US Healthcare Remains an Outlier in Performance and Cost

The analysis, which benchmarks the U.S. against nearly two dozen wealthy countries, points to a for-profit structure as the primary driver of these disparities. While Americans face record-high costs, the system leaves 27 million people uninsured. Projections suggest that pending policy changes, including potential Medicaid cuts, could strip coverage from another 17 million people by 2034, leading to 50,000 additional preventable deaths annually.

Financial hurdles remain a defining feature of the American experience. Out-of-pocket costs for prescription drugs in the U.S. average $400 per person—four times the cost seen in France. These expenses force many to forgo essential diagnostic tests and treatment. Simultaneously, the nation faces a critical shortage of primary care providers and the highest medical tuition fees in the study, stifling the growth of the physician workforce.

Disparities in Care and Outcomes

Health inequities are particularly stark regarding maternal mortality. The U.S. recorded nearly 19 maternal deaths per 100,000 live births in 2023, while 11 of the 18 peer countries maintained rates below five. Among Black women in the U.S., the rate climbs to 50 deaths per 100,000. Commonwealth Fund president Dr. Joseph Betancourt argued that these results stem from policy choices rather than a lack of resources. Although proposals like Medicare for All enjoy broad public support—with 65% of voters in favor—legislative progress remains stalled by concerns over cost and political feasibility. Reginald Williams II, a senior vice president at the organization, noted that the current failure is not one of ideas, but a lack of political will to implement proven, universal models.