NCQA Fireside Chat: What’s Holding U.S. Health Care Back, and How We Move Forward
June 18, 2025 · Maya Spieske
At our recent NCQA Fireside Chat, we invited Dr. Joseph Betancourt, President of The Commonwealth Fund, to share his perspective on the current state of U.S. health care—where our health system consistently fails patients, how digital innovation can enhance primary care and the outlook for health equity work in today’s political climate. The Commonwealth Fund is a nonpartisan, nonprofit organization dedicated to independent research that advances a high-performing, equitable U.S. health care system.
Keep reading for key insights and standout moments from the discussion.
Where U.S. Health Care Falls Short—And Why
Since 2004, The Commonwealth Fund’s Mirror, Mirror report has compared health system performance across high-income countries, offering insights for U.S. improvement. Year after year, the U.S. ranks last in health outcomes, despite spending 17% of its GDP on health care—well above the 11%–12% spent by peer nations.
Research consistently shows that the U.S. health system falls short due to its poor health outcomes, wide disparities by geography and demographics, underinvestment in primary care and persistent barriers to accessing care.
What can we learn from our international peers? Dr. Betancourt points to three key drivers that set high-performing countries apart: universal coverage, strong primary care systems and robust investment in social supports. These same factors also separate the highest- and lowest-performing U.S. states. “At the end of the day, this notion that your zip code is the better predictor of your genetic code for your health outcomes is very real,” he says.
The Future is Here, and Unevenly Distributed: Reflections on Digital Innovation in Primary Care and Health Equity
Dr. Betancourt acknowledges that AI is not a silver bullet, but with thoughtful regulation and inclusive design, it has the potential to modernize care and help close long-standing gaps in our health system.
While AI carries the risk of reinforcing existing biases, he sees it as a powerful tool to standardize care, expand access and improve equity—if it is developed and implemented responsibly. In his day-to-day work with AI, Dr. Betancourt advocates an “offense-minded” approach that emphasizes innovation over fear of risk.
He believes AI and digital tools will transform primary care in the next 5–10 years by automating low-acuity care, reducing administrative burdens and enabling more proactive, guideline-based treatment. This shift would allow clinicians to focus on complex cases and lean into the human side of care: empathy, listening, trust.
Still, without equitable access to AI and digital tools, disparities could worsen. Dr. Betancourt views states as essential engines of innovation and equity, even as they face mounting pressures from potential Medicaid work requirements and slashed budgets. Now, more than ever, high-performing states show that strategic investments in digital infrastructure, primary care and social supports can drive meaningful progress.
Tough Headwinds Are Ahead, But Don’t Over-Chill
The conversation underscored mounting challenges to advancing health equity amid a shifting political and regulatory landscape, and its implications on data accessibility.
Dr. Betancourt highlighted how emerging political narratives, along with a shrinking federal data infrastructure caused by workforce cuts and de-prioritization, are driving the rollback or under-collection of race, ethnicity and health disparities data, undermining progress and weakening the foundation of equity-focused efforts.
He warned that without accurate, comprehensive data, health systems are flying blind, unable to identify or address inequities—creating what he called a chilling effect on institutions and data collection in general.
Despite the headwinds, Dr. Betancourt urged practitioners and health organizations not to “over-chill,” stating that a renewed commitment to data collection, backed by advocacy, collaboration and legal clarity, is essential to restoring trust and advancing health equity.
What’s Next for The Commonwealth Fund
Looking ahead, The Commonwealth Fund is reaffirming its core mission of providing rigorous, evidence-based analysis to policymakers and academics, while also expanding its reach to include everyday constituents. Dr. Betancourt emphasized the need to clearly communicate complex health policy issues to the public—for example, about Medicaid and the ACA. The Fund plans to deepen its engagement at the state and community levels, serving as a trusted source of accessible health information and demonstrating how policy decisions affect real lives by making data more relatable and actionable.
NCQA thanks Dr. Joseph Betancourt for sharing his time and thoughtful insights with our audience.
Visit our video gallery to watch the full Fireside Chat recording.
