Count the Crashes, Not Just the Steps: What the Work-From-Home Health Scare Leaves Out

 

Before turning office attendance into a health prescription, count what getting there costs—in lives, injuries, alertness, money, and time.

StudyFinds published an alarming headline: “Why Working From Home May Be Much Worse For Your Health.” Yet the same article acknowledges: “None of this means remote work is bad for health.” That is a substantial gap between the headline and the evidence. (StudyFinds)

A finding about movement is not a verdict on overall health. To reach that verdict, we would need to count both sides: the activity lost at home and the hazards, expenses, and barriers eliminated by not commuting.

Where are the avoided crashes? The recovered sleep? The money workers keep? The experienced employees who remain employed because they no longer have to exhaust themselves getting to an office?

Those are not distractions from the health question. They are part of it.

What the study actually found

Researchers followed 97 Finnish university employees for one week, comparing their office and remote days using thigh-worn sensors. Remote days were associated with approximately 44 additional minutes of sedentary time, 37 fewer minutes of light activity, 21 fewer minutes of moderate-to-vigorous activity, and 14 additional minutes in bed. Those are behavioral measurements—not evidence of increased heart attacks, injuries, or deaths, which were not measured. (Springer Link)

The light-activity category included standing. Consequently, nearly an hour less recorded activity does not mean nearly an hour less exercise. Comparing participants with themselves was a strength, but work location was not randomly assigned, and detailed information about work tasks and home-versus-office conditions was unavailable. Someone might reserve concentrated writing for home and meeting-heavy work for the office. Sensors cannot resolve that possibility by themselves.

Another important detail: 54% usually walked or cycled to work. Eliminating a bicycle commute is not equivalent to eliminating an hour sitting in traffic. That difference matters when applying the findings to car-dependent workers.

The useful question is how remote workers can replace lost activity—not whether an office address should be treated as a medical intervention.

Start with the people who will not die on the road

Commuting is not a risk-free baseline.

Consider an illustrative calculation. Assume a worker eliminates a 30-mile round-trip solo drive on 230 workdays annually, with no replacement driving. That removes 6,900 vehicle-miles each year.

For national benchmarks, NHTSA estimated 1.10 traffic deaths per 100 million vehicle-miles in 2025. Its 2024 report gives an injury rate of 74 injured people per 100 million vehicle-miles. These are rates for all traffic, not specifically commuting. (NHTSA)

Applying those rates proportionately produces the following illustrative annual estimates—not measured remote-work outcomes:

Drivers eliminating those commutes	Vehicle-miles removed annually	Estimated deaths avoided	Estimated injuries avoided
1 million	6.9 billion	About 76	About 5,100
10 million	69 billion	About 760	About 51,000
20 million	138 billion	About 1,520	About 102,000

Even a two-day-a-week remote arrangement for 10 million such drivers would produce an estimated reduction of approximately 300 deaths and 20,400 injuries annually under the same assumptions.

These calculations are not precise forecasts. Commuting routes and times have different risks; some people carpool or use transit; remote workers may make additional nonwork trips; and changes in congestion can affect speeds. The estimates cover potential effects across road users, not just the employees themselves, and injuries include different severities.

Nevertheless, the point is unmistakable: the potential safety consequences are large enough to belong in the analysis.

We cannot responsibly count minutes of standing while treating avoidable road trauma as irrelevant.

Driving can make people sleepy—not just transport sleepy people

The commute can also consume alertness.

In a controlled study published in Ergonomics, 15 volunteers completed simulated drives with and without low-frequency seat vibration. Exposure to vibration at 4–7 Hz produced increasing drowsiness and physiological signs of greater effort to remain alert within approximately 15–30 minutes. The investigators described the effect as occurring even among healthy, well-rested participants. (PubMed)

An earlier laboratory study involving 18 volunteers found that 20 minutes of seated vibration increased sleepiness and impaired performance on a psychomotor vigilance test. This was not merely a complaint that driving felt boring; performance was tested. (PubMed)

Separately, driving-simulator research established that prolonged wakefulness can impair performance as seriously as alcohol. Arnedt and colleagues found that 18.5 hours awake produced changes comparable to 0.05% blood-alcohol concentration, while 21 hours awake produced changes comparable to 0.08%, on measures of road position and variability in lane position and speed. The comparison was specific to those tested functions, but the impairment was substantial. (PubMed)

Sleepiness does not become harmless because vibration or monotonous driving helped produce it. Its relevance is the loss of alertness and performance.

The population-level danger is considerable. The AAA Foundation estimated that drowsy drivers were involved in 17.6% of fatal crashes during 2017–2021, with approximately 29,834 deaths over those five years. Those figures cover all types of trips and overlap with—not add to—the traffic deaths already discussed. (AAA Foundation for Traffic Safety)

The additional workplace errors attributable specifically to arriving drowsy after commuting have not been reliably quantified by these studies. But an unmeasured consequence should be investigated, not quietly assigned a value of zero.

Eliminating the commute can function like a substantial raise

Workers do not pay commuting expenses with imaginary money. They pay them from their earnings.

Take an illustrative worker earning $80,000 annually, driving the same 30-mile round trip on 230 days. Assume 30 cents per mile in avoidable vehicle-running expenses, $5 daily in parking or tolls, and $500 in additional annual home-working costs.

Expense change	Annual financial effect
Avoided driving expenses	+$2,070
Avoided parking or tolls	+$1,150
Additional home-working expenses	−$500
Net money retained	+$2,720

At an assumed 25% marginal tax rate on additional wages, retaining $2,720 provides the same spending power as approximately a $3,627 pretax raise—about 4.5% of salary.

The benefit can be larger when more vehicle costs genuinely disappear. For comparison, the IRS business-mileage benchmark for July–December 2026 is 76 cents per mile. Applying that broader benchmark to the same annualized example yields $5,894 after the assumed parking savings and home-working costs—equivalent to approximately a 9.8% pretax raise under the same tax assumption. But that is a broader cost scenario, not guaranteed cash savings: fixed ownership expenses remain when someone keeps the same car. Nor is this calculation a claim that commuting is tax-deductible. (IRS)

The right calculation is individualized. Count expenses actually avoided, subtract additional home expenses, and distinguish reduced running costs from eliminating a vehicle altogether.

Remote work can increase a worker’s spending power without requiring the employer to increase payroll.

Then count the unpaid weeks workers get back

Money is only half the calculation.

A one-hour daily commute over 230 workdays consumes 230 hours annually. That is almost 29 eight-hour days, or 5.75 forty-hour weeks.

Those hours do not appear on the paycheck. They still come out of the worker’s life.

At unchanged salary and an eight-hour workday, eliminating that one-hour commute increases effective compensation per hour of work-plus-commuting time by 12.5%. Eliminating a 90-minute commute increases it by 18.75%; eliminating two hours increases it by 25%.

These are arithmetic comparisons, not salary increases. They describe how much less personal time must be committed to obtain the same pay. They also should not simply be added to the expense-saving percentages above.

There is observational evidence that workers use some recovered time for health-related activities. The UK Office for National Statistics found that people working at home saved an average of 56 commuting minutes on the observed day and spent 24 additional minutes on sleep and rest and 15 additional minutes on exercise, sports, and well-being. Those comparisons do not prove causation, but they show that home working does not inevitably mean abandoning exercise. (Office for National Statistics)

An hour formerly spent in a car could become a 30-minute walk plus 30 minutes returned to the worker. Whether that happens depends on how the day is organized.

The alternative to commuting is not necessarily inactivity.

Loyalty shows up in fewer resignation letters

There is stronger evidence for retention than speculation about how grateful workers might feel.

A six-month randomized trial involving 1,612 employees at Trip.com in China, published in Nature, tested a hybrid arrangement with two home-working days per week. Resignations fell from 7.2% to 4.8%—a one-third relative reduction. Job satisfaction improved, and the study found no adverse effect on its measured performance outcomes. That supports this particular hybrid arrangement, not every possible remote-work model. (PubMed Central (PMC))

Now consider replacement costs.

A figure of 175% of annual salary can be used as an explicit planning assumption for an expensive-to-replace role, but it is not a universal rate. Gallup estimates vary considerably: approximately 40% for frontline workers, 80% for technical professionals, and 200% for leaders and managers. (Gallup.com)

Using the 175% assumption, replacing an $80,000 employee costs $140,000.

A hypothetical 1,000-person employer reproducing the trial’s 2.4-percentage-point difference over six months would avoid approximately 24 departures. At $140,000 per departure, that represents $3.36 million in estimated avoided turnover costs.

That is a scenario, not a guaranteed saving. Turnover estimates may include lost output and management time rather than only immediate cash expenditures.

But the business logic deserves attention: a benefit employees value can also reduce the employer’s costs. Flexibility need not be purchased at the expense of performance.

For some people, working from home means being able to work at all

A person can be unable to tolerate a commute or office environment while remaining fully capable of doing the actual job. EEOC guidance explicitly recognizes that telework may be a reasonable accommodation when disability prevents successful on-site work but the job can be performed at home without undue hardship. (EEOC)

Consider the difference between a job’s productive duties and the physical demands surrounding them.

