Tom Banning
| Guest columnist
America’s health care system is stuck in the past and long overdue for transformation.
Despite remarkable advancements in medical science and technology, its structural foundation remains frozen in time, built on mid-20th-century policy decisions that prioritized hospital construction and highly specialized care over preventive, community-based primary care.
This deep misalignment between how we pay for care and what people actually need isn’t just inefficient — it’s costing us dearly in both dollars and lives.
The U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services recently established the Healthcare Advisory Committee, charged with delivering strategic recommendations to improve how care is financed and delivered across Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. Additionally, the recently passed One Big Beautiful Bill provides a $50 billion Rural Health Transformation Program fund.
This committee, along with the administration’s broader Make America Healthy Again vision, offers a long-overdue opportunity to pivot away from a model of care centered on hospitals. With these initiatives, the Trump administration and Texas can lay the groundwork for a modern health system built around prevention, primary care, and patient outcomes.
The roots of today’s system stretch back nearly 80 years. The Hill-Burton Act of 1946, enacted in response to postwar hospital shortages, poured billions into hospital construction and made inpatient facilities the default hubs for care. When Medicare and Medicaid launched two decades later, they reinforced that model by generously reimbursing inpatient services, which rewarded treatment after illness struck instead of preventing disease in the first place.
These well-intentioned policies inadvertently shaped a system that rewards “sick care,” treating people only after illness develops. It’s no surprise, then, that hospital care now accounts for nearly one-third of total U.S. health care spending. But our dependence on hospitals is not only expensive, it is fundamentally misaligned with the needs of modern medicine.
This is not to minimize the importance of hospitals. The services they provide remain vital for maternity care, trauma care, and inpatient mental health. But today’s greatest threats to health are no longer primarily acute conditions that require hospitalization. They are chronic diseases such as diabetes, heart disease, and depression — conditions best treated through early intervention, long-term care coordination, and behavioral health support, the cornerstones of primary care.
The Trump administration and Texas’ leadership recognize that the status quo no longer serves the American people and are tackling it head-on. This must be the heart of the Make America Healthy Again agenda: realigning our health care system to prioritize wellness over illness, patients over profits, and outcomes over procedures.
This is more than a policy shift; it is a philosophical reorientation. It means envisioning a future in which staying healthy is easier and more affordable than getting sick. A future in which care is delivered closer to home, and one where hospitals serve not as the default destination for every health need, but as high-quality, specialized centers for acute and complex care.
Yet entrenched challenges remain. The fee-for-service payment model still dominates, incentivizing quantity over quality. Hospitals — especially large, consolidated systems — have little financial incentive to support reforms that may reduce admissions and revenue. As these systems grow in market power, they also expand their political and economic influence, often blocking or stalling change that would benefit patients and communities.
By accelerating the transition to value-based care, investing in primary and behavioral health infrastructure, and expanding access to team-based care models, the Trump administration can help lay the foundation for a truly modernized system that delivers better outcomes at lower costs and meets people where they are.
This transformation won’t be easy, but it is absolutely necessary. We cannot continue building our future on the foundations of a bygone era. In a time defined by chronic disease, demographic change, and rising costs, clinging to a hospital-first model is both ineffective and unsustainable.
We have a once-in-a-generation opportunity to reorient our health care system into one that puts people first, keeps them healthier longer, and uses hospitals for what they do best — not as overextended default providers, but as targeted, high-value partners in a broader, more humane system of care.
Tom Banning is CEO and executive vice president of the Texas Academy of Family Physicians.