The United States does not have a health care resource problem in the traditional sense. It has world-class clinicians, advanced hospitals, major research universities, powerful computing infrastructure, enormous public programs, innovative biotechnology companies, community health centers, pharmacies on nearly every busy street, and enough health-related data to make a spreadsheet beg for mercy.
The harder problem is alignment. Resources are scattered across thousands of organizations, payment arrangements, technology platforms, jurisdictions, and insurance plans. Too often, the patient becomes the unofficial project manager responsible for connecting all the pieces while also coping with an illness.
That model will become increasingly difficult to sustain. U.S. health expenditures reached roughly $5.3 trillion in 2024 and are projected to approach $9 trillion by 2034. Spending is expected to grow faster than the overall economy throughout the projection period. The next decade, therefore, cannot simply be about buying more care. It must be about using existing U.S. health care resources more intelligently, equitably, and consistently.
The Pressures Reshaping U.S. Health Care
An Older Population With More Complex Needs
Population aging will alter nearly every corner of the health system. By 2030, all baby boomers will be older than 65, and about one in five Americans is projected to be of retirement age. Older adults generally need more medication management, rehabilitation, home-based care, specialty services, caregiver support, and coordination across multiple providers.
This shift does not mean the country should build a hospital room for every birthday cake with 65 candles. It means care must move beyond hospital walls. Home health services, remote monitoring, primary care, rehabilitation, pharmacy support, transportation, caregiver education, and long-term services will become more important parts of the national health care infrastructure.
Chronic Disease Is the Main Event
Acute medical breakthroughs receive dramatic headlines, but chronic and mental health conditions drive much of the everyday workload. The Centers for Disease Control and Prevention reports that approximately 90% of annual U.S. health care expenditures are associated with people who have chronic or mental health conditions. Diabetes, heart disease, cancer, obesity, depression, respiratory illness, and related conditions cannot be managed effectively through occasional rescue missions in emergency departments.
The better approach is less theatrical but more effective: identify risk early, help patients follow treatment plans, make healthy choices practical, monitor changing symptoms, and intervene before a manageable condition turns into a very expensive siren-filled afternoon.
A Workforce That Cannot Simply Work Faster
Workforce shortages will place additional strain on access. Current federal projections indicate a potential shortage of more than 140,000 full-time-equivalent physicians by 2038, including a substantial shortage in primary care. Nursing shortages are also projected during the coming decade, although supply and demand will vary significantly by state and care setting.
Health care leaders cannot solve this challenge by asking exhausted clinicians to become even more heroic. The country must redesign work around teams, technology, flexible training pathways, expanded scopes of practice where appropriate, and far less administrative clutter.
America’s Health Care Resource Inventory
People and Community-Based Care
The health care workforce includes far more than physicians working in major medical centers. Nurses, pharmacists, physician assistants, nurse practitioners, behavioral health professionals, community health workers, therapists, emergency medical teams, laboratory specialists, home health aides, public health staff, and family caregivers all contribute to health outcomes.
Federally supported health centers illustrate the scale of community-based capacity already available. Nearly 1,400 health center organizations collectively provide affordable primary care to more than 32 million people each year, including patients in rural communities, public housing, and medically underserved areas. These centers are not side projects. They are major national assets that can support prevention, behavioral health integration, maternal care, dental services, chronic disease management, and connections to social services.
Data, Research, and Scientific Infrastructure
The United States possesses an extraordinary research ecosystem spanning the National Institutes of Health, academic medical centers, pharmaceutical companies, biotechnology firms, public health laboratories, patient registries, insurers, and health systems. The NIH All of Us Research Program, for example, combines electronic health records, genomic information, surveys, physical measurements, biospecimens, and wearable-device data to support more representative precision-medicine research.
The opportunity is not merely to collect more data. The country already has data in abundance. The goal should be to turn trustworthy information into earlier diagnoses, safer treatments, better population-health planning, and clearer decisions at the point of care.
Public Purchasing Power
Medicare and Medicaid are not only insurance programs; they are powerful engines for changing how care is delivered. Their payment policies influence hospitals, physician practices, nursing facilities, laboratories, private insurers, technology vendors, and investors.
Accountable care organizations demonstrate how payment can encourage coordination instead of rewarding volume alone. In the 2024 performance year, Medicare Shared Savings Program organizations generated an estimated $2.5 billion in net savings for Medicare while earning $4.1 billion in shared savings. Participating organizations also reported improvements in measures such as blood-pressure control, diabetes management, and depression screening.
These results do not prove that every value-based care model works perfectly. They do show that payment rules can encourage providers to invest in prevention, data analysis, follow-up care, and care coordination rather than simply increasing the number of billable encounters.
