We Built a Sick-Care System. It’s Time to Build a Healthcare System.

By Russell H. Greenfield, MD, Founding Executive Director, The Institute for the Advancement of Whole Health at Southern California University of Health Sciences

Key Takeaways

• Despite extraordinary medical advances and outsized healthcare spending, Americans continue to experience poorer health outcomes than people in other wealthy nations.
• Our healthcare system is largely structured around diagnosing and treating illness, as opposed to preventing disease and helping people achieve lifelong health and well-being.
• Improving health outcomes and controlling healthcare costs will require fundamentally rethinking the financial incentives that drive our healthcare system, along with how we deliver, teach, and evaluate care—with greater emphasis on prevention and long-term well-being.

The United States has built one of the most sophisticated medical systems in the world. We have extraordinary hospitals, groundbreaking technologies, advanced pharmaceuticals, and highly skilled healthcare professionals capable of interventions that would have been unimaginable a generation ago. Yet for all our medical advances, Americans are not nearly as healthy as they should be.

In 2024, U.S. healthcare spending reached $5.3 trillion—approximately $15,474 per person and 18% of our gross domestic product—according to the Centers for Medicare & Medicaid Services. That’s more than any other nation spends, both per capita and as a share of its economy. Yet despite this extraordinary investment, the U.S. ranked last overall—including last in health outcomes—among 10 high-income countries in the Commonwealth Fund’s 2024 comparison of healthcare systems. Meanwhile, chronic disease continues to place an enormous burden on our healthcare system. According to the Centers for Disease Control and Prevention, 90% of the nation’s annual healthcare expenditures are for people with chronic and mental health conditions, many of which could be prevented, delayed, or better managed through more proactive approaches to health.

These statistics reveal a fundamental disconnect between what our healthcare system is designed to do and what people actually need. We have built a system that is remarkably capable of diagnosing and treating illness, but far less effective at preventing disease, promoting well-being, and helping people stay healthy throughout their lives. In many ways, what we call a healthcare system is actually a sick-care system.

Consider how healthcare is typically delivered and financed in the United States. Our payment structures have historically rewarded the volume of services provided: office visits, diagnostic tests, procedures, hospitalizations, and other medical interventions. Although value-based payment models are expanding, much of the system still operates within incentives tied to delivering care after a problem has developed. We know that factors such as nutrition, physical activity, sleep, stress, social connection, and living conditions are critical to prevention and health maintenance, yet our healthcare financing and delivery systems often provide limited support for addressing these factors in sustained, meaningful ways.

A physician may recognize that a patient’s uncontrolled diabetes is influenced by food insecurity, chronic stress, and limited opportunities for physical activity. But recognizing those challenges and having the time, resources, and reimbursement mechanisms to address them are very different things. Similarly, a patient experiencing persistent back pain may benefit from education, physical therapy, exercise, or other evidence-based nonpharmacological approaches. Yet the availability, affordability, and coordination of those services can vary considerably, potentially steering patients toward pharmacological treatments that are more readily accessible rather than those best aligned with their needs and preferences.

These are not failures of individual healthcare professionals. They are consequences of a system in which the structures surrounding clinical care can make it difficult to prioritize long-term health. We have become highly proficient at paying for healthcare services. But what would it take to pay for health?

Answering that question requires more than expanding preventive screenings or encouraging healthier lifestyles, important as those efforts are. It requires rethinking the purpose of healthcare itself, and moving toward an approach that places the person, rather than the disease, at the center of care.

This is the fundamental premise of Whole Health. Instead of organizing care primarily around diagnoses and symptoms, Whole Health begins by asking a different question. Rather than simply “What’s the matter with you?” it asks, “What matters to you?” That distinction recognizes that health is not merely the absence of disease, but the ability to live a meaningful, fulfilling life. A person’s goals, values, relationships, environment, and daily circumstances become central to understanding what health means for them and how healthcare can best help them achieve it.

Whole Health brings together conventional medical care, prevention, lifestyle approaches, evidence-informed complementary practices, and support for self-care. It emphasizes collaboration across healthcare disciplines and meaningful partnerships with patients, families, and communities. Importantly, this is not simply an aspirational philosophy. In its landmark 2023 report, Achieving Whole Health: A New Approach for Veterans and the Nation, the National Academies of Sciences, Engineering, and Medicine outlined a framework for transforming healthcare to prioritize well-being, prevention, and the needs and goals of individuals. The report also examined the Veterans Health Administration’s experience implementing Whole Health as an important example of system-level transformation and measurable success.

But we cannot expect healthcare professionals to deliver a fundamentally new model of care while operating within systems designed around competing priorities. If we want healthcare to emphasize prevention, our payment models must support prevention. If we want clinicians to address the whole person, our educational programs must prepare them to work collaboratively across disciplines. And if we want patients to take an active role in their health, they need meaningful access to the information, resources, and services that support their goals.

We also need rigorous research demonstrating which approaches improve outcomes, for whom, under what circumstances, and at what cost. That evidence must inform not only clinical practice, but also healthcare policy, financing, professional education, and the design of care delivery systems. Meaningful transformation will require collaboration among healthcare professionals, researchers, educators, health systems, insurers, employers, policymakers, community organizations, and the people they serve. No single profession, institution, or sector can accomplish this alone.

None of this diminishes the extraordinary achievements of modern medicine or suggests that prevention can eliminate the need for treatment. Rather, the opportunity is to build on those strengths while expanding our definition of what a successful healthcare system should accomplish. We should measure success not only by the services we deliver or the diseases we treat, but also by the health, function, well-being, and quality of life we help people achieve.

Transforming American healthcare will require rethinking financial incentives, generating new evidence, and building partnerships across disciplines and sectors. But we have the knowledge, innovation, and expertise to make meaningful progress. Imagine what we could accomplish if we brought the same ingenuity and determination we’ve devoted to treating illness to helping people stay healthy in the first place. The future of American healthcare depends not simply on how well we treat illness, but on how effectively we help people achieve and sustain health.

Russell H. Greenfield, MD, is the Founding Executive Director of The Institute for the Advancement of Whole Health at Southern California University of Health Sciences. The Institute brings together leaders across healthcare, education, research, and policy to advance the transformation toward a Whole Health system that prioritizes prevention, well-being, and person-centered care.