A new report from the Commonwealth Fund ranks the U.S. health care system last in an international comparison of 10 countries.
Americans spend nearly twice as much on health care as other countries, yet our health care system performs poorly in terms of health equity, access to care, and health outcomes.
“I see the human toll of these flaws every day,” said Joseph Betancourt, president of the Commonwealth Fund, a foundation that focuses on health research and policy.
“We see patients who can’t afford their medicines. We see older patients coming into the hospital who are sicker than they should be because they’ve been uninsured most of their lives,” Betancourt said. “It’s finally time to build a health care system that provides quality, affordable care to all Americans.”
But the economy and inflation are voters’ top concerns, even as rising health care costs eat into workers’ paychecks. Neither Kamala Harris nor Donald Trump have proposed any major reforms to the health care system.
Democratic presidential candidates are largely reframing health care as an economic issue, promising to relieve medical debt while highlighting Biden administration successes such as Medicare drug price negotiations.
The Republican presidential candidate said he has a “visionary plan” to improve health care but has offered no proposals. His conservative policy agenda, Project 2025, primarily proposes gutting science and public health infrastructure.
But when asked about health care issues, voters overwhelmingly cited cost as their top priority. The Kaiser Family Foundation Health Care Poll found that the cost of drugs, doctors and insurance is the top issue for Democrats (42%) and Republicans (45%). According to federal data, Americans spend $4.5 trillion a year on health care, with each person spending more than $13,000 a year on health care.
The Commonwealth Fund report is the 20th in its “Mirror Mirror” series, which compares the U.S. health care system internationally with nine other wealthy democracies, including Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, Sweden and Switzerland. The Commonwealth Fund called this year’s report “a portrait of a U.S. health care system that is in disarray.”
The report uses 70 indicators across five key areas, including access to health care, health equity, health processes, administrative efficiency and outcomes. These indicators are drawn from surveys conducted by the Commonwealth as well as publicly available indicators from the World Health Organization, OECD and Our World in Data.
In every area except “care process” — an area that includes issues such as medication reconciliation — the U.S. ranked last or second-to-last. Commonwealth presenters noted that the U.S. is often in a “class of its own” far beyond its closest peer countries.
“Other countries don’t run their health care systems so tightly against poverty, homelessness, hunger, discrimination and drug abuse,” said Reginald D. Williams II, the foundation’s vice president. He said most other countries cover more of their citizens’ basic needs. “Too many people in the United States face inequality throughout their lives, but it doesn’t have to be this way.”
But implementing recommendations to improve the U.S. health care system’s standing among peer countries will not be easy.
The foundation said the United States needs to expand insurance coverage, “meaningfully” improve the amount of out-of-pocket costs patients incur, minimize complexity and variation in insurance plans to improve administrative efficiency, build viable primary care and public health systems, and invest in social services rather than pushing social inequality problems onto the health system.
“I don’t believe we can rewrite the social contract in one fell swoop,” said Dr. David Blumenthal, a former president of the foundation and author of the report. “It’s up to the American voters to choose which direction to go, and that’s a big issue in this election.”