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US health system ranks last compared with peer nations, report finds.

Despite Americans paying nearly double that of other nations, the US fares poorly in list of 10 countries.

By
Jessica Glenza/The Guardian
Thu 19 Sep 2024 00.01


The United States health system ranked dead last in an international comparison of 10 peer nations, according to a new report by the Commonwealth Fund.

In spite of Americans paying nearly double that of other countries, the system performed poorly on health equity, access to care and outcomes.

see the human toll of these shortcomings on a daily basis,” said Dr Joseph Betancourt, the president of the Commonwealth Fund, a foundation with a focus on healthcare research and policy.

“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,” said Betancourt. “It’s time we finally build a health system that delivers quality affordable healthcare for all Americans.”

However, even as high healthcare prices bite into workers’ paychecks, the economy and inflation dominate voters’ concerns. Neither Kamala Harris nor Donald Trump has proposed major healthcare reforms.

The Democratic presidential nominee has largely reframed healthcare as an economic issue, promising medical debt relief while highlighting the Biden administration’s successes, such as Medicare drug price negotiations.

The Republican presidential nominee said he has “concepts of a plan” to improve healthcare, but has made no proposals. The conservative policy agenda Project 2025 has largely proposed gutting scientific and public health infrastructure.

However, when asked about healthcare issues, voters overwhelmingly ranked cost at the top. The cost of drugs, doctors and insurance are the top issue for Democrats (42%) and Republicans (45%), according to Kaiser Family Foundation health system polling. Americans spend $4.5tn per year on healthcare, or more than $13,000 per person per year on healthcare, according to federal government data.

The Commonwealth Fund’s report is the 20th in their “Mirror, Mirror” series, an international comparison of the US health system to nine wealthy democracies including Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK, Sweden and Switzerland. The foundation calls this year’s report a “portrait of a failing US health system”.

The report uses 70 indicators from across five main sectors, including access to care, health equity, care process, administrative efficiency and outcomes. The measures are derived from a survey conducted by Commonwealth as well as publicly available measures from the World Health Organization, OECD and Our World in Data.

In all but “care process” – the domain that covers issues such as reconciling medications – the US ranked as the last or penultimate nation. Presenters for Commonwealth noted the US is often “in a class of its own” far below the nearest peer nation."

Poverty, homelessness, hunger, discrimination, substance abuse – other countries don’t make their health systems work so hard,” said Reginald D Williams II, vice-president of the fund. He said most peer nations cover more of their citizens’ basic needs. “Too many individuals in the US face a lifetime of inequity, it doesn’t have to be this way.”

But recommendations to improve the US health system’s standing among peer nations will not be easy to implement.

The fund said the US would need to expand insurance coverage and make “meaningful” improvements on the amount of healthcare expenses patients pay themselves; minimize the complexity and variation in insurance plans to improve administrative efficiency; build a viable primary care and public health system; and invest in social wellbeing, rather than thrust problems of social inequity onto the health system.

"I don’t expect we will in one fell swoop rewrite the social contract,” said Dr David Blumenthal, the fund’s past president and an author of the report. “The American electorate makes choices about which direction to move in, and that is very much an issue in this election.”
deadgerbil · 22-25
Better healthcare is seen as demonic socialism
Elessar · 26-30, M
@deadgerbil By the folks who see Kenneth Copeland and genuinely believe that's the kind of dude their God would speak through
whowasthatmaskedman · 70-79, M
As usual, Americans were sold a bill of goods about "freedom" and small government being the only way. In that basis the military should be privatized. (Oh Wait, they are to a large extent) But their is no oversight or regulation to stop profiteering. So big pharma works with big medical and the insurance companies to maximise profits at every level (as they should) and no one looks behind the curtain to see who is pulling the levers. Public health care is the simplest thing in the world. The government carries the indemnity and it is funded by a small surcharge on income taxes. The unemployed get it free. All citizens and residents are covered. Those currently "free" clinics can claim funding just like everyone else and even VA people have an alternative avenues of care. And Drug companies, and hospitals and HMOs submit to some oversight in exchange for having their claims paid.. I can all be organised before lunch..IF there werent so many snouts in the trough with lobbyieats making campaign donations..😷
whowasthatmaskedman · 70-79, M
@JimboSaturn While the medical care isnt "free" technically. (there is a tax impost) The profit motive is reduced close to ero in the actual insurance section. Here we have a two tier scheme with general coverage for anything up to and including a heart transplant. But I can "go private" and carry my own insurance to cover the extra to choose a specialist, or hospital more convenient in location or wait time. (as I do) If I choose one of these local Private hospitals (I recommend the food and the service) the hospital claims part of my cost from the governemt system and part from my insurance. My cost? $300 per admission with a max of $900 per year. (And that includes the mid morning cappuchino and wifi. And I pay less than most Americans..😷
JimboSaturn · 51-55, M
@whowasthatmaskedman I would gladly pay more taxes so everyone in my country can have health care not driven by the profit motive. I believe its a right not a priveledge.
whowasthatmaskedman · 70-79, M
@JimboSaturn And as you said, it soon focuses on preventative health care and "wellness" as even my private cover does to keep costs down..A number of the private health insureres are "Not for profit" so no shareholders other than members.😷
JimboSaturn · 51-55, M
Well when public health care is regarded as Marxist and evil, this is the result.
Yes. This has been true for some time.
SunshineGirl · 36-40, F
One of the least helpful contributions to public health that the USA made was the idea of a "war against drugs", which blanket criminalises or stigmatises those dealing with substance abuse. Even while those facilitating that abuse were often "respectable" pharmaceutical corporations.
No surprise. A few years ago the results of a 10 year study comparing US healthcare outcomes to the NHS found that even the wealthiest Americans have the same outcomes as the poorest people in the UK.
deadteddy · 26-30, F
My nausea medication cost me $700 without insurance 🥲 when in other country I had traveled to it cost like $30 for the same days supply.
It’s ridiculous.
@deadteddy

When I experienced a minor stroke about three years ago I got almost too much care - if you get my drift. Being a Canadian, everything was taken care of (including 2 MRI scans which I understand are expensive).
Here's the kicker - for agreeing to take part in a follow-up in a one afternoon "question and answer" in order to create a data base for further heart & stroke understanding, I was paid $350!
An informed electorate can make wise voting choices. So, with the repubs gung-ho on dumbing down the populace, good luck with anything changing for the better.
About the only thing US healthcare is great at is allowing people to jump the line based on their net worth.
GeistInTheMachine · 31-35, M
Yeah, I absolutely hate the healthcare system here. It's nearly killed me.
Crazywaterspring · 61-69, M
No surprise. The curated politicians who are allowed in office routinely ignore national healthcare and gun control. These are two topics that consistently poll as quite popular.

They demonstrate the validity of Marx daily.
Who can fix all this?
22Michelle · 61-69, T
@mysteryespresso The American electorate, if they want to. If they stop believing that their system is so wonderful, and that any changes that impinge on health industry profits are somehow harbringers of "Communism"!
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