The United States' health system ranked last in an international comparison of 10 countries, according to a new report from the Commonwealth Fund.
Although Americans pay nearly twice as much as other countries, the system has performed poorly on health care equity, access to health care, and outcomes.
“I see the human toll of these shortcomings on a daily basis,” said Dr. Joseph Betancourt, president of the Commonwealth Fund, a health care research and policy organization.
“I see patients who can’t afford their medications… I see older patients who are coming into the hospital worse off than they should be because they’ve been uninsured most of their lives,” Betancourt said. “It’s finally time to build a health system that provides high-quality, affordable health care for all Americans.”
But even as health care costs rise, the economy and inflation dominate voters’ concerns, and 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 to alleviate medical debt while highlighting the Biden administration’s successes, such as Medicare drug price negotiations.
The Republican presidential candidate said he had “concepts for a plan” to improve health care, but he offered no proposals. The conservative policy agenda, “Project 2025,” largely proposed destroying the public health and scientific infrastructure.
Yet when voters were asked about health care issues, they overwhelmingly ranked cost at the top. The cost of drugs, doctors and insurance is the top issue for Democrats (42%) and Republicans (45%), according to polls by the Kaiser Family Foundation for Health Care. Americans spend $4.5 trillion a year on health care, or more than $13,000 per person per year on health care, according to federal government data.
The Commonwealth Fund report is the twentieth in its “Mirror, Mirror” series, an international comparison of the U.S. health system with nine wealthy democracies including Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, Sweden and Switzerland. The foundation describes this year’s report as “a portrait of a failing U.S. health system.”
The report uses 70 indicators across five key sectors, including access to health care, equity in health care, process of care, administrative efficiency and outcomes. The measures are drawn from a Commonwealth survey as well as publicly available measures from the World Health Organization, the Organisation for Economic Co-operation and Development and Our World in Data.
In everything except “process of care” — an area that covers issues like medication reconciliation — the United States ranked last or next to last. The Commonwealth presenters noted that the United States is often “in a league of its own,” far below its closest peer.
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“Poverty, homelessness, hunger, discrimination, drug abuse—other countries don’t make their health systems work as hard,” said Reginald D. Williams II, the fund’s vice president. Most comparable countries cover more of their citizens’ basic needs, he added. “Too many people in the United States face a life of inequality, and it shouldn’t be that way.”
But recommendations to improve the standing of the U.S. health system among peers will not be easy to implement.
The fund said the United States would need to expand insurance coverage and make “meaningful” improvements in the amount of out-of-pocket health care expenses; reduce the complexity and variability of insurance plans to improve administrative efficiency; build a workable primary and public health care system; and invest in social welfare, rather than dumping social inequality problems on the health system.
“I don’t expect us to rewrite the social contract all at once,” said Dr. David Blumenthal, former head of the fund and author of the report. “American voters are making decisions about where they want to go, and that’s a very important issue in this election.”
