US Healthcare System is not sustainable
The healthcare system in the United States is, in many respects, fundamentally unsustainable—especially for the people who most desperately need it. Nearly half of U.S. adults say it’s difficult to afford their healthcare costs. For households earning under $40,000 annually or who are uninsured, the burden is even more severe. (KFF) Because cost becomes a barrier, many simply forgo care or delay treatment—undermining the promise of care for all and amplifying the risk of worse outcomes over time. (Health System Tracker) Low‐income families, marginalized communities, and the uninsured bear the brunt of this burden—creating a two‐tier system where health outcomes align with income or insurance status rather than with need.
In particular, access to mental health and addiction recovery services is markedly deficient, despite the growing prevalence of mental illness and substance use disorders. In 2020, an estimated 64.5 million nonelderly adults in the U.S. had a mild, moderate, or severe mental illness or substance use disorder. (KFF) Yet even among those with insurance, significant barriers remain: a shortage of providers (especially in rural and underserved areas), low reimbursement rates for behavioral health, insurance network inadequacies, and restrictive coverage policies. (AAMC) For someone struggling with addiction recovery, for example, being told the treatment isn’t “medically necessary” under their plan, or finding that few providers are in‐network, can mean the difference between getting help or spiraling further downward.
Insurance requirements exacerbate the problem in subtle and structural ways. Many plans reimburse behavioral health providers at significantly lower rates than medical providers—making it financially unviable for clinics to accept them. (APA Services) Public insurance programs like Medicaid often pay even less, and in low‐income communities the physician and behavioral health provider shortages are stark. (NCBI) One study found that people in households designated as “poor” had worse access to care than those in high‐income homes on 79% of access measures. (NCBI) So even with “coverage,” the actual access and quality of services can be severely compromised. For addiction recovery—where continuity, trust, culturally competent services and wrap-around supports matter—these insurance‐based gaps matter deeply.
Given all of this, what we urgently need is more grassroots, community-based organizations that can supplement where the formal system is failing. These organizations are often better positioned to provide real connection, cultural competency, long‐term peer support, and flexible access (often sliding scale or no insurance required). The formal health system—driven by insurance reimbursement, medical necessity gates, and provider networks—is simply not built to absorb the emotional work, the trust‐building, the peer-led engagement that recovery and mental health often require. For low‐income families and historically marginalized communities, community-grounded organizations can fill critical gaps: meeting people where they are, offering prevention and early-stage support, helping navigate the labyrinth of insurance and care, and building a network of care that does not simply start when someone becomes acute.
In sum: the U.S. healthcare system, as currently structured, is unsustainable for those who need it most—high costs, insurance barriers, provider shortages and structural inequities all converge. Mental health and addiction recovery services are especially vulnerable to these breakdowns because of how care is organized and reimbursed. By strengthening and investing in grassroots organizations—those rooted in communities, focused on human connection rather than only “medical episodes”—we can begin to bridge the gap between promise and practice. We need a system that doesn’t just treat illness after it’s cascaded into crisis, but one that builds relationships, fosters resilience, and supports healing in places where the formal system falls short.