Lessons for healthcare delivery from “It’s a Wonderful Life” 

By J. Michael Connors, MD, Anytime Telecare 

Every December, “It’s a Wonderful Life” returns to our screens, usually framed as a sentimental reminder to appreciate family, friendship, and small town life. But beneath the warmth and snowflakes is a far sharper story about money, power, and what happens when institutions forget who they exist to serve. Few scenes capture this better than the run on the Bailey Building and Loan, when frightened townspeople demand their deposits and George Bailey is forced to explain a truth that feels almost foreign today. “Your money’s not here,” he tells them. “It’s in Joe’s house . . . and the Kennedy house . . . and a hundred others.” George isn’t reassuring anyone about liquidity. He’s explaining a philosophy. The money entrusted to the Building and Loan was never meant to sit idle or accumulate for its own sake. It was meant to circulate through the community, stabilizing families, spreading risk, and ensuring that when one neighbor struggled, the town as a whole didn’t collapse. 

That moment captures what insurance was originally meant to be. At its core, insurance was a community agreement. Everyone contributed something so that no one would be ruined by misfortune. Risk was shared, not isolated. Resources flowed back into the same neighborhoods that supplied them. Success wasn’t measured by how much money remained untouched, but by how many people remained housed, healthy, and able to move forward. It was neither charity nor extraction. It was stewardship. The Bailey Building and Loan did not promise wealth. It promised continuity. It promised that the town would still be standing tomorrow because it invested in itself today. 

Henry Potter understood this model completely, which is precisely why he opposed it. Potter’s bank represented a different logic, one that should sound uncomfortably familiar to anyone working in modern healthcare. To Potter, money existed to accumulate power. The community wasn’t a network of shared obligation, but a collection of costs to be controlled. When he dismisses the working people of Bedford Falls as “discontented, lazy rabble,” he’s not merely being cruel. He’s articulating a worldview. People who require support are liabilities. People who cost more than they generate are problems. Stability for the many matters less than leverage for the few. Potter doesn’t deny that the town needs housing or security. He simply believes those needs should be met only if they produce profit for him. 

For much of the twentieth century, health insurance more closely resembled the Bailey Building and Loan than Potter’s Bank. Premiums were pooled locally. Plans were often regional. Insurers had a tangible presence in the communities they served. While far from perfect, there was a recognizable connection between where money came from and where it went. Hospitals, physicians, and insurers were bound together by geography and long standing relationships. When communities were healthier, everyone benefited. When times were hard, the expectation wasn’t abandonment, but shared strain. 

That model has quietly but decisively changed. Modern health insurance no longer behaves like a community institution. It behaves like a financial instrument. Premium dollars still come from workers, families, and employers, but they rarely stay anywhere near the people who paid them. They move upward into national and multinational structures governed by growth targets, shareholder expectations, and quarterly performance. Risk is no longer shared across a community. It’s redistributed downward. Physicians absorb it through productivity pressure. Hospitals absorb it through shrinking margins and consolidation. Families absorb it through deductibles, denials, and delays. Those who need care the most are increasingly defined not by their circumstances, but by their cost. 

As insurance shifted, so did healthcare employment. Hospitals and health systems began to adopt the same logic that governed payers. Employment structures became tools for managing expense rather than supporting care. Clinicians were no longer primarily stewards of community health, but units of labor whose value was measured in throughput and revenue capture. Time spent listening became inefficiency. Continuity became inconvenience. Patients who required more attention, more coordination, or more compassion were quietly reframed as burdens on the system. The language softened, but the meaning did not change. High utilizers. Complex patients. Noncompliant families. The vocabulary differs, but the posture echoes Potter’s disdain with professional polish. 

In the film, Pottersville isn’t created by a single catastrophic event. It emerges gradually as Potter’s values take hold. Housing becomes transactional. Desperation becomes profitable. Community spaces turn hollow. People still live there, but they’re no longer connected by mutual investment. The town functions, but it no longer flourishes. This is what happens when money stops circulating with purpose and starts accumulating without accountability. It’s also what happens when healthcare systems prioritize margin over mission, efficiency over equity, and scale over stewardship. 

The consequences aren’t theoretical. Primary care practices close in underserved neighborhoods because they can’t survive under payer contracts designed for volume rather than need. Pediatric practices drown in high visit counts while lacking the resources to address behavioral health, social stressors, or chronic disease. Hospitals withdraw services from communities deemed unprofitable, even as those same communities continue to supply premium dollars and labor. Coverage remains, at least on paper, but care becomes thinner, more fragmented, and more impersonal. Like Pottersville, the system looks successful from a distance but feels brittle and unforgiving up close. 

What makes this shift so insidious is that it’s often justified as inevitable. We’re told that scale demands centralization, that complexity requires standardization, that markets are simply responding to incentives. But “It’s a Wonderful Life” offers a different explanation. Potter’s model doesn’t nearly prevail because it serves people better. It nearly prevails because it’s easier on those who control the money. It asks less of them. It requires no patience, no moral imagination, and no willingness to absorb short term discomfort for long term stability. George Bailey nearly collapses under the weight of doing the right thing, not because his model fails, but because it demands more courage and endurance than Potter’s ever would. 

Healthcare today faces the same choice, though we rarely name it as such. We can continue to design insurance and employment structures that extract value from communities while blaming those communities for the strain they reveal. Or we can remember what insurance was meant to do in the first place. We can choose to keep money close to the people it serves. We can measure success not only by surplus, but by stability. We can recognize that those who require the most care aren’t evidence of failure, but the very reason the system exists. 

At the end of the film, George Bailey isn’t rescued by wealth or power. He’s rescued by relationship. The town shows up because the Building and Loan kept their money working for them. Because George treated their needs as legitimate. Because stewardship, practiced over time, built trust that no balance sheet could capture. That ending isn’t sentimental. It’s instructive. Systems rooted in community may struggle, but they endure. Systems built on extraction may thrive briefly, but they hollow out the foundations they depend on. 

If we continue to neglect those in need, if we allow profit to become the primary lens through which healthcare insurance and employment are designed, the outcome shouldn’t surprise us. Towns turn into Pottersville not because people stop caring, but because institutions stop serving. Healthcare becomes efficient, scalable, and lucrative, while growing increasingly disconnected from the lives it is meant to protect. Bedford Falls doesn’t disappear on its own. It disappears when we decide it’s no longer worth the effort to sustain. The warning has been with us for nearly 80 years. The question is whether we’re finally willing to listen. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.