The U.S. health system ranks last in an international comparison of 10 peer countries, according to a new report from the Commonwealth Fund.
Even though Americans pay nearly twice as much as other countries, the system performs poorly on health equity, access to care, and outcomes.
“I see the toll of these deficiencies every day,” said Dr. Joseph Bettencourt, president of The Commonwealth Foundation, which focuses on health care research and policy.
“I see patients who can’t afford their medications…I see older patients who are sicker than they should be because they haven’t had insurance most of their lives,” Bettencourt said. “Now is the time for us to finally build a health care system that delivers quality, affordable health care to all Americans.”
Yet even as high health care prices erode workers’ wages, the economy and inflation continue to dominate voters’ concerns. Neither Kamala Harris nor Donald Trump has proposed major health care reform.
The Democratic presidential nominee has largely reframed health care as an economic issue, promising medical debt relief while highlighting the Biden administration’s successes such as Medicare drug price negotiations.
The Republican presidential candidate said he has a “concept of a plan” to improve health care but has not yet made any proposals. The conservative policy agenda Project 2025 proposes, in large part, the destruction of scientific and public health infrastructure.
Yet when asked about health care, voters overwhelmingly ranked cost first. The cost of drugs, doctors and insurance is the top issue among Democrats (42%) and Republicans (45%), according to a Kaiser Family Foundation Health Systems Poll. According to federal data, Americans spend $4.5 trillion per year on health care, or more than $13,000 per person per year.
The Commonwealth Fund’s report is the 20th in its “Mirror, Mirror” series, which examines the U.S. health system and nine countries including Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, Sweden and Switzerland. International comparisons of wealthy democracies were conducted. The foundation called this year’s report “a portrait of the failing U.S. health system.”
The report uses 70 indicators from five major sectors, including access to care, health equity, care processes, administrative efficiency and outcomes. The measures stem from a survey conducted by the Commonwealth and public measures from the World Health Organization, the OECD and Our World in Data.
The U.S. ranked last or second to last in every category except “process of care,” an area covering issues such as coordinating medications. The host of “The Commonwealth” noted that the United States often “stands in a league of its own” and falls far short of its nearest equivalents.
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“Poverty, homelessness, hunger, discrimination, substance abuse — health systems in other countries don’t work so hard,” said Reginald D. Williams II, the fund’s vice president. express. Most peer countries, he said, were able to provide more of the basic needs of their citizens. “Too many people in America face inequality throughout their lives, and it doesn’t have to be this way.”
But recommendations to improve the U.S. health system’s standing among similar countries will not be easy to implement.
The fund said the U.S. needs to expand insurance coverage and make “meaningful” improvements in the amount of money patients pay out-of-pocket for care; minimize insurance plan complexity and variation to improve administrative efficiency; and establish a viable primary health and public health systems; and investing in social well-being rather than imposing social inequalities on health systems.
“I don’t think we’re going to rewrite the social contract all at once,” said Dr. David Blumenthal, a former chairman of the fund and one of the report’s authors. “American voters choose the way forward, and that’s a very important issue in this election.”
