Like an endangered species, preventive medicine and chronic disease management—the US primary care system—face extinction. With nearly 30% of American adults lacking a source of care and 28 percent reporting delaying or not getting care due to cost, the consequences are far-reaching.  The focus on chronic disease prevention and addressing its root causes demands greater attention, as the health of the system—and the people it serves—depends on it. If we are frustrated about something, this is worth the outrage.

It has been almost impossible for elected officials, who too often look for singular villains, to grasp the extent of this system-wide dysfunction. This crisis extends beyond consumer comfort with technology or the cost of medicines. Primary care medicine—the basis for health delivery—is marginalized as an honored medical discipline. Somehow, we opt for a national health system prioritizing sick care over healthcare.

Primary care providers are grappling with burnout and inadequate compensation compared to their specialist counterparts, and the system often prioritizes paperwork over quality of care. Economics drives health delivery and access, and it’s simply not working to the advantage of consumers and primary care physicians.  

Finger-pointing and Senate HELP Committee photo ops cannot solve this nation’s care crisis. What’s needed is a fundamental shift in our approach to illness, prevention, and access—one that addresses the root causes of our failing primary care system and ensures that quality healthcare is accessible to all Americans, regardless of zip code or digital literacy. That will reduce our total health costs.

Obesity and Heart Disease: A Multigenerational Threat

America’s waistline is changing—we are adding notches to the nation’s belts. Obesity rates among younger Americans are climbing, creating an abundance of chronic diseases that once seemed confined to older generations. Alarmingly, heart disease, which had been in decline for decades, is creeping back up.

The invention of new weight-loss drugs like GLP-1 receptor agonists helps many struggling with chronic weight issues and mitigates some health risks. Yet, these drugs are not a complete answer to the challenge. They do not adequately address the underlying risks—heart disease, diabetes, and other chronic conditions—that require ongoing, consistent engagement with health professionals. Without this, even those who benefit from these medications – looking trim – may still end up battling old health challenges.

The persistent challenge of obesity across various age groups in the US, which hovers at +/- 40 percent, reinforces worrisome trends that impact people by age, race and region. A rate stable at 40 percent is not something to celebrate – it requires action. It’s a tipping point for illness.

Prediabetes: A Perfect Public Health Storm

Prediabetes is the nation’s silent epidemic. Close to 90 million adults—more than 1 in 3 Americans—have it, and 90% don’t know they do. Left unchecked, some 20 percent of these people “graduate” to Type 2 diabetes and other complications annually. The rise in obesity among younger populations only exacerbates this issue, setting the stage for an earlier onset of chronic diseases that worsen over time.

Prediabetes demands a dedicated behavior-focused treatment plan. Without significant lifestyle changes, individuals are on a fast track to diabetes and its life-altering complications. And yet, the primary care system—our first line of defense—is buckling under pressure, unable to provide the consistent support patients need. It’s not just the use of medications – it’s understanding that obesity is a multi-system condition and a unique disease that transcends more belt notches.

The Limitations of GLP-1 Drugs:

GLP-1 drugs do reduce weight and lower the risk of diabetes and heart disease. But they are not a substitute for comprehensive care. The underlying dangers—poor cardiovascular health, insulin resistance, and other metabolic issues—don’t disappear with weight loss alone. Without engagement with allied health professionals trained to address the complexities of obesity to monitor and address these risks, consumers will face new challenges despite these drugs’ initial success in losing pounds.

We live in what Katherine Saunders, MD, DABOM, a Weill Cornell Medicine’s Comprehensive Weight Control Center and co-founder of FlyteHealth, calls the “Obese-a-genetic” era.  Her efforts at FlyteHealth leverage the latest in science, technology, patient support, and a range of medications to individually tailor weight treatment based on a person’s unique biology alongside the complexity of obesity treatment:

“Overweight and obesity are misunderstood medical conditions that are more complex than calories in and calories out. The advice many patients receive—to eat less and exercise more—often fails to address the problem.”

Saunders and her colleagues are at the cutting edge of results-oriented care, but she is among the handful who have dedicated their careers to this pressing clinical discipline.

Walk-In Clinics are about Convenience

Convenience of care is essential to people’s well-being. Entrepreneurial internists have recognized this, creating “pop-up” vaccination and care centers to bring services closer to those in need and better work/life balance. But convenience alone isn’t enough. Urgent care clinics underscore one of the nation’s most pressing public health threats—the erosion of primary care—has reached a retail-like inflection point.

Walk-in clinics and telehealth check-ins are helpful but do not offer dedicated follow-up. They are geared to address the consumer’s immediate need and are not structured for the longitudinal engagement for the hard-to-tackle considerations that call for comprehensive support.

We are stuck between a system that focuses on its self-preservation and what is in our and national long-term interests – protecting our most important asset – our health.

The Rise of the Make American Health Again Movement

Primary care physicians, the cornerstone of preventive health, are becoming extinct as a medical profession species. The reasons are many: medical school debt driving doctors to higher-paying specialties, they are paid by the number of patients seen daily burnout, and the rise of retail clinics offering quick, transactional care.

