Oct 2, 2024
A comprehensive new study comparing the health care systems of 10 wealthy nations delivers a stark conclusion for the United States: despite spending more on healthcare than any other country, Americans have the "most avoidable deaths” and “live the sickest lives.”
The “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System” report, published by the Commonwealth Fund, reviewed data from 70 healthcare systems in 10 high-income nations: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom and the United States.
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The result is a harrowing snapshot of America’s diminished standing when it comes to health care in the developed world.
“The U.S. is failing one of its principal obligations as a nation: to protect the health and welfare of its people,” read a statement from Joseph R. Betancourt, president of the Commonwealth Fund. “The status quo — continually spending the most and getting the least for our health care dollars — is not sustainable.”
The U.S. is an outlier
The nonprofit Commonwealth Fund has released international health policy surveys since 2004.
Researchers used a range of international health data accumulated between 2021 and 2023 — including surveys involving older adults (65+), the general population (18+), and primary care physicians — to analyze the performance of the participating countries across five key areas:
- Access to care
- Care process
- Administrative efficiency
- Equity
- Health outcomes
Among the countries studied, the U.S. ranks last in life expectancy, with the average American living to 77.5 years, and has the highest rate of preventable and treatable deaths.
The report reveals roughly 30% of U.S. adults live with two or more chronic conditions, such as diabetes or heart disease, nearly double the rate of other wealthy nations.
The lack of affordability was cited as a pervasive problem due to a “fragmented insurance system” that saw 26 million Americans without insurance.
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The survey also revealed that Americans are more likely to not have a regular doctor or healthcare clinic to go to compared to other nations. A Yahoo/YouGov poll found that, while 77% of Americans claim they have a primary care physician, 20% do not. Another 4% say they aren’t sure if they do or not.
The U.S. also has the highest rates of maternal and infant mortality among the countries surveyed, with Black women, in particular, being three times more likely to die from pregnancy-related complications than women in nations like the Netherlands or Sweden.
Finally, despite spending nearly 17% of its gross domestic product (GDP) on health care — far more than any other nation — the U.S. ranks last overall in health system performance.
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What’s behind these poor outcomes?
The paradox of the U.S. healthcare system — spending the most but delivering the worst outcomes — can be traced to several root causes, the study concluded.
Lack of universal coverage: While programs like Medicare and Medicaid provide coverage for specific populations, an estimated 26 million Americans (or 8.6% of the U.S. population) remain uninsured.
High administrative costs: The U.S. healthcare system is riddled with administrative complexity, driven by a multi-payer model involving private insurers, government programs, and numerous intermediaries.
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This complexity contributes to high overhead costs, with a significant portion of health care spending going to administrative processes rather than direct patient care.
Socioeconomic disparities: Low-income Americans are more likely to be uninsured, have chronic conditions, and experience poorer health outcomes overall.
Race and geography fuel these inequities, with rural areas often lacking sufficient health care infrastructure.
Focus on specialized over primary care: The U.S. healthcare system places a heavy emphasis on specialized care and advanced treatments, often at the expense of primary and preventive care.
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“The data makes it clear: spending more doesn’t guarantee better health outcomes,” said Karen Davis, a co-author of the annual report. “We need a fundamental rethinking of how we approach health care in this country.”
At its core, the U.S. healthcare system prioritizes profit models and administrative structures over patient-centered care, the study contends. Many Americans are excluded from accessing necessary care, and those who are insured often face high deductibles, co-payments, and out-of-pocket expenses.
As Blumenthal put it in his statement: “We have the knowledge and the resources to create a better system. What we lack is the political will.”
Possible solutions
Reforming the U.S. healthcare system is a daunting task, but the report’s authors outline several steps that could make a difference.
They start by recommending making health care more affordable and accessible by expanding coverage to those who remain uninsured and reforming insurance plans to ensure they meet basic standards, including capping out-of-pocket expenses for patients.
Next, it’s recommended that the U.S. strengthen the primary care system by increasing compensation for primary care providers and supporting their training — helping to improve patient outcomes and reduce reliance on costly specialized care. Curbing the consolidation of health care systems could help consumer costs, the authors said.
Finally, the authors state that the U.S. should invest in addressing social determinants of health by tackling issues such as poverty, homelessness, food insecurity, gun violence, and substance abuse, which have outsized impact on public health outcomes beyond traditional health care.
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Chris Clark is a Kansas City–based freelance contributor for Moneywise, where he writes about the real financial choices facing everyday Americans—from saving for retirement to navigating housing and debt.
