Why Doesn't the Richest Nation on Earth Guarantee Its Citizens the Healthcare They Need?
What it would take to build a healthcare system around health itself — whole-person, preventive, and equitable by design.
Imagine two Americans.
One receives world-class medical care after a serious illness and comes home grateful for the skill and compassion of the doctors and nurses who saved their life.
The other delays seeing a physician because of cost, struggles to find mental health care, or faces bankruptcy after an unexpected diagnosis.
Both stories are true. That’s the paradox of American healthcare.
We’re home to extraordinary medical professionals, pioneering research, remarkable hospitals, and groundbreaking innovation. We also spend more on healthcare than any other nation on earth — while millions of Americans still worry about whether they can afford the care they need. Families carry medical debt. Clinicians burn out. Chronic disease keeps rising. Two people living twenty minutes apart can have dramatically different odds of a long, healthy life, simply because of where they live.
This isn’t only a healthcare problem. It’s a national challenge that touches our economy, our communities, our democracy, and the opportunities open to every American.
At Moonshot Press, we believe there’s a better way to have this conversation.
Moving Past the Usual Debate
Most conversations about healthcare start with politics: should government do more, or less? Should markets play a bigger role? Reform the system, or replace it?
These are real questions. But they tend to turn into arguments before anyone agrees on what the problem actually is.
Project 2026 starts somewhere else. Instead of asking who’s right, we’re asking:
How do we build a system where everyone can get the care they need to live healthy, flourishing lives?
That question belongs to everyone with a stake in the answer — which is to say, everyone. Patients, families, physicians, nurses, employers, insurers, researchers, community organizations, and government all hold a piece of it.
A Different Starting Point: What Creates Health?
Our healthcare system, as it exists today, is built almost entirely around one job: treating disease once it shows up. That’s necessary — but it’s not sufficient. What if the system were also built to create health before disease ever develops?
That’s the idea behind salutogenesis, a framework developed by medical sociologist Aaron Antonovsky. Instead of asking only “what causes disease,” it asks a second question most systems never get around to: what creates health?
Health, in this view, is more than the absence of illness. It’s the capacity of a person or a community to live a meaningful, resilient life — which means physical health, mental health, social connection, housing, nutrition, education, and meaningful work all shape each other, rather than living in separate silos. As the WHO Constitution puts it, health is “a state of complete physical, mental and social well-being,” not merely the absence of disease — and the enjoyment of that standard of health is a fundamental right, not a privilege reserved for those who can afford it.
A truly modern healthcare system should help people build health, not just repair what’s broken.
What This Looks Like in Practice
Building a healthcare system around health itself means shifting focus in a few concrete directions:
Helping people stay healthy, not just treating them once they’re sick — starting with prevention across the entire lifespan, beginning with the First 1,000 Days of life.
Treating the whole person — integrating physical, mental, behavioral, and social health instead of managing them as unrelated problems.
Supporting the clinicians already doing this work, by reducing the administrative burden that keeps them from the patients in front of them.
Using technology and AI to empower people, not replace the human relationships that make care work in the first place.
Measuring success by healthier people and healthier communities — not simply by how much healthcare gets delivered.
This is the organizing focus of the Institute for Salutogenesis, and the vision behind what we’re calling our Salutogenic Healthcare System: sustainable, accessible, high-quality care for every American, built around the creation of health rather than only the treatment of illness. You can read the fuller model at mysaluto.org.
Citizens Belong in This Conversation
Healthcare reform has too often been something done to people rather than with them. Project 2026 starts from a different premise: citizens are capable of understanding complex problems, when those problems are explained clearly, honestly, and without condescension.
That’s why Moonshot Press is launching The Case of the U.S. Healthcare System — a public, deliberative exploration that treats the healthcare system itself the way a medical team treats a difficult patient: gathering the history, reviewing the evidence, weighing treatments that have worked and those that haven’t, and building toward a plan of care. No single organization — not government, not medicine, not the market, not technology — has the whole answer on its own. Together, we can see more of the picture than any of us can see alone.
An Invitation
Whether you’re a patient, a caregiver, a clinician, a policymaker, a researcher, a student, an employer, or simply someone who believes America can do better, there’s a place for you in this conversation.
Because this was never only about healthcare. It’s about the kind of country we want to become — and it begins with one question worth asking together:
How do we build a system where everyone can get the care they need to live healthy, flourishing lives?
That’s the case we’re inviting America to explore.
Healthcare: Enhancing Health and Wellbeing
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States.
WHO Constitution
