What's broken in medicine — and how to fix it: Primary care

The U.S. health care system remains one of the most advanced — and one of the most dysfunctional — in the world. Although the system 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 among 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, and 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 — 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 among 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, M.D., Ph.D., 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. In this episode, Runge discusses the challenges of primary care.