An employee may be able to review documents, write reports, answer calls, or analyze data, yet struggle with transportation, prolonged travel, an inaccessible building, a rigid schedule, or an environment that aggravates symptoms. Telework can change those surrounding conditions without eliminating the essential work. Accommodation guidance calls for evaluating the actual duties and the individual’s needs, rather than assuming that physical attendance and productive capacity are identical. (Job Accommodation Network)

This is not simply theoretical. A study published in American Economic Review: Insights in June 2026 estimated that the expansion of working from home explained 68–85% of the post-pandemic increase in full-time employment among people with physical disabilities, after accounting for compositional changes and labor-market tightness. That is an econometric estimate, not a randomized result, but it identifies a major potential employment benefit. (American Economic Association)

The implications extend beyond accommodating a single workday: preserving earnings, retaining experience, and allowing people to contribute despite physical limitations.

Eligibility for a legal accommodation remains individualized; essential duties, effectiveness, alternative accommodations, and undue hardship matter. (EEOC)

For some workers, remote work is not a convenience. It is the difference between earning a living and being excluded from employment.

The other benefits do not disappear because a sensor did not measure them

More family and caregiving time. Research across 27 countries found average commuting-time savings of 72 minutes per home-working day, with approximately 11% of saved time allocated to caregiving. Workers also allocated about 40% to their jobs. Recovered time benefited both households and employers. This does not imply that someone can simultaneously provide full-time childcare and perform full-time work. (American Economic Association)

Less exposure to contagious coworkers. Remote capability can help employees avoid bringing respiratory infections into a shared workplace. CDC guidance recommends flexible leave and telework arrangements to support staying home when sick or caring for sick relatives. Someone too ill to work still needs sick leave; remote work should not become an excuse to abolish it. (CDC)

Greater geographic choice and potential productivity benefits. A natural experiment at the U.S. Patent and Trademark Office found a 4.4% increase in output without increased rework when employees moved from a geographically restricted work-from-home arrangement to a work-from-anywhere program. The study also documented qualitative evidence of benefits to employees and real-estate savings for the employer. It was a comparison between two remote arrangements, not proof that all remote work outperforms office work. (SMS)

A broader pool of available workers. An employer that can hire beyond a practical daily commuting radius is not restricted to people able and willing to make that journey. EEOC guidance identifies attracting and retaining valuable workers among telework’s potential benefits. (EEOC)

Continuity during disruptions. Remote capability can keep suitable work functioning when weather or other emergencies make offices inaccessible. OPM’s continuity guidance emphasizes preparing equipment, connectivity, and employees before a disruption occurs. (U.S. Office of Personnel Management)

Potentially lower environmental costs. A Cornell–Microsoft study published in PNAS modeled a 54% lower work-related carbon footprint for fully remote workers under its assumptions. The result depended on transportation, office energy, home energy, and lifestyle changes. It was not a universal reduction, but it demonstrates another important outcome that movement tracking alone cannot assess. (PNAS)

None of these benefits requires pretending that every job can be remote or every home provides an adequate workspace. They require recognizing that work arrangements have several consequences, not just one.

Fix the movement problem without pretending the commute is treatment

The sensible response to insufficient movement is to address insufficient movement.

Build opportunities for walking and activity into the workday. Protect breaks. Provide suitable equipment. Make in-person gatherings purposeful rather than treating attendance itself as the outcome.

The Finnish researchers themselves suggested exploring ways to compensate for the observed behavioral differences; they did not establish that returning to the office improves overall health. (Springer Link)

A useful next study would compare well-designed remote work—including planned movement and adequate support—with office work including the entire commute. It would measure activity, sleep, symptoms, injuries, performance, retention, costs, and the ability to remain employed.

That is the comparison needed to assess the whole arrangement.

An office address is not a medical treatment. A commute is not an exercise prescription. And a movement sensor cannot, by itself, tell us which working arrangement produces a better life.

Count the crashes. Count the fatigue. Count the unpaid weeks. Count the money retained. Count the employees who do not resign—and the people who can keep working.

Then assess health. Not merely movement.

Thrive Now: Advice to My Younger Self—Sex Is Not a Bathroom Break. For adult readers.

 Don’t confuse satisfying an urge with satisfying a partner.

My assessment, from experience, is blunt: a young man may approach sex like a bathroom function—seven minutes, relief, finished. Making the experience outstanding for a woman can mean thinking in hours, not minutes.

That does not mean hours of nonstop intercourse. It means affection, conversation, flirtation, anticipation, kissing, and unhurried attention beginning well beforehand.

Understand the difference and adjust your behavior accordingly. Your timetable is not automatically hers. My comparison is a reminder to invest attention, not a biological timetable for every person or encounter.

Study Instead of Guessing

My advice to my younger adult self: explore Alex Grendi’s YouTube channel as one starting point for learning about intimacy. His lesson subjects range from female pleasure and kissing to ejaculation control and sexual confidence.

There is more to becoming a good lover than learning how to last longer. Study female anatomy, desire, arousal, orgasm, comfort, and the different ways people enjoy affection and touch.

Treat intimacy as something worth learning about—not something you should automatically understand because you have reached adulthood or accumulated sexual experience.

Experience and understanding are not the same thing. Repeating the same mistakes for twenty years is not twenty years of education.

Both Sexes Have Something to Learn

There is a great deal to learn about female sexual function, and both sexes would benefit from studying it.

Do not assume that being female automatically makes someone fully informed about female sexuality. Do not assume that being male—or sexually experienced—makes someone knowledgeable about a woman’s pleasure.

Education should flow in both directions. A woman can teach her partner, and an informed man can share something his partner has not encountered. When one person knows something the other does not, explain it kindly, share trustworthy educational material, and explore the subject together.

There is no shame in not knowing. Make it comfortable to ask questions and change your understanding.

But distinguish between sharing knowledge and claiming authority over someone else’s experience. You can explain an anatomical fact; you cannot tell another person what they must enjoy.

Study the subject together, then learn each other.

Alex Grendi’s Lesson Subjects—with Video Links

These are selected lessons, not a complete catalogue. The linked titles identify the videos; their promotional wording should not be mistaken for guaranteed results.

Lesson subject	Video
Kissing	How to French Kiss Like a Pro! (Step By Step Guide).
Massage and unhurried touch	Sensual Massage Mastery: 7 Moves That Will Make Her Scream!.
Clitoral stimulation	Clitoris Stimulation Mastery: 9 Moves That Will Make Her Scream!.
G-spot-focused stimulation	G-Spot Stimulation Mastery: 7 Moves That Will Make Her Scream!.
Breast stimulation	Breast Play 101: How To Drive Her Wild With Pleasure.
Oral sex and female pleasure	How to Eat Her Out: 5 Tips for AMAZING Oral Sex.
Movement and pacing during intercourse	Thrust Like This to Last Longer During Sex.
Ejaculation control	How to Last Longer During Sex Naturally.
Masturbation habits and partnered sexual function	7 Masturbation Hacks for Men to Last Longer in Bed.
Pelvic-floor exercises	Try THESE Kegel Exercises To LAST LONGER in Bed.
Performance anxiety	How To Overcome Performance Anxiety In The Bedroom (Simple Techniques).
Erection difficulties—his proposed coaching approach	How To Cure Erectile Dysfunction FAST (& For Good!). The “cure” wording is his title, not a medical conclusion established here.
Squirting	6 Steps to Give Her a Squirting Orgasm.
Multiple orgasms in men	Multiple Orgasms for Men (3 Biggest Tricks & DEMO).
Communication, feedback, shame, and sexual expectations	Sex: How to Be Better at It and Get More of What You Want—his Order of Man video interview. The publisher specifically lists asking for feedback and communicating one’s own desires among the subjects discussed.

Use these videos to identify subjects worth learning about, not as instructions that every partner must follow. Learn from the educator; listen to the person you are with.

Think Beyond the Few Minutes of Intercourse

Do not save all your warmth and attention for the moment you want sex.

Put the phone away. Be interested in her day. Offer affection without immediately demanding something in return. Flirt. Give a sincere compliment. Make room for anticipation.

The point is not to spend hours completing a checklist. It is to stop treating everything before intercourse as an obstacle to the main event.

Make the whole experience the main event.

Give affection freely, not as a down payment that obligates your partner to have sex. The aim is a mutually desired experience—not collecting a debt.

Ask, Listen, and Adjust

A video cannot tell you what your particular partner enjoys. Ask.

“What feels good to you?” and “Would you like something different?” are more useful starting points than “Wasn’t that great?”

Listen without getting defensive. When your partner suggests a change, welcome the information rather than treating it as a failing grade.

Feedback is information, not an insult.

Share your own preferences, too. Neither partner should have to guess everything or carry the entire responsibility for teaching, initiating, and creating a satisfying experience.

Replace the Stopwatch With Attention

Do not turn intimacy into an endurance contest. Do not demand a particular orgasm, a dramatic reaction, or a performance that resembles a video.

Pay attention to comfort, enthusiasm, and enjoyment. Be willing to slow down, change direction, or stop. Do not assume that your own climax automatically marks the end of the shared experience.

Keep medical problems separate from performance promises. Persistent erection difficulties can involve physical conditions, medication effects, or psychological factors; they warrant appropriate medical assessment rather than an assumed quick cure from a video.

The goal is not to prove that you know every technique. It is to help create an experience both people enjoy and look forward to repeating.

Less ego. More study. Better communication.

