Almost every conversation about US healthcare is dominated by concerns about unsustainable costs. We spend far more, per capita, on healthcare than any other country in the world — more than $8,000, compared with $3,000 in Japan, for example — yet obesity, asthma, mental health, and other chronic diseases are increasing burdens. On the other hand, we spend much less on social services: for every healthcare dollar spent from 2000 to 2009, the US spent about 90 cents on social services, compared with $2 among peer countries in the Organisation for Economic Cooperation and Development. Could this be the real source of poor health in the US and should it reframe our spending discussion? How might we pursue evidence-based, health-promoting strategies?