An easy way to gauge the health of a country, and to compare the health of a country with that of other countries, is to look at average life expectancy. And if you look at a chart comparing average life expectancy in the U.S. with the average life expectancy of eleven other wealthy countries from 1980 to 2021, you will find that in 1980, the U.S. was just about equal with those other countries. But as the years have progressed since then, life expectancy in the U.S. has fallen further and further behind. Until 2014, our life expectancy was going up, but we were losing ground to the populations of other advanced countries.

By 2019, prior to COVID, life expectancy in the U.S. had fallen relative to that in the other countries so much that 500,000 Americans were dying each year in excess of the death rates of the citizens of those other countries. To exclude poverty as a factor in these numbers, a study looked at the health of privileged Americans—specifically, white citizens living in counties that are in the top one percent and the top five percent in terms of income. This high-income population had better health outcomes than other U.S. citizens, but it still had worse outcomes than average citizens of the other developed countries in such areas as infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction.

Now combine this with the fact that we in the U.S. are paying an enormous excess over those other countries on health care. In the U.S., we spend on average $12,914 per person per year on health care, whereas that figure in the other comparable countries is $6,125. That comes to $6,800 more per person—and if you multiply that by 334 million Americans, we are spending an excess $2.3 trillion a year on health care—and getting poorer results.

Which means that our health care system is broken and needs fixing.

Prior to leaving office in 1961, President Eisenhower famously warned the nation about what he called the “military-industrial complex.” I suggest that we now have a medical-industrial complex that is sucking America’s wealth away from the other things that will make us healthier and create better lives for the American people.

Ask yourself, what ought to be the primary goal of American health care? To my mind it is this: to maintain and improve individual and population health most effectively and efficiently. And if that is correct, there are two critical questions we all need to ask: (1) Why are we failing so miserably to achieve this goal? and (2) Why are doctors and other health care professionals willing to go along with this dysfunctional system?

One of the fundamental reasons for the disparity between the health of Americans and the health of people in other wealthy developed countries is that our medical-industrial complex has taken control over what doctors and the public accept as medical knowledge. This is something that has evolved over time.

Turning to the issue of excess cost, there are three main factors. One is that the U.S. is the only wealthy developed country that has no formal mechanism of price negotiation. A second is that because most consumers are insured, they pay only a small part of the price—so high prices don’t provide market discipline. A third important factor is that, as a country, we are perhaps too mesmerized by the idea of biomedical innovation.

Regarding this third factor, historian Jill Lepore has written: “Innovation might make the world a better place, or it might not.” Innovation, she goes on to say, is not necessarily “concerned with goodness,” but often “with novelty, speed, and profit.” It is certain that in the biomedical area, too many innovations we are being sold today are not being properly evaluated in terms of their true value for the public.

We in the U.S. are spending 96 percent of our biomedical research money on medical drugs and devices, and only four percent on how to make the population healthier and how to deliver health care more efficiently and effectively. Put another way, the U.S. spends $116 billion on researching new drugs and devices—which comprise only 13 percent of total health care costs—but only $5 billion on research concerning the remaining 87 percent of health care costs. Why? Because the drug companies’ job is to maximize the money they return to their investors, and the highest return on research investment is not going to be from studying and promoting healthy diets and lifestyles. The money is in selling drugs and devices. This leads to a tremendous epidemiological imbalance in the information coming down to doctors.