United States Health Care Trails Peers Despite Highest Spending

The Commonwealth Fund’s 2024 “US Health Care from a Global Perspective” report compares the United States with 19 other high-income OECD members, including the United Kingdom, France, Japan, and Mexico. The United States spends 18 % of GDP on health care—about twice the OECD average—yet records some of the lowest life expectancy and highest rates of preventable deaths among the group.

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• Health-care spending: 18 % of U.S. GDP (2024).

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• Uninsured population: 27 million, with projected growth of 17 million by 2034 under current policy trends.

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• Avoidable deaths: 312 per 100 000 people.

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• Out-of-pocket prescription costs: $400 per person annually, versus $100 in France.

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• Maternal mortality: 19 deaths per 100 000 live births, rising to 50 per 100 000 for Black women.

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• Life expectancy: roughly five years shorter than Japan, Spain, and Switzerland.

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The Commonwealth Fund says poor outcomes result from systemic choices, not resource scarcity. Congressional Budget Office and Yale analyses estimate that expanding Medicare nationwide could save $650 billion annually and prevent 68 000 avoidable deaths. A Data for Progress poll finds 65 % of U.S. voters favor a national, government-run health program, with bipartisan majorities. Republican leaders oppose continued ACA subsidies and propose $1 trillion in Medicaid cuts over the next decade, projecting more uninsured and preventable deaths.

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Republican policymakers contend that a single-payer system lacks sufficient public backing and would be fiscally unsustainable. They emphasize the need for market-based solutions and warn that Medicare-for-All proposals are “unpopular and too expensive,” despite polling indicating broader voter support. Democratic opponents of the single-payer model also raise concerns about implementation costs and political feasibility.

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• “The US is one of the only countries to have enacted policies that reduce coverage.” — Commonwealth Fund report

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• “ "We spend more than any other nation on healthcare, so our poorer health outcomes aren’t due to a lack of resources—it is about how we choose to use them," said Betancourt.” — Dr. Joseph Betancourt, President, Commonwealth Fund

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• “the support for a true single-payer system isn't there yet.” — Sen. Mallory McMorrow (D-8)

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• “It’s the result of different choices,” — Reginald Williams II, Senior Vice President, Commonwealth Fund

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The report highlights a paradox: the United States allocates the most financial resources to health care among peer nations yet lags in life expectancy, maternal health, and preventable mortality. High out-of-pocket costs and limited insurance coverage drive care avoidance, deepening disparities—particularly for Black women. The findings suggest that policy reforms expanding universal coverage could improve outcomes without additional spending.

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Legislators will revisit Medicare-for-All in upcoming congressional sessions, while Republican Medicaid-cut proposals could shape the uninsured landscape through 2034. The Commonwealth Fund plans to issue its next annual comparison in 2025, which will assess the impact of any policy shifts enacted in the interim.

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