Dear Friends,
One of the things that is of most concern to working people is the cost and accessibility of healthcare in the US. Adopting a healthcare system with free universal coverage would make the lives of working people much more financially secure and remove a major daily worry. Unfortunately, even though the American healthcare system is a complete disaster, politicians, egged on by lobbyists and corporate contributions, are unwilling to adopt a better system. How is that in the world’s richest country, we pay the most per capita of any of the other industrialized nations for healthcare, and yet we have some of the worst outcomes? Rich people in the United States can, of course, get some of the best healthcare in the world, but our system rations healthcare by ability to pay.
The Commonwealth Fund is a well-known and often cited private foundation. According to its website, https://www.commonwealthfund.org/about-us?utm_source=chatgpt.com its mission is
to promote a high-performing, equitable health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including people of color, people with low income, and those who are uninsured.
The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.
A recent study by the Commonwealth Fund entitled, “U.S. Health Care from a Global Perspective, 2026” demonstrates how expensive our healthcare system is, how poor our outcomes are and how inequitable it is. https://www.commonwealthfund.org/publications/issue-briefs/2026/may/us-health-care-global-perspective-2026 The study compares our healthcare system with those of the other members of the Organisation for Economic Co-operation and Development (OECD). https://www.oecd.org/en.html There are 38 highly industrialized countries in the OECD .
Today, I will review data from the Commonwealth Fund study in more detail to demonstrate how the US healthcare system is broken. I will explore several topics – universal coverage, life expectancy at birth, avoidable deaths, cost of care, care delivery, years of lost life and a flagrant example of inequality - infant mortality for black women.
Universal Coverage
Of the 38 members of the OECD only the US and Mexico do not have universal healthcare coverage. Mexico is on track to provide universal coverage for all in 2027. The United States will substantially increase the number of uninsured people in 2027. https://www.kff.org/quick-insights/about-17-million-more-people-could-be-uninsured-due-to-the-big-beautiful-bill-and-other-policy-changes/ By 2027 the US will be the sole member of the OECD to lack universal healthcare coverage and will be falling further from the goal of universal coverage.
Life Expectancy at Birth
The Commonwealth Fund summarizes the above data as follows:
Americans lead among the shortest lives of those in OECD countries included in this study. U.S. life expectancy reached its peak of 79 years in 2024 — two years below the OECD average and third-lowest among all OECD countries, after Mexico (75.5 years) and Türkiye (77.3 years).
Average life expectancy in 2023 for non-Hispanic Black Americans (74 years) and non-Hispanic American Indians or Alaska Natives (70.1 years) is four and eight years lower, respectively, than it is for non-Hispanic white Americans (78.4 years). Meanwhile, life expectancy for Hispanics (81.3 years) is higher than it is for whites.
Avoidable Deaths
The Commonwealth Fund summarizes the above data as follows:
Avoidable mortality refers to deaths that are preventable and treatable. Preventable deaths are those that can be avoided through effective public health measures and through “primary prevention,” such as a nutritional diet and exercise. Treatable deaths can be avoided through timely and effective health care interventions, including regular exams, screenings, and treatment.
Until the 2020 COVID-19 pandemic, the rate of avoidable mortality was on the decline in most countries. In the U.S., however, the rate had been increasing before the pandemic and then spiked in 2021. Since that time, the U.S. avoidable mortality rate has dropped. Still, it remains above the prepandemic level and is currently second-highest among OECD countries included in this analysis, after Mexico.
Cost of Care
The Commonwealth Fund summarizes the above data as follows:
In each country, health care spending growth has outpaced economic growth over the past four decades. New and often costly medical technologies, rising prices, and higher demand for services are all contributing to this growth.
During this time, the U.S. has spent more on health care than any other nation, and 2024 was no exception. The U.S. devoted 18 percent of its gross domestic product (GDP) to health-related spending, nearly twice as much as the average OECD country.
The Commonwealth Fund summarizes the above data as follows:
Per capita health spending in the U.S. was 1.5 times as much as the next-highest-spending country, Switzerland, and 10 times higher than Mexico.
The Commonwealth Fund summarizes the above data as follows:
U.S. patients incur higher out-of-pocket costs for prescription drugs compared to patients in other countries. Americans spend more than $400 on average each year, compared with less than $100 in France.
The Commonwealth Fund summarizes the above data as follows:
Although all the countries we studied, except the U.S. and Mexico, provide universal health coverage, patients’ out-of-pocket costs for health services vary widely depending on health needs, geographic location, and income. In many cases, these costs make essential services unaffordable.
In the U.S., where approximately 8 percent of the population is uninsured and one-quarter has coverage that comes with high out-of-pocket costs or deductibles, people are far more likely to forgo needed care because of costs than people in peer countries. This can mean not filling prescriptions, not obtaining diagnostic tests, treatment, or follow-up care, or being unable to adhere to clinician-recommended care plans.
