WHY IT TAKES SO LONG TO CHANGE ANYTHING IN HEALTHCARE — AND WHAT WE CAN DO ABOUT IT

Margarita Kilpatrick
Jan 20
2 min read

Everyone agrees the healthcare system needs to change. But almost no one agrees on how to change it. And even when they do? It takes forever.

I've spent decades working in and around healthcare policy, from CMS reimbursement structures to NIH research funding to on-the-ground hospital operations. If there’s one thing that’s clear, it’s this:

The biggest barrier to reform isn’t lack of ideas. It’s the system’s inability to implement them.

THE SYSTEM ISN’T DESIGNED TO MOVE QUICKLY

Healthcare is a web of payers, providers, regulators, and manufacturers, all operating on different incentives and timelines. Change in one corner of the system rarely leads to change across the board. Instead, it gets caught in a tangle of billing codes, reimbursement schedules, and regulatory processes. Even something as simple as updating a pricing structure can take years because of required review cycles, stakeholder input, and political posturing.

That’s not a glitch. It’s how the system was built.

EVERY STAKEHOLDER PROTECTS THEIR OWN TURF

Another reason change is so slow? Every group involved in healthcare reform has something to lose.

Hospitals fear reimbursement cuts.
Insurers don’t want unpredictable claims.
Physicians worry about more administrative burden.
Regulators fear backlash if a new policy backfires.
Lawmakers don’t want to take a risky vote in an election year.

So instead of bold reforms, we get tweaks. Instead of a better system, we get a slightly more complicated version of the current one.

COMPLEXITY REWARDS STASIS

One of the biggest healthcare reform barriers is simply that the system is too complex to fix cleanly. There’s no “one lever” to pull. No single agency to hold accountable.

And that works in favor of the status quo. The more complicated the system, the easier it is to delay change, bury inefficiencies, and avoid accountability.

WHAT WE CAN DO

I don’t pretend this is easy. But I do know three things that could help:

Incentivize simplicity. The system rewards complexity today. We need to reward clarity—simpler regulations, clearer pathways for reimbursement, and leaner requirements for innovation.
Fund demonstration projects with teeth. Pilot programs are too often ignored. If we want to test reform, we need real experiments with defined timelines, measurable outcomes, and authority to scale what works.
Create cross-agency mandates. Most reforms fail because one agency shifts while others stay still. Aligning incentives across CMS, FDA, and NIH could accelerate real change across the system, not just on paper.