As the seemingly endless primary campaign heads into Pennsylvania and other states, including North Carolina next month, and then into November, we’re going to be hearing lots more about health care. It’s past time for the candidates on both sides to tell us what they’d do about a trend that threatens to render all of their proposals and the entire health-care system unsustainable.

So far, the conversation has mainly been about extending health coverage to the more than 47 million Americans who are uninsured. Democrats call for universal coverage through either mandates or financial incentives, which may cost more than $150 billion a year initially. Republicans emphasize free-market approaches.

These proposals have merit, but the underlying dilemma, about which we hear far less, is that health-care costs are going through the roof with no end in sight. Our country now spends more than $2.2 trillion annually on health care — that’s trillion with a "T" –and will spend more than twice that within a decade. At that point, health-care spending will account for a fifth of the entire U.S. economy, an amount that could crush any of the proposals now being debated.

Do we need to cover the uninsured? Absolutely. But if our country is finally getting serious about fixing its health-care crisis, it also needs to rein in these accelerating costs. The costs are due in large part to the staggering sums we now spend on an extraordinarily inefficient system of piecemeal interventions for late-stage chronic diseases and the perverse reimbursement system that rewards this inefficiency.

Chronic diseases such as heart disease, cancer and diabetes account for two-thirds of all health-care expenditures. In many cases, they are preventable. Any rational system would seek to reduce this financial and health burden by doing everything possible to help Americans stay healthy.

Instead, our system encourages people to abandon responsibility for their own health and to interact with their physicians only when they become sick. It rewards expensive procedures and therapeutics instead of prevention. For instance, a physician gets virtually no reimbursement for teaching a patient to avoid diabetic complications, but receives thousands of dollars for amputating the patient’s leg if the diabetes persists.

All of us, whether we are physicians or patients, have become so accustomed to this reactive system that it’s easy to lose sight of how deeply dysfunctional it has become in serving our own interests. We need to remember that it’s only within the past century that scientists developed our current "find-it-and-fix-it" emphasis on identifying a disease’s root cause and eliminating it with a drug. It’s an approach that has yielded wondrous cures and longer life spans, but now we are face to face with its limits.

Fortunately, just as discoveries about germs and other scientific advances revolutionized medicine 100 years ago, so are advances in genomics and other fields now making it possible for us to embrace a fundamentally more rational approach to health care. Physicians like myself are on the verge of being able to predict each person’s disease risks, and increasingly we are able to develop tools to help our patients dramatically reduce their risks of certain diseases. This approach of averting problems before they occur could prevent untold personal suffering and societal cost.

The campaign debate over health care should reflect this emerging reality. It’s a delusion to think we can expand access to the existing system without breaking the bank, regardless of whether we end up adopting the Democratic or Republican solutions now under discussion.

To slash the burden of chronic disease, we must rework our backward-looking reimbursement system so that it encourages, rather than inhibits, the development of a continuum of care that starts with personalized health promotion. We need to combine the many strengths of today’s disease-oriented approach with a new focus on personalized, long-term prevention strategies. This means giving individuals the capabilities and support they need to take more control of their own health, and providing comprehensive rather than piecemeal care if they do develop a chronic disease.

Simply continuing to fuel our inefficient, uncoordinated delivery system is expensive and wasteful. To bring about real change, we must expand our current debate over health-care access to embrace this rapidly emerging promise of personalized health promotion, disease prevention, and strategic health planning. Otherwise, the current situation will continue to worsen and costs will drag down the economy, regardless of who wins the White House.