Chronic disease prevalence continues to rise in high-income healthcare systems despite escalating expenditure, increasingly sophisticated biomedical interventions, and earlier detection. While acute outcomes have improved, durable disease resolution remains rare, and multimorbidity has become the norm rather than the exception. This paper proposes a systems-level explanation for this paradox. Building on a regulatory framework in which chronic disease reflects failure of adaptive response termination rather than failure of response initiation, the paper argues that modern healthcare systems are structurally optimized to suppress pathological outputs while remaining largely blind to termination reliability and recovery dynamics. By stabilizing biological compensation without restoring regulatory plasticity, healthcare systems unintentionally amplify regulatory drift, increasing disease prevalence while preventing collapse. This framework integrates biological regulation with institutional design, offering a coherent explanation for rising prevalence, escalating cost, stable average outcomes, and expanding multimorbidity without attributing failure to individual behavior or professional malfeasance.
Matthew Dominik (Sun,) studied this question.