Healthcare needs investment in people
Joshua Tamayo-Sarver, MD, PhD, FACEP, FAMIA and Demi Goheen
Focusing on “The U.S. spends much more on healthcare than any other country and has worse outcomes” is bad for our health
The longer we spend in medicine, whether in the chaos of the ER, the boardroom of a tech startup, or the trenches of product development, the more I see the same pattern: our health system is obsessed with what happens inside the medical encounter, but the real drivers of health often live outside its walls.
The Numbers Tell a Story-But Not the Whole Story
It’s tempting to point to the oft-cited statistic: the United States spends over $6,000 more per person on healthcare than its peer countries, yet ranks dead last in outcomes like life expectancy (Figure 1).
On the surface, this looks like a straightforward case of wasteful spending and poor returns. But that narrative misses the complexity of how health is financed and delivered in the U.S. context. This misconception is dangerous because it leads to the wrong conclusions about how to make the country healthier.
What’s less obvious is that, in the U.S., funding for social programs-think substance abuse support, food security, or housing-is frequently funneled through healthcare budgets, while direct investment in social services lags behind other countries. When you combine healthcare and social spending, the U.S. actually performs better (though still not great) relative to its total investment, suggesting that the problem isn’t simply overspending on medical care, but rather a structural misalignment in how we support health (Figure 2).
The Real Levers of Health: Social Determinants
If you’ve spent enough time in any medical setting, you see the same root causes over and over. Patients miss appointments because they can’t afford transportation. Chronic diseases spiral because healthy food is out of reach. Mental health issues fester in the shadow of job loss or discrimination. These are not medical failures, but they are failures to address the foundation of health: economic stability, education, access to care, safe neighborhoods, and social support.
Decades of research confirm that these non-medical factors account for as much as half of the variation in health outcomes, dwarfing the impact of clinical care alone. For example, economic stability is tightly linked to access to healthcare, nutritious food, and safe housing. Without a steady income, people delay care, ration medications, and face higher rates of preventable hospitalizations. The same is true for education, safe environments, and community support.
What the Jobsite Taught Me About Health’s Hidden Foundations: Demi’s “Aha” Moment
Demi: I can still feel the thump of boots across concrete when I think back to my days managing safety in my previous construction project. There was one week that stands out, not because of any dramatic accident, but because of a quiet pattern I couldn’t ignore.
Every morning, I’d run my safety checks for hard hats, harnesses, the usual drill. But I started noticing that a few of our crew were always dragging. Not just tired, but running on empty. One guy in particular, let’s call him Jon, was late three days in a row. He’d show up, eyes rimmed red, hands shaking as he fumbled with his gear. I flagged it in my log, thinking maybe he was burning the candle at both ends.
But when I pulled him aside, it wasn’t what I expected. Jon wasn’t out partying or slacking off — he was working a second job at night to cover rent. He was barely sleeping, skipping meals, and the stress was written all over him. He wasn’t just at risk for a safety violation, he was at risk, period.
That was a wake-up call for me. I realized that all the safety protocols in the world couldn’t protect someone whose basic needs weren’t being met. We were laser-focused on what happened inside the gates, but the real hazards started long before anyone clocked in. Jon’s exhaustion wasn’t a “personal problem” it was a system problem. And it was affecting not just his safety, but the safety of everyone around him.
Why This Isn’t Just Semantics
That lesson echos in healthcare every single day. We talk about outcomes, protocols, and compliance, but the truth is, what happens outside (housing, food, work, stress) shapes health more than any prescription. Just like on the jobsite, if we ignore the social and economic realities people face, we’re only seeing half the picture.
So, when we advocate for integrating social risk screening or building partnerships beyond the clinic, it’s not just theory it’s lived experience. The “hidden” factors shape whether someone thrives or just gets by. If we want to move the needle in healthcare, we have to start where people’s real lives begin.
