The latest government shutdown was caused by more than just political machinations. It was triggered by Congress鈥� refusal to address whether temporary COVID-era health insurance subsidies should be added as a permanent federal entitlement. These subsidies, sold as emergency relief, lowered Affordable Care Act premiums and cut hospital charity-care losses. Making them permanent, however, would cost billions each year and worsen health care inflation without improving quality or access.
The shutdown exposed the central fallacy of U.S. health policy: the belief that Washington can subsidize its way out of structural dysfunction. It cannot. No subsidy will realign incentives that are fundamentally misaligned.
The U.S. spends almost twice as much on health care as other wealthy nations while achieving generally worse outcomes, even when adjusting for racial disparities. That鈥檚 not because Americans lack compassion. It鈥檚 because we never built a coherent health care system. Instead, we assembled one piecemeal, assuming each new program or subsidy might finally make the whole thing work.
It didn鈥檛. And it can鈥檛.
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Jay Wolfson is the interim dean at the 最新天美传媒 Taneja College of Pharmacy. He is also the Distinguished Service Professor of Public Health, Medicine and Pharmacy at USF Health, and a founding collaborative faculty member at the Florida Center for Health Policy.
Charles Lockwood is the executive vice president of USF Health, dean of the University of South Florida Morsani College of Medicine, and a founding collaborative faculty member at the Florida Center for Health Policy.