Esshan Kharat — September 5, 2026
As the richest nation on Earth, the United States spends more on healthcare than any other nation in history; however, even with such massive spending, healthcare outcomes are repeatedly reported to be lower than in other developed nations.
For some context: the United States spent more than $5.3 trillion on healthcare in 2024. Taking that per capita, that’s $15,474 per person or 18% of the nation’s GDP. However, countries like Germany or Japan, with much cheaper healthcare, are often touted as having better service and longer lives than Americans. In one 2024 ranking by the Commonwealth Fund’s Mirror, the United States ranked dead last among 10 wealthy nations in access to healthcare, healthcare equity, and outcomes across the general population.
In nearly every respect, the U.S. healthcare system fails to meet the standards set by other nations, despite its massive spending. The failures infiltrate nearly all aspects of healthcare: the quality, speed of delivery, and cost. As such, we’ll take a closer look at each. The comparisons ahead focus on America in comparison to other wealthy nations.
Life Expectancy
If you want to measure healthcare, there’s one simple way to check: are people living long enough? Relative to the nation’s wealth, the United States is completely failing. Life expectancy at birth is 79 years, the highest level ever; however, when we compare this with other high-income countries similar to the United States, the average is 82.7 years. Among all OECD countries, the United States is only ahead of Mexico and Turkey in life expectancy. This was not always the case. In the mid-1980s, the United States had a life expectancy comparable to that of other wealthy nations. However, since then, the U.S. healthcare system has consistently underperformed, leading to a widening gap in life expectancy over time.
Maternal Mortality
Another clear example of failing healthcare can be seen by looking at maternal deaths within the United States. The United States maternal mortality rate sits at 22.3 deaths per 100,000 live births, and as of 2022, that was more than 50% higher than the next closest country. During that same period, Norway and Sweden recorded 0 and 3 deaths per 100,000 live births, respectively.
Avoidable Mortality
Furthermore, the United States has a high rate of deaths before 75 that could be prevented with better public health measures. One study found that between 2009 and 2021 avoidable mortality rose in all 50 states in the United States, while in the other 40 comparison high-income countries it fell in every single one. Between 2009 and 2019, the United States saw an increase of 29 deaths per 100,000 people, while other countries fell by nearly 14 per 100,000. While the United States is increasing its deaths, other countries are decreasing theirs.
The Inconsistency of Care
Even with the poorest general health outcomes, the American healthcare system is paradoxical. That’s because American medicine is actually great at specialty treatment specifically. In fact, the United States ranked second in the aforementioned Commonwealth Fund Mirror’s rankings for covering prevention, safety, and coordination of care. Even further, 5-year cancer survival rates in the United States are actually among the best in the world.
Specialty interventions aren’t the problem. Rather, it’s the population problem that is plaguing the nation. Population health is far more dependent on primary care managing chronic diseases than on specialty interventions that save a few lives. The United States has the fewest primary care physicians per capita among wealthy nations. One of the primary reasons for this is the fragmentation of care across systems. There are thousands of insurers and providers across the nation, and managing that makes it harder to ensure consistent primary care across the board. Another issue that drags down the average quality of care is America’s struggle with patient safety. Every single year, nearly 795,000 Americans either die or are permanently disabled just from diagnostic errors.
Geography is also one of the main issues that makes American healthcare so inconsistent. Rural hospitals are losing maternity units at an alarming rate. 34.6% of U.S. counties are maternity care deserts, meaning there is little to no hospital care for mothers who need to deliver babies. Pregnant women living in these counties are often forced to drive more than an hour to have their baby. When the delay in getting healthcare is so prevalent, it leads to the United States having some of the worst outcome statistics in the world.
Long Wait Times
Although America’s fragmented insurance system remains the primary reason for major healthcare failures, a common counterargument to switching to a universal healthcare system is the time it would take. However, an analysis of evidence on American healthcare waiting lists and wait times shows that Americans still wait much longer than they should for care. Across 15 large metro areas surveyed, the average wait time to schedule an appointment with a new-patient physician is 31 days, up nearly 50% since the early 2000s. Furthermore, these large cities have the best provider ratios in the nation. Moving into rural areas, it becomes even harder to find physicians who can fit care into their schedules. Looking at other specialties, such as obstetric-gynecologic care, the average wait time for a single appointment is over 41 days.
