The most honest sentence I've read about American healthcare came from Goldman Sachs. In 2018, one of their analysts asked: "Is curing patients a sustainable business model?" That one question explains most of our medical system. It isn't broken. It's working exactly the way it's paid to, and that's the problem. The system isn't paid to make you healthy. It's paid when you're not. This isn't a conspiracy. Every player is simply responding to how it gets paid. 1. Food companies are paid to sell more, not to keep you healthy. Big food engineers products to be as craveable as possible, because the more you eat, the more they sell. Your health doesn't show up anywhere on the balance sheet. Example: Nearly 3 out of 4 packaged foods Americans buy contain added sugar, including many breads, ketchups and pasta sauces. The industry even has a name for the exact amount of sugar that makes a product taste best: the bliss point. And food, drink and restaurant companies spent almost $14 billion on US advertising in 2017, with more than 80% of it promoting fast food, sugary drinks, candy and unhealthy snacks. 2. Insurers make more when healthcare costs more. Insurers keep a fixed slice of what they collect, so their profit grows when total spending grows. Lowering the cost of care doesn't make them richer, because the law makes them refund the difference. Example: The ACA lets insurers keep up to 20% of premiums for admin and profit. On $1,000 in premiums, that's $200. On $2,000, it's $400. It works like a waiter paid on tips: the bigger the bill, the bigger the tip. 3. Media makes billions from drug ads. Media is paid by whoever buys your attention, and in health, the biggest buyer is the drug industry. Example: Drug companies spent over $10 billion on ads in 2024. In early 2025, nearly 1 in 4 ad minutes on the evening news were for drugs, and the US is one of only two countries that allows these ads at all. So the loudest health message on TV isn't "find the cause." It's "ask your doctor if it's right for you." 4. Pharma makes the most from drugs you never stop taking. A cure is sold once. A drug you take every day for the rest of your life is sold forever, and that's where the money is. Example: Many of the most prescribed drugs in America treat cholesterol, blood pressure and blood sugar, and people usually take them for years, often for life. Now compare hepatitis C. A cure came out that works in over 95% of cases, and it cured so many people that its US sales were expected to fall from $12.5 billion in 2015 to under $4 billion by 2018. That drop is what led Goldman to ask whether curing patients is a sustainable business model. 5. Doctors are paid per visit, not per result. Most doctors are good people with too little time. In a short visit, the fastest complete answer is to follow the guideline and write a prescription. Looking for the cause takes longer and pays the same or less. Example: A primary care visit gives your doctor about 15 to 20 minutes to cover your history, your symptoms, your labs and a plan. Four years of medical school include, on average, under 20 hours of nutrition training. Insurers and Medicare also pay practices bonuses based on how many eligible patients are on certain medications. 6. Nobody fixes it, because prevention pays off too late. The cost of being sick is paid today. The savings from staying healthy arrive years later, usually for someone else, so nobody wants to pay for them. Example: About 90% of US healthcare spending goes to people with chronic and mental health conditions. Roughly 3% goes to public health and prevention. Put the chain together. The food sets up the problem, the ads sell the treatment, the treatment is built to last a lifetime, the visit is too short to look for the cause, and the insurer takes a cut of every step. Each piece makes sense on its own. Together, they add up to one thing: Nobody in this system is paid to look out for your long-term health. The food isn't made to keep you well, the ads aren't there to inform you, and the system that treats you isn't paid to find the cause and fix it for good. Every one of them gets paid while you're sick, and the money stops when you're not. That's how America spends more on healthcare than any other wealthy country, and Americans still die younger. So go back to that question. Is curing patients a sustainable business model? For the system, maybe not. But there's one person in this whole chain who wins when you get healthy. You.