Ask most people what’s broken about American healthcare, and they’ll answer with one of two words: access or cost.
Myra Ahmad, a physician who has spent years studying how chronic care actually gets delivered, argues that both answers miss the deeper failure.
A patient can have excellent insurance and the means to pay for anything a specialist recommends and still fall out of care entirely, because no single person is accountable for managing the whole picture over time.
In her view, that missing continuity, not access or cost alone, is the real crisis.
It’s a sharper claim than it first sounds. Access and cost are real barriers, but they’re barriers to entry.
Continuity is what determines whether a patient who clears those barriers actually stays in effective treatment. Ahmad’s research suggests that a shocking number of them don’t, for reasons that have nothing to do with what their insurance covers.
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The Debate Everyone Has Isn’t the Right One
Health policy conversations tend to fixate on coverage expansion and price control, both important, both incomplete.
Ahmad’s clinical observation was that even patients who could get an appointment and afford it were still bouncing between specialists, bariatric surgeons, endocrinologists, primary care doctors, without any of them treating the underlying condition.
Care existed. It just wasn’t connected to anything. A system can solve access and cost completely and still produce that outcome, because neither problem is the one causing patients to disengage.
What Gets Rewarded Instead of Outcomes
The reason continuity breaks down is structural. “Our healthcare system is optimized for billing codes rather than clinical outcomes,” she has said.
“Patients bounce from specialist to specialist, yet no one seems to ‘own’ their care.” When a provider is compensated for the volume of billable encounters rather than whether a patient actually improves or stays engaged, there is no financial incentive built into the system to maintain a single, accountable relationship over time.
Everyone in the chain can be doing their job correctly by the metric they’re paid on, and the patient still falls through.
Complex Conditions Don’t Respect Specialty Lines
The problem compounds for the patients who need continuity most: those managing conditions that cut across multiple specialties at once.
Obesity, to take one example, is rarely a standalone diagnosis. It travels with metabolic, hormonal, and cardiovascular concerns that don’t stay inside any single specialist’s lane.
A patient referred from one practice to the next ends up managed in fragments, with each visit addressing a slice of the problem rather than the whole of it.
That fragmentation lands hardest on patients whose conditions interact with each other rather than sitting neatly in one specialty.
Ahmad has pointed in particular to women managing overlapping conditions, obesity alongside PCOS, perimenopause, or fertility concerns, where treating any one issue in isolation tends to miss how it’s compounding the others.
Continuity isn’t a nicety for that patient. It’s the only way anyone catches the interaction at all. Ahmad has documented the broader pattern as a dropout curve: patients start treatment, lose the thread as it splits across providers, and eventually disengage, not because they lacked access or couldn’t afford the next visit, but because nobody was tracking the full picture closely enough to catch them before they did.
The Data Follows the Same Broken Pattern
Continuity fails at the clinical level, but it fails again at the level of the record. “Most providers are getting labs from separate systems that never talk to each other,” Ahmad has said.
A specialist making a treatment decision without visibility into what another provider already tried, or what a recent lab result actually showed, is being asked to individualize care with an incomplete file.
That’s not a technology gap that better access or lower prices would fix. It’s the same continuity failure showing up as a data problem instead of a scheduling one.
Naming the Real Crisis Is the First Step
Most of the national conversation about fixing healthcare is still organized around expanding who can get in the door and lowering what they pay once they’re inside.
Ahmad’s argument reframes the target: those fixes, even done well, leave the actual mechanism of patient dropout untouched.
Until the system rewards keeping a patient connected to one accountable relationship over time, patients with perfectly good insurance and the ability to pay will keep falling out of care for reasons no coverage expansion or price cap was ever going to solve.
Naming that clearly, Ahmad’s central contribution to this debate, is what separates a real diagnosis of the crisis from a conversation about its symptoms.