Don’t mistake your relief for mutual satisfaction. Learn enough to contribute, listen enough to adapt, and give the whole experience the attention it deserves.

 

Thrive Now: What Attraction Is Really Seeking

Attraction has biological roots. Many women are drawn to men who signal strength, confidence, competence, and the ability to protect and provide. Many men are drawn to women who signal health, warmth, and the capacity to nurture.

Runway fashion is different from everyday attraction. Models are chosen to display clothing—not to represent everyone’s romantic ideal.

Appearance may open the door, but feelings decide what happens next. People want partners who make life better: someone supportive, peaceful, affectionate, and dependable.

My advice to my younger self: look beyond beauty. Choose the person who brings out your best—and become that person for someone else.

Thrive Now, Advice to Your Younger Self, Relationships: The Law of Social Equity

 Successful couples usually perceive themselves as bringing roughly equal total value to the relationship—but that value does not have to come from the same qualities. A wealthy, successful man who is not conventionally handsome may attract a beautiful woman of modest means. A handsome young man without money may attract someone because of his looks, intelligence, confidence, humor, ambition, or future potential.

This is what is called the Law of Social Equity: relationships are most stable when both partners believe the exchange is reasonably balanced.

When one partner’s perceived social value changes dramatically, the relationship may change with it. Imagine two struggling actors waiting tables together. If one suddenly lands a million-dollar role and becomes famous, the couple’s balance is disrupted. The relationship may survive, but it will face pressures that did not previously exist. As Marilyn Monroe’s modeling career took off, for example, her marriage to merchant seaman James Dougherty ended.

Celebrity may be the most powerful form of social status. It can make even destructive or dangerous people strangely attractive, which helps explain why notorious imprisoned killers sometimes receive love letters and marriage proposals.

Money—and the realistic prospect of earning it—is another powerful source of attraction. Future earning potential is suggested not merely by intelligence, but also by discipline, ambition, judgment, competence, and social skill. Wit can be especially attractive because a clever, unexpected remark displays intelligence in real time. That is different from incessant clowning, which may make a person appear immature or desperate for attention.

Physical attractiveness also matters. A handsome face, a healthy body, good grooming, and confident posture can substantially increase perceived value. Much of male competition for achievement, status, money, and physical fitness is connected, at least partly, to the desire to attract desirable partners.

The greatest losses of relationship value often come from untreated destructive behavior: criminal conduct, addiction, uncontrolled aggression, or severe psychiatric symptoms that a person refuses to address. A diagnosis alone does not make someone unlovable. Refusing treatment while repeatedly harming or frightening a partner does. Even a devoted partner eventually reaches a limit.

The lesson is not to treat love as a cold financial transaction. It is to understand that attraction responds to value, stability, and change. Develop the qualities within your control: health, competence, humor, reliability, ambition, kindness, and sound judgment. Then choose someone who values what you bring—and whose contributions you genuinely value in return.

Thrive Now: Advice to My Young Self—Start Investing Now

 If I could give my younger self one piece of financial advice, it would be simple:

Start investing your savings immediately.

Do not wait until you earn more. Do not wait until you understand every financial term. Do not wait for the “right time” to enter the market. The great advantage of being young is not having a large income. It is having time.

Let Time Do the Work

Money invested today may have 40, 50, or even 60 years to grow. Over that enormous span, the Dow Jones Industrial Average may rise to many times its present level—perhaps even 200 times its current value during an exceptionally strong period.

That is not a prediction or guarantee. It illustrates the astonishing potential of long-term compounding. Small amounts invested early can become more valuable than much larger amounts invested late.

Your first dollars may be the most important dollars you ever invest.

You Do Not Have to Become a Stock Expert

If you enjoy studying businesses, accounting, and financial markets, learn how to evaluate individual investments carefully.

If you do not want to make investing a hobby, you do not have to. Consider putting your long-term savings into a low-cost, broadly diversified index fund. An index fund spreads your money among many companies instead of depending on your ability to select one future winner.

The SEC explains that index funds generally follow a passive strategy and may offer lower expenses, although investors should always examine a fund’s actual fees and risks. Even apparently small fees can substantially reduce returns over several decades. (Investor.gov)

Use a tax-advantaged retirement account when one is available. If your employer offers matching contributions, try to contribute enough to receive the entire match. Otherwise, you are leaving part of your compensation behind.

The Most Important Rule: Do Not Panic

The stock market will fall. Sometimes it will fall sharply. Headlines will predict disaster. Commentators will announce that everything has changed. Your account balance may drop so quickly that you feel physically sick.

That is when many inexperienced investors make their most damaging mistake: they sell after prices have already fallen.

A temporary decline becomes a permanent personal loss when you panic and sell low. FINRA notes that passive, periodic investing can help people avoid emotional reactions and abandoning their plans during volatility. (FINRA)

Do not treat a falling account statement as proof that your plan has failed. If you own a diversified index fund for a distant retirement, remember why you bought it.

Your younger self should follow a simple rule:

Do not sell merely because the market frightened you.

Big Drops Can Be Buying Opportunities

When stores reduce prices, customers celebrate. When the stock market reduces prices, many investors run away.

Young investors should think differently. A major decline allows each new contribution to purchase more shares. If you still have decades before retirement, a broad market drop may be an opportunity to invest more—not a signal to flee.

During a large decline, invest as much additional money as you can genuinely spare. “Spare” is the essential word. Keep an emergency fund. Pay your necessary expenses. Do not invest the rent money, borrow recklessly, or use money you will soon need.

No one can identify the exact bottom. Do not try. Continue buying regularly, and consider increasing your contributions when prices are substantially lower.

Make Investing Automatic

The best investment plan is often boring:

1. Build an emergency reserve.

2. Pay off extremely expensive debt.

3. Contribute regularly to a retirement account.

4. Choose a diversified, low-cost index fund appropriate for your time horizon.

5. Automate every contribution.

6. Increase the amount whenever your income rises.

7. Refuse to panic during market declines.

8. Leave the money alone for decades.

You will see bubbles, crashes, recessions, wars, elections, scandals, and frightening predictions. You will repeatedly hear convincing reasons why “this time is different.”

Your greatest advantage will not be knowing the future. It will be refusing to let fear destroy a long-term plan.

The Gift Your Younger Self Can Give You

A young person may think that $25, $50, or $100 is too little to matter. That is backward. The amount can grow, but lost time can never be recovered.

Start with what you have. Add to it whenever you can. Buy broadly. Keep costs low. Let dividends and gains compound. When the market falls, keep your head—and, if your finances permit, buy more.

Then allow your older self to receive the gift that only your younger self could provide: decades of uninterrupted growth.

This article provides general financial education, not individualized investment advice. Index funds can lose value, and past market performance does not guarantee future results.

Thrive Now, Advice to Young Self: A Great Kisser Pays Attention: The Back-Scratch Lesson

 Teen advice about kissing usually focuses on lips, technique, and avoiding awkward mistakes. But what often makes affection memorable is much simpler: noticing what would make the other person feel comfortable.

Suppose you are making out and your partner mentions that their back is itchy or dry. Because the back is difficult to reach, gently scratching the itchy area can be surprisingly soothing. You might say:

“Show me where it itches. Do you want me to scratch it gently?”

Use clean, short fingernails and moderate pressure. The goal is to relieve an itch—not leave scratches or marks. Ask whether the pressure feels right instead of assuming.

If the skin is dry, you could also offer:

“Would you like me to put some moisturizer on your back? It’s hard to reach that spot yourself.”

Applying moisturizer can be affectionate because it combines physical closeness with genuine care. Use a plain, fragrance-free moisturizer when possible, warm it between your hands, and rub it in gently. Do not apply products to broken, painful, or badly inflamed skin, and never use someone else’s prescription cream.

The larger lesson is that being good at affection is not about performing a complicated technique. It is about paying attention, communicating, and responding to the other person as an individual. A considerate partner notices discomfort, asks before touching, listens to the answer, and adjusts.

Not everyone will want their back scratched or moisturizer applied. Some people dislike certain sensations, have sensitive skin, or simply do not want that kind of touch. A brief question preserves the caring nature of the gesture:

• “Would that feel good?”

• “Is this pressure okay?”

• “Do you want me to stop?”

• “Would you rather have lotion?”

If the itching is severe, keeps returning, disturbs sleep, or comes with a rash, swelling, bleeding, or signs of infection, scratching is not the solution. The person should tell a parent, school nurse, pharmacist, or healthcare professional.

A back scratch may sound like a small thing—and it is. But healthy relationships are largely made from small things: noticing, asking, helping, and respecting the answer. The best affection communicates, “I enjoy being close to you, and I care whether you are comfortable.”

Medicine in Failure: The Broken Hospital Window: Why Eliminating Healthcare Waste Makes America Richer

 

Proposals to cut healthcare costs are often described as if hundreds of billions of dollars could simply be erased from an accounting ledger. That is not what happens.

Every dollar of healthcare spending becomes revenue for somebody: a hospital, physician, pharmaceutical company, insurer, law firm, landlord, billing contractor, construction company or government agency. Cutting $300 billion in costs means that some of those recipients will earn less. Offices will close. Buildings will lose tenants. Some jobs will disappear.

That disruption is real. But it does not follow that waste is valuable merely because someone is paid to produce it.

