A recent analysis by The Commonwealth Fund has revealed what many Americans may already suspect: the United States health care system ranks last among wealthy nations. Despite spending more on health care than any other country, the US continues to underperform in critical areas like accessibility, efficiency, equity, and health outcomes.
A Troubling Report Card
In the "Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System" report, researchers compared health care systems across 10 high-income countries -- Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States. The US came in last place overall, ranking 10th in accessibility and health outcomes, and poorly in administrative efficiency and equity.
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According to a September article in AJMC, Joseph Betancourt, MD, president of The Commonwealth Fund, summed it up saying: "The US is failing one of its principal obligations as a nation: to protect the health and welfare of its people... Continually spending the most and getting the least for our health care dollars is not sustainable."
What's Holding the US Back?
One of the biggest issues is access to care. With 26 million uninsured Americans and sky-high out-of-pocket costs, health care remains out of reach for many. In contrast, countries like the Netherlands and Germany offer universal coverage and affordable care, making access far more equitable.
The shortcomings of the US health care system are further evident in its unparalleled spending. According to the Peter G. Peterson Foundation, in 2022, the United States spent an estimated $12,742 per person on health care -- the highest per capita spending among wealthy nations. For comparison, Switzerland, the second-highest spender, allocated $9,044 per person, while the average for other Organization for Economic Development Cooperative and Development countries, excluding the US, was just $6,850.
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Administrative inefficiency is another key weakness. The US ranked ninth in the category due to its complex insurance system, which forces patients and providers to navigate endless denials, appeals, and paperwork.
In terms of equity, the US fared poorly as well, with widespread disparities in care based on race, ethnicity, and income. Issues like racial discrimination and uneven access to resources disproportionately impact vulnerable communities, worsening health outcomes for millions.