Seven Priorities for the Next Decade
1. Build the System Around Primary Care
Primary care should function as the operating system of American health care, not as an underfunded help desk. Strong primary care teams can provide prevention, medication management, behavioral health screening, routine treatment, referrals, and continuous support for chronic conditions.
Investment should focus on longer visits for complex patients, team-based care, same-day access, after-hours support, digital communication, home visits, and reliable referral networks. Payment should reward continuity and outcomes rather than forcing clinicians to race through appointments like contestants on a medical game show.
2. Treat Prevention as Infrastructure
Preventive care is often discussed as a collection of screenings and vaccinations. Those services matter, but prevention also includes safe housing, nutritious food, clean air and water, exercise opportunities, maternal support, addiction treatment, and early behavioral health care.
Health systems should use clinical and community data to identify local risks, then form practical partnerships with schools, employers, public health departments, food organizations, housing agencies, and transportation services. The goal is not to make hospitals responsible for every social problem. It is to stop pretending those problems have no effect on hospital demand.
3. Redesign the Health Care Workforce
The coming decade requires a workforce strategy that goes beyond increasing medical-school enrollment. Training should prepare professionals for team-based practice, geriatrics, behavioral health, informatics, virtual care, home-based services, population health, and emergency preparedness.
Organizations should assign tasks according to expertise. Pharmacists can support medication optimization. Community health workers can improve outreach and trust. Nurses can manage education and follow-up. Behavioral health specialists can work inside primary care. Artificial intelligence can assist with documentation and routine analysis, provided clinicians remain accountable for important decisions.
Public health departments need similar attention. The Government Accountability Office has identified persistent hiring, retention, funding, and data-skills gaps across state, local, territorial, and tribal public health agencies. A resilient system needs permanent capacity between emergencies, not frantic recruitment after the emergency has already arrived.
4. Make Health Information Follow the Patient
Interoperability should become an everyday utility. Patients should not have to repeat their medication list at five facilities, carry imaging discs across town, or discover that one clinician cannot see results ordered by another clinician in the same metropolitan area.
The Trusted Exchange Framework and Common Agreement establishes a nationwide foundation for secure exchange among health information networks. Its expansion, including standards-based application programming interfaces, creates an opportunity for clinical records to move more reliably among providers, payers, public health agencies, and patients. By early 2026, participating networks had facilitated the exchange of hundreds of millions of health records.
The next step is converting exchange into usefulness. Records must be organized, reconciled, summarized, and delivered inside clinical workflows. Sending a physician 600 pages of unfiltered data is technically an exchange, but it is also a creative new form of punishment.
5. Use Artificial Intelligence With Discipline
Artificial intelligence may help detect abnormalities, predict deterioration, automate documentation, match patients with clinical trials, simplify scheduling, and identify population-level risks. The Food and Drug Administration already maintains a growing list of authorized AI-enabled medical devices, particularly in radiology and cardiovascular care.
However, AI should be judged by real outcomes rather than impressive demonstrations. Health organizations need independent validation, ongoing performance monitoring, transparent governance, cybersecurity controls, bias testing, human oversight, and clear procedures for correcting errors.
The most valuable AI tools may not be futuristic robot physicians. They may be systems that reduce documentation time, organize records, identify missed follow-up, translate instructions, and give clinicians several minutes back in their day. In health care, a few rescued minutes multiplied by millions of visits becomes a serious national resource.
6. Expand Hybrid Care Without Creating a Digital Divide
Telehealth can connect rural patients with specialists, support behavioral health treatment, enable chronic-condition monitoring, and reduce unnecessary travel. Approximately one in five Americans lives in a rural or frontier area, making virtual access an important component of national capacity.
Yet telehealth is not automatically accessible. Broadband limitations, device costs, limited digital literacy, language barriers, privacy concerns, and complicated reimbursement rules can exclude the very patients who might benefit most. Rural communities still face major internet-access gaps, so hybrid care must include telephone options, community access points, technical assistance, remote-monitoring support, and dependable pathways to in-person care.
7. Make Affordability a Clinical Quality Measure
A treatment that a patient cannot afford is not an effective treatment plan. Nearly half of U.S. adults report difficulty affording health care costs, and financial pressure affects insured as well as uninsured families. High deductibles, uncovered services, prescription prices, confusing bills, and out-of-network charges can lead people to delay care or abandon treatment.
Health systems should discuss cost during care planning, provide accurate estimates, connect patients with assistance, prescribe affordable alternatives when clinically appropriate, and simplify billing. Policymakers and purchasers should also address market concentration, administrative waste, weak competition, and payment structures that reward expensive settings over efficient ones.
