Analyzing the State of Healthcare in the United States

The healthcare system in the United States is a subject of intense debate and scrutiny, with various stakeholders weighing in on its strengths and weaknesses. Despite being one of the wealthiest nations globally, the U.S. consistently ranks low in healthcare performance among developed nations. This article will delve into the reasons behind the U.S.’s lagging performance in healthcare, exploring critical issues such as insurance coverage, administrative inefficiencies, and underperforming primary care.

The Current State of U.S. Healthcare

The American healthcare system has been a topic of national discussion for several decades, yet its complexities and high costs remain a significant concern for many. Despite substantial advancements in medical technology and treatment methods, the U.S. healthcare system struggles with inefficiency, high costs, and unequal access to care.

Ranking of the U.S. Healthcare System

The Commonwealth Fund, a private foundation that promotes high-performing healthcare systems, frequently assesses healthcare systems globally. According to its evaluations, countries such as the United Kingdom, the Netherlands, and Australia typically outrank the U.S. in healthcare performance.

Despite having the highest healthcare expenditure globally, the U.S. healthcare system consistently underperforms compared to its peers. This discrepancy is due to several factors, which will be discussed in the following sections.

Major Issues in the U.S. Healthcare System

Three primary issues contribute significantly to the U.S. healthcare system’s inefficiency and high costs:

  1. Lack of Insurance Coverage: Despite the existence of health insurance programs, a significant portion of the U.S. population remains uninsured. In 2016, more than 27 million people in the U.S. did not have health insurance, largely due to affordability issues, residing in states that did not expand Medicaid, or being undocumented. This lack of insurance coverage contributes to higher mortality rates and poorer health outcomes.
  2. Administrative Inefficiency: The U.S. healthcare system is bogged down by administrative inefficiencies that increase costs and waste time. Doctors and patients often waste valuable time on insurance claims and billing, leading to unnecessary delays and frustration.
  3. Underperforming Primary Care: The U.S. primary care system is fragmented and under-resourced, leading to inefficient care and missed opportunities for disease prevention and management. There is a lack of investment in social services, which are crucial determinants of health, such as housing, food security, and supportive care.

These three issues, along with other systemic problems, contribute to decreasing life expectancy in the U.S., a trend not observed since the 1960s.

The High Cost of Healthcare in the U.S.

One of the most pressing issues in the U.S. healthcare system is its high cost. The U.S. spends more on healthcare than any other country, yet it does not deliver the highest quality care. This high cost, coupled with the high number of uninsured or underinsured individuals, places a significant financial burden on many Americans, often resulting in bankruptcy in the face of serious illness.

Price Inconsistencies and Lack of Transparency

One of the peculiarities of the U.S. healthcare system is the wide variation in prices for the same services and the near impossibility of comparing healthcare quality or costs. Even diligent patients who research and ask questions in advance can still receive surprise bills due to complicated insurance networks and lack of price transparency.

Access to Healthcare

Access to healthcare is another significant issue in the U.S. healthcare system. The current model, which ties health insurance to employment, can jeopardize individuals’ access to healthcare in the event of job loss. This system also contributes to healthcare disparities, as those most in need of high-quality care but least able to afford it are often delayed or denied care.

Impact of High Healthcare Costs

High healthcare costs have significant impacts on individuals and families, often leading to delayed or avoided care and financial hardship.

Difficulty Affording Medical Costs

Despite having health insurance, many U.S. adults struggle to afford healthcare costs. Approximately half of U.S. adults report that it is challenging to afford healthcare costs, with uninsured adults under age 65 being much more likely to report difficulty. Similarly, racial and ethnic minorities and individuals in lower-income households are more likely to struggle with healthcare costs.

Delayed or Skipped Care

The high cost of care often leads individuals to delay or skip necessary medical services. Approximately one-third of adults report that they or a family member in their household have not gotten a medical test or treatment recommended by a doctor in the past year due to cost. Dental services, vision services, and doctor’s office visits are the most common types of care that people report delaying or skipping due to cost.

Prescription Drug Costs

Prescription drug costs are another major component of healthcare costs. Approximately one in four individuals currently taking prescription drugs report difficulty affording their medication, particularly those in lower-income households and racial and ethnic minorities. The high cost of prescription drugs often leads individuals to cut back on their medications or try to obtain medications outside of a clinical setting.

Health Care Debt

Healthcare debt is a significant issue for many Americans. Approximately 41% of U.S. adults report having debt due to medical or dental bills. This issue disproportionately affects lower-income adults, uninsured individuals, racial and ethnic minorities, women, and parents.

Worries About Rising Costs

Inflation and rising living costs have led to increased worries about being able to afford basic expenses, including healthcare costs. Recent surveys show that affording gasoline or other transportation costs is now a top concern for adults in the U.S. However, significant shares of adults still report worries about affording medical costs, including unexpected bills, deductibles, and long-term care services.

Improving the U.S. Healthcare System

Despite these challenges, there are potential solutions to improve the U.S. healthcare system. These solutions include reducing healthcare costs, improving insurance coverage, and addressing administrative inefficiencies.

Reducing Healthcare Costs

Reducing healthcare costs is a critical step towards improving the U.S. healthcare system. This could involve enforcing current laws that require hospitals to publish the prices they collect from health insurers, encouraging employers to consider prices in their healthcare purchasing decisions, and implementing comprehensive reforms in how Americans pay for care.

Improving Insurance Coverage

Improving insurance coverage can help protect individuals from high out-of-pocket spending. This could involve reducing deductibles and out-of-pocket limits in marketplace plans, making temporary premium subsidies permanent, and adding an out-of-pocket maximum to Medicare.


The healthcare system in the United States faces significant challenges, including high costs, lack of insurance coverage, and administrative inefficiencies. However, through concerted efforts from policymakers, employers, and other stakeholders, it is possible to improve the system and ensure that all Americans have access to high-quality, affordable healthcare.