If a preventable medical error inflicts terrible pain on a patient and the hospital then bills $500,000 to repair the damage, measured gross domestic product increases. Economically, however, the country is poorer. The patient has suffered, the family has been disrupted, work has been lost and scarce medical resources have been consumed repairing an injury that should never have occurred.

This is the healthcare version of the broken-window fallacy: breaking a window creates employment for the glazier, but society would have been richer if the window had never been broken.

What does “saving $300 billion” actually mean?

The reform program previously proposed identified approximately $300 billion in potential annual economic benefits. But that figure contains three very different categories:

Category	Estimated annual value	Practical meaning
Expenditures and property losses avoided	$100B–$140B	Revenue actually disappears
Worker and clinician productivity recovered	$140B–$150B	Existing people produce more useful work
Value of lives and health preserved	Potentially $1.5T or more	Social value, not a government budget saving

Only the first category directly eliminates existing spending. Productivity improvements do not necessarily fire anyone. They allow the same workforce to treat more patients, reduce waiting times or spend more time on useful care.

The value of a life saved is not money transferred to the government. It is the economic value society places on reducing the risk of death, pain and disability.

These categories must be kept separate. Otherwise, an economic benefit is falsely presented as a budget saving, or a real reduction in revenue is falsely presented as painless efficiency.

Could healthcare reform eliminate one million jobs?

Potentially—but not necessarily, and certainly not all at once.

The private healthcare sector employs approximately 18.5 million people, including about 9.2 million in ambulatory care, 5.8 million in hospitals and 3.5 million in nursing and residential facilities. (Bureau of Labor Statistics)

At a fully loaded employment cost of $80,000 to $100,000:

• Eliminating $40 billion in payroll corresponds to approximately 400,000 to 500,000 positions.
• Eliminating $70 billion corresponds to approximately 700,000 to 875,000 positions.
• Eliminating one million $100,000 positions would reduce annual costs by approximately $100 billion.

Because only a portion of the $100 billion to $140 billion in direct savings consists of payroll, the initial employment effect would probably be several hundred thousand positions rather than an automatic one million layoffs.

A comprehensive restructuring could eventually approach one million affected jobs when employment in insurance, billing, law, pharmaceutical marketing, commercial real estate, automobile repair, construction and criminal justice is included.

But “affected” does not necessarily mean fired. BLS projects approximately 1.9 million healthcare occupational openings every year, including openings created when workers retire or leave their occupations. A five-year transition could therefore eliminate many unnecessary positions by declining to replace departing workers while transferring others into understaffed patient-care services. (BLS Occupational Outlook)

Which jobs would contract?

The greatest reductions should occur in activities that exist because the system is unnecessarily expensive and complicated:

• Billing, coding and claims processing
• Prior authorization and repetitive utilization review
• Manual medical-record transcription and clerical documentation
• Defensive tests and procedures performed primarily because of litigation risk
• Malpractice litigation and expert-witness services
• Pharmaceutical sales, marketing and monopoly-protection activities
• Duplicate management and compliance departments
• Reception, parking and facility operations for visits that can safely occur through telehealth
• Treatment and rehabilitation required by preventable medical injuries
• Emergency, correctional and legal activity associated with preventable addiction and drug crime
• Automobile repair and medical treatment resulting from preventable crashes

Some clinical jobs would also be affected. If unnecessary procedures disappear, clinicians and facilities that derive revenue from those procedures will lose income. A serious cost-reduction policy cannot promise that every existing provider will retain the same revenue.

The relevant distinction is not between healthcare workers and administrative workers. It is between activities that improve patients’ lives and activities that consume money without producing comparable benefit.

Offices and buildings would close

Telehealth, AI-generated documentation, fewer unnecessary appointments and better prevention would reduce the need for physical facilities.

More than three million people currently work in physicians’ offices, and approximately 1.2 million work in outpatient centers. (BLS)

The likely consequences would include:

• Consolidation of medical offices
• Nonrenewal of commercial leases
• Smaller waiting rooms and administrative suites
• Fewer new medical-office buildings
• Reduced demand for reception, parking, security, cleaning and utilities
• Conversion of surplus offices into housing or other commercial uses
• Lower values for buildings designed around high-volume office attendance

Patients would save travel time, fuel, parking fees and unpaid time away from work. Personnel could be paid more from money previously spent maintaining buildings that contribute nothing to the outcome of a remote encounter.

The cost of a building is not free merely because it is included in the physician’s overhead and ultimately hidden inside an insurance premium.

Hospitals would lose revenue by becoming safer

Preventing medical errors means fewer additional hospital days, repeat operations, infections, readmissions and rehabilitation admissions.

Under fee-for-service payment, a hospital can earn more revenue when a patient develops an expensive complication. The institution may not have caused the complication intentionally, but the payment structure rewards additional activity rather than prevention.

A successful safety program would therefore produce:

• Fewer occupied beds
• Reduced revenue from treating preventable complications
• Closure or consolidation of persistently underused units
• Reduced demand for some procedural and rehabilitation capacity
• Repurposing of beds for psychiatric care, long-term care and other unmet needs
• Greater use of payment based on outcomes rather than the number of services delivered

A safer hospital could report lower revenue and make a smaller contribution to measured GDP while producing vastly greater human value.

Revenue is not health. Expenditure is not success.

The disruption would extend beyond hospitals

Healthcare reform would affect industries throughout the economy.

Law firms would lose malpractice revenue. Insurers would require fewer claims processors and prior-authorization employees. Drug companies would lose some monopoly income. Commercial landlords would lose medical tenants. Construction companies would build fewer medical offices. Automatic braking would reduce automobile-repair work. Successful addiction prevention would reduce demand for emergency care, policing, courts and correctional facilities.

Local communities dependent upon a large hospital or medical complex could experience substantial economic disruption. Commercial property values and local tax receipts could fall.

Those effects should be acknowledged rather than concealed. But preserving preventable disease to support local employment would be equivalent to preserving automobile crashes to support body shops.

Workers deserve transitional assistance. Waste does not deserve permanent protection.

A responsible employment transition

Reform should be implemented over several years and include:

• Attrition and hiring reductions before involuntary layoffs
• Transfer of workers into nursing, primary care, psychiatry, home care and elder care
• Retraining for medical-safety investigation and direct patient assistance
• Temporary wage insurance and relocation assistance
• Conversion of surplus medical buildings into housing
• Sharing administrative and facility savings with frontline personnel
• Public reporting showing whether savings reached patients and taxpayers

The goal should not be unemployment. It should be moving labor from the machinery of billing, error and illness into useful care and other productive industries.

What is the economic value of preventing fatal medical errors?

The number of preventable hospital deaths remains disputed.

A modern systematic review estimated approximately 22,165 preventable inpatient deaths annually. The older Institute of Medicine estimate ranged from 44,000 to 98,000. Much higher estimates have been published, but they are too uncertain to use as the principal basis for national calculations. (PubMed, AHRQ Patient Safety Network)

The Department of Transportation currently uses $14.2 million as its 2025 value of a statistical life. This is not the price of an identifiable person or a proposed payment to a family. It measures the aggregate value people place on reducing mortality risks. (Department of Transportation)

At $14.2 million per life:

Preventable deaths	Economic value
22,165	$315 billion
44,000	$625 billion
75,000	$1.065 trillion
98,000	$1.392 trillion

If an aviation-style safety program eliminated 90% rather than literally every preventable fatal error, approximately 19,949 to 88,200 lives would be preserved annually.

Their gross statistical value would be approximately $283 billion to $1.25 trillion.

But survivors will require future healthcare

A complete calculation must include the additional medical care used during the years of life preserved.

Assume:

• Each survivor lives ten additional years.
• Medical spending averages $25,000 annually.
• Future costs are discounted at 3%.

The present value of that future spending is:

[
$25,000 \times 8.53=$213,255
]

The net value per life saved is therefore:

[
$14,200,000-$213,255=\boxed{$13,986,745}
]

Future medical spending reduces the standard statistical value by only about 1.5%.

Death estimate	Lives saved at 90%	Gross value	Future healthcare	Net value
22,165	19,949	$283.3B	−$4.3B	$279.0B
44,000	39,600	$562.3B	−$8.4B	$553.9B
75,000	67,500	$958.5B	−$14.4B	$944.1B
98,000	88,200	$1.252T	−$18.8B	$1.234T

The major uncertainty is not future medical spending. It is how many deaths are genuinely preventable and how long those patients would otherwise have lived.

A more conservative life-years calculation

Many hospital patients are older or already seriously ill. Critics may therefore object to applying the full population-average statistical-life value.

A conservative alternative values only the additional years actually preserved.

HHS uses a central estimate of approximately $495,000 per statistical life-year in sensitivity analysis. Subtracting $25,000 in annual healthcare spending leaves a net annual benefit of $470,000. The discounted value over ten years is:

[
($495,000-$25,000)\times8.53
=\boxed{$4.009\text{ million per survivor}}
]

Using this method:

Preventable-death estimate	Lives saved at 90%	Conservative net value
22,165	19,949	$80.0B
44,000	39,600	$158.8B
75,000	67,500	$270.6B
98,000	88,200	$353.6B

HHS also uses approximately $591,000 as its central value per quality-adjusted life-year, allowing analysts to value reductions in disability, pain and impaired functioning. (HHS standard values)

Even under the conservative life-years approach, approaching aviation-level medical safety produces between $80 billion and $354 billion in net annual value from fatal errors alone.

