Commonwealth Fund: The U.S. Health Care System Is an International Embarrassment

The U.S. spends twice as much as other rich countries but our citizens are mired in medical debt.

The Commonwealth Fund this week released its biennial ranking of the health systems of 10 of the world’s richest countries, and once again the United States comes in dead last – as it has for the past 20 years – not just overall but on most performance measures, especially access and affordability.

Throughout the report, it’s clear that one of the reasons the U.S. always brings up the rear internationally is the fact that far too many Americans – including those of us with health insurance – can’t afford to get the care we need. And tragically, so many of us who do seek care – with or without insurance – wind up deep in debt. As the Commonwealth Fund reports over the years have shown, that is a uniquely American tragedy.

As KFF News has reported, more than 100 million Americans – 41% of adults – are mired in medical debt, and the vast majority of those people have both jobs and health insurance. The problem is that their “coverage” is just not nearly sufficient because of the ever-increasing out-of-pocket demands big insurance conglomerates (and the employers that hire them to administer health care benefits) saddle us with to boost their profits. (We’re the only country that allows for-profit insurance companies to run its health care system.)

As the Commonwealth Fund’s report shows, we spend around twice as much for health care as the average of the other nine countries and almost twice as much as a percentage of GDP, yet we are the only one of the bunch that has not achieved universal coverage.

Despite the big gains in coverage we’ve made since the enactment of the Affordable Care Act, more than 26 million of us remain uninsured. But just as unacceptable is the fact that far more than that – one of every four working adults in this country – are underinsured because of the uniquely American high-deductible plans that our employers and insurers have forced us into. For many of us they are not just high, they are sky-high. Forbes magazine has called people in such plans functionally uninsured.

The Commonwealth Fund’s researchers note that unaffordable cost-sharing requirements – deductibles, copays and coinsurance obligations – “render many patients unable to visit a doctor when medical issues arise, causing them to skip medical tests, treatments, or follow-up visits, and avoid filling prescriptions or skip doses of their medications.” And when they do get the tests, treatments and medications they need, they all too often find themselves buried in debt.

It has become such a problem that the Biden-Harris administration has made alleviating medical debt a priority. The White House is expected to lay out at least some of the steps the federal government can take to do that in the coming weeks.

One important thing the administration already has done is ask Congress to pass legislation that would cap out-of-pocket costs for prescription drugs at $2,000 a year – and make sure that cap applies to all of us – not just Medicare beneficiaries. A $2,000 cap for people enrolled in Medicare Part D (and the private replacement plans marketed as Medicare Advantage) will go into effect in January.

The Lower Out-of-Pockets NOW coalition that I lead called on members of Congress to do exactly that last year. Let’s hope they’ll get around to doing it before the end of this year.

P.S.: We will be unpacking other parts of the eye-opening Commonwealth Fund report in the coming weeks. If you still hold the belief that the U.S. has the best health care system in the world, that report will surely disabuse you of that notion once and for all.