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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 · 26-30
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.
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!
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.
Yes. This has been true for some time.
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.
AthrillatheHunt · 51-55, M
How come we only discuss one side of this argument . How come we never discuss how bad people treat their own bodies ? 300 pound chain smoker , and you think it’s the governments responsibility for you to have a clean bill of health ? Puh-leeeeze.
MethDozer · M
@AthrillatheHunt " in some communities".
Some is most eh?
What dog whistle might this be BTW?


Stop blaming down on people to defend the greedy. It's unbecoming
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JSul3 · 70-79
@AthrillatheHunt IMO, the American diet is why we have heart disease and obesity.
Bumbles · 51-55, M
For those with good insurance the US is second to none.
oldguy73 · 70-79, M
@Bumbles very true, i have great insurance, see any doctor anytime
Bumbles · 51-55, M
@22Michelle About 10% don’t have health insurance, but I have no idea how many have good health insurance.
22Michelle · 61-69, T
@Bumbles @Bumbles And how many insurance policies have a cap on payments? How many Americans are bankrupted by medical bills?
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.
oldguy73 · 70-79, M
all depends, if on welfare you get anything you need, if you have excellent insurance, which i have, and it is free from my emplower, i have great healthcare, see any doctor i want , then lots of people have poor insurance, which means they have to pay more, we have lots of variables in healthcare
@oldguy73 since 1995 all adults must work forty hours a week to get food stamps and nobody gets a welfare payment.
You sure don't want no boyfriend moving in for free. That's too much freedom. As a socialist I'll sleep with whom I like. You should have no freedom there,- especially if you're not rich.
oldguy73 · 70-79, M
@Roundandroundwego well, i know girls that do not work have a kid under 18, and they get food stamps and rent, paid, all free, like where you live??
@oldguy73 girls under 18 or any age can't be raising kids with support! You want them working and barren, learning BJ's and work skills until them eggs is half scrambled and they're sexually distorted and weirdly celebate.
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"!
SSDecontrol · 56-60, M
What a joke. Could you possibly have found more dubious sources

That must be why every doctor worth his salt wants to practice here
World Health care in 2024.
Symptom A
Pharmaceutical drug X

Thank you, come again (Apu voice)
Donotfolowme · 51-55, F
Don't know when it will change. Only the riches can stay healthy.
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