The Simple Reason U.S. Healthcare is Failing

a Practical Path Forward

It’s perplexing: How can the United States, with its renowned doctors, cutting-edge medical technology, and highest per capita healthcare spending, still see such disappointing health outcomes? At first glance, it doesn’t make sense. But upon closer examination, this is precisely the issue with the U.S. healthcare system.

The answer is simpler than it seems. The system is excellent at treating diseases but fails to prioritize preventing them. And that’s a serious flaw we can no longer afford to overlook.

What’s Working: The Strength of Acute Care

There’s no denying the strength of acute care in the U.S. If you’re involved in a serious accident, need a complex surgery, or face a rare and life-threatening illness, American healthcare can be extraordinary. Particularly for those with adequate insurance coverage, this system has delivered some of the most advanced, life-saving treatments in the world.

This isn't by accident. The U.S. healthcare system has been built, over decades, around specialists—each focused on honing deep expertise in specific areas of medicine. Primary care physicians (PCPs) act as navigators, directing patients to specialists with precision. And this disease-focused, specialist-driven model is optimized for treating severe, complex conditions.

The Critical Weakness: Reactive, Not Preventive

Yet, this very focus on treating diseases reveals a major shortcoming: the system is largely reactive. It waits for problems to emerge, for symptoms to worsen, before springing into action. This isn’t just inefficient; it’s dangerous.

Think of it this way: Imagine your house had no smoke detectors, no fire extinguishers, and no circuit breakers. If you called the fire department at the first sign of smoke and they told you, “Wait until the fire spreads before we intervene,” the result would be catastrophic. More damage, higher costs, and greater loss of life. Unfortunately, that’s often how the U.S. healthcare system handles disease—it waits until the flames are high before taking action.

Why Doesn't Prevention Get the Focus It Deserves?

You might ask, why doesn’t the system—and insurance companies in particular—do more to focus on preventive care? After all, isn't prevention less costly than treating full-blown disease?

The reality is that incentives don’t align with this logic. On average, Americans switch insurance providers every few years. Because of this, insurers have little financial motivation to invest in long-term preventive care for patients who are likely to leave their plans before the benefits of that investment materialize. If one insurer were to prioritize prevention, they would likely see costs rise in the short term, with no guarantee of recouping that investment down the road. In a competitive market, that’s a losing proposition.

The Way Forward: Building a Parallel System for Prevention

Given these structural challenges, some advocate for a complete overhaul of the U.S. healthcare system. But that’s not only risky; it’s unnecessary. The key is not to dismantle what works, but to augment it with something new—a parallel system focused on prevention and managing chronic diseases.

We’re already seeing early signs of this shift with direct-to-consumer healthcare companies, where individuals pay out of pocket for preventive services. While patients might not be able to afford major surgeries out of pocket, preventive care—like screenings, diagnostic tests, and wellness programs—is much more accessible financially. In fact, more consumers are stepping into this role, paying for prevention both through direct costs and, ultimately, through the health outcomes they experience.

Innovative payment structures, like Individual Coverage Health Reimbursement Arrangements (ICHRA), are also fueling this movement. These plans allow workers to access preventive care with little or no upfront costs, empowering them to take more control over their health decisions. And this control, or agency, is key to making real progress.

Technology and Innovation: Catalysts for Change

Technology, especially AI, is accelerating this shift. Companies like Function Health are already offering affordable, in-depth health analyses through personalized testing, leveraging AI to provide tailored health insights at scale. While technology alone won’t solve all the problems, it can play a critical role in making preventive care more accessible, affordable, and effective.

That said, we must approach this optimism with caution. Startups and AI-driven healthcare solutions are exciting, but they must be integrated thoughtfully. The risk is that these technologies could exacerbate healthcare inequities, leaving behind those who can’t afford or access these new tools. It’s essential to ensure that technological innovation doesn’t widen the gap between the haves and the have-nots in healthcare.

Empowering Patients: The Real Key to Lasting Change

At the heart of this transformation is patient empowerment. But empowerment isn’t just about giving people more choices; it’s about creating the right structures so that individuals can make informed decisions about their health. Preventive care should be something people can easily access and afford—not a luxury for the few.

When patients are empowered with the right tools, resources, and support, they take more responsibility for their health outcomes. Combine that agency with a healthcare system that incentivizes prevention, and we can start to see a shift away from the reactive, disease-centric model that has defined American healthcare for too long.

The Path to a Better System

In the end, the answer lies not in tearing down what’s working, but in building on it. By creating a healthcare system that supports prevention alongside acute care, we can reshape the way healthcare is delivered in this country. And as we continue to innovate, we’ll see more startups, more patient-driven solutions, and more opportunities to improve health outcomes.

The incentives are there. The tools are coming into place. Now, it’s about taking the next step—toward a system that prioritizes prevention, empowers patients, and creates better outcomes for everyone.