Injury and pain create additional losses

Deaths are only part of the medical-error burden. Federal investigators found that approximately 13% of hospitalized Medicare patients experienced preventable harm in the month studied. (HHS Office of Inspector General)

Preventable injuries can cause:

• Permanent neurological disability
• Loss of mobility or independence
• Additional operations
• Hospital-acquired infections
• Amputations and organ damage
• Months or years of severe pain
• Inability to work
• Family caregiving
• Depression, anxiety and traumatic memories

If preventing medical errors restored 100,000 quality-adjusted life-years, the HHS central valuation would be approximately $59 billion. Restoring 500,000 would be worth approximately $296 billion.

A reliable national estimate of error-related QALYs does not yet exist, so these are illustrations rather than proven savings. Nevertheless, any calculation limited to deaths necessarily understates the complete burden.

Returning patients to productive work

Patients who avoid death or disability can return to work, produce goods and services, pay taxes and support their families. Caregivers also regain time.

The calculation is:

[
\text{Workers restored}
\times
\text{annual output}
\times
\text{remaining work years}
]

For example:

Workers restored	Annual output	Work years	Production restored
10,000	$75,000	10	$7.5B
25,000	$75,000	10	$18.75B
50,000	$75,000	10	$37.5B

These earnings should be reported separately rather than automatically added to the statistical value of life, which already reflects much of the value people place on continued living and working. Otherwise, the analysis would double-count part of the benefit.

For government budgeting, however, increased payroll and income-tax receipts and reduced disability payments are legitimate separate fiscal effects.

Future health spending is not a reason to tolerate death

It is true that a dead patient incurs no future Medicare costs. It is equally true that the patient produces no future work, purchases no goods, pays no taxes, enjoys no relationships and experiences no additional life.

Saving a person may increase future Social Security and medical spending. That is a fiscal cost, but it is not proof that death is economically desirable.

Healthcare used during additional years of worthwhile life is not the same as healthcare wasted repairing a preventable injury. One buys health and longevity. The other attempts to restore what an avoidable mistake destroyed.

The correct equation is:

[
\begin{aligned}
\text{Net benefit}={}&
\text{value of deaths prevented}\
&+\text{value of disability and pain prevented}\
&+\text{direct error-treatment costs avoided}\
&+\text{production restored}\
&-\text{safety-program costs}\
&-\text{future healthcare consumed}
\end{aligned}
]

Using the lowest modern death estimate, a 90% reduction produces:

• Approximately $279 billion under the standard federal statistical-life method after future healthcare costs
• Approximately $80 billion under the conservative ten-year life-years method
• Another $26 billion to $45 billion in potentially avoidable treatment costs
• Additional, presently unquantified value from preventing nonfatal injury, pain and disability

Under the older high death estimate, the standard net mortality benefit exceeds $1.2 trillion annually.

Who should receive the savings?

Savings do not automatically reach the public. They can be retained by insurers, hospital systems or intermediaries unless policy determines where they go.

A proper reform should require:

• Medicare and Medicaid savings to reduce taxes, deficits or beneficiary costs
• Private-insurance savings to reduce premiums or produce rebates
• Employer-plan savings to increase wages or reduce employee contributions
• Administrative and building savings to increase frontline compensation
• Generic-drug savings to reach consumers rather than being captured by intermediaries
• Public reporting of savings, layoffs, facility closures and patient outcomes

The people who bear the disruption should be visible, but so should the people currently paying for waste through taxes, premiums, lower wages, pain, disability and premature death.

The bottom line

Cutting healthcare costs is not painless. Several hundred thousand positions could eventually disappear or never be created. Medical offices and hospital units would close. Landlords, law firms, billing companies, insurers and drug manufacturers would lose revenue.

That is the unavoidable meaning of eliminating real spending.

But waste does not become economically valuable because it employs people. A system that injures patients and then employs thousands of people to treat, bill and litigate the injuries is not creating wealth. It is consuming wealth while imposing suffering.

The right objective is not to preserve every existing healthcare dollar. It is to preserve every activity that produces more health than it costs, eliminate activities that do not, compensate workers during the transition and return the resulting savings to patients and the public.

Preventing medical errors alone could create $80 billion to more than $1.2 trillion in annual net value, depending on the death estimate and valuation method—even after paying the future healthcare costs of the people whose lives are saved.

That is not austerity. It is exchanging preventable suffering for longer lives, greater production and a richer country.

Medicine in Failure: The $300 Billion Prevention Dividend: What These Health Reforms Could Save America

America spent approximately $5.3 trillion on health care in 2024—more than $15,000 per person. Yet enormous sums still purchase avoidable injuries, repetitive paperwork, unnecessary procedures, preventable addiction, litigation overhead and painful treatment that offers dying patients no meaningful benefit. (CMS)

A reasonable accounting of the reforms proposed here identifies approximately:

• $100 billion to $140 billion a year in potentially avoidable expenditures and property losses

• $140 billion to $150 billion in recovered productivity and professional capacity

• A core tangible economic opportunity of roughly $245 billion to $290 billion a year

• Additional liability and payment-integrity reforms that could bring the practical target to approximately $300 billion annually

• $1.5 trillion to $2.5 trillion in broader annual social value when the economic value of lives and healthy years preserved is included

The distinction is essential. A life saved has immense economic value, but it does not deposit that value into the Treasury. Likewise, freeing a physician from unnecessary typing creates productive capacity, but it becomes cash savings only if the capacity is actually redeployed.

The estimates below therefore separate expenditures avoided, productivity recovered and the broader economic value of better health.

Reform	Plausible annual tangible benefit	What the estimate represents
Reduce drug-related harm toward Singapore’s rate	About $198 billion	Approximately $65B in health, treatment and justice costs; $134B in productivity
Near-zero preventable medical error	$26B–$45B	Avoidable treatment and hospital costs
Automatic emergency braking and vehicle intervention	More than $5B	Primarily property damage, before valuing lives and injuries
Bedside urinals and nighttime fall prevention	$5B–$15B	Scenario based on preventing 5%–15% of older-adult fall costs
Early palliative care and limits on nonbeneficial treatment	$3B–$7B	Gross hospital savings under a scaled implementation scenario
AI-generated encounter documentation	$8B–$17B	Recovered clinical capacity, not necessarily reduced spending
Liability and defensive-medicine reform	$18B–$35B	Partial realization of an older addressable-cost estimate
Payment-integrity enforcement	$19B–$38B	Scenario capturing 20%–40% of identified improper-payment exposure
Patent, approval, outcome-payment and genetic reforms	Not counted	Too dependent on policy design and future technologies

These figures should not simply be added together. Defensive medicine, payment errors, preventable harm and low-value treatment overlap. The defensible conclusion is not that every theoretical dollar can be collected. It is that a $300 billion annual prevention dividend is a credible national objective.

Make medical error as exceptional as an airline catastrophe

The most important reform is to treat every serious preventable medical injury as aviation treats a crash: investigate it independently, identify every contributing system failure, publish de-identified findings and require corrective action.

Federal investigators found that approximately one-quarter of hospitalized Medicare patients experienced some form of harm in one studied month. About 13% experienced harm judged preventable. (HHS Office of Inspector General)

Older studies estimated the direct annual cost of measurable preventable hospital errors at approximately $17 billion to $29 billion. Adjusted roughly into 2026 dollars, that is about $26 billion to $45 billion. (Commonwealth Fund, AHRQ Patient Safety Network)

That estimate excludes much of the lost work, disability, family caregiving and economic value of premature deaths. A modern meta-analysis estimated approximately 22,000 preventable inpatient deaths annually, while earlier national estimates ranged as high as 75,000 to 98,000. (PubMed, AHRQ Patient Safety Network)

Using a standard regulatory value of a statistical life, those deaths represent roughly $300 billion to more than $1 trillion in annual social loss. That is not a medical bill and should never be represented as budget revenue. It is the economic measure government agencies use when deciding whether safety regulations are worth their cost.

The reform should include protected reporting. Findings disclosed completely to an independent safety authority—and published in de-identified form—should generally be protected from use as admissions in civil litigation. Concealment, alteration of records and failure to report would remain punishable. The purpose is to make truthful investigation safer than silence.

Replace the malpractice lottery with dependable patient compensation

The present malpractice system is costly, slow and unreliable. One major study found that approximately 54 cents in administrative expense was generated for every dollar paid as compensation, including legal fees, experts and court costs. (New England Journal of Medicine study)

A better system would provide:

• Prompt administrative compensation for qualifying medical injuries

• Published compensation schedules with additions for exceptional losses

• Independent medical adjudication

• Payment of reasonable representation costs separately from patient compensation

• Preservation of court remedies for intentional wrongdoing, concealment and extreme misconduct

This would distribute compensation more consistently among injured patients instead of concentrating large awards among the comparatively small number who find representation and prevail after years of litigation.

It could also reduce defensive medicine. A national analysis estimated medical-liability-system costs at $55.6 billion in 2008, including $45.6 billion attributed to defensive medicine. In approximate 2026 dollars, the latter would exceed $70 billion. (Health Affairs)

It would be unrealistic to assume that every dollar disappears. If reform eliminated only one-quarter to one-half of the old inflation-adjusted defensive-medicine estimate, the potential benefit would be approximately $18 billion to $35 billion annually. Because some of this spending overlaps other categories, it should be treated as supporting evidence for the $300 billion target rather than automatically added to it.

