Sustainability
Can the system keep running?
18.0% of GDP spent on health care in 2024
The through-line
Health spending is on track for 20.6 percent of GDP by 2034, nearly half of physicians report a burnout symptom, the sector emits 8.5 percent of US greenhouse gases, and 154 rural hospitals have stopped inpatient care since 2010.
Spending growth 18.0% of GDP on health care, 2024 open dashboard → Workforce burnout 45.2% of physicians report a burnout symptom, 2023 open dashboard → Climate footprint 8.5% of US greenhouse gas emissions, 2018 open dashboard → Rural hospital closures 154 rural hospitals lost inpatient care since 2010 open dashboard →
What’s moving on this
Legislation in play that touches sustainability
In this bucket
- WWII Nurses Congressional Gold Medal Act
- Conrad State 30 and Physician Access Reauthorization Act
- Title VIII Nursing Workforce Reauthorization Act of 2025
Counts from Congress.gov + state-legislation trackers, keyword-mapped to this Iron Triangle force. As of 2026-06-18. See the methodology note on the legislation dashboard.
Sources & methodology
- CMS Office of the Actuary, NHE Fact Sheet
- CMS NHE Projections Table 1, National Health Expenditures and Selected Economic Indicators
- CMS NHE Projections Table 3, National Health Expenditures by Source of Funds
- SSA Office of the Chief Actuary, National Average Wage Index
- CMS Medicare Geographic Variation Public Use File, by National, State and County
- Shanafelt et al., Mayo Clinic Proceedings (AMA / Mayo Clinic / Stanford national study)
- Medscape Physician Burnout and Depression Reports 2023 and 2024
- Holmgren et al., J Gen Intern Med 2024 (EHR time); Medscape 2023 (burnout)
- Olfson et al., JAMA 2023, Suicide Risks of Health Care Workers in the US
- Davidson et al., Worldviews on Evidence-Based Nursing 2020, A Longitudinal Analysis of Nurse Suicide in the US
- American Association of Colleges of Nursing, Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing
- American Association of Colleges of Nursing, Salaries of Instructional and Administrative Nursing Faculty
- Eckelman and Sherman, Health Affairs 2020, Health Care Pollution and Public Health Damage
- Health Care Without Harm and Arup, Health Care's Climate Footprint
- EPA ENERGY STAR Portfolio Manager, DataTrends: Energy Use in Hospitals
- UNC Cecil G. Sheps Center for Health Services Research, Rural Hospital Closures tracker
- Chartis Center for Rural Health, 2026 Rural Health State of the State
- American Hospital Association, Fast Facts on U.S. Hospitals 2026
Per-chart citation straps carry the in-context detail; this is the full bibliography.