US health care system ranks last among peers, report finds

According to an international study, the US health care system ranked last in a comparison of ten comparable countries. new report by the Commonwealth Fund.

Even though Americans pay nearly double what other countries pay, the system underperforms on health equity, access to care, and outcomes.

“I see the human toll of these shortcomings every day,” said Dr. Joseph Betancourt, president of the Commonwealth Fund, a foundation focused on health care research and policy.

“I see patients who can’t afford their medications … I see older patients coming in sicker than they should because they’ve been uninsured most of their lives,” Betancourt said. “It’s time that we finally build a health care system that delivers affordable, quality health care to all Americans.”

But even as high health care prices bite into workers’ wages, the economy and inflation dominate voters’ concerns. Neither Kamala Harris nor Donald Trump has proposed major health care reforms.

The Democratic presidential candidate has largely reframed health care as an economic issue, promising relief from medical debt while highlighting Biden administration successes, such as negotiating drug prices for Medicare.

The Republican presidential candidate said he “concepts of a plan“to improve health care, but has made no proposals. The conservative policy agenda Project 2025 has largely proposed hollowing out the scientific and public health infrastructure.

However, when asked about health care issues, voters overwhelmingly put cost at the top. The cost of drugs, doctors and insurance is the most important issue for Democrats (42%) and Republicans (45%), according to Kaiser Family Foundation health system surveyAmericans 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’s report is the 20th in its “Mirror, Mirror” series, an international comparison of the U.S. health care system with nine wealthy democracies, including Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, Sweden and Switzerland. The foundation calls this year’s report a “portrait of a failing American health care system.”

The report uses 70 indicators from five main sectors, including access to care, health equity, care process, administrative efficiency and outcomes. The measures are derived from a survey conducted by Commonwealth and from publicly available measures from the World Health Organization, OECD and Our World in Data.

In all but “process of care”—the domain that includes issues such as combining medications—the U.S. was ranked last or next-to-last. Presenters for Commonwealth noted that the U.S. is often “in a league of its own,” far below its nearest peer nation.

“Poverty, homelessness, hunger, discrimination, drug abuse — other countries don’t make their health care systems work this hard,” said Reginald D. Williams II, vice president of the fund. He said most peer nations are covering more of their citizens’ basic needs. “Too many people in the U.S. are facing lives of inequality, and it doesn’t have to be this way.”

But implementing recommendations to improve the U.S. health care system’s position relative to peer countries will not be easy.

The fund argued that the US should expand insurance coverage and make “meaningful” improvements in the amount of health care costs that patients pay out of pocket; minimize the complexity and variation in insurance plans to improve administrative efficiency; build a viable primary care and public health care system; and invest in social welfare, rather than offloading the problems of social inequality onto the health care system.

“I don’t expect that we’re going to rewrite the social contract overnight,” said Dr. David Blumenthal, a former president of the fund and one of the report’s authors. “The American electorate is making choices about which direction it wants to go, and that’s a big issue in this election.”