And for the youth in America, longer healthcare wait times are going to become the new normal, as the U.S. is projected to face a shortage of nearly 86,000 physicians by 2036. This is driven by an aging population of physicians, with 20% of active doctors already 65 or over. With lower rates of people getting into medical school and residency, it’s becoming increasingly difficult to count on a future with enough physicians to treat Americans. As a result, it’ll take even longer for Americans to access the care they need.
However, the number one factor behind delay has nothing to do with physicians or scheduling. It’s actually Americans themselves. Because healthcare is so expensive, people simply don’t get care and checkups when they need them.
In fact, nearly one in every three adults, or 72 million people, don’t seek healthcare in the 3 months prior to treatment because of the cost. Fewer than half of Americans are cost-secure, meaning they can’t afford to seek treatment when symptoms appear. This means that people are rationing their bank balances rather than going to hospitals for care. Additionally, because the U.S. healthcare system relies so heavily on insurance, separate delays result. In fact, 93% of authorization delays for necessary care are due to insurance. 78% of people report that when these delays occur, their patients simply abandon treatment. This could lead to adverse events for patients, including hospitalization, permanent impairment, or death, all of which contribute to poor health outcomes in the United States.
Countries like Canada and the United Kingdom, with universal healthcare, often face criticism for scheduling care. Indeed, there is some validity to this criticism, as only 41% of Canadians could get a same or next-day appointment. However, in the United States, which does not have universal healthcare, this number jumps to 51%. In countries like Australia, which still uses a non-single-payer healthcare system, 67% of people could get a same or next-day appointment. And in countries like the United Kingdom, Germany, the Netherlands, and Sweden, only 1 in 10 patients avoid treatment because of cost. These global comparisons serve to prove that Americans are waiting longer for poorer, more expensive treatment.
Exorbitant Costs
When appealing to a campaign of lowering costs, Presidents Biden and Trump focused on one area specifically: the price of prescription drugs. This is because data shows that U.S. drug prices are nearly 3 times higher than in other wealthy nations, and when using brand-name drugs, that jumps up to more than 4.2 times higher.
Additionally, looking up becomes an issue. Administrative overhead drives healthcare costs up across the board for Americans. U.S. insurers spend more than $800 billion every single year just on administration. That’s nearly 33% of national health expenditures. In countries like Canada, administration accounts for only 17% of expenditures. That money is stripped from Americans’ pockets through premiums, deductibles, and debt. The average annual premium for family coverage was nearly $27,000 in 2025. And over time, because premiums are growing faster than wages, Americans will be squeezed out of their paychecks just to afford poor healthcare. Additionally, with deductibles climbing, the average single-coverage deductible is nearly $2,000, meaning that for most small treatments, Americans are still paying thousands.
Within expensive coverage, millions of Americans fall into debt just to pay their bills. In fact, Americans owe more than $200 billion in medical debt. Additionally, with consolidating hospitals, prices in monopoly markets are 15.3% higher than in markets with four or more hospitals.
Conclusion
While American healthcare may struggle for millions of Americans, it does have a few strengths, particularly in innovation. The United States accounts for nearly 55% of global biopharmaceutical R&D investment. Furthermore, when it comes to actually getting the care from this innovation, the United States gets access to new drugs faster than nearly any other nation on Earth.
Despite these advantages, poor outcomes continue to proliferate, and they aren’t just a function of poor American healthcare. There are also factors outside of the clinic. The United States has higher rates of obesity, gun deaths, and drug use than other nations. This drives down life expectancy, regardless of how strong the medical care system is.
Yet across the board, American healthcare simply is not where it needs to be. Building stronger healthcare in America requires fundamentally reforming the system. By improving public health measures, reducing bureaucratic inefficiency, increasing training for doctors, and reconsidering single-payer insurance, America can build a system that serves the people it’s intended to serve.
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