The Price of Being Human
When health becomes currency, survival becomes conditional.
When Care Stopped Being a Moral Guarantee
There was a time when illness, though feared, did not immediately translate into financial dread. Health systems were imperfect, uneven, and often unjust—but the act of seeking care was not, in itself, an economic negotiation. That moral baseline has eroded.
Today, the experience of illness is inseparable from cost calculations. Before diagnosis comes coverage verification. Before treatment comes authorization. Before healing comes an invoice. The modern health system no longer asks first what does this patient need? It asks who pays, and how much risk does this case represent?
This shift is not anecdotal; it is structural. According to the World Health Organization’s Global Health Expenditure Database (2023), global health spending has reached historic highs. Yet increased spending has not translated into proportional protection. On the contrary, financial hardship associated with seeking care remains pervasive across income levels and regions.
Health, once treated as a social obligation, has been reorganized as an economic variable.
Coverage Without Protection
Governments frequently point to insurance expansion as proof of progress. Universal health coverage dominates policy language. Yet the World Bank’s Universal Health Coverage Global Monitoring Report (2023) makes a sobering clarification: coverage alone does not guarantee financial protection. Billions of people worldwide remain vulnerable to catastrophic health spending—medical costs severe enough to destabilize households or push them into poverty.
This pattern was identified years earlier by Xu, Evans, and colleagues in The Lancet, who demonstrated that out-of-pocket health spending is among the most powerful drivers of impoverishment globally. The persistence of this trend decades later signals not policy inertia, but policy misalignment.
Insurance, as it is currently structured, often functions as a registration system, not a shield.
The Economics of Insurance: Risk, Not Care
Insurance markets are frequently framed as ethical instruments—mechanisms for pooling risk and protecting the vulnerable. In practice, they are optimized for cost containment.
OECD analyses on health insurance coverage and financial protection (2022) show that even in advanced economies, rising cost-sharing mechanisms—deductibles, copayments, coinsurance—have weakened insurance’s protective function. The burden of uncertainty has shifted from institutions to individuals.
In the United States, this shift is particularly stark. Data from the Centers for Medicare & Medicaid Services (2024) confirm that the country spends more on healthcare than any other nation. Yet surveys from the Kaiser Family Foundation (2024) reveal that employer-sponsored insurance—long considered the gold standard—now exposes families to rising premiums and unprecedented deductibles. Coverage exists, but certainty does not.
Insurance has become a conditional promise—one that weakens precisely when illness becomes serious.
Administrative Complexity as Strategy
The most revealing indicator of misaligned priorities lies not in clinical outcomes, but in paperwork.
Research by Himmelstein and Woolhandler (2020) shows that administrative costs in U.S. healthcare consume a staggering share of total spending—far exceeding those of countries with more centralized or publicly coordinated systems. This finding builds on earlier work by Woolhandler, Campbell, and Himmelstein (2003), which demonstrated that private insurance systems generate administrative waste not as a side effect, but as a feature.
Complexity serves a purpose. It delays care. It discourages claims. It shifts cognitive and emotional labor onto patients and clinicians. The United States Government Accountability Office (2023) has repeatedly documented rising premiums alongside shrinking coverage generosity, a pattern that signals deliberate cost containment through friction.
Denial, delay, and exhaustion are not failures of the system. They are how the system functions.
Pricing Without Logic, Costs Without Meaning
If high prices reflected high quality or true cost, the moral discomfort might be defensible. They do not.
Uwe Reinhardt’s analysis of U.S. hospital pricing made clear that prices are rarely tethered to actual production costs. Instead, they are shaped by bargaining power, opacity, and fragmentation. Insurance intermediates this chaos rather than correcting it, absorbing confusion while passing costs downstream.
Steven Brill’s Bitter Pill exposed how insured patients could still face devastating medical bills through opaque pricing, out-of-network traps, and coverage loopholes. What was once a scandal has since become normalized. The system no longer shocks—it conditions.
Pricing, in this environment, is not an economic signal.
It is an instrument of power.
Underinsurance: The Quiet Crisis
Between access and exclusion lies underinsurance, a state increasingly common and dangerously invisible.
