Saturday, September 5th, 2026
The Long View
Tirzepatide came off the FDA shortage list in December 2024 and semaglutide in February 2025. Ifosfamide, a decades-old chemotherapy used in curative regimens, is three months into a shortage the FDA expects to run into autumn and European regulators into 2027. Same country, same regulator, same manufacturing base.
A survey of more than 1,800 employers puts the 2027 increase in health benefit costs at 8.2 percent, the steepest since 2003. That figure is what remains after the changes employers plan to make, and the largest of those changes is asking employees to pay more.
Hospitals across the state have agreed to stop turning ambulances away when the emergency department fills up. Diversion was never extra capacity. It was a way of moving a full department's problem onto the ambulance and the patient inside it.
A would-be maker of a scarce cancer drug may produce it only while the drug is officially in shortage. Succeed at ending the shortage and the permission ends with it, which is a rule that guarantees nobody builds durable capacity.
A hospital can substitute a drug, a surgeon and a shift. It usually cannot substitute the single-source device a procedure was built around, and nobody notices which items those are until one of them stops arriving.
The medicines that run short are almost never the expensive new ones. They are decades-old generics made on thin margins in a handful of plants, where a single inspection failure removes a meaningful share of world supply.
Assaults on hospital workers are frequent enough that security has become a standing cost, and the spending competes directly with the staffing whose absence contributes to the problem.
Dental coverage sits outside major medical for reasons that are historical rather than clinical, and the consequences arrive in emergency rooms that cannot treat teeth.
Federal rules oblige providers to offer interpretation and no payment mechanism accompanies the obligation. What fills the gap is a family member, which is where the errors start.
Imaging systems and infusion pumps are capital assets depreciated over a decade or more, running software the manufacturer stops supporting long before the hardware wears out.
Federal rules ended most balance billing for out-of-network care. Ground ambulance rides were excluded, which leaves the one service nobody selects still able to bill the difference.
Separating the property from the operation made nursing homes financeable. It also created a fixed obligation that does not move when occupancy does, and that is where the failures start.
Independent physician practices have been bought at scale by hospital systems, insurers and investment firms. Patients are largely unaware, and the ownership determines more than the medicine does.
