Health care continues to be a leading concern for voters in this year’s election and with good reason. Whether it’s premiums, deductibles, prescriptions or other out-of-pocket costs, the price of healthcare continues to rise, putting even basic access out of reach for millions and creating barriers to better health even among people who have coverage.
When it comes to healthcare, a new report from the Commonwealth Fund confirms what many health advocates and patients already know: Americans pay too much for healthcare and, all too often, that spending more doesn’t make us healthier.
The Commonwealth Fund compared 10 countries’ health care systems based on criteria like access to care, care process, administrative efficiency, equity, and health outcomes. Their report, Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System found that the United States underperformed on most measures, coming in last on access to care and healthcare outcomes.
Access to care is measured in terms of affordability and availability. Other countries that outperformed the US in the Commonwealth study offer universal coverage with low costs and few out-of-pocket payment requirements like those Americans face. While the US has made tremendous progress on reducing the number of uninsured people and on improving the quality of coverage, 26 million people are still uninsured, forced to pay the full cost of care out of pocket.
Moreover, being covered by insurance in the United States doesn’t guarantee affordability. A significant share of the insured population still struggles to afford care because of high deductibles, co-pays and other cost-sharing. Previous research from Commonwealth shows that 43% of people with employer coverage, 45% with Medicaid, 51% with Medicare, and 57% with an ACA (Affordable Care Act) plan have trouble affording care despite their coverage. Around 15 million Americans have medical debt from one or more unpaid medical bill.
High costs in the Unites States are driven by factors like corporate profits, rampant price-gouging from unregulated industries like the pharmaceutical manufacturers, administrative complexity, and waste. These features of the health system curtail access to care, resulting in worse health outcomes than other countries where care is more accessible because it’s much more affordable. Meanwhile in the United State, patients—even those with coverage—skip medical tests, treatments, or follow-up visits, and avoid filling prescriptions because they can’t afford them.
In some cases, patients also can’t access care because of the shortage of providers in many areas. People that live in rural areas or provider desserts must travel long distances at significant expense to access healthcare. The report notes that U.S. patients are more likely than patients in other countries to say they don’t have a regular doctor or place of care and have limited options for getting treatment after regular office hours. Research shows that continuity of care is associated with lower mortality, more consistent prevention and improved health outcomes. The recent COVID crisis both exposed the extent of the direct care staffing shortage in the United States and worsened matters by putting incredible physical and mental health strain on workers, many of whom left the field or are still struggling to recover. Employment across the health care sector remains below pre-pandemic trends, per KFF. A massive deficit in doctors, nurses and direct care workers is forecast even as demand for staff increases. The aging of the American population is creating dire need for many more care workers, as is the exploding mental health crisis, and escalating rates of chronic disease. All these factors will contribute to access and ultimately, to health outcomes and mortality rates for Americans in the future.
Life expectancy in the United States is declining for the first time in history. According to the report, life expectancy here is more than 4 years below the average in other countries. High rates of gun-related deaths, overdose deaths, and preventable and treatable deaths contribute to shorter lives.
The Commonwealth report reveals that when Americans can access care, the treatments they receive are high-quality. The United States is a top performer on care process factors like prevention of disease and patient safety. For instance, there has been successful reduction in adverse events during hospital stays for heart attacks, pneumonias, and major surgery between 2010 and 2019. While more delivery system reform is needed to keep improving quality, there’s at least a good foundation and progress to build upon.
To improve affordability and quality of coverage as well as address some of the socioeconomic and political factors that contribute to poor outcomes will require complex solutions. Reforms in Congress that can curtail the monopoly power of insurance and drug corporations, investment in Medicaid, Medicare and public health infrastructure and meaningful efforts to recruit, train, support and retain an army of health care workers to meet the growing need for services and treatment must be prioritized.
The outcome of the 2024 elections will either create increased opportunity for these kinds of changes or will continue the United States on a path of underperformance. In either case, there will be real health consequences for millions of Americans and generations to come.
