The United States’ health system ranked last in an international comparison of 10 peer countries, according to a new Commonwealth Fund report.
Despite the fact that Americans pay almost twice as much as other countries, the system performs poorly in terms of health equity, access to care and outcomes.
“I see the problems of people with these limitations every day,” said Dr Joseph Betancourt, president of the Commonwealth Fund, a foundation focused on health research and policy.
“I see patients who can’t afford their medicine … I see older patients coming in sicker than they should be because they’ve spent most of their lives without insurance,” Betancourt said. “It’s time to finally create a health care system that provides affordable health care for all Americans.”
However, even as high health care costs bite into workers’ wages, the economy and financial growth dominate voters’ concerns. Neither Kamala Harris nor Donald Trump has proposed major health reforms.
The Democratic presidential candidate has largely reframed health care as an economic issue, promising medical debt relief while highlighting the successes of the Biden administration, such as the Medicare drug price negotiations.
The Republican presidential candidate said he has “ideas for a plan” to improve health care, but has yet to make any proposals. The Conservative Project 2025 strategy has strongly promoted scientific and social health services.
However, when asked about health care issues, voters ranked cost higher. The cost of drugs, doctors and insurance is a top issue for Democrats (42%) and Republicans (45%), according to a Kaiser Family Foundation health care survey. Americans spend $4.5tn a year on health care, or more than $13,000 per person a year on health care, according to federal government data.
The Commonwealth Fund report is the 20th in their “Mirror, Mirror” series, an international comparison of the US health care system with nine wealthy democracies including Australia, Canada, France, Germany, the Netherlands , New Zealand, UK, Sweden and Switzerland. The foundation calls this year’s report “a portrait of the failing US health care system”.
The report uses 70 indicators from five main areas, including access to care, health equity, care effectiveness, system effectiveness and outcomes. These measures come from a Commonwealth survey as well as publicly available measures from the World Health Organisation, OECD and Our World in Data.
In all but “process of care” – an area that deals with issues such as medication reconciliation – the US is ranked as the last or penultimate country. The Commonwealth of Nations noted that the US is often “in its own league” below its nearest peer country.
“Poverty, homelessness, hunger, discrimination, drug abuse – some countries are not making their health systems work,” said Reginald D Williams II, the fund’s vice president. He said that many peer countries provide the basic needs of their citizens. “Too many people in the US have faced injustice for the rest of their lives, it doesn’t have to be this way.”
But recommendations to improve the US health care system’s standing among peer nations will not be easy to implement.
The fund said the US would need to expand insurance coverage and make “meaningful” improvements in the amount of health care costs patients pay; reduce the complexity and diversity of insurance plans to improve administrative efficiency; build an effective primary care and public health system; and investing in social welfare, instead of introducing problems of social injustice into the health system.
“I don’t expect that we will simultaneously rewrite the social contract,” said Dr David Blumenthal, a past president of the fund and author of the report. “American voters are making a choice about where they’re going to run, and that’s a big issue in this election.”
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