Healthcare disparities in outcomes despite high expenses
Califf highlighted striking disparities within the U.S., including differences in life expectancy based on geography, wealth and education. Maps color coded by county showing infant mortality rates and life expectancy highlight the increased risks in predominantly low-income, minority and Native American areas.
“Even within major cities like Raleigh-Durham or San Francisco, you can see up to a 10-year difference in life expectancy by moving down just a few metro stops,” he explained.
Rural communities, he noted, face particularly severe challenges, with limited access to healthcare providers and resources exacerbating their health struggles. These issues are getting worse as growing shortages of physicians are disproportionately impacting rural areas.
Social determinants of health, such as wealth, education and being located in or close to a large urban area are critical factors influencing these outcomes.
Primary care and prevention are the missing links in US healthcare
One of the most glaring gaps, according to Califf, is the U.S. primary care system. Other nations with better health outcomes rely heavily on accessible, community-based primary care services. By contrast, U.S. patients often face logistical hurdles such as lengthy waits and high costs for basic preventive care.
“What distinguishes the U.S., is that we are the only high income country in the world now where healthcare is not a right. And we have the worst primary care system of any country,” Califf explained.
He criticized the fragmented nature of the American healthcare system, where private insurance administrative costs eat up a significant portion of spending. However, he praised Medicare for its lower administrative costs and standardized outcomes, suggesting it could serve as a model for broader reform.
Medical technology and innovation is a double-edged sword
Despite leading the world in medical innovation, Califf said the U.S. struggles to integrate technology effectively into patient care. He advocated for digital tools to support healthcare teams rather than replace them. Experiments with “digital-first” primary care have largely failed, even among educated populations, underscoring the importance of human interaction in health management.
Califf outlined an FDA initiative to create centralized “healthcare hubs” in homes, where monitoring devices and various healthcare apps can be consolidated into a central dashboard to streamline patient management and make healthcare more accessible. “Imagine a docking station in your home, more like the cockpit of an airplane, to simplify and support your health needs,” he said.
A call for establishing healthcare as a right
Califf expressed hope for a shift in U.S. healthcare policy, starting with the recognition of healthcare as a fundamental right, which is something most other developed nations have made central to their national health policies that established universal healthcare programs.
He added that Medicaid expansion in the remaining states could significantly improve health outcomes and bolster local economies. He argued that the issue is not a lack of resources, but a failure to allocate them effectively.
“Let’s look at it carefully and spend the money in the places where it gets the best help, including supporting people who are in difficult circumstances. We’re currently spending $4.5 trillion a year, so there’s enough money to go around,” Califf said.
As the nation grapples with these challenges, Califf’s message is clear: meaningful reforms are not just necessary, they are overdue.