The US spends more on health care than any other country, pouring in hundreds of billions of dollars each year on research, sprawling government programmes, and high-profile initiatives. But what does it have to show for this massive investment? Skyrocketing costs, deep inequalities in access, and health outcomes that lag many developed nations. Both its medical and research systems have grown bloated and inefficient, increasingly disconnected from the real needs of patients.

The US Cancer Moonshot is a textbook example of this dysfunction. Launched by President Barack Obama in 2016, with Vice President Joe Biden championing it, the programme promised to transform cancer care — accelerating research, delivering new treatments, and saving lives. Touted as a bold mission to achieve 10 years of progress in just five, it secured over $2 billion in funding. Biden made it a personal crusade, reviving and expanding the initiative during his presidency. Yet nearly a decade later, the results are meagre. Announcements were made and papers published, but little came of this.

In sharp contrast, India is demonstrating what true health care innovation looks like — with a fraction of the resources. Karkinos Healthcare, a private venture I have mentored and advised, set out to revolutionise cancer care with just $100 million in investor funding — a sum that would barely register in US health care budgets. And in just four years — less than the Moonshot’s original........

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