Editorial Response: Bridging vs Filling in US Health Care Quality-Beyond the Chasm

In their recent Viewpoint, Yang and Sage describe persistent structural deficiencies in US health care, including fragmentation, administrative complexity, and misaligned incentives.¹ Their analysis is persuasive, but their emphasis on incremental reform may understate the need for more fundamental change.

One issue warranting more candid examination is compensation across the health care system. Nurses and other frontline workers remain essential yet often undervalued. At the same time, some sectors of medicine warrant closer reassessment of physician compensation and the incentives that shape it.

Compensation structures influenced by market pressures, staffing intermediaries, and contracting organizations may not always align with the goals of equitable, high-value patient care. This concern does not argue against fair compensation, nor does it diminish the expertise and responsibility physicians assume. Rather, it asks whether current incentives align with medicine’s ethical obligations and the goal of equitable, patient-centered care.

Physicians have historically participated in difficult conversations about reform. A candid reassessment of compensation, alongside administrative costs and corporate profit structures, could strengthen public trust and contribute to a more sustainable health care system.

Clark Newhall, MD, JD

Reference

Yang YT, Sage WM. Bridging vs Filling in US Health Care Quality—Beyond the Chasm. JAMA. 2026;335(19):1657-1658. doi:10.1001/jama.2026.4353.