OECD data show that millions of people are technically insured yet financially exposed. Their policies do not meaningfully protect them from hardship. They delay diagnostics, ration medication, and hope conditions resolve before costs escalate. Studies consistently link underinsurance to poorer health outcomes and higher long-term system costs.
Emanuel and colleagues (2020) describe the U.S. health system as a patchwork of compromises mistaken for coherence. That description increasingly applies beyond national borders. Systems measure enrollment while ignoring lived vulnerability.
Being insured now often means being documented—not protected.
Read also: Diseases That Pay: The Global Health Economy—Part 2
Global Inequality, Systematically Reproduced
In low- and middle-income countries, the consequences are more visible but no less structural.
World Bank and WHO reports show that out-of-pocket payments remain the dominant mode of financing in many regions, exposing households to extreme risk. Health becomes something accessed conditionally—when money is available, when illness is advanced, when alternatives are exhausted.
Aid programs and insurance pilots soften the edges, but rarely disrupt the underlying logic. Survival remains stratified by income. The poor do not experience illness differently—they experience systems differently.
Health inequity is not incidental. It is engineered through financing.
Insurance as Moral Alibi
Perhaps the most insidious role of insurance is psychological.
It allows societies to believe the healthcare problem has been solved. If people suffer, responsibility is individualized. If they are insured, the system absolves itself. If they are not, blame shifts entirely to personal circumstance.
McWilliams (2019) highlights how political resistance to meaningful reform is sustained by this diffusion of responsibility. Insurance becomes a moral buffer—absorbing outrage while preserving structure. Systems that fail quietly endure longest.
Counting the Cost of Being Human
The price of being human should never have been negotiable.
Yet today it is calculated daily—in premiums, deductibles, exclusions, and delayed care. It is calculated when patients hesitate before seeking help, when families choose between treatment and rent, when survival waits for authorization.
This is not the cost of innovation.
It is the cost of design choices.
Until health systems are rebuilt around protection rather than profit, solidarity rather than segmentation, survival will remain conditional. And history will not ask what medicine could do.
It will ask why so many were charged for the right to live.
Professor MarkAnthony Ujunwa Nze is an internationally acclaimed investigative journalist, public intellectual, and global governance analyst whose work shapes contemporary thinking at the intersection of health and social care management, media, law, and policy. Renowned for his incisive commentary and structural insight, he brings rigorous scholarship to questions of justice, power, and institutional integrity.
Based in New York, he serves as a full tenured professor and Academic Director at the New York Center for Advanced Research (NYCAR), where he leads high-impact research in governance innovation, strategic leadership, and geopolitical risk. He also oversees NYCAR’s free Health & Social Care professional certification programs, accessible worldwide at:
https://www.newyorkresearch.org/professional-certification/
Professor Nze remains a defining voice in advancing ethical leadership and democratic accountability across global systems.
Selected Sources
World Health Organization. (2023). Global health expenditure database.
Organisation for Economic Co-operation and Development. (2023). Health at a glance 2023.
Centers for Medicare & Medicaid Services. (2024). National health expenditure accounts.
United States Government Accountability Office. (2023). Private health insurance: Enrollment, premiums, and coverage trends.
Himmelstein, D. U., & Woolhandler, S. (2020). Administrative costs in US health care. Annals of Internal Medicine, 172(2), 134–135.
Brill, S. (2013). Bitter pill: Why medical bills are killing us. Time Magazine.
McWilliams, J. M. (2019). Cost containment and the politics of health care. Health Affairs, 38(9), 1411–1418.
Kaiser Family Foundation. (2024). Employer health benefits survey.
OECD. (2022). Health insurance coverage and financial protection.
Woolhandler, S., Campbell, T., & Himmelstein, D. U. (2003). Costs of health care administration in the U.S. and Canada. New England Journal of Medicine, 349(8), 768–775.
Reinhardt, U. E. (2013). The pricing of U.S. hospital services. Health Affairs.
World Bank. (2023). Universal health coverage global monitoring report.
Xu, K., Evans, D. B., et al. (2007). Protecting households from catastrophic health spending. The Lancet, 370(9603), 111–117.
Emanuel, E. J., et al. (2020). Understanding the U.S. health care system. JAMA, 323(1), 21–22.*