Stop paying for time, typing and unnecessary activity

Health care often pays for measurable activity instead of useful results. A clinician who recognizes a dangerous condition in two minutes may create more value than one who conducts a routine 20-minute encounter. Payment should recognize diagnostic skill, complexity, appropriate follow-up and outcomes—not merely elapsed time.

At the same time, clinicians should not spend large portions of their days typing information that can be generated from the encounter itself. With patient notice and appropriate privacy protections, encounters can be recorded, transcribed and converted into draft notes, orders and patient instructions. The clinician must remain responsible for reviewing and signing the record.

Controlled studies of ambient AI documentation have found reductions in time spent writing notes and improvements in burnout measures, although safety review remains necessary. (JAMA Network Open, randomized trial)

If one million clinicians recovered only 15 to 30 minutes per working day, the country would regain roughly 55 million to 110 million professional hours annually. At an illustrative value of $150 per clinical hour, that is $8 billion to $17 billion in productive capacity.

This is not automatically a reduction in national health spending. The gain appears when the recovered time is used to see more patients, reduce staffing requirements, shorten waiting lists or improve safety.

Treat knowingly unnecessary billing as a compliance offense

A medically appropriate decision not to perform a test must be safe legally. Conversely, knowingly billing for services that are not medically necessary should be treated as a serious payment-integrity violation.

A fair enforcement system should distinguish mistakes from repeated misconduct:

1. Correct the first substantiated violation and provide education.

2. Issue a formal warning and repayment demand for the second.

3. Apply prosecution or substantial administrative penalties to the third knowing violation and subsequent violations.

Fraud, falsified records and intentional patient harm should not receive warnings.

In fiscal year 2025, CMS reported approximately $94 billion in gross improper payments across Medicare fee-for-service, Medicare Advantage, Part D and Medicaid. Improper payments are not synonymous with fraud; many involve insufficient documentation or other payment errors. (CMS)

Preventing or recovering 20% to 40% of that exposure would represent approximately $19 billion to $38 billion annually. Some of it overlaps unnecessary-care and defensive-medicine estimates, so it should not be counted twice.

Capture the enormous economic benefit of preventing addiction

Drug-use disorders cause medical spending, treatment costs, policing, incarceration, disability, absenteeism, impaired work, accidents and premature death.

A comparison using Global Burden of Disease rates indicates that if the United States matched Singapore’s age-standardized drug-use-disorder mortality rate, annual deaths could fall by roughly 70,000, while more than six million disability-adjusted healthy years could be preserved. (Journal of Global Health)

Applying those proportional reductions to a detailed US estimate of the opioid-use-disorder and fatal-overdose burden produces an illustrative annual benefit, in approximate 2026 dollars, of:

• $65 billion in avoided health, treatment and criminal-justice costs

• $134 billion in recovered productivity

• Approximately $1.16 trillion in the economic value of preserved life and health

The underlying US cost study estimated a 2017 opioid burden exceeding $1 trillion, most of which was the value of premature death and reduced quality of life. (CDC, peer-reviewed cost analysis)

This is a counterfactual, not proof that punishment alone produces Singapore’s outcomes. Singapore differs from the United States in geography, enforcement certainty, social conditions, health services and drug-market access. A successful American policy would need prevention, rapid treatment, recovery support and consistent enforcement—not severity without effectiveness.

Nevertheless, the scale is unmistakable: addiction prevention is potentially the largest individual component of the tangible prevention dividend.

Prevent nighttime falls with simple equipment

Falls among older Americans generate approximately three million emergency-department visits and one million hospitalizations annually. A CDC-supported analysis estimated $80 billion in nonfatal fall-related medical expenditures in 2020, equivalent to roughly $103 billion in 2026 dollars. (CDC, cost study)

Toileting is a significant contributor to inpatient falls, particularly when older patients attempt to walk without assistance at night. (PubMed)

Bedside male and female urinals, safe disposable liners, lighting, handrails, medication review and scheduled assistance should therefore be routine options—not objects of embarrassment. If such measures prevented only 5% to 15% of national older-adult fall costs, gross medical savings could approach $5 billion to $15 billion annually.

That range is a policy scenario, not the measured effect of urinals alone. It should be tested in hospitals, nursing facilities and home-health programs before national savings are booked.

Let vehicles intervene before a collision

Automatic emergency braking and related driver-assistance systems can detect rapidly rising crash risk and intervene before a human reacts.

The National Highway Traffic Safety Administration estimates that its automatic-emergency-braking requirement will save at least 360 lives, prevent approximately 24,000 injuries and avoid more than $5 billion in property damage each year. (NHTSA)

The $5 billion is a tangible annual saving. The value of the lives preserved adds approximately another $5 billion in social benefit, before counting prevented injuries, medical treatment, emergency response, traffic disruption and lost work.

Replace futile treatment with honest end-of-life care

Care near death is not automatically wasteful. Many treatments relieve suffering or provide valuable time. But invasive treatment that has no reasonable prospect of achieving a patient’s goals can inflict pain while consuming hundreds of thousands of dollars.

Early palliative-care consultation has been associated with lower direct hospital costs. A meta-analysis found an average reduction of approximately $3,237 per admission in 2015 dollars when palliative care began within three days. (JAMA Internal Medicine) A Medicare demonstration also reported lower net spending and fewer hospital admissions among participating beneficiaries. (CMS)

If early consultation and enforceable advance-care planning reached one million suitable high-risk admissions, gross savings could be approximately $4 billion to $5 billion annually. A broader implementation might produce $3 billion to $7 billion, depending on eligibility and program cost.

This policy must never become forced undertreatment. The governing standard should be informed patient preference, realistic prognosis, symptom relief and independent review—not age, disability or a family’s wealth. Some palliative-care programs improve care without lowering spending, so savings should remain a secondary objective rather than the bedside decision rule.

Shorten monopoly periods without weakening safety review

A five-year effective post-approval exclusivity period would bring generic or biosimilar competition forward for many products. A presumptive six-month review deadline could also force agencies to identify specific deficiencies promptly rather than allowing applications to remain unresolved.

But these two reforms have different budget effects.

Earlier generic competition could produce large savings. As a simple illustration, if a medicine has $10 billion in annual sales and competition reduces its net price by 80%, beginning competition five years earlier could generate as much as $40 billion in gross savings over those five years.

Faster approval, however, does not necessarily reduce spending. It may bring an expensive but valuable treatment to patients sooner. The gain may appear in longer life, avoided disability or future medical savings rather than an immediate reduction in the drug budget.

Any redesign must also preserve sufficient incentives for expensive, high-risk research. A better policy would tie exclusivity to the date of actual approval, require transparent development-cost evidence for extensions and reward therapies according to demonstrated clinical value.

Invest in cures—but do not pretend the savings have already arrived

Public investment in gene engineering for familial hypercholesterolemia, inherited cardiomyopathies, sickle-cell disease and other familial chronic conditions could eventually replace decades of medication, hospitalization and disability with a one-time intervention.

That is potentially transformational. It is not an immediate budget cut.

Research programs require substantial upfront public spending, and early gene therapies can be extraordinarily expensive. For that reason, no speculative genetic-engineering savings are included in the $300 billion target. The investment should be judged by long-term cost per healthy year gained, durability of benefit and whether public financing produces affordable public access.

The honest bottom line

A prudent annual accounting is:

• Avoidable medical, treatment, justice and property expenditures: approximately $100 billion to $140 billion

• Recovered worker and clinician productivity: approximately $140 billion to $150 billion

• Core tangible economic benefit: approximately $245 billion to $290 billion

• Practical national target after carefully designed liability and payment reforms: approximately $300 billion a year

• Ten-year tangible opportunity, before growth and discounting: roughly $2.5 trillion to $3 trillion

• Broader annual social value, including lives and healthy years preserved: approximately $1.5 trillion to $2.5 trillion

These are gross opportunities. Implementation costs—treatment capacity, safety investigators, compensation administrators, equipment, software, enforcement, palliative teams and research—must be deducted. Results must also be measured so that overlapping savings are never counted twice.

A major review previously estimated total US health-system waste at $760 billion to $935 billion annually, with interventions then available potentially saving $191 billion to $286 billion. (JAMA) That provides a useful reality check: a $300 billion prevention dividend is ambitious, but it is not fantastical in a $5.3 trillion system.

The central economic principle is simple. The cheapest medical catastrophe is the one that never happens. The least expensive overdose is the addiction prevented. The least expensive fall is the safe bedside transfer. The least expensive malpractice case is the error learned from before it is repeated. And the most valuable hour in medicine is the one a skilled clinician spends helping a patient rather than serving a billing system.

Medicine in Failure: The Near-Zero Harm Agenda: How These Reforms Could Save 93,000 to 169,000 American Lives Every Year

 

Commercial aviation made fatal accidents extraordinarily rare by investigating failures, protecting candid reporting, publishing findings, and redesigning systems. Medicine should pursue the same near-zero standard for preventable death and injury.

Why should Americans accept tens of thousands of deaths from medical error when nearly ten million scheduled passenger flights operate in the United States each year with remarkably few fatal accidents?

