Representative Maxine Dexter, a Democrat from Oregon and former critical care physician, is warning that the U.S. healthcare system is in a state of emergency, comparing the current situation to a patient in hemorrhagic shock. In a stark assessment, she argues that Washington's incremental responses are inadequate and that immediate action is needed to prevent irreversible damage.
Dexter identifies two converging forces driving the crisis. First, the Republican-controlled Congress and White House have enacted multibillion-dollar cuts to Medicaid and allowed enhanced Affordable Care Act tax credits to lapse, pushing an estimated 8 million Americans off their health insurance. In Oregon's 3rd District alone, nearly 30,000 residents could lose coverage. Second, the rapid consolidation of healthcare providers—hospitals, physician practices, nursing homes, and community clinics—is placing more of the system under the control of large, profit-driven corporations.
These trends are mutually reinforcing, Dexter contends. When federal funding for Medicaid is slashed and coverage becomes less affordable, clinicians lose critical revenue streams and are forced to do more with less. Some independent practices close permanently, leaving communities without local care. Others are compelled to sell to corporate buyers that prioritize profit margins over patient outcomes. As independent providers disappear, communities lose control over their healthcare, and patients are left navigating systems designed to maximize returns rather than meet medical needs.
Dexter points to the closure of Hahnemann University Hospital in Philadelphia as a cautionary tale. The 171-year-old institution, which primarily served low-income patients and communities of color, was acquired by a private equity firm in 2018. The new owner failed to improve conditions and shut the hospital down less than two years later, selling the real estate for redevelopment. A longtime nurse at Hahnemann said the buyer seemed to have intended all along to let the hospital fail.
Drawing on her medical experience, Dexter notes that a crisis rarely begins at the moment a patient arrives in the ICU. Warning signs build for hours, days, or years. The same is true for the healthcare system. If Congress waits too long to act, the damage could become irreversible.
To stabilize the industry, Dexter argues that healthcare delivery must be treated as essential national infrastructure. She compares it to the interstate highway system, which was built not for quarterly returns but to connect communities and expand opportunity. She laments that the nation has never applied that same logic to the places where people are born, healed, and cared for at the end of life.
While the healthcare debate in Washington has focused on expanding insurance coverage, Dexter insists that coverage is meaningless without clinicians to deliver care, clinics that accept new patients, pharmacies that stay open, and a workforce large enough to meet community needs. Preserving and expanding coverage must go hand-in-hand with stabilizing the delivery system and investing in the professionals who make care possible.
Dexter has convened a working group of experts, physicians, and advocates to develop solutions. Their guiding principle is straightforward: healthcare delivery is infrastructure, as critical as roads, bridges, and clean water. She points to the 1946 Hospital Survey and Construction Act as precedent for federal investment in healthcare infrastructure, noting that Congress recognized access to care as a national priority. She argues that public investment should preserve hospitals and clinics as community assets, accountable to patients rather than investors. Today, public hospitals make up only 15 percent of the nation's hospitals but handle a disproportionate share of Level I trauma centers, often on tighter budgets than their private counterparts.
Dexter frames the choice before Congress as a too-big-to-fail moment. Lawmakers can continue to stand by while private equity and corporations buy up the healthcare system, or they can recognize healthcare as infrastructure and publicly invest in a system designed to serve people for generations. She concludes with a call to action: stop the bleeding and stabilize the system, then build it to last. The time for pretending there is time to spare is over.