While these clinics improve access, their focus is not on a long-term patient-physician relationship. This shift leaves a dangerous gap in the medical safety net, particularly for chronic conditions like obesity, prediabetes, and heart disease. Without a trusted health provider to guide them, patients are left to navigate their health journeys solo—often with devastating consequences.

Many are aghast at Robert F. Kennedy Jr.’s nomination to the Department of Health and Human Services as Secretary of the nation’s key organization setting national health policy. This justified anxiety centers on his stated positions on vaccines and his off-hand comments dismissing the importance of medicines in preventing more serious illnesses. However, his thoughts about America’s poor health report card grades deserve attention regardless of the outcome of the Senate confirmation hearings.

His Make America Healthy Again movement has an approach that deserves consideration: the need to tackle the chronic disease epidemic, which has become the leading cause of death in the US and, later, drives massive costs in hospitalization.

“There are some things that RFK Jr. gets right,” says Resolve to Save Lives CEO Dr. Tom Frieden, who was appointed Director of the Centers for Disease Control and Prevention during the Obama Administration. “We do have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science.” Frieden made his comments in an NPR interview on the RFK Jr. nomination.

We need (much) more than medications and pop-up clinics to address America’s growing health crises. The health ecosystem must be reimagined to center around people’s health outcomes – not a one-size-fits-all approach to keeping them well. We must foster long-term patient-provider relationships, ensure easy access to understandable health data, emphasize nutrition and physical education in schools, and make care accessible to people across racial and generational lines.

As the ticking time bombs of obesity, prediabetes, and heart disease continue to warn, the urgency for change cannot be overstated. The frustration over the current complexity of access underscores what happens when we prioritize the system over prevention. Access to care isn’t just a convenience—it’s a matter of survival. To prevent the collapse of this fragile house of cards, we must act decisively and collaboratively to build a health system that sustains us all.

The post Conceptually, the “Make America Healthy Again Movement” Needs a Nod appeared first on Medika Life.

Not to take anything away from the Senator’s apparent concern for his constituents’ real, valid frustration with the health system, but is his villain the right one? Is it a fundamental misreading of the facts of the US health ecosystem to believe that there is any one villain in the system at all? The real, underlying reason that the US health system is so fragmented is that the system itself is the problem. And, as it must be, the system will be the source of any viable solution that makes navigating less challenging and more holistically unified.

Stop Blaming Individual Sectors — Look at the Aggregate

High drug prices are just one symptom of a health ecosystem already becoming increasingly fragmented several decades ago. The problem was well-established and recognized when economist Dr. Alain C. Enthoven wrote about it in the American Journal of Managed Care more than a decade ago, positing that inefficient allocation of resources negatively impacted quality, cost of care and medicines, and patient outcomes.

Since then, little has changed. In 2016, FINN Partners released a survey showing that the fragmented health ecosystem was placing an ever-greater burden on patients, the people the system is supposed to protect and serve — and was increasingly failing. Eight years later, the results of this survey will not have changed significantly.

For decades, payers, patients, policymakers, product innovators, and providers turned a blind eye to fragmentation. And while policymakers prefer to spotlight a popular villain — drug cost — the relentless search for villains won’t fix fragmentation. If we attack one piece of the ecosystem rather than look at the problem, we will fail to make meaningful change. While putting pharmaceutical company CEOs under the glare of the Senate HELP spotlight may provide a tremendous election-year photo-op, bipartisan grandstanding is antithetical to addressing the health system’s continued splintering.

If the System Were a Patient with Multi-System Failure, Would We Treat Only One Organ?

We now know beyond a doubt that the health system is fragmented and has a cost impact. It is time to move from this era of fragmentation into the “post-fragmentation” period. Rather than finger-pointing and finding scapegoats, what’s needed is a fuller understanding of how the system works — and fails to work — for the patient. This requires looking at the full picture objectively, without accusation, to understand better how the different players in the system can work together to support the same goal: a health system in which the patient, not the system itself, is the health system’s true beneficiary.

It’s a fact: prescription drug prices in the United States are higher than in other nations, averaging 2.78 times those seen in 33 different countries, according to the February 2024 RAND report. But are pharma companies the sole cause of this patient burden and health-system chaos? Absolutely not: drug costs comprise about 11 percent of the total $4 trillion in US health expenditures. In reality, provider and hospital services total almost half of US health spend (31.4 percent and 20.3 percent respectively).

Fragmentation Adds to Patient Care Burdens and Costs

Fragmentation leads to out-of-control spending across the system. According to a 2018 Commonwealth Fund study, Medicare recipients “with three to four chronic conditions and highly fragmented care are 14 percent more likely to visit the emergency department, and six percent more likely to have a hospital admission.”

If the US health system were a publicly traded corporation, this hemorrhaging of cash would have been decisively stopped years ago. Taken together, the $4 trillion in annual US healthcare costs can be laid on the doorstep of nearly every player in the ecosystem, from insurance companies to PBMs, pharmacies, pharmaceutical companies, government, hospitals, and venture capital, to name a few — even endless consumer demand and neglected preventive care.

