What's broken in medicine—and how to fix it: A conversation with Marschall Runge, MD

The U.S. health care system remains one of the most advanced—and one of the most dysfunctional—in the world. While it leads in innovation, research, and the development of breakthrough treatments, it struggles with rising costs, uneven access, and deep structural inefficiencies. Patients often face a fragmented system where coordination between providers is poor, wait times are long, and navigating insurance coverage can be overwhelming.

Costs continue to spiral, placing a financial burden not only on individuals but also on the overall economy. Prescription drug prices are among the highest globally, while administrative overhead consumes a disproportionate share of health care spending. At the same time, disparities in access mean that outcomes can vary widely based on geography, income, race, and insurance status.

Preventive and primary care—which are critical for keeping patients healthy and reducing long-term costs—are often undervalued and underfunded. Meanwhile, rapid advances in technology, such as artificial intelligence, gene therapies, and at-home monitoring tools, offer potential breakthroughs but raise new questions around privacy, access, and affordability.

The system’s structure also discourages collaboration, with misaligned incentives between hospitals, insurers, physicians, and pharmaceutical companies. This often leaves patients caught in the middle of a system that prioritizes volume over value and treatment over prevention.

To better understand what’s broken—and what can be done to fix it—Medical Economics spoke with Marschall Runge, MD, PhD, CEO of Michigan Medicine and author of The Great Healthcare Disruption. Drawing on decades of experience, Runge offers insight into the root causes of dysfunction and outlines paths forward for a more equitable, effective, and patient-centered system.