That’s especially true when it comes to healthcare. The stakes are high, but the system is so sprawling, technical, and emotionally charged that ordinary people, the very people it’s supposed to serve, often don’t feel like they understand it, let alone trust it.
I sit at the intersection of several systems: finance, community development, policy, and increasingly, healthcare. I serve on the Community Bank Advisory Board of the Federal Reserve and have been commissioned by the National Academy of Medicine to contribute to a deeper conversation about healthcare financing, access, and systems change.
I don’t share that to suggest I have any answers, but to say I’m genuinely trying to understand and find a path forward. Not as a policymaker. Not as an academic. Just as someone who wants the systems we live in to make more sense to more people.
One thing I’ve learned from my time with the Federal Reserve is the value of a clear, overarching mission. The Fed’s dual mandate is simple:
Maintain maximum employment and ensure price stability.
There’s a lot of complexity under the hood, but the clarity of that mission guides action, accountability, and strategy.
Every time I hear that phrase, I ask myself:
What would it mean to have that kind of clarity in other sectors?
As a banker, I’ve tried to answer that question in my own work. We often talk about stakeholder value, about growth, about service, but at the end of the day, I’ve distilled our mission to this:
We exist to drive shared economic prosperity for those we serve, and to do so in a way that ensures sustainable profitability, allowing us to grow, reinvest, and remain a force for good across generations.
It’s simple, yet powerful.
And it’s got me wondering, what if we applied this same clarity to healthcare?
What Is the Healthcare System For, Anyway?
Ask ten people what the U.S. healthcare system is supposed to do, and you might get ten different answers.
Some will say it’s about saving lives.
Others might say access.
Still others may emphasize innovation or personal choice.
And that’s the problem.
If we can’t agree on what the system is for, we’ll never design it to succeed.
We need a dual mandate for healthcare, a guiding framework. One that creates enough clarity to aim at something meaningful, while also leaving room for personal agency and freedom.
Here’s where my thinking has landed:
Optimize Population Health
Promote long-term health, well-being, and health agency for all Americans through prevention, access, and evidence-based care.
Ensure Sustainable Cost Stewardship
Maintain affordability and financial efficiency across the healthcare ecosystem to preserve access and avoid economic harm.
These aren’t just theoretical ideas. Right now, healthcare is consuming a larger and larger share of our economy.
In 2023, U.S. healthcare spending reached 17.6% of GDP, up slightly from 17.4% in 2022. It had peaked at 19.5% during the COVID-19 pandemic.
But what’s more concerning is where we’re headed. The Centers for Medicare & Medicaid Services (CMS) project that by 2032, healthcare will account for 19.7% of GDP, growing at a pace that outstrips economic growth itself.
Part of that increase comes from rising input costs. But a major driver is systemic misalignment, misaligned incentives, fragmented delivery, and a lack of market discipline that allows costs to balloon with little accountability.
Our national income (GDP) is projected to grow at 4.3% annually, while healthcare spending is expected to grow at 5.6%.
And I struggle with that.
I struggle anytime growth outpaces the income meant to support it.
Think about it this way: If your personal spending is growing at 10% every year but your income is only growing at 5%, you’re going to run into trouble. Eventually, the math just doesn’t work.
This is what misalignment looks like.
And right now, our healthcare system is deeply misaligned.
If we don’t name that misalignment, and work to correct it, we’ll keep spending more while achieving less.
I hear the stories all the time, family members helping loved ones sort through stacks of medical bills. Charges for services they don’t understand. Denials for care they thought was covered.
Last year, my son was picked up by an ambulance and driven just a few miles to the ER in Tampa. Someone had slipped something into his drink, and he had a serious reaction. Thankfully, he recovered quickly.
But then came the bill: $27,000.
No warning. No explanation. Just numbers that didn’t make sense.
I’m still trying to make sense of it, just like so many others sorting through the chaos of a system that feels designed to confuse.
And every time I hear another story like this, I’m reminded:
How can we expect people to make informed choices when the system itself isn’t even legible?
Of course, healthcare is complex.
Policy, science, behavior, economics, it’s all there.
But complexity doesn’t excuse us from having clarity of purpose.
In fact, the more complex a system is, the more important it is to be clear about what we’re aiming for.
Because if we don’t know what the system is trying to do, we can’t measure whether it’s succeeding.
And we can’t build public trust in a system that doesn’t seem to know its own purpose.
What if our national conversations started with this question:
What are we trying to do with healthcare?
And is our system aligned to deliver that?
Let’s stop letting the debate be dictated solely by politics or industry interests.
Let’s ask the question plainly.
And let’s challenge each other to respond with a little more clarity,
a little more humility,
and a lot more focus on outcomes that matter.
If you’re a policymaker, a physician, a hospital administrator, or a family caregiver,
what would it look like for your corner of the system to align with a clear, national dual mandate?
This is just a starting point. I hope to keep exploring these ideas with others who care about building systems that actually serve people, whether you work in healthcare, finance, government, or simply care about your family’s future.
"If you aim at nothing, you’ll hit it every time."
It’s time we decided what we’re aiming for.
Because when the aim is clear, progress becomes possible.