A new report from the Commonwealth Fund provides a sobering if unsurprising assessment of the health care system in America. Compared to similarly wealthy countries, the U.S. scored dead last in most measures of decent health care, which included having the highest infant and maternal mortality rate.
Since 2004, the Commonwealth Fund—a nonprofit organization focused on health care reform founded in 1918—has been periodically publishing its Mirror, Mirror report, a comparison of the U.S. health care system to those in other high-income countries (the last was in 2017). The latest version was published this week and matched up the U.S. to 10 other countries, including Norway, the UK, Switzerland, and France. All of the nations were measured on five basic aspects of health care, from access to equity to concrete health outcomes, based on recent and publicly available data.
The top three performing countries overall were Norway, the Netherlands, and Australia, followed by the UK, Germany, and New Zealand. And in the rear, far away from its closest peer, Canada, was the U.S. In four out of these five metrics, the U.S. ranked 11th. The only metric where it did much better was in care process, where it came in second.
The authors defined care process as a country’s ability to provide residents timely preventive care like cancer screenings, safe care in general, organized coordination between different parts of the system, like primary care doctors and emergency departments, and good communication between doctors and patients about health risks like smoking.
Everywhere else, though, the U.S. was completely abysmal at safeguarding the health and longevity of its residents. It ranked last in infant mortality rate, with 5.7 deaths per 1,000 live births (Norway, the top ranked, has a rate of 2 deaths per 1,000 live births); last in maternal mortality, with 17.4 deaths per 100,000 live births (more than twice the rate of its closest peer, France), and last in life expectancy past the age of 60, at 23.1 years (people over 60 in Australia are expected to live over two years longer than those in the U.S.). It fared worst at equity as well, with the gap in various health care outcomes substantially larger between the rich and poor in the U.S. All of this, it should be noted, was despite the U.S. as a whole actually spending more money in health-care related costs than any other country.
“We have almost two healthcare systems in America: one for people with means and insurance, and another one that falls short for people who are uninsured or don’t have adequate insurance coverage,” lead author Eric Schneider, senior vice president for policy and research at the Commonwealth Fund, told the Washington Post.
Notably, the U.S. remains the only high-income country to not ensure universal health coverage—a key factor for its flagging performance, the authors say. Top-performing countries not only guarantee health coverage to most every resident, they also keep out-of-pocket costs relatively low and ensure that services are available to everyone regardless of location. Some countries, like Norway, have many more doctors relative to the population than the U.S. And these universal health care systems also tend to require less paperwork to operate, reducing their administrative costs relative to the U.S.
There do remain organizations and political leaders who want the U.S. to adopt universal health coverage through the implementation of a single-payer system like the ones seen in other wealthy countries—one that may still have some private insurance providers, like in Germany. But it’s fair to say that this isn’t a priority the current Democratic administration has, and certainly not the GOP. But the authors hope there are lessons that the U.S. can adopt from its peers, such as the need for greater bargaining power in negotiating drug prices.
“As the COVID-19 pandemic has amply shown, no nation has the perfect health system. Health care is a work in progress; the science continues to advance, creating new opportunities and challenges,” the authors wrote in their conclusion. “But by learning from what’s worked and what hasn’t elsewhere in the world, all countries have the opportunity to try out new policies and practices that may move them closer to the ideal of a health system that achieves optimal health for all its people at a price the nation can afford.”