International comparisons continue to show that the United States spends more while performing poorly on affordability, equity, administrative efficiency, and health outcomes. At the same time, U.S. care processes perform relatively well in areas such as preventive services and patient safety. The lesson is not that the country lacks expertise. It is that its strengths are not consistently converted into accessible population-wide results.
How Progress Should Be Measured
A successful strategy needs a scorecard that matters to patients, clinicians, employers, taxpayers, and communities. National and local leaders should monitor whether people can obtain primary and behavioral health care promptly, whether chronic conditions are controlled, whether avoidable hospital use is falling, and whether rural and underserved communities are gaining meaningful access.
Measurement should also include clinician burnout, administrative time, household medical debt, cybersecurity performance, medication adherence, maternal outcomes, preventable mortality, patient-reported experience, and the percentage of health information that is usable at the moment a decision is made.
AHRQ’s national reporting already tracks access, affordability, coordination, effective treatment, patient safety, healthy living, and disparities. The next decade should turn such measurements into management tools, with public reporting that shows where improvement is occurring and where resources remain trapped in organizational silos.
Experience-Based Lessons: What Better Resource Use Looks Like
The following illustrative scenarios combine common experiences reported across American health care. They are not descriptions of specific patients, but they show how coordinationor the lack of itchanges the care journey.
The Older Adult Managing Several Conditions
Consider an older adult with diabetes, heart failure, arthritis, and mild depression. In a fragmented system, this person may see several specialists, receive overlapping instructions, fill prescriptions at different pharmacies, and return home from the hospital without a clear understanding of which medications changed. A daughter may spend hours calling offices while trying to interpret an online portal that displays test results but offers no useful explanation.
In a better-organized system, a primary care team maintains an updated care plan. A pharmacist reviews medications after every transition. A nurse checks symptoms remotely and notices early weight gain associated with fluid retention. A community health worker helps arrange transportation and connects the family with meal support. The cardiologist and primary care clinician see the same discharge information. A potentially serious problem is handled before another hospitalization becomes necessary.
No miracle cure occurred. The system simply used its existing professionals, data, and communication tools as a coordinated resource.
The Rural Patient Who Needs Specialty Care
Now imagine a patient living two hours from the nearest specialist. A traditional model requires a day away from work, transportation expenses, and perhaps child-care arrangements for a 20-minute consultation. If the appointment is canceled, the entire logistical Jenga tower collapses.
A hybrid model can begin with an examination at a local clinic. A nurse collects vital signs and performs appropriate testing. A distant specialist joins by video, reviews the same record, and develops a plan with the local clinician. Routine follow-up occurs remotely, while procedures and complex examinations remain in person.
This experience reveals an important lesson: telehealth works best as part of a trusted local network. A video call alone cannot draw blood, stabilize an emergency, or guarantee broadband. Digital access becomes truly valuable when it strengthens nearby care rather than attempting to replace it.
The Clinician Buried Under Administrative Work
Finally, consider a primary care clinician whose day ends with dozens of unfinished notes, refill requests, prior-authorization forms, inbox messages, and alerts. Adding another dashboard may look like innovation from the conference room while feeling like digital confetti at the clinic.
A resource-conscious organization begins by removing low-value work. It standardizes forms, automates routine data entry, routes questions to the appropriate team member, and uses AI to prepare draft summaries that the clinician verifies. Important alerts are prioritized, while repetitive warnings are reduced. The physician spends more time discussing treatment and less time searching for information hidden inside the record.
This experience demonstrates that technology should not merely increase the amount of activity. It should create capacity. The practical test is simple: Did the tool help the patient, reduce unnecessary work, improve safety, or support a better decision? When the answer is no, the software may be sophisticated, but it is not a useful health care resource.
Conclusion
The next decade will test whether the United States can convert extraordinary health care capacity into reliable health. The country already has many of the necessary components: skilled professionals, community organizations, scientific expertise, public programs, health data, advanced technology, and substantial financial resources.
The winning strategy is not endless expansion. It is alignment. Primary care must connect with specialty care. Public health must connect with clinical delivery. Payment must support prevention and coordination. Technology must reduce friction. Research must include diverse populations. Patients must be able to understand, access, and afford the care being offered.
Harnessing U.S. health care’s resources will require difficult choices, consistent measurement, and cooperation among organizations that are accustomed to guarding their own territories. But the reward is significant: a system that spends more of its energy keeping people healthy and less of it repairing avoidable breakdowns. That is how American health care can navigate the next decade without merely paying more to remain lost.
Editorial note: The experience-based examples in this article are illustrative composite scenarios created to explain common coordination, access, technology, and workforce challenges. They do not describe identifiable patients or claim personal clinical experience.
