Despite spending more on health care than any other country in the world, Americans rank last compared to citizens in peer nations in healthcare, according to a new report from the Commonwealth Fund, a private foundation that advocates for better healthcare in the United States.
“The U.S. continues to be in a class by itself in the underperformance of its health care sector,” reads the report. “While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.”
The Commonwealth Fund has compared healthcare systems among 10 high-income countries since 2004 according to access to care, care process, administrative efficiency, equity, and health outcomes. In the eight reports issued since then, the US has ranked last overall every time.
According to the report released Thursday, Americans have the shortest lives and most avoidable deaths, face the most barriers to obtaining and affording healthcare, and experience some of the “greatest burdens” in billing and payment. The United States is ranked lowest alongside New Zealand when it comes to health equity.
“I see the human toll of these shortcomings on a daily basis,” Dr Joseph Betancourt, the president of the Commonwealth Fund, told The Guardian. “I see patients who cannot afford their medications…I see older patients arrive sicker than they should because they spent the majority of their lives uninsured. It’s time we finally build a health system that delivers quality affordable healthcare for all Americans.”
While it might appear that for some time during the 2024 election cycle, healthcare took something of a backseat to hotter button issues such as immigration or the economy, aspects are still near the forefront of the minds of voters. According to a Pew Research poll conducted near the beginning of September, 65 percent of voters overall consider health care a “very important issue.” Some 51 percent of voters overall consider abortion - an integral part of healthcare - a “very important issue.”
There does not appear, however, to be much movement electorally to further move forward from the poor position the American healthcare system is in overall. Instead it seems we merely have a choice between protecting the little access to affordable healthcare people currently have or dismantling it completely.
Since it was first passed, Republicans swore they would dismantle the Affordable Care Act, which helped provide insurance coverage for tens of millions of Americans. Former President Donald Trump made it a core campaign issue in 2016, spent plenty of time during his presidency aiding congressional efforts to repeal it, and has continued to promise to “repeal and replace” it. Despite having nearly a decade to tell Americans exactly what he means by replacing the ACA with “something terrific,” the most detail Trump has been able to muster is that he has “concepts of a plan.”
Trump’s running mate JD Vance gave a small window into what could be part of Trump’s “concept of a plan” over the weekend. On Meet the Press, Vance said that the best way to make sure Americans are covered is to “promote some more choice in our health-care system and not have a one-size-fits-all approach.” According to Washington Post columnist Catherine Rampell, that word salad is pretty much code for upending the current system we have and allowing insurance companies to once again discriminate against people with pre-existing conditions.
“Higher-risk people require more medical care, which is expensive. Segregating these people into their own separate pool would drive up their premiums. This would lead to some less sick people in that pool dropping their coverage, while the very sick people would remain. This in turn would drive premiums even higher, prompting even more people to drop out.”
The Harris campaign has continually said it would protect the current system in place from Republican attacks. The campaign’s rapid response director Ammar Moussa recently tweeted that “healthcare is back on the ballot,” adding that Harris would “protect and expand the ACA.”
Merely protecting or even expanding the ACA though, won’t be enough to dig the United States out of the healthcare hole it’s been in for decades. There are still more than 26 million Americans without health insurance, and millions more have insurance they can barely afford that barely covers the most minimal of care. According to the report from Commonwealth:
“In the U.S., lack of affordability is a pervasive problem. With a fragmented insurance system, a near majority of Americans receive their health coverage through their employer.10 While the ACA’s Medicaid expansions and subsidized private coverage have helped fill the gap, 26 million Americans are still uninsured, leaving them fully exposed to the cost drivers in the system. Cost has also fueled growth of private plan deductibles, leaving about a quarter of the working-age population underinsured. In other words, extensive cost-sharing requirements render many patients unable to visit a doctor when medical issues arise, causing them to skip medical tests, treatments, or follow-up visits, and avoid filling prescriptions or skip doses of their medications.
In terms of care availability, U.S. patients are more likely than their peers in most other countries to report they don’t have a regular doctor or place of care and face limited options for getting treatment after regular office hours. Shortages of primary care services add to these availability problems.”
Backsliding from where we are currently on healthcare or fully dismantling it would be a disaster for most Americans, and that’s despite our current system being an unmitigated disaster for most Americans.
“The U.S. is failing one of its principal obligations as a nation: to protect the health and welfare of its people,” Betancourt said in a press release. “The status quo — continually spending the most and getting the least for our health care dollars — is not sustainable. It isn’t about lack of resources — it’s clearly about how they are being spent. Too many Americans are living shorter, sicker lives because of this failure. We need to build a health system that is affordable and that works for everyone. It’s past time that we step up to this challenge.”
We would do well to learn from our peer countries in the Commonwealth report and build a system based on providing the most equitable care for the most people possible in the nearest possible future. Ping-ponging from complete disaster to near disaster is literally killing us.