On Making US Health Care Great and Affordable

The US is unquestionably an outlier in health system performance compared to other high-income countries.The US spends more, and has worse health system achievement than, many of its peers.A 2024 Commonwealth Fund report reviewed 70 health system performance measures in 5 areas: equity, access to care, care process, administrative efficiency, and health outcomes. 1It found that the US is indeed an outlier, with dramatically lower health system performance despite substantially higher spending than all other peer countries.In 2022, the US spent 16.5% of its gross domestic product on health; the next highest spender that year, Germany, spent 12.6% of its gross domestic product on health.The reasons for the high spending on health in the US, and its misalignment with actual health outcomes, have been amply discussed. 2,3Fundamentally, the US population is sicker than that of other peer countries, imposing a greater burden on the health care system tasked with keeping people healthy.Prices, particularly drug prices on exclusive patents, are much more