The United States spends a lot on health care, but it does poorly in comparison to other nations on measures of quality and access. The top performers on our Mirror, Mirror 2024 ranking are the Netherlands and Germany, which also have the lowest levels of overall spending as a percentage of GDP (Exhibit 1).
These countries excel at providing affordable and accessible care to their populations. But they also invest heavily in innovation, which is a critical factor in producing better treatment options that lead to improved outcomes and lower costs.
For these reasons, the U.S. system has become an international outlier. And the sluggish economy, combined with a series of temporary policies during the COVID-19 pandemic that drove up uninsured rates, has left many Americans frustrated and wondering where we go from here.
The nation faces many challenges in promoting healthy behaviors, preventing and treating disease, and keeping people healthy and insured. But it can do better. The key is putting people in control of their own health. That means helping them make wise decisions about diet and exercise; allowing people to buy insurance on their own instead of through an employer or the government; and lowering barriers to primary care that can prevent expensive emergency, hospital, and specialty care visits.
It also means lowering the price of coverage to keep it affordable. We can do this by eliminating the loopholes in our tax code that allow health insurance companies to sell bare-bones plans with hidden charges and excessive deductibles. And we can encourage the private sector to offer more affordable and flexible insurance plans that include a wider range of benefits.
We can also do better at encouraging the use of cost-effectiveness data when making treatment choices. Currently, too few doctors and other providers are using evidence in their practice. And we can do better at addressing chronic shortages of primary care clinicians, who are being lured away by higher pay from hospitals and health systems. And we can do better at reducing the burden of medical debt on households and communities.
But there are no easy solutions. The country has a patchwork of clashing ideas: private insurance provided through employment; the public Medicare program for seniors; state-managed Medicaid programs for low-income individuals and families; and subsidized private insurance purchased on marketplaces established by the Affordable Care Act. Some experts, including Uwe Reinhardt of the University of Washington, have advocated a single-payer system, but economic theory and careful reviews of comparative performance suggest that centralized government control over financing and provision achieves less efficient results than would a well-designed market-based system.
So which system should we model ours after? Uwe: France. Its performance is far more equitable than that of the United States, it offers superior quality on the measures that matter to patients, and it provides strong incentives for innovation. But the biggest advantage is its affordability, which is crucial for a health care system to survive.