Overcoming zero-sum thinking to advance US population health

Abstract

There is broad consensus that the US healthcare system is failing. Policy initiatives to reduce costs and improve healthcare outcomes have been longstanding priorities across presidential administrations, but there has been limited success. The USA continues to achieve worse outcomes than those of comparable high-income countries while spending more on healthcare¹.

One important factor preventing reforms is zero-sum thinking about health inequities: the belief that investing to improve the health of population segments with the worst outcomes comes at the expense of those with better baseline health². Here we challenge the zero-sum thinking that denies the broader, population-level benefits of eliminating health inequities. First, we show how health inequities harm the whole US population, not just marginalized groups, highlighting how reducing inequities benefits everyone. Second, we identify four common fallacies in healthcare-related zero-sum thinking and counter each. Finally, we argue the importance of overcoming zero-sum thinking for advancing substantive healthcare reforms.