A recent report by the Commonwealth Fund reveals that the United States health system ranks last among ten peer nations. Despite spending nearly twice as much on healthcare as other countries, the U.S. struggles with issues related to health equity, access to care, and overall health outcomes.
Dr. Joseph Betancourt, president of the Commonwealth Fund, highlighted the human toll of these shortcomings. Many patients find it difficult to afford their medications, and older adults often arrive at hospitals in worse health due to lifelong insurance gaps. He advocates for a healthcare system that provides quality and affordable care for all Americans.
High healthcare costs remain a pressing issue, but many voters prioritize economic concerns and inflation. Neither Vice President Kamala Harris nor former President Donald Trump has proposed significant reforms in healthcare. Harris has framed the issue as economic, emphasizing medical debt relief and the Biden administration’s efforts to negotiate lower drug prices through Medicare. Trump has mentioned potential plans but has not offered specific proposals.
Polling data from the Kaiser Family Foundation indicates that cost is the primary concern for voters. Drug prices, doctor fees, and insurance costs are top issues for both Democrats (42%) and Republicans (45%). Currently, Americans spend about $4.5 trillion annually on healthcare, averaging over $13,000 per person.
The Commonwealth Fund’s report, the 20th in their “Mirror, Mirror” series, compares the U.S. health system to those of nine other wealthy democracies, including Australia, Canada, and the UK. It describes the current state of U.S. healthcare as a “portrait of a failing” system.
Using 70 indicators across five categories—access to care, health equity, care process, administrative efficiency, and outcomes—the report shows that the U.S. ranks last or second-to-last in nearly all categories, with the exception of care processes like medication reconciliation. Presenters noted that the U.S. often operates “in a class of its own,” falling significantly behind its peers.
Reginald D. Williams II, vice president of the Commonwealth Fund, pointed out that factors such as poverty and discrimination add unique challenges to the U.S. health system. He argued that many Americans face a lifetime of inequity that could be addressed.
The report acknowledges that improving the U.S. health system will be difficult. It recommends expanding insurance coverage, lowering out-of-pocket costs, simplifying insurance plans, enhancing primary care and public health systems, and investing in social well-being.
Dr. David Blumenthal, former president of the fund and a co-author of the report, stated that significant changes to the health system will not happen quickly. He emphasized that the direction of healthcare reform will depend on the choices made by American voters in upcoming elections.