Operating with a business-as-usual approach will carry steep costs in money and lives. When the system fails to engage people proactively with heightened risk for heart disease, cancer, diabetes, and other non-communicable illnesses, when it denies patients diagnostic procedures ordered by their physicians, when it shifts patients from working medications to substitute therapies due to a non-medical switch decision, curiously, some parts of the system benefit to the detriment of patients.

These situations shouldn’t be, as the consequences of the current line and the decisions they reward can be dire, leading to rising costs, diminished patient care, and even death. Ultimately, the chaos around care delivery comes from considering patients a necessary fly in the system’s ointment. The patient is not the health system customer. The system is a customer unto itself.

Can We All Focus On Why the System Exists — To Heal Patients?

We recognize the health system’s failings but must also identify its strengths and potential for improvement. This will allow us to reorient our thinking and ask, “Now, what do we do to put the patient back into focus as the ultimate customer and the preferred beneficiary of the system?”

Stanford Physician Ilana Yurkiewicz, an internist, hematologist, and oncologist, in her book Fragmented: A Doctor’s Quest to Piece Together American Health Care, published by W. W. Norton, argues that it’s actually fragmentation that’s the central failure of health care today, resulting in a system that uses more than twice the economic resources other developed nations dedicate toward health and which results in poorer life expectancy outcomes:

“There’s an unspoken assumption when we go to see a doctor: the doctor knows our medical story and is making decisions based on that story. But reality frequently falls short. Medical records vanish when we switch doctors. Critical details of life-saving treatment plans get lost in muddled electronic charts. The doctors we see change according to specialty, hospital shifts, or an insurer’s whims.”

No longer are we debating whether the system is fragmented or not. We must shift our mindsets and drop the mistaken belief that identifying bad players in the ecosystem will fix the problem. With ecosystem fragmentation as the diagnosis, what is the treatment path to better management? This is where “Health System Kinetics” (HSK) enters. HSK fosters collaboration and leverages health information technologies — AI, ChatGPT, GenAI, and LLMs — to create an eco-dynamic that prioritizes people’s well-being and works toward longer, healthier lives.

The Health System is Greater Than Its Sector Parts — Study its Kinetics

Health System Kinetics objectively studies factors and sector-to-sector relationships influencing individual and collective health outcomes. It includes biological, environmental, social, and economic determinants of health. Understanding health system kinetics will allow the health system to evolve for the better, benefiting its stakeholders and addressing gaps and inefficiencies in people’s care by fostering a proactive, positive approach.

Understanding why fragmented care is a system-wide illness is a starting point we passed long ago. Looking at the health ecosystem as an ever-changing aggregate — kinetics — rather than separate sectors at fault is the opportunity to move beyond the present chaos.

Fragmentation goes beyond the left hand, not knowing what the right is doing. Too often, it means that the left hand won’t acknowledge the right hand’s very existence. While rising costs concern everyone, it’s essential to keep our eye on the goal of keeping people healthier at home, out of the hospital, and, if possible, far away from illnesses. To do that, we must address the misalignment of incentives and lack of coordination in the health ecosystem.

Applying Health System Kinetics will allow us to understand better how we can do this to provide better patient care, reduce health professional burnout, and give patients with chronic conditions greater attention. The objective study of the interconnectedness of the parts of the healthc system will promote a better understanding of how these components work together now — and how they can be changed to work better together in the future. Failing to take this approach means we won’t see meaningful change, and that’s not an option.

Do Not Let the Virus Kill its Host — the Health System

We have diagnosed the illness that plagues our health system; it’s a virus called fragmentation. It’s time to examine our biases, behaviors, and business goals. The primary mission is to recognize that we are people — sometimes patients — all seeking to enjoy a healthier life. Suppose fragmentation is the wall that separates us from better access to care. In that case, health professionals in every ecosystem sector can be empowered to pursue their calling with passion and tear down that wall.

Looking for a villain in the health ecosystem, something lawmakers have been doing for the last several election cycles, may be suitable for campaigning but not for progress — not for continued innovation and patient care. Progress can only be achieved when we get past the mindset of the period in which we have been — the period of acknowledging the system is fragmented — and move into the post-fragmentation era, in which we view the system through the lens of health kinetics and eco-dynamics.

When we look at and understand how all parts of the system work together — or fail to –we enter an era in which we no longer debate who’s to blame. Proper understanding will allow us to compromise, adjust our aims, improve our practices, and finally, make changes that remove the health system as its own beneficiary, replacing it with the patient as the system’s customer.

[Special thanks to John Bianchi for his review of this health policy economics article that shifts the conversation from sector-to-sector blame to a forward-looking perspective; to industry friend and mentor John Nosta for encouraging me to put these thoughts into publication and to Dr. Dean and Anne Ornish, pioneers in preventive and consumer empowered health and co-founders of Ornish Lifestyle Medicine.]

The post We Know the Health Ecosystem is Fragmented, Resulting in Rising Costs and Poorer Patient Outcomes, But What Are We Doing About It? appeared first on Medika Life.