who delayed care because the copay was 400 dollars.
You can mandate staffing on paper. You cannot mandate it into existence without addressing why hospitals chronically understaff in the first place. The answer to that is not complicated. It costs money they would rather spend elsewhere.
This is not a coincidence. It is architecture. Naming it is the first step toward building something different.
Start asking the harder questions
If you are a healthcare leader navigating the gap between what the system admits is true and what its financial architecture is built to deliver, you are not alone. Genuine Growth LLC works with healthcare leaders who want to stay inside the system and change it, not from a place of burnout, but from a place of clarity. Visit here to learn more.
Read more from Angie West
Angie West, Founder of Genuine Growth LLC, Coach, Speaker and Herbalist
Angie West, MSN, RN, ACC, spent 15 years inside healthcare leadership before leaving a senior role to do the work systems won't. As founder of Genuine Growth LLC, she works with nurses and healthcare leaders who are tired of shrinking — helping them reclaim agency, which she defines as the power to act from their values, trust their own voice, and lead in ways that don't cost them everything. She writes and speaks candidly on moral injury and the structural forces driving good clinicians out of the field. Angie is also a practicing herbalist and founder of An-G's Apothecary. Her mission: bring the heart back to healthcare.
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