When we talk about the return on investment in the U.S. for “healthcare” spending compared to other countries, we are engaging in a conversation that misunderstands the game. This misunderstanding leads to a focus on “waste,” which then reduces investments in research for life-saving treatments. There is clearly inefficiency in our medical spending, but this statistic and figure 1 do not show it.
Instead, let’s expand our view of investing in healthcare to encompass investing in people. If we broaden our lens to include social investments (education, economic opportunity, housing, supportive social structures), we uncover opportunities to improve outcomes more efficiently.
This shift is not theoretical. As a physician and technology leader, I’ve seen firsthand how interventions targeting social needs- connecting patients to food resources, addressing housing instability, or supporting job training can reduce medical emergencies, improve chronic disease management, and ultimately drive better health at a lower cost. The challenge is not a lack of evidence, but a lack of alignment between what we know works and how we view healthcare.
Moving Forward: Practical Steps for Healthcare Leaders
To truly move the needle on health outcomes, healthcare leaders must:
- Broaden the view of healthcare to acknowledge that disease happens in a person and a weakened person is an opportunity for disease. When we don’t invest in people, we see sickness. Healthcare is the canary in the coal mine and should take seriously our responsibility to highlight where we need more investment in people.
- Identifying the areas where we are under-investing in people is not enough. But healthcare and “medical spending” is an inefficient mechanism to invest in the person. Once healthcare leaders have identified those investment opportunities they need to partner with the professionals who can provide the job training, education, meals, and social support that help us all thrive.
- Stop advocating for medical payment models that reward improvements in social outcomes. Medical spending is an inefficient delivery mechanism for this investment. We need to allow social spending to go through social organizations who can deliver real results efficiently. We need to partner with a bigger, holistic pie, not try to take more pieces of the pie for healthcare.
- It takes a village to make a healthy person. We need to abandon our love of data silos and the perceived market advantage of owning and controlling the person’s data. We need to create secure, private, and closely governed data infrastructure so that the whole ecosystem of person investment can be efficiently delivered.
The Path to Lasting Change
Building a system that prioritizes investing in the whole person is not easy. We already have many pieces of that in our world right now, but they are disjointed, uncoordinated, and often fighting over the same dollars. It requires collaboration across sectors, a willingness to challenge entrenched incentives, and a relentless focus on what actually drives health. But the evidence is clear: if we want to see real progress, we must look beyond the exam room and invest in the social and economic foundations of well-being.
As someone who has worked in every corner of the healthcare system, I’ve learned that the most meaningful innovations are those that bridge the gap between medical care and the realities of patients’ lives. The future of health depends on our ability to see-and act on-the full picture.
Dr. Joshua Tamayo-Sarver, MD, PhD, FACEP, FAMIA, develops and deploys technology solutions in the healthcare ecosystem as a clinician, business leader, software engineer, statistician, and social justice researcher. As the Vice President of Innovation at Inflect Health and Vituity, his unique formula of skills has helped develop over 35 solutions and scale multiple new healthcare products, including the first AI occult sepsis tool with FDA breakthrough designation. Dr. Tamayo-Sarver oversees corporate venture, internal incubation, and advisory services for AI-driven healthcare solutions, blending consumerism and clinical quality to fit the delicate balance of patient desire, user experience and quality medical care. A Harvard graduate, he holds degrees in biochemistry, epidemiology, and biostatistics, as well as a medical degree from Case Western Reserve University. He is a Mentor in the Emergence Program at Stanford University.
Follow him on LinkedIn — Joshua Tamayo-Sarver, MD, PhD, FACEP, FAMIA
Demi applies a multidisciplinary background in safety, human resources, and healthcare to streamline operations and fuel innovation. As Administrative Coordinator at Inflect Health, she plays a pivotal role in optimizing team efficiency, supporting healthcare ventures, and shaping systems that drive meaningful change. Her passion for people and process makes her an essential force behind Inflect’s mission to transform care delivery.
Follow her on LinkedIn — Demi Goheen
