CW: Death
For a generation now, American workers have been living inside a quiet crisis. Their paychecks inch upward, slowly and predictably, while the cost of staying insured surges. Health insurance premiums in the U.S. rose significantly between 1999 and 2024, outpacing wage growth by a factor of 3, according to newly published research in the journal JAMA Network Open.
It’s the kind of crisis that doesn’t happen all at once. It begins slowly. And then, for some people, it devastates them.
Premiums can rise if the costs of the medical services they cover increase. Using the consumer price index to look at the main components of medical care — such as services provided in clinics and hospitals as well as administrative expenses — and drawing on federal data and data from KFF, it was found that the cost of hospital services increased the most, while the cost of physician services and prescription drugs rose more slowly.
Some of the premium increases can be attributed to an increase in hospital outpatient visits and the growing coverage of GLP‑1 drugs such as Ozempic. But research suggests that premiums have risen rapidly largely because of health system consolidation — when hospitals and other healthcare entities merge. These mergers have allowed hospitals to raise prices that far exceed their costs.
In other words, the system isn’t just getting more expensive because care costs more. It’s getting more expensive because the structure of the system itself rewards higher prices.
You can see the impacts of these rising costs every day. Often, people talk about open enrollment, as if it’s something to dread. You can hear it in the conversations between parents who forgo their own care so their kids can go to the doctor. You can feel it in the exhaustion of employees who stay in jobs they are unhappy with, because losing insurance feels far more dangerous than losing income.
Every year, premiums rise and deductibles rise and out-of-pocket costs rise-and wages do not. The math stops working long before anyone admits the system is broken.
And then there are stories like Alec Raeshawn Smith’s that simply make the crisis impossible to ignore. Alec was 26 when he died. He lived with Type 1 diabetes, a condition that requires regular doses of insulin.
Without it, the body begins to break down fat at an alarming rate, quickly flooding the bloodstream with ketones, making the blood acidic — what’s known as diabetic ketoacidosis. It is life‑threatening. It is preventable. It is exactly what killed him.
In February 2017, three months shy of his 26th birthday, Alec knew he was going to age out of his mother’s insurance plan. At the pharmacy, he learned that his insulin and supplies would cost more than $1,000 a month without insurance. The options weren’t much better with insurance.
Alec worked full‑time as a restaurant manager in Minnesota, earning about $35,000 a year. He earned too much to qualify for Medicaid, but too little to afford the plan available to him. The deductible was more than $7,000. The monthly premium was more than $400.
So Alec did what millions of Americans do when the system fails them. He went without insurance because he couldn’t afford it. He tried to ration his insulin. He tried to make it work. And less than a month after losing coverage, he was dead.
Alec’s death wasn’t the result of a rare disease or freak accident. It was the predictable result of a system where the cost of staying alive rises faster than wages. No one should die because they can’t afford their medication.
The result of decades of premium increases outpacing earnings, until the gap becamea deep gap widened not only by rising medical costs, but by consolidation, allowing hospitals to charge more simply because they can.
Alec’s story is heartbreaking, but it isn’t unique. His story is a mirror held to a system that has drifted so far from its purpose that it now endangers the very people it is supposed to protect. When premiums rise nearly three times faster than wages, people are forced to make impossible decisions. Some forego vital care. Some people ration medication. Some take on debt. And some, like Alec, don’t survive.
Alec’s life shouldn’t have ended at age 26. His story shouldn’t be a cautionary tale. But it is, and it makes us face a painful truth: a healthcare system that lets this happen isn’t only expensive-it’s failing. And unless something changes, the next 25 years will look like the last, only more costly, more unfair, and more deadly for people when they fall through the cracks.
Sources:
Ho, Vivian, and Salpy Kanimian. “Health Insurance Premiums Rose Nearly 3x the Rate of Worker Earnings over the Past 25 Years.” The Conversation, The Conversation , 8 Dec. 2025, theconversation.com/health-insurance-premiums-rose-nearly-3x-the-rate-of-worker-earnings-over-the-past-25-years-271450.
Sable-Smith, Bram. “Insulin’s High Cost Leads to Lethal Rationing.” NPR, NPR, 1 Sept. 2018, https://www.npr.org/sections/health-shots/2018/09/01/641615877/insulins-high-cost-leads-to-lethal-rationing.