The US Spends $5.3 Trillion a Year on Healthcare. Almost None of It Goes to Keeping You Healthy.
We do not have a healthcare system in this country. We have a sick care system.
That is not a political statement. It is a structural one. The US spent $5.3 trillion on healthcare in 2024, or $15,474 per person, accounting for 18 percent of the entire US economy. (CMS, 2024) That is the highest per capita healthcare spend of any country on earth. And yet by nearly every major health outcome measure, Americans are sicker than people in comparable wealthy nations.
The reason is not complicated. We are spending that money overwhelmingly on treating disease after it happens, not on preventing it before it does. Spending on preventive care in the US has actually declined as a percent of total national health spending, from 3.7 percent in 2000 to 2.9 percent in 2018. (Peterson-KFF) Meanwhile spending on hospitals, drugs, and procedures keeps climbing year after year.
A system that profits from treating sick people has no financial incentive to keep people well. That is not a conspiracy. It is just how the incentives are structured. And until you understand that, you cannot fully understand why preventive care is so underprioritized, underutilized, and undervalued in this country.
The Number That Should Concern Everyone
In 2015, only 8.5 percent of adults aged 35 and older received all recommended high-priority clinical preventive services. By 2020 that number had fallen to 5.3 percent. (Office of Disease Prevention and Health Promotion, 2024)
Read that again. By 2020, fewer than 6 in 100 American adults were getting all the preventive care recommended for them. Not because the care does not exist. Not because it is not covered. Because the system is not built to make it happen, and most people do not know what they are missing.
This matters because the diseases that are killing the most Americans, heart disease, type 2 diabetes, obesity-related illness, and several cancers, are largely detectable and often preventable. Research estimates that more than a quarter of all US healthcare spending is attributable to preventable causes. (The Lancet Public Health, 2020) We are spending hundreds of billions of dollars treating conditions that the evidence says we could have caught earlier, or avoided entirely.
What Preventive Care Actually Is
Most people think of preventive care as an annual physical. It is more than that.
Clinical preventive care includes blood pressure screening, cholesterol and blood sugar testing, cancer screenings, vaccinations, counseling for behavioral risk factors like smoking and physical inactivity, and mental health screening. These are not optional extras. They are the early warning system that allows intervention before a manageable condition becomes a catastrophic one.
The logic is straightforward. Catching high blood pressure before it damages arteries is cheaper, easier, and less devastating than treating the heart attack it causes. Finding a blood sugar trend before it crosses into diabetic range gives you years of runway to reverse course. Identifying a cancer at stage one versus stage four is the difference between treatment and survival.
Early detection and intervention work. The system just is not consistently delivering them.
Why People Are Not Getting It
The barriers are real and worth naming honestly.
Cost and access remain the biggest obstacles for millions of Americans. Despite the Affordable Care Act requiring most insurance plans to cover recommended preventive services at no cost to the patient, more than 25 million Americans remain uninsured. And even among the insured, navigating what is covered, finding a provider, and taking time off work to go are not equally easy for everyone.
But even among people who have insurance and access to a primary care provider, the gap remains. Appointments are short. Providers are stretched. The focus in a 15-minute visit tends to be on what is currently wrong, not on comprehensively reviewing what screenings and preventive services are due. The system is not designed for prevention. It is designed for response.
There is also a cultural piece. We have been conditioned to engage with the healthcare system when something hurts. Prevention requires engaging before anything hurts, which feels counterintuitive and often gets deprioritized against more immediate demands on time, money, and attention.
What You Can Actually Do About It
Here is where your agency sits. Because while the system has real structural problems, waiting for those to be fixed before taking action is not a strategy your health can afford.
Know your numbers. Blood pressure, fasting blood glucose or HbA1c, cholesterol panel, and resting heart rate are the four that matter most for chronic disease risk. If you do not know yours, that is the starting point. These are standard blood tests your primary care provider can order at a routine visit, and most insurance covers them at no cost.
Do not skip the annual visit. Even if you feel fine. Especially if you feel fine. Chronic diseases are often asymptomatic for years. The visit exists to find what you cannot feel yet.
Know what screenings you are due for based on your age, sex, and family history. The US Preventive Services Task Force publishes evidence-based recommendations for all of them. Your provider should be reviewing these with you. If they are not, ask.
Share what you know with the people around you. The most powerful preventive health intervention is often a conversation. Ask your partner when they last had their blood pressure checked. Ask your parents if they are current on their screenings. Ask the people you love if they know their numbers. Prevention is not just a personal practice. It is a community one.
What This Means for Your Kids
If you have children, the habits and systems you build now shape their relationship with healthcare for life. Kids who grow up in households where preventive care is normalized, where annual checkups happen, where health conversations are not avoided, carry those patterns into adulthood. That is a more powerful intervention than any public health campaign.
The Bottom Line
The system is not built to keep you healthy. It is built to treat you when you are sick. That is the honest reality of how it is structured and where the money flows.
But that does not make you powerless. It makes it more important that you understand what preventive care you are entitled to, pursue it actively, and do not wait for the system to bring it to you.
Your health is too important to be entirely dependent on a system with misaligned incentives.
When did you last have your numbers checked? Not a vague estimate. Do you actually know your blood pressure, your blood sugar, your cholesterol? If the answer is no, that is the single most useful thing you can do this week.
The Reset Compass is a free tool built to help you figure out where to start based on where you actually are. No program, no account required.
Try The Reset Compass for Free
The system waits for you to get sick. Do not wait with it.
Marcus Clark is the founder of Evolution of Wellness LLC and holds a Master of Public Health degree. This post is for informational purposes and does not constitute medical advice. Always consult your healthcare provider for personalized guidance.
Get posts like this in your inbox.
Every five days. Research-backed. Free.