New Report: U.S. Health Care Ranks Last – High Costs, Poor Outcomes, and the Path Forward

Photo byIllustration by Zoë Petersen

When it comes to health care, the United States is spending big but reaping small rewards. A recent report by The Commonwealth Fund has delivered a harsh truth: the U.S. ranks last in healthcare performance compared to nine other high-income countries. The findings reveal a troubling reality—Americans are dying younger and experiencing more avoidable deaths, even though the country spends nearly double what others do on health care.

These are not just numbers on a page; they represent real lives. It’s evident that the current system is failing too many people, leading to unnecessary suffering and loss.

High Costs, Low Return

The U.S. healthcare system stands out for all the wrong reasons. While other countries manage to keep their healthcare systems running efficiently and equitably, the U.S. invests heavily yet falls short on nearly every measure of success. The Commonwealth Fund’s report graded the U.S. alongside countries like Australia, the United Kingdom, and Germany in five key categories: access to care, care process, administrative efficiency, equity, and health outcomes.

In nearly every category, the U.S. ranked last or second to last, except in the “care process” category, where it came in second place behind New Zealand. Ironically, despite the advanced medical treatments available in the U.S., only those who can afford them benefit, leaving vast swaths of the population struggling with either high medical bills or no access to care at all.

Dr. Joseph Betancourt, president of The Commonwealth Fund, pointed out that “no other country in the world expects patients and families to pay as much out of pocket for essential health care as they do in the U.S.”

A System in Need of a Doctor

One of the report's key findings was that the U.S. health system is grossly undersupplied in critical areas, such as the number of doctors and hospital beds. This shortage leads to long wait times for specialty care and difficulty finding a primary care physician.

But the real kicker is the administrative inefficiency. The U.S. has a dizzying maze of insurance companies, each offering different products with unique requirements. This results in an exhausting and often frustrating experience for patients and providers, with endless negotiations between doctors, hospitals, and insurance companies to get services paid for. This complex insurance system leads to service denials and delays, making it harder for people to promptly receive the care they need.

Photo byDavid Blumenthal et al., Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

Equity Issues Leave Many Behindpromptly receive the care they need

Another area where the U.S. underperforms is equity. Lower-income Americans, especially racial minorities, often find themselves uninsured or underinsured, leading many to skip necessary medical care. For them, visiting the doctor can mean facing an insurmountable financial burden. This lack of access contributes to stark health disparities, where those in less affluent areas are far more likely to experience preventable diseases and die prematurely.

The report highlighted that many people in the U.S. experience unfair treatment or discrimination when trying to access health care, further widening the gap between the haves and have-nots.

Life Expectancy: A National Crisis

One of the report's most alarming findings is the U.S.’s low life expectancy. While the average life expectancy in many high-income countries hovers around 80 years, the U.S. lags behind, with an average of 77.5 years as of 2022. This issue is compounded by high rates of preventable and treatable deaths, a problem aggravated by the pandemic. Despite progress in recovering from the health crisis, the U.S. still shows weaknesses in its ability to handle large-scale health emergencies.

The U.S.'s lack of universal health coverage significantly sets it apart from other developed nations. Universal healthcare systems provide more consistent access to medical services, ensuring that individuals can see a doctor when needed and maintain long-term relationships with healthcare providers. This continuity of care helps address common health conditions early, preventing them from escalating into more severe and life-threatening issues.

Photo byDavid Blumenthal et al., Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

Why Do Americans Pay More?

The U.S. spends a staggering 18% of its gross domestic product on health care, far more than any other developed nation, but still ranks poorly on critical health outcomes. The high costs don’t just come from hospitals and doctor visits but from a bloated administrative system that is bogged down by inefficiency. Hospitals, doctors, and insurance companies are often stuck in a game of back-and-forth negotiating payments and coverage, making care more expensive and complicated to access.

Despite these high costs, the return on investment remains surprisingly low. The U.S. healthcare system struggles to provide essential resources, with shortages in critical areas like medical professionals and hospital beds, revealing that the system is not adequately equipped to meet its population's basic healthcare needs.

Is Change on the Horizon?

With health care being a vital issue for voters in the upcoming presidential election, there’s hope that solutions may come. Vice President Kamala Harris has advocated for building on the Affordable Care Act, aiming to expand coverage and lower costs. Meanwhile, former President Donald Trump and his running mate, JD Vance, have suggested a more deregulated approach, though details remain scarce.

The Commonwealth Fund’s report highlights problems and offers pathways to improvement. Lowering the cost of care and expanding access to coverage are the first steps. Reducing the labyrinth of administrative red tape could significantly improve the system's efficiency and the overall patient experience.

While the U.S. healthcare system faces deep-rooted issues, the opportunities for change are still within reach. As the report concludes, “The shortcomings of the United States are clear, but so are the opportunities for change.”

For now, the question remains: will policymakers rise to the challenge, or will Americans continue to pay more for less?