The comparison is not perfect. Patients are already sick, human biology is less predictable than an aircraft, and some complications cannot be prevented. But aviation did not become safe by eliminating human fallibility. It became safe by building systems in which an individual mistake is detected, contained, investigated, and prevented from killing people.

That should be the objective of American medicine: near-zero preventable death and near-zero serious preventable harm.

Combined with aggressive drug prevention, automatic automobile intervention, fall prevention, faster access to effective treatments, genetic engineering, malpractice reform, AI documentation, and appropriate end-of-life care, the United States could plausibly save between 93,000 and 169,000 lives annually.

A reasonable central planning estimate is approximately 146,000 lives per year.

The quantifiable opportunity

Reform	Potential annual benefit
Near-zero preventable hospital deaths	22,000–98,000 lives
Central medical-error planning estimate	Approximately 75,000 lives
Matching Singapore’s drug-use-disorder mortality rate	Approximately 70,421 lives
Matching Singapore’s drug-related disability rate	Approximately 6.17 million healthy life-years
Automatic emergency braking	At least 360 lives and 24,000 injuries
Preventable hospital morbidity among Medicare patients	Potentially more than 1 million preventable harm events
Bedside urinals and nighttime fall prevention	Share of 41,000 annual older-adult fall deaths not yet measured
Palliative and nonbeneficial-care reform	Less pain, delirium, restraint, intensive treatment and unwanted hospitalization
Faster drug approval, genetic engineering and AI-supported medicine	Potentially very large, but not yet quantifiable

The lower combined mortality estimate is approximately:

$$22,165 + 70,421 + 360 = 92,946$$

Using 75,000 preventable medical deaths as a central planning estimate:

$$75,000 + 70,421 + 360 = 145,781$$

Using the upper Institute of Medicine estimate:

$$98,000 + 70,421 + 360 = 168,781$$

These are ambitious prevention scenarios, not guaranteed forecasts. But they establish the scale of preventable death that America continues to tolerate.

1. Make preventable medical death as rare as an airline crash

The Federal Aviation Administration handles more than 9.8 million scheduled passenger flights annually. FAA air-traffic statistics

Commercial aviation is not literally error-free. The January 2025 collision near Washington, D.C., killed 67 people, demonstrating that no complex system permanently reaches zero risk. National Transportation Safety Board

But fatal commercial-airline accidents have become extraordinarily rare relative to the number of flights. Aviation achieved that result through:

• Mandatory reporting of accidents and serious incidents

• Confidential, nonpunitive reporting of near misses

• Preservation of data and physical evidence

• Independent investigation

• Public findings and probable-cause determinations

• Safety recommendations directed to regulators, manufacturers and operators

• Standardized procedures and checklists

• Redundant systems

• Simulation and recurrent training

• Continuous collection of operational data

• Redesign after failure

Medicine needs the same structure.

The medical-error death count

The exact number of Americans killed by preventable medical error remains disputed because death certificates rarely identify error, reviewers disagree about preventability, and many affected patients have serious underlying illnesses.

A 2020 systematic review estimated approximately 22,165 preventable inpatient deaths annually. It found that about 3.1% of hospital deaths were probably preventable. Systematic review

The Institute of Medicine’s landmark estimate was 44,000 to 98,000 deaths annually. A former director of the Agency for Healthcare Research and Quality later proposed approximately 75,000 preventable in-hospital deaths as a reasonable estimate. AHRQ Patient Safety Network

The much-publicized estimate of more than 250,000 deaths has been criticized for extrapolation and classification problems. It is therefore not used in this article’s headline total.

Using the evidence-supported range of 22,000 to 98,000, reducing preventable medical deaths to near zero would save somewhere within that range annually. The 75,000 figure is a reasonable central planning benchmark, not a settled death count.

The morbidity is even greater

Death represents only the visible peak of medical injury.

The HHS Office of Inspector General reviewed a national sample of hospitalized Medicare patients and found:

• 25% experienced some form of harm.

• 12% experienced an adverse event involving prolonged hospitalization, permanent disability, life-saving intervention, or death.

• Another 13% experienced temporary harm requiring medical intervention.

• Physician reviewers judged 43% of the harm events preventable.

• The overall preventable-harm rate was approximately 13% of hospitalized Medicare patients.

The injuries included medication complications, delirium, pressure injuries, infections, surgical injuries, bleeding, kidney injury, strokes, respiratory failure and failures to recognize deterioration. HHS-OIG hospital-harm report

The study represented roughly one million hospitalized Medicare patients during one month. A simple annualization of the 13% preventable-harm rate suggests approximately 1.5 million preventable-harm admissions per year among Medicare patients alone.

That is a planning extrapolation rather than a count of unique patients. It may include repeat admissions and seasonal variation. Nevertheless, it reveals the scale of avoidable morbidity.

Create a National Medical Safety Board

Every fatal, permanently disabling, or potentially catastrophic medical event should be reported immediately to an independent National Medical Safety Board.

The board should investigate:

• Diagnostic delay or failure

• Medication errors and interactions

• Failure to review laboratory or imaging results

• Wrong-patient and wrong-procedure events

• Inadequate monitoring

• Failure to respond to deterioration

• Infection-control failures

• Surgical and procedural complications

• Staffing and supervision failures

• Defective equipment or software

• Communication and handoff failures

• Patient falls, elopements and suicides

• Errors caused by fatigue, distraction or excessive documentation

• Information known to the family but never obtained by the treatment team

The investigation should preserve:

• The original medical record

• Medication-administration records

• Monitor and ventilator data

• EHR audit logs

• Staffing schedules

• Laboratory and imaging timelines

• Device and software logs

• Relevant audio or video

• Interviews conducted promptly after the event

Protect the investigation—and publish the lessons

Aviation obtains information that would otherwise remain concealed by providing confidential and nonpunitive reporting systems.

The FAA’s Aviation Safety Reporting System is confidential and nonpunitive. Its Aviation Safety Action Program encourages pilots, mechanics, dispatchers, flight attendants and other personnel to report safety problems so corrective action can occur before an accident. FAA voluntary-reporting programs

Medicine should do the same.

The additional safety investigation—its interviews, deliberations, causal analysis and draft recommendations—should be privileged against discovery and use in civil litigation. Federal law already provides limited privilege for qualifying patient-safety work product, but the protection is fragmented and incomplete. HHS patient-safety protections

The privilege should not conceal the original medical record, falsify what happened, or deprive an injured patient of independently existing evidence. It should protect the additional investigation conducted to discover why the event occurred.

After completion, the health department should publish a de-identified report containing:

• What happened

• The sequence of events

• Direct and contributing causes

• Similar prior events

• Corrective actions

• Responsible institutions for implementation

• Deadlines

• Subsequent compliance

• Evidence that the correction actually worked

That is how aviation turns one disaster into prevention across an entire industry.

Investigate near misses, not only deaths

Waiting for a fatality is too late.

A nurse catches the tenfold medication error before administration. A pharmacist identifies a dangerous interaction. A laboratory result is discovered shortly before the patient deteriorates. A surgeon stops before operating on the wrong side.

These are free warnings from the system.

Near misses should be reported confidentially, aggregated nationally and analyzed by AI to identify recurring patterns. Reporters acting in good faith should receive protection from retaliation and discipline. Recklessness, intentional falsification, impairment and deliberate concealment would remain outside the protection.

The objective is not to prove that physicians and nurses never make mistakes. The objective is to ensure that one person’s mistake cannot pass through multiple layers and kill the patient.

2. Replace the malpractice lottery with patient compensation

The present malpractice system discourages candid investigation while consuming money that should compensate injured patients.

A major study found that for every dollar paid in compensation, another 54 cents was consumed by administrative expenses, including attorneys, experts and courts. New England Journal of Medicine study

America should replace conventional medical-injury litigation with an administrative compensation system:

• Independent expert review

• Published compensation schedules

• Rapid payment for medical expenses, lost earnings and disability

• Lifelong-care funding for catastrophic injuries

• Legal fees paid separately and strictly limited

• Compensation based on avoidable injury rather than success in a litigation lottery

• Separate professional discipline for reckless, dishonest or repeatedly incompetent conduct

Sweden, Denmark and New Zealand demonstrate that patients can seek compensation through administrative systems without conventional malpractice litigation. Commonwealth Fund review

The purpose of medical-injury compensation should be to care for injured patients—not to provide a jackpot for a few successful plaintiffs while most injured patients receive nothing.

3. End defensive medicine and knowingly unnecessary billing

Care ordered primarily to create a litigation defense is legally motivated rather than medically motivated.

Evidence-based clinical pathways should create liability safe harbors. Physicians should remain free to depart from a pathway when the patient’s condition justifies it, but the reason should be documented.

Insurers and regulators should also stop requiring visits, tests and procedures that do not improve diagnosis, treatment or outcome.

Repeated, knowing billing for medically unnecessary treatment should face escalating enforcement:

1. First substantiated pattern: education, repayment and corrective plan.

2. Second substantially similar violation: formal warning, audit and monitored compliance.

3. Third knowing repetition: mandatory referral for fraud prosecution, civil penalties and program exclusion.

Good-faith medical disagreement is not fraud. A documentation defect is not automatically fraud. But federal law already prohibits claims a provider knows or should know are false. HHS-OIG fraud guidance

CMS estimated $28.83 billion in Medicare fee-for-service improper payments for fiscal 2025. CMS correctly warns that improper payments are not synonymous with fraud; many arise from insufficient documentation. CMS payment-integrity data

Enforcement should focus on deliberate extraction of payment for care known to be unnecessary—not on criminalizing clinical judgment.

