The U.S. healthcare system ranks last among 10 advanced economies, according to a report released today by the Commonwealth Fund.
“Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System,” the eighth such study the Commonwealth Fund has published since 2004, studied five areas of healthcare system performance: access to healthcare, the care process, administrative efficiency, equity and health outcomes.
According to the report, “The U.S. continues to be in a class by itself in the underperformance of its health care sector.”
The other countries studied include Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom.
The report stated:
“The nine nations we examined are more alike than different with respect to their higher and lower performance in various domains. But there is one glaring exception — the U.S. …
“The ability to keep people healthy is a critical indicator of a nation’ capacity to achieve equitable growth. In fulfilling this fundamental obligation, the U.S. continues to fail.”
The report also singled out the poor performance by the U.S. in COVID-19-related metrics, including excess deaths resulting from the pandemic, where the U.S. ranked last.
“The U.S. has the highest rates of … excess deaths related to the pandemic for people under age 75,” the report stated.
The report also highlighted examples of countries that have achieved success with child healthcare, including the Netherlands and Switzerland.
“In the Netherlands, visits to primary care, maternity care, and child health care providers are fully covered; other health care services are covered once patients pay their annual deductible,” the report said.
“Switzerland’s small size, along with the nation’s extensive transit options and, as of 2015, increased funding for women’s health, led to improved performance, including fewer childbirth injuries and a higher rate of postpartum checkups,” the report added.
According to a research letter published in JAMA Pediatrics in July, children and teens in the U.S. are dying at higher rates than their peers in 16 other high-income countries. The U.S. infant mortality rate consistently exceeds those of other high-income countries.
In a Substack post responding to the “Mirror, Mirror 2024” report, physician and scientist Dr. Robert Malone wrote, “Clearly, the US Healthcare system is failing to provide value for money, and is failing the citizens of the United States.”
“Generally speaking, US Citizens are glad to pay more for longer, healthier lives. But in fact, we are paying the most of the ranked countries for the worst overall outcomes,” Malone wrote.
U.S. spends ‘vast amounts’ for ‘generally poor results’
One of the report’s key findings is that the U.S. lags behind its international peers considerably in terms of health system performance — yet the U.S. is also “an outlier on health care spending.”
In 1980, U.S. health expenditures were “comparable to outlays in Sweden and Germany (8.2% of GDP).” However, since then, “the U.S. has far outpaced other nations, spending more than 16 percent of its GDP on health care in 2022” — a figure “predicted to exceed 20 percent by 2035.”
According to the report, this finding reflects the “enduring U.S. dilemma of spending vast amounts for generally poor results — the very definition of a low-value health system.”
Americans ‘face the most barriers to accessing and affording health care’
Americans also face the most barriers to accessing and affording healthcare, the report concluded.
Calling the “lack of affordability” of healthcare “a pervasive problem” in the U.S., the study cited “a fragmented insurance system” as a key factor contributing to this outcome.
According to the report:
“While the ACA’s [Affordable Care Act’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.”
As a result, “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,” the report notes.
‘Americans live the shortest lives and have the most avoidable deaths’
Despite higher-than-average healthcare spending and the high cost of health services for patients, the report found that the U.S. ranks last among the countries studied in health outcomes, noting that “Americans live the shortest lives and have the most avoidable deaths.”
According to the report, the U.S. ranks last in 4 of 5 health outcome metrics included in the study, including life expectancy and rates of preventable and treatable deaths.
“Life expectancy is more than four years below the 10-country average, and the U.S. has the highest rates of preventable and treatable deaths for all ages,” the report noted. “The ongoing substance use crisis and the prevalence of gun violence in the U.S. contribute significantly to its poor outcomes.”
Malone called this finding “the most compelling inditement” of the U.S. healthcare system and the U.S. “medical-industrial, pharmaceutical-industrial and federal public health service complex.”
The report compared poor COVID-19 performance in the U.S. with other countries, including Australia, New Zealand and Switzerland.
The report praised these countries for implementing “stringent border controls, lockdowns, quarantine requirements, and movement restrictions” during the pandemic.
The report did not mention that Sweden’s health outcome metrics were similar to those in Australia, New Zealand and Switzerland — even though Sweden eschewed lockdowns and most COVID-19-related restrictions during the pandemic.
U.S. not protecting ‘the health and welfare of its residents’
“Despite spending a lot on health care, the United States is not meeting one of the principal obligations of a nation: to protect the health and welfare of its residents,” the report concluded. “The U.S., in failing this ultimate test of a successful nation, remains an outlier.”
Citing “ample opportunities for cross-national learning,” the report included several recommendations for areas where the U.S. can improve its healthcare performance.
It suggested the U.S. “continue to reduce financial barriers to access to care by extending coverage to the remaining uninsured,” including “reducing the cost of care, which is driven primarily by high prices charged by providers.”
The report also recommended the U.S. minimize “the variation and complexity of insurance plans,” and “address the uncontrolled consolidation of health care resources in local markets, which helps drive prices higher and makes insurance less affordable for Americans.”
This article was originally published by The Defender — Children’s Health Defense’s News & Views Website under Creative Commons license CC BY-NC-ND 4.0. Please consider subscribing to The Defender or donating to Children’s Health Defense.
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