Celebrating Progress, Confronting Reality

A few articles ago, I shared how far healthcare in our country has come. We’ve made some remarkable progress, no longer living in fear of diseases like polio, smallpox, or tuberculosis thanks to vaccines and treatments that past generations could only dream about. Technology helps us catch illness earlier and treat it more effectively and people are living longer, more active lives because of it. Something definitely worth celebrating.   

But while we’ve made huge strides, there’s another story playing out quieter, but just as urgent. A recent Wall Street Journal article summed it up well: despite all the money we spend and the innovation we’ve built, the U.S. still has the lowest life expectancy of any high-income country, and the gap is growing. In 2023, our average life expectancy inched up to 78.4 years. But we still trail behind places like Japan (84.5), France (82.3), and the UK (80.7).

This isn’t because we lack cutting-edge medicine. It’s because of something closer to home: the choices we make every day, and how our system is designed to respond to them.

Let’s start with the basics. The challenges we’re facing in healthcare aren’t new, but they’re as urgent as ever. Many of us struggle with poor diets of too much sugar, processed food, and unhealthy fats which contribute to a wide range of chronic conditions. At the same time, addiction and mental health issues are driving a rise in deaths from opioids, alcohol, and suicide. And throughout it all, our healthcare system continues to prioritize treatment over prevention. We pour resources into specialty care while primary care and public health efforts, often the first line of defense, are underfunded and overlooked.

The result? We’re spending over $4.5 trillion a year on healthcare, nearly 20% of our GDP! And that cost hits everyone. Families pay more out of pocket. Employers see benefit costs squeezing wages and margins. And public programs like Medicare and Medicaid are under strain, limiting what we can invest elsewhere in education, infrastructure, or research.

So where do we go from here?

There’s no single fix but there is a path forward, starting with two things: personal responsibility and systemic change. At an individual level, we all have a role to play. Eating better. Moving more. Sleeping enough. Managing stress. Nobody gets it right all the time, but small daily choices add up.

But lasting change can’t rest on individuals alone. Systems need to evolve along with us. And if we’re looking for inspiration, two of the best examples are seat belt laws and the decline in smoking. Both show what’s possible when public policy, culture, and personal behavior align.

Take seat belts. There was a time when hardly anyone wore them. But with public education, legislation, better car design, and consistent enforcement, that changed. Today, over 90% of us buckle up and seat belts reduce the risk of death in a crash by nearly half. This shift didn’t happen because everyone suddenly decided to be safer. It happened because the system changed and expectations changed with it.

We’re at a similar point when it comes to preventive care. We know it works. Screenings, vaccines, good nutrition, managing chronic conditions early, these things make a big difference. Even so, only about 8% of U.S. adults get all the recommended preventive services. Prevention is still treated as optional, when it should be nonnegotiable.

So how do we make this shift?

One idea is to create stronger incentives. What if the tax benefits employers receive for offering healthcare were tied to how well they support prevention, like promoting screenings, wellness programs, and chronic care management? Employers who invest in keeping their people healthy could see greater rewards. Rewarding what works.

We already have examples of this in action. Medicare Advantage uses a “Stars” system to rate health plans based on their ability to deliver preventive care, measuring outcomes across diabetes, heart health, mental health, and more. Why not extend that kind of accountability to Medicaid and ACA plans too?

We can also learn from how we tackled smoking. In 1965, 42% of American adults smoked. By 2023, that number had dropped to 11.5%. Didn’t happen by accident. It took decades of education, regulation, higher tobacco taxes, and a complete cultural shift. Smoking went from being common (even cool) to something people now avoid.

Today, we face a similar challenge with ultra-processed foods. These products are often packed with sugar, salt, and unhealthy fats. They’re inexpensive, heavily marketed, and widely available, especially in lower-income communities. And much like tobacco’s impact on health, they’re contributing to rising rates of obesity, diabetes, and heart disease.

We need to take a similar approach here, starting with clear, honest conversations about the risks, especially when it comes to kids. That means putting policies in place like taxing sugary drinks, adding easy-to-understand labels on food, and cutting back on junk food ads aimed at children. At the same time, we’ve got to make healthier options more affordable through smart subsidies. And we need to shift the culture, starting in schools, workplaces, and neighborhoods so that real, nutritious food becomes the everyday choice, not the exception.

If we bring the same determination to prevention and nutrition as we once brought to seat belts and smoking, we can turn this around. The playbook exists. The tools are in front of us. What we need now is the resolve to act with focus, urgency, and consistency.

I’ve always written from a place of optimism, and that hasn’t changed. I still believe deeply in the people who power our healthcare system … the innovators, the caregivers, the leaders on the front lines. But what has changed is the sense of time. We can’t afford to wait.

We know what works. We have the talent. We have the funding. Now it’s time to act, with greater resolve, with sharper focus on prevention and equity, and with a commitment to helping more people live longer, healthier lives.

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So I’ll leave you with this:

What small step can you take today to support your own health? And what bigger step, through your voice, your vote, or your leadership, can you help move forward?

We each have a role to play. Not just for ourselves, but for our families, our communities, and the generations to come.