A representation of the US Healthcare Financing Flow Sankey diagram in the style of Ernst Haeckel’s Art Forms in Nature .
11 minute read time
Follow the money and you might get lost. That’s why I made a diagram for the entire US healthcare system’s financial flows - covering an incomprehensible $5 Trillion in healthcare spending.
The US healthcare system looks like an eldritch horror - tentacles reaching into every corner of American life.
But we built this creature. Like Dr. Frankenstein, we assembled it piece by piece - Medicare for the elderly, insurance through jobs, Medicaid for the poor, exchanges for everyone else. Each piece solved a specific problem. Each addition made sense in isolation.
Put them together and you get something alive. Something vast. Something no one would have designed from scratch - because we never agreed on what we were designing.
The flows in the diagram represent $4.9 Trillion - but they also trace every medical decision made in America last year. Every dose administered and every diagnosis delivered. Every ambulance ride and every rehabilitation. Every birth and every final goodbye.
The flows are the aggregate infrastructure of how we keep people alive and healthy - and also, the accumulated friction that makes it harder to stay that way.
This chart holds the confused senior on dialysis, lost between three different insurances. The branch has a brilliant researcher, waiting for approval to start her life-saving trial. Lost in the flow is a desperate parent calling six numbers to pray for one “in-network” specialist. The ends show a struggling hospital with a whole floor for billing - and a closet for social work.
Every flow in the diagram is someone’s life intersecting with the creature we created. And every flow is also a choice about obligation. Who do we owe care to? What do we owe and how much?
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