The U.S. health care system is broken, with particularly low performance for health outcomes, access to care, equity, and administrative efficiency in comparison with other high-income countries, despite high cost. By virtue of the many elements required for optimal care, the poor diabetes care quality and outcome metrics of the U.S. are canaries in the coal mine for the health care system. The fundamental problem with the U.S. health care system is that it does not prioritize the long-term health and well-being of all individuals and communities. Three intertwined elements are foundational for an understanding of why the U.S. health care system is built the way it is and what changes are necessary to improve it: 1) ethics and culture; 2) political economy, the underlying political and economic structures that shape our nation and thus our health system; and 3) the definition and measurement of value in health care. This article recommends that health care policies around health insurance and payment be designed to support, incentivize, and sustain effective population health models that address medical, social, psychological, and behavioral needs of all individuals and communities. Good governance is essential to assure that payer and provider market incentives are explicitly aligned to prioritize the health and well-being of individuals and communities and cost-effectiveness of care, beyond short-term financial gain for health care systems and investors. Equitable access allows for health care resource distribution according to need, enabling all individuals to have a fair and just opportunity for health.
The thoughts and ideas expressed in this article are those of the authors and do not necessarily represent the views or policies of their employers or other organizations associated with the authors.
