Salus Health Care Forum: November 5, 2025

There are vast and rising healthcare workforce shortages. And we have the most expensive healthcare delivery system in the world, with very low consumer satisfaction, which hovers in the mid-40s. It is now safer to give birth in Canada than in any state in the United States, except for California, as I understand it right now. It is now safer to give birth in Mexico than in several of our states.

Our healthcare is fragmented, complex, and costly. So, I think that enumerates the array of challenges. This NASEM report really tried to get into some of the nitty-gritty of what needs to happen.

In the report, they indicate that we’ve got to move towards a whole person, whole population health model. That is a very ambitious statement. We have discussed population health periodically here, but I hope we can have some discussion about why that’s so hard to do in a country that’s very focused on individualism.

It will require a shift from an individual-focused to a population-focused framework. It will require developing a social movement, they say, which I thought was interesting because we’ve discussed that here, that we really feel we need to be part of some sort of broader social movement that aligns finance with rewarding health and well-being. They give several specific recommendations.

One, which I thought was bold of them, was to decrease low-value care spending by 50%. They name a few things in there: spine surgery, skin substitutes, unnecessary procedures, and expensive medications. Number two, those preparing the report recommended an increase in high-value care spending by 50%. That would include primary care, behavioral health, and other things, which we’ve done the exact opposite over the last 20 years.

We need to shift to the population-based global funding across all sectors, incentivizing 75% of spending in health care to tie to metrics that matter, which I thought was interesting. That’s kind of a reframe. Primary care has had evidence that matters for many years, so the idea that we would have metrics that matter is kind of an exciting tie-in to strengthening primary care’s influence on the spending.

The last, I thought, was really brave. Those preparing the report say we need to focus on improving the health outcomes in the first 50 worst counties in the nation. They did not name them, but there are ways to find out who they are. The 50 worst health counties are identified, based on three or four entities that are reporting these county-based health outcomes. I thought that was good. They gave us somewhat of a vision of what they thought the future would look like, and that would be that health outcomes in the United States are just as good as European countries.

It doesn’t sound like the typical way America sets up its visionary, but that’s the truth. If we could become as good as Europe in health care, we really would be something. Health becomes a priority beyond health care and public health.