The American health care system is sick. We hear pundits, the media, and the presidential candidates describe its symptoms—47 million Americans are uninsured[i] and an alarming 16% of our GDP is spent on health care[ii]—but these statistics miss the causes of its disease. The sky-high costs of care and insurance, the increasing prevalence of chronic diseases like obesity, and many other failings of our health care system stem from a single underlying problem: we treat people after they become sick. The only way to cure America’s health care system is to stop merely reacting to disease, and instead take a preventive, prospective approach to health care.

America’s obesity epidemic is a prime example of the failure of our reactionary health care system. In 2003, more than 30% of Americans were obese.[iii] Obesity increases the risk of many serious diseases, including hypertension, heart disease, and diabetes.[iv] It is also often entirely preventable: the major causes of the obesity epidemic stem from social changes occurring over the last 40 years, namely decreased amounts of physical activity and higher caloric intake.[v] Yet the current health care system usually becomes involved only after an individual’s obesity leads to a serious medical condition.

Chronic diseases like obesity account for almost 75% of America’s health care spending, and two-thirds of our health care dollars are spent caring for patients with five or more chronic conditions.[vi] Americans have the right to see their health care dollars used as efficiently as possible, yet billions of dollars are spent each year treating these often-preventable conditions.[vii] If we reduce the prevalence of chronic disease, America will spend less on health care and be healthier.

Preventing many of these chronic diseases is possible today with a novel approach to health care developed at Duke University.[viii] This approach, called prospective health care, makes use of recent scientific and medical innovations to accurately predict each individual’s susceptibility to a variety of diseases. Doctors can use this information to create personalized health care plans designed to prevent disease entirely when possible, and at the very least treat disease early and effectively. Patients are able to take responsibility for their own health by following their tailor-made plan, with continuous support from the prospective health care system.

If we have the ability to prevent chronic disease with prospective health care, we must ask why we aren’t doing it. One answer to this question is that our diseased health care system is designed only for reactive medicine. Even though disease prevention costs much less than treating serious illness,[ix] it is difficult or even impossible for doctors to charge insurers for preventative medicine. It is especially hard for doctors to be reimbursed for ordering cutting-edge medical tests or using other new technologies, even if they are the most effective option.[x] Our reimbursement system actually penalizes doctors who practice prospective health care: in addition to difficulties with billing insurers, these doctors will lose business down the road from their patients who would have otherwise become ill.

Politicians are beginning to notice these problems. All three presidential candidates list various aspects of prospective health care as part of their health care platforms.[xi] Their plans also include elements of the substantial changes necessary to make prospective health care available on a national scale. These changes must begin with insurers and Medicaid/Medicare: patients’ health care budgets are already exhausted from paying into the current system, so it is essential insurers and government programs begin to both encourage and pay for prospective health care. Likewise, access to care must be extended to those currently without insurance to avoid creating a two-class system of prospective care haves and have-nots. Health care providers need to be educated about prospective care, and as mentioned above, the way doctors are reimbursed by insurers must change. Additionally, pharmaceutical research and regulation are in need of significant reform.[xii] The last time politicians proposed such sweeping changes to health care was under the Clinton administration in 1993—and faced with strong opposition from many fronts, they were ultimately unsuccessful.[xiii]

Despite political challenges, making prospective health care available to all Americans is a critical part of curing our health care system. If the high rates of chronic disease are not directly addressed, we will continue to suffer from the current system’s inefficiencies and inadequacies. Nation-wide prospective health care has the potential to reduce chronic disease and make us healthier—even save our lives—while lowering the amount we spend on health care. We should settle for nothing less.