We pay the most. We get less.
America has extraordinary doctors, nurses, and hospitals. But the system they work in costs more and delivers less than in any comparable nation.
These are not partisan talking points. They are the facts, with sources, so you can see for yourself where we stand.
The most expensive system in the world, and not the best
| Measure | United States | Peer-nation average |
|---|---|---|
| Health spending per person (2024) | $14,775 | $7,860 |
| Health spending as a share of the economy (2024) | 17.2% of GDP | 11.2% of GDP |
| Life expectancy at birth (2024) | 79.0 years | 82.7 years |
| Overall health system performance (Commonwealth Fund, 2024) | Last of 10 wealthy nations | Australia and the Netherlands ranked first and second |
“Peer nations” are wealthy countries similar to the U.S.: Australia, Austria, Belgium, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom.
$14,775
Nearly double what similar nations spend per person.
17.2%
Of GDP, versus 11.2% across peer nations.
3.7 fewer years
U.S. life expectancy: 79.0 years versus 82.7 years in peer nations.
Ranked last
10th of 10 wealthy nations for overall system performance.
Even Switzerland, the next-highest spender and a famously expensive country, spends almost $5,000 less per person than the U.S., while covering every resident. The two top performers in the Commonwealth Fund’s comparison, Australia and the Netherlands, were also among the lowest spenders. Spending more has not bought better health.
In America, getting sick can mean going broke
20 million
Adults owe more than $250 in medical debt — nearly 1 in 12.
3 million
Adults owe more than $10,000 in medical debt.
$220 billion+
At least this much medical debt is owed by Americans.
In nations that guarantee coverage, medical debt on this scale is rare. Here, it can follow people for years, damaging credit, draining savings, and leading families to delay care they need. And it doesn't only affect the uninsured: many families with insurance still face bills their coverage didn't protect them from.
“Every dollar entering the healthcare system represents a form of public trust.”
— Healthcare as Infrastructure
Figures reflect debt owed at the end of 2021, the most recent detailed federal survey data available. Source: Peterson-KFF Health System Tracker , “The burden of medical debt in the United States” (February 2024).
Healthcare costs are quietly eating your raises
Average job-based family health plan cost in 2025
Up 6% in a single year
The average job-based family health plan cost $26,993 in 2025, up 6% in a single year. Workers paid $6,850 of that directly, and employers paid the remaining $20,143.
That employer share isn't free money. It is part of what your employer spends to employ you, and every dollar that goes to rising premiums is a dollar that can't go to your paycheck. Economists have documented this pattern for years. As a RAND health economist told the U.S. Senate in 2024:
“As health care spending has increased over the last two decades, employers have reduced wages for workers.”
Why it matters: When healthcare is governed like ordinary commerce, its rising costs don't just show up at the doctor's office. They show up as smaller raises and as higher costs for every business that offers coverage.
Having a card in your wallet isn't the same as having care
Americans had no health insurance for all of 2025, representing 7.9% of the population.
Of working-age adults with coverage all year were still underinsured in 2024. Nearly 3 in 5 of them (57%) skipped needed care because of cost.
Physicians could be in short supply by 2036, according to projections from the Association of American Medical Colleges.
Coverage gaps, high deductibles, and workforce shortages add up to the same result: Americans who delay care until a manageable problem becomes a crisis.
As a surgeon, I see the consequences of that delay in the operating room.
These numbers aren't an accident. They are the output of a design.
It's tempting to blame greedy companies, lazy bureaucrats, or the other political party. But the U.S. has some of the most talented clinicians and most advanced medical science in the world. The problem isn't the people. It's the structure they work in.
We govern healthcare like ordinary commerce, so it behaves like ordinary commerce. Margins are rewarded, costs are shifted, and no one is responsible for how the pieces fit together. Peer nations made a different choice. They classified healthcare as essential infrastructure and built guardrails to match.
We can't change the past. But we can change how we govern what comes next.
Classification determines governance. Governance determines incentives. Incentives shape behavior. Behavior produces outcomes.