US health care: Chaos and controversy without real progress

Robert Pearl, Tribune News Service

The year 2025 has been one of the most turbulent years in modern U.S. health care. The headlines were explosive, the rhetoric dramatic, and the controversies nonstop. Yet for all the hoopla and upheaval, the medical care Americans receive now, month in and month out, looks no better than what they experienced on Jan. 1 — but far more expensive.

Here are five areas of health care that generated chaos, confusion, and conflict in 2025 without meaningful improvement.

1. Political Chaos: Turning science into a battleground. No aspect of health care saw more volatility in 2025 than in the political arena. The tone was set in January when President Donald Trump returned to office and began reshaping federal health agencies with unprecedented speed. Within days, he issued a record flurry of executive orders targeting the Affordable Care Act, Medicaid waivers, Medicare Advantage oversight, prior-authorisation rules, and federal nutrition standards.

He replaced long-entrenched leaders at HHS, NIH, CDC, and FDA with political outsiders, many of whose views on vaccines, chronic disease, and scientific evidence diverged sharply from the career experts they superseded. The nomination of RFK Jr. to lead HHS became a flashpoint. His reluctance to confront the measles outbreak in Texas, combined with mixed messaging on vaccine policy, has deepened public health concerns. Since then, senior scientists and leaders in federal health care agencies have resigned, with key programs becoming stalled and career staff reporting political interference in decisions that previously rested on data and expert consensus.

2. Economic Crisis: Costs soar as coverage becomes more fragile. Beneath the political theatrics of 2025 lay a sobering reality: Americans will once again pay far more for health care next year than the year before. And for many, the financial protections that once softened those increases are disappearing. Insurers on the Affordable Care Act marketplace requested median premium hikes of 18% for 2026, the steepest jump since 2018 and well above this year’s 7% hike. If Congress fails to extend the enhanced ACA subsidies, families who once paid affordable monthly premiums will see their costs double or even triple.

The broader economic picture makes these pressures unavoidable. The United States is now spending $5.6 trillion annually on health care, with costs projected to rise 7.1% this year, far outpacing economic growth.

3. Regulatory Confusion: This year shook the foundations of America’s public-health architecture and left yawning gaps where trust, clarity, and expert oversight once stood. Politics has replaced science as the primary driver of health care policy. The Centers for Disease Control and Prevention lost its director just weeks after her confirmation. Within days, top-level scientists and center heads resigned en masse, citing political interference and a collapse of scientific independence. At year’s end, there still is no permanent CDC head. Federal health recommendations — particularly those issued by agencies and advisory committees — have shifted away from rigorous, peer-driven review and toward decisions increasingly shaped by anecdote and ideology.

Meanwhile, the administration’s sweeping “health-freedom agenda” (under the banner Make America Healthy Again) has identified food packaging, additives, school-lunch standards and “ultra-processed” diets as public-health priorities. But the proposals to improve nutrition remain largely unformed, as the likelihood of meaningful improvements fade in the face of pushback from the food industry. What remains at year’s end is a set of agencies still functioning, but with public trust weakened and no clear path to rebuilding it.

4. Technological Contradiction: AI leapt forward while medicine stood still. No field generated more excitement, or exposed more contradictions, in 2025 than generative artificial intelligence. In the broader economy, GenAI models transformed finance, logistics, law, retail and customer service. New large language models, including GPT-5, DeepSeek and Gemini 3, demonstrated near-expert performance on clinical reasoning, interpretation of complex symptoms and risk prediction. And with the emergence of Artificial General Intelligence (AGI), Americans are increasingly relying on large language models when they have medical questions. In polling I conducted this fall, 77% of patients and 63% of health care professionals reported using a generative-AI tool in the past three months for health-related information or decision support.

Yet inside traditional medicine, progress remains stalled. Clinicians continue to be encouraged to use AI for administrative shortcuts (coding, charting, prior authorisation claims) but national specialty organisations haven’t pushed them to use GenAI for diagnosing disease, reducing medical errors or improving clinical outcomes. Meanwhile, medical schools still teach pre-AI workflows, even as medical students and residents turn to GenAI for clinical knowledge and case analysis. The divide between institutional practice and the behaviors of patients and the next generation of physicians is expanding at an accelerating pace.

5. Cultural Conflict: A growing divide between the public and the profession. If 2025 revealed anything about American health care, it was a widening cultural rift: between younger patients and medical professionals, and between science and public belief. This rift is felt particularly among Gen Z and Millennials, generations that grew up online, are accustomed to second-screen verification and skeptical of traditional authority. Younger Americans expect shared decision-making, transparency and digital-first convenience — expectations medicine failed to fulfill in 2025.