The United States health system has been ranked last among ten peer nations in a recent report by the Commonwealth Fund, highlighting significant issues in health equity, access to care, and overall outcomes.
Despite Americans spending nearly double on healthcare compared to other countries, the US system performs poorly in key areas. Dr. Joseph Betancourt, president of the Commonwealth Fund, expressed concern over the human cost of these deficiencies. “I witness the impact of these failures daily,” Betancourt stated. “Patients struggle with medication affordability and many older adults come in sicker than necessary due to years of being uninsured.”
As healthcare costs continue to strain workers’ finances, economic and inflation concerns dominate the political landscape. Neither Kamala Harris nor Donald Trump has proposed significant healthcare reforms. Harris has framed healthcare as an economic issue, focusing on medical debt relief and the successes of Medicare drug price negotiations. Meanwhile, Trump has indicated vague plans for healthcare improvement but has not provided concrete proposals. His conservative policy agenda Project 2025 suggests reducing scientific and public health infrastructure.
Voter priorities, however, remain firmly focused on healthcare costs. According to Kaiser Family Foundation polling, the cost of drugs, doctor visits, and insurance is the top issue for both Democrats (42%) and Republicans (45%). Americans spend approximately $4.5 trillion annually on healthcare, equating to over $13,000 per person, as reported by federal data.
The Commonwealth Fund’s latest report, part of its “Mirror, Mirror” series, marks the 20th edition comparing the US health system with those of nine other wealthy democracies, including Australia, Canada, and Germany. The foundation describes this year’s report as a “portrait of a failing US health system.”
The report evaluates 70 indicators across five main sectors: access to care, health equity, care process, administrative efficiency, and outcomes. Data from surveys and sources such as the World Health Organization and OECD were used. The US ranked last or second-to-last in all areas except “care process,” which involves medication reconciliation.
Reginald D. Williams II, vice-president of the Commonwealth Fund, criticized the US system’s struggle with broader social issues. “Poverty, homelessness, hunger, and discrimination place undue strain on our health system,” Williams said. He noted that other countries manage to address these basic needs more effectively, resulting in better health outcomes.
The report suggests several measures for improvement, including expanding insurance coverage, reducing patient out-of-pocket expenses, simplifying insurance plans, and investing in primary care and public health systems. Dr. David Blumenthal, former president of the Commonwealth Fund, acknowledged the challenges in implementing these recommendations. “Reforming the health system will be complex and gradual,” Blumenthal said. “The direction we take will depend on the choices made by the American electorate in this election.”
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