Care Delivery
The Commonwealth Fund summarizes the above data as follows;
The U.S. has the highest medical tuition fees of any country in our analysis. This high cost, coupled with limited residency training positions, has produced one of the lowest ratios of medical school graduates, 8.6 for every 100,000 people. This is far lower than the OECD average of nearly 15 graduates per 100,000 people, and well below Denmark’s leading rate of 21 per 100,000.
The Commonwealth Fund summarizes the above data as follows:
With not enough medical graduates, inadequate primary care funding, and a growing problem of physician burnout, the U.S. has the fewest primary care physicians per capita. Without significant action, the shortage of primary care providers is expected to worsen in the years ahead.
The Commonwealth Fund summarizes the above data as follows:
The number of hospital beds is an indicator of a health system’s capacity to manage inpatient care. In the U.S., the total number of hospital beds for every 1,000 people — three — is lower than the OECD average of 4.3. At the other end, Japan and Korea have 13 beds per 1,000 people, which may be an indication of unnecessary health care utilization and overtreatment.
Years of Lost Life
The Commonwealth Fund summarizes the above data as follows:
Years of potential life lost (YPLL) is a measure that public health experts use to estimate premature deaths in a population. It’s the average number of years a person would likely have lived had they not died prematurely and instead had lived until age 75. For example, dying from a preventable cause at age 30 is akin to losing 45 years of potential life, while at age 70 it’s akin to losing five years.
A higher YPLL indicates a greater prevalence of early deaths, particularly among younger populations. The United States has one of the highest YPLL rates, driven largely by preventable causes such as drug overdoses, gun violence, and obesity — conditions that disproportionately affect younger people. In Switzerland, which has the lowest YPLL rate, most avoidable deaths are due to cardiovascular disease, which primarily affects older adults. Because these deaths occur later in life, they contribute fewer years of potential life lost compared to deaths at younger ages.
An Example of Flagrant Inequality – Black Women in the US have the Highest Maternal Death Rate in the OECD
The Commonwealth Fund summarizes the above data as follows:
Compared to countries included in this analysis, the U.S. has long had among the highest rates of maternal deaths related to complications of pregnancy and childbirth. In 2023, there were nearly 19 maternal deaths for every 100,000 live births in the U.S., a decline from previous years. By contrast, in 11 of the 18 countries we studied there were less than five maternal deaths per 100,000 live births. A high rate of cesarean section, inadequate prenatal care, and socioeconomic inequalities contributing to chronic illnesses like obesity, diabetes, and heart disease may help explain high U.S. maternal mortality.
For Black women in the U.S., maternal mortality is exceptionally high: 50 deaths per 100,000 live births. This far exceeds national maternal mortality in any of the other countries. Inequities in access to care and patients’ care experiences — often rooted in discrimination and clinician bias — may be prime contributing factors.
How to Fix the US Healthcare System
Since the US healthcare system, the world’s most expensive healthcare system, produces some of the worst outcomes, we certainly should be able to find a better system. After looking at the data from the Commonwealth Fund, I decided to look closer at the German and French healthcare systems to find a model that we might use. Of course, no system is perfect, but it would be impossible to find one worse than that of the US.
The German and French healthcare systems are broadly similar. Both provide universal coverage. In Germany all must have either the statutory health insurance or a substitute private health insurance. 89% have the statutory health insurance and all but 0.1% of people have coverage. In France the statutory insurance covers everybody and about 95% of the people have complimentary insurance. In both countries the system is paid for primarily with public funds and the care is provided by a mix private providers and state employed providers as well as public and private hospitals. For more information and the French healthcare system see https://eurohealthobservatory.who.int/publications/m/france-country-health-profile-2023 and for the German healthcare system see https://eurohealthobservatory.who.int/publications/m/germany-country-health-profile-2025
I summarized some of the data in the Commonwealth Fund to compare the US, French and German systems.
| US | France | Germany |
Cost per capita | $12,649 | $6,113 | $7,553 |
Cost of pharmaceuticals per capita | $462 | $92 | $171 |
Life expectancy at birth in years | 79 | 81.1 | 81.2 |
Avoidable deaths per 100,000 population | 312 | 162 | 195 |
Primary care physicians per 1,000 population | 0.3 | 1.4 | 1.1 |
Hospital beds per 1,000 population | 2.8 | 5.4 | 7.7 |
Years of lost life per 100,000 population | 7,384 | 4,125 | 4,041 |
Maternal mortality per 100,000 births* | 19 | 7.3 | 4 |
*From a different report from the Commonwealth Fund which permits comparison of healthcare systems of different countries. https://www.commonwealthfund.org/international-health-policy-center/country-comparison-tool
My conclusion is that the US should use the German and French healthcare systems as models for designing a new healthcare system that actually helps all the people and that has a cost commensurate with the outcomes.
Thanks for reading and please comment,
The Unabashed Liberal