4. Apply the complete Singapore drug strategy

Singapore combines prevention, strict enforcement, compulsory rehabilitation, testing, supervision, aftercare and severe punishment of commercial trafficking. Some people caught solely for drug use are routed into rehabilitation without a criminal conviction. Singapore Central Narcotics Bureau

Harmonized 2021 Global Burden of Disease data show an age-standardized drug-use-disorder death rate of 19.52 per 100,000 in the United States and 0.13 in Singapore.

If the United States matched Singapore’s relative rate:

• Annual deaths would decline from approximately 70,893 to 472.

• Approximately 70,421 lives would be saved annually.

• Approximately 6.17 million disability-adjusted life years would be preserved.

A disability-adjusted life year represents one healthy year lost through death or disability. Global Burden of Disease study and country tables

An American version should combine severe, proportionate punishment for organized commercial trafficking with compulsory recovery pathways for addicted users. Treatment in correctional facilities is essential: medication treatment in jails has been associated with a 52% reduction in fatal opioid overdose after release. National Institutes of Health

This comparison does not prove that punishment alone caused Singapore’s lower death rate. The effective strategy is the entire system: prevention, detection, rapid intervention, rehabilitation, supervision and enforcement.

5. Prevent nighttime toileting falls

Older-adult falls cause approximately:

• 41,000 deaths

• 9 million injuries

• 3 million emergency-department visits

• 1 million hospitalizations

Falls are also a major cause of traumatic brain injury, hip fracture, disability, fear and institutional placement. CDC fall statistics

A study of hospitalized older adults found that 34% of falls were toileting-related and at least 44% of those occurred at night. In 80% of nighttime toileting falls, the patient was moving without the recommended assistance. Toileting-fall study

Bedside male and female urinals should be routinely offered to people with:

• Nocturia

• Previous falls

• Weakness or impaired balance

• Orthostatic hypotension

• Brain injury or cognitive impairment

• Sedating medications

• Urgency or incontinence

• Recent surgery

• Need for assistance with transfers

The receptacle can be emptied into the toilet, avoiding an unnecessary nighttime journey. Female urinal devices and bedside commodes should be readily available rather than treated as unusual equipment.

The precise number of falls and deaths preventable through bedside urinals has not been measured nationally. Hospitals and residential facilities should therefore implement prospective trials measuring falls, fractures, hospital transfers and patient satisfaction.

The absence of an expensive commercial sponsor should not prevent testing an inexpensive preventive intervention.

6. Require vehicles to intervene when a crash becomes imminent

An automobile should not merely warn a driver when a collision is highly probable. It should brake automatically when the driver fails to respond.

NHTSA estimates that its automatic-emergency-braking standard will prevent at least:

• 360 deaths annually

• 24,000 nonfatal injuries annually

• More than $5 billion in annual property damage

NHTSA automatic-braking rule

Real-world research has found that forward-collision warning with automatic braking reduces rear-end crashes by approximately 50% and rear-end injury crashes by 56%. Insurance Institute for Highway Safety

The next generation should combine emergency braking with:

• Pedestrian and cyclist detection

• Blind-spot intervention

• Lane-departure control

• Driver-impairment and inattention detection

• Intelligent speed assistance

• Automatic crash notification

The driver would ordinarily remain in control. The system would intervene only when validated sensors determine that death or serious injury is becoming highly probable.

7. Stop paying clinicians to type

Medical personnel should spend encounters observing, listening, examining, deciding and explaining—not functioning as clerks.

With patient consent, encounters should be recorded and converted by AI into:

• A transcript

• A structured clinical note

• Medication and laboratory orders

• Patient instructions

• Follow-up reminders

• Proposed billing codes

The clinician should review and approve the final note. The AI should draft; the licensed professional should remain responsible.

A 2025 multicenter study found that clinician burnout declined from 51.9% to 38.8% after 30 days of ambient AI-scribe use. Clinicians also reported less after-hours documentation, lower cognitive burden and better attention to patients. JAMA Network Open

The mortality effect has not yet been measured. But removing clerical distraction creates more time to detect symptoms, review risks, obtain information from families and identify deterioration.

8. Pay for skill and outcome—not elapsed time

A highly skilled clinician may identify the central problem in two minutes. A less skilled clinician may spend 20 minutes without solving it.

Payment should reflect:

• Complexity

• Risk

• Skill required

• Accuracy

• Functional improvement

• Prevention of hospitalization

• Avoidance of unnecessary testing

• Patient-reported outcome

• Durability of the result

Time may remain one factor, but it should not define value.

Existing value-based programs have produced mixed results, partly because many reward documentation and process measures rather than meaningful outcomes. Value-based-payment review

Outcome measures must be risk-adjusted, clinically meaningful and resistant to gaming. A physician should not be punished for accepting difficult patients, and a patient should not be denied care because poor outcomes would damage a provider’s score.

9. Create a new pharmaceutical bargain

The standard utility-patent term is generally 20 years from filing. U.S. Patent and Trademark Office

A replacement pharmaceutical bargain could provide:

• Five years of effective post-approval market exclusivity.

• Presumptive approval of a complete application within six months unless the FDA issues a formal, evidence-based objection.

• Immediate withdrawal authority for serious safety problems.

• Mandatory postmarketing surveillance.

• Rapid generic and biosimilar competition after exclusivity.

• Government prizes and purchase commitments for important discoveries.

• Expanded public financing of trials and genetic research.

The FDA already uses a six-month review goal for priority applications, compared with ten months for standard review. FDA priority review

Faster approval can get effective treatment to dying patients sooner. Shorter exclusivity can make treatment affordable sooner. But shorter patent protection must be paired with public research funding, milestone prizes and purchase commitments so society does not reduce the incentive to develop future treatments.

The number of lives saved cannot be known in advance because it depends on therapies that have not yet been discovered.

10. Surge investment in genetic engineering of familial disease

Gene editing is no longer theoretical. The FDA has approved the first CRISPR-based treatment for sickle-cell disease. FDA gene-therapy announcement

National research should prioritize:

• Familial hypercholesterolemia

• Hypertrophic cardiomyopathy

• Inherited arrhythmias

• Hereditary cancer syndromes

• Familial kidney and liver diseases

• Monogenic diabetes and obesity

• Neurodegenerative conditions

• Hemoglobin disorders

Familial hypercholesterolemia may affect roughly one in 250 people. Without treatment, approximately half of affected men experience a heart attack by age 50 and 30% of affected women by age 60. Early diagnosis and treatment can reduce coronary-disease risk by about 80%. CDC familial-hypercholesterolemia guidance

Screening and conventional treatment can save lives immediately. Gene editing may eventually replace decades of treatment with a durable correction.

11. End painful treatment that cannot benefit the patient

A patient who is irreversibly dying should not be subjected to painful procedures that cannot restore consciousness, function, discharge, or meaningful survival.

The reform should not be based on the unsupported claim that every dying patient receives $300,000 of futile care. Nor should all last-year-of-life treatment be classified as waste. Many treatments provide real comfort or meaningful additional life.

The standard should be medical benefit:

• Early prognosis discussions

• Default palliative-care consultation for defined high-risk conditions

• Clear identification of the treatment goal

• Independent ethics and medical review when disagreement occurs

• A reasonable opportunity for transfer

• No obligation to provide treatment incapable of accomplishing its physiological purpose

• Aggressive relief of pain, dyspnea, anxiety and delirium

A meta-analysis of randomized trials found that palliative care improves quality of life and symptom burden, although it did not demonstrate a significant overall survival benefit. JAMA meta-analysis

The morbidity prevented includes pain, delirium, restraints, repeated resuscitation, invasive lines, treatment complications, prolonged ventilation and dying in circumstances the patient would never have chosen.

The final prevention total

A near-zero medical-harm system, Singapore-level drug outcomes and automatic collision intervention together produce a potential annual mortality reduction of:

• Low estimate: approximately 93,000 lives

• Central planning estimate: approximately 146,000 lives

• Upper established estimate: approximately 169,000 lives

The morbidity reduction would include:

• 6.17 million healthy life-years preserved from drug-use disorders

• Potentially more than one million preventable Medicare hospital-harm events

• At least 24,000 automobile injuries

• Uncounted falls, fractures and traumatic brain injuries

• Less pain and delirium at the end of life

• Fewer adverse effects from unnecessary tests and procedures

• Earlier access to effective treatment

• Reduced disability from familial disease

• More clinician attention directed toward patients

The numbers should not be treated as guaranteed savings or added without attention to overlap. They are a statement of achievable scale.

America should stop treating medical injury as an unavoidable cost of doing business.

Aviation’s lesson is not that pilots never make mistakes. It is that every accident and near miss must make the entire system safer.

That should become the governing rule of medicine:

Investigate every serious error. Protect the investigation. Publish every lesson. Correct every identified hazard. Measure whether the correction works. Continue until preventable medical death becomes as rare as a fatal commercial-airline accident.