There’s a particular kind of arrogance in being the most expensive and among the worst. The United States has perfected it.
Every few years, a new report confirms what anyone paying attention already knows: the American healthcare system is a catastrophe — not by accident, not by bad luck, but by sustained political choice. Meanwhile, nine other countries are running systems that cover everyone, cost far less, and produce people who live longer. Some call it a comparison. It’s more of an indictment.
What the numbers say (and they are damning)
Start with spending. The United States spends more on healthcare than any other country, averaging around $14,885 per person annually. Switzerland, the next most expensive, comes in at around $9,963. The average for wealthy peer nations is $7,371. Americans pay nearly twice as much as Europeans do per person every single year. (Exhibit 1)
Exhibit 1
For that premium, what do Americans get?
- Lower life expectancy than peer nations, a divide that has widened since COVID.
- More barriers to care.
- Medical debt carried by more than 100 million people.
In 2024, 26 million Americans had no insurance at all (a tragedy), and 43 million more were underinsured, meaning their coverage wouldn’t protect them from financial ruin if something serious happened.
Approximately 41% of Americans spent more than $1,000 out of pocket on healthcare in a single year. Germany caps co-payments at 2% of a household’s gross income — 1% for the chronically ill. The Netherlands uses a flat annual deductible of about $440, after which most care is covered. These models are concrete reality, not wishful thinking, and have delivered reliable care for decades.
And where does all that American spending actually go? Administrative costs. The United States spends over $1,000 per person on healthcare paperwork and bureaucracy — approximately five times more than the average of other wealthy countries. Sweden, by contrast, spends 22 times more on long-term care than on administrative overhead. The United States spends about the same amount on both. The machine exists to feed itself.
The countries doing it right
Sweden, Denmark, Norway and Finland operate universal systems funded through taxation. Everyone is covered. Preventive care is routine. Life expectancy is high, and avoidable mortality is low. These are not socialist experiments but mature, stable systems that have delivered for more than half a century. The U.S. records 160 avoidable male deaths per 100,000, compared with 56 in Sweden. The difference reflects policy choices compounded over decades.
Germany and the Netherlands use social insurance models — a mix of public and private insurers operating under strict government regulation. Coverage is effectively universal. Out-of-pocket costs are capped. Insurers can’t deny coverage or profit from denying care the way American insurers can. Both countries appear consistently across global healthcare rankings for access, quality and efficiency. Germany and the Netherlands demonstrate system performance sustained across comparable economies.
Switzerland is the go-to example for anyone arguing private insurers can deliver universal care. Fine. Swiss people still pay roughly $5,000 less per person than Americans do; they’re all covered, and they live longer. If building the American system on private insurers still yields worse results than universal coverage, the model is not the failure. The absence of meaningful regulation is.
Canada and the United Kingdom have known issues with waiting times for elective procedures, and the delays are well-documented. But the notable difference is that patients in Canada and the UK know they’ll receive care. The question is when, not whether, and certainly not how much it’ll cost them. In the United States, the question of whether you can afford it, whether your insurer will cover it or whether the in-network hospital is 40 miles away never leaves the table.
The maternal mortality disgrace
If one number captures what American healthcare has become, it’s this: the United States has the highest maternal mortality rate of any wealthy country! In 2023, 18.6 women died for every 100,000 live births. That’s nearly twice the average of comparable economies. And it’s almost exactly the same rate as two decades ago!!
While global maternal mortality fell by 40% between 2000 and 2023, the U.S. rate spent years climbing. Two-thirds of pregnancy-related deaths in America are considered preventable. Nearly 8 million women of reproductive age in the United States are uninsured. Many receive no prenatal care before complications arise.
For Black women, the maternal mortality rate is 50.3 per 100,000 — nearly 3.5 times the rate for white women. High-income Black women are as likely to die in their first year of motherhood as the poorest white women. This is a healthcare system problem that has been documented, studied, reported on, ignored and left unchanged while insurers and hospital systems generated record profits.
Sweden. Norway. The Netherlands. Germany. The UK. None of them have a maternal mortality crisis. That’s no coincidence.
The excuse that stopped working
The standard defense of the American system used to be outcomes — we spend more, but we have the best doctors, the best technology, the best survival rates for serious conditions. That holds truth. The U.S. performs well on survival outcomes for major illnesses, including cancer, but those outcomes are unevenly distributed because access is uneven.
But population-level outcomes like life expectancy, avoidable mortality, maternal health, equitable access and chronic disease management don’t compare well. Spending far more money than any peer nation and delivering worse population health is not a flex. It is a monumental failure of system design, mislabeled as innovation.
In every country on this list, risk is distributed broadly across the entire population through taxation or regulated insurance. In the United States, risk is distributed individually, which means it lands hardest on people who can least absorb it.
The price of profit
This is no mystery. The countries with functional healthcare systems collectively decided that medical bankruptcy, preventable maternal deaths, skyrocketing drug costs and employer-dependent care have no place in a civil society. They built systems around that decision… systems they’ve been refining for decades.
The United States made a different decision, or rather, allowed a different outcome to persist, because the people who benefit from the current arrangement have the means to protect it.
Every year that passes without serious structural change is not stagnation. It is a choice, with a body count attached to it.
I’m not suggesting a utopian fantasy world exists within the healthcare spectrum of these nine countries. Assuredly, imperfections run through those nine systems as well. They have wait times, funding pressures and workforce shortages. But their people are covered, their mothers are surviving and they’re doing it for thousands of dollars less per person than the country that keeps telling itself it has the greatest healthcare system in the world.
It does not.
Sources:
Peterson-KFF: U.S. health spending vs. other countries
Peterson-KFF: Quality of U.S. health system vs. other countries
Peter G. Peterson Foundation: U.S. healthcare comparison
KFF Health Policy 101: International comparison
Commonwealth Fund: U.S. Health Care from a Global Perspective, 2026
Center for Reproductive Rights: U.S. maternal health crisis
AJMC: U.S. ranks worst in maternal care
Maternal, Child Mortality Higher in the US Compared With Majority of High-Income Countries | AJMC
North American Community Hub: US vs Europe healthcare
The Best Healthcare in the World in 2026: Country Rankings
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