Health care and our healthcare system are always major issues for Americans, and they have been especially front-and-center in the past few months – in almost the worst possible way. The issue is complicated, but the short version is that, over decades, Republican and other right-wing legislators and power brokers have refused to seriously entertain devising the type of system that is in place in all other advanced democracies around the world. 
As we have argued earlier, and as lawmakers such as Senator Bernie Sanders (I-VT) have long opined, we are the wealthiest country in the world but do not provide health care for our citizens through some kind of efficient, government-run, single-payer healthcare system. (We do generally give our healthcare providers high marks; that is not the challenge.) Over and over, Democrats and other left-leaning leaders and activists, supported by such professional organizations as the American Public Health Association, the American College of Physicians, and the American Medical Association, have tried valiantly to change our system for the better, to no avail. The latest salvo against the Affordable Care Act has led to the high probability that all its gains will be essentially erased by Trump and his cronies’ Big Ugly Bill and harm millions of Americans. This is inexcusable – and uniquely American.
Here we will try to present a few of the ways that our nation can be improved if only we would follow the wisdom of our sister nations in the area of health care. First, let us review some of the downsides of the dysfunctional way we do things.
- Our healthcare system is vastly more expensive than the systems in most other countries. “In 2024, the United States spent an estimated $14,885 per person on healthcare — the highest healthcare costs per capita across similar countries. For comparison, Switzerland was the second highest-spending country with $9,963 in healthcare costs per capita, while the average for wealthy OECD countries, excluding the United States, was $7,371 per person.
Such comparisons indicate that the United States spends a disproportionate amount on healthcare.” The OECD is the Organisation for Economic Co-operation and Development, comprising approximately 100 countries. - “Despite spending nearly twice as much on healthcare per capita, utilization rates for many services in the United States is lower than other wealthy OECD countries.”
- One reason that our healthcare prices are higher than those of other countries is the consolidation of hospitals, which leads to a lack of competition.
- In addition, inefficiencies and administrative waste results from the complexity of our system. We spend over $1,000 per person on administrative costs, “approximately five times more than the average of other wealthy countries.”
- Another factor is long-term health care. There is a mismatch in funding in the US compared to other nations. One example is Sweden: that EU nation “spends 22 times the amount on long-term care as it does on administrative costs; the United States spends approximately the same amount on both.”
- Unfortunately, our extreme spending habits do not result in better results. “The United States actually performs worse in some common health metrics like life expectancy, infant mortality, unmanaged diabetes, and safety during childbirth.”
- According to the Scheinman Institute on Conflict Resolution at Cornell University, approximately 66.5% of Americans “who file for bankruptcy blame medical bills as the primary cause,” resulting in about 550,000 people filing for bankruptcy each year for this reason.
- The resulting anxiety from a bankruptcy situation is, of course, enormous for the individuals and families involved. High levels of anxiety, however, can still result from the burden of medical expenses even if their situation does not lead to bankruptcy.
- A related factor in the healthcare situation that is different between the US and our sister nations, as we have explored, is the absence of a national sick leave policy. In our country, if someone in the workforce becomes ill and their employer does not offer paid sick leave, the worker often comes to work sick, thus often making others sick in turn. This places a burden on the overall system. Similarly, if a worker has a dependent family member who becomes ill and that worker must take unpaid leave, s/he loses essential wages, putting a burden on that family.
- Speaking of the workplace, because we in the US do not have a national healthcare system, much of the financial burden not only falls on individuals and families – through direct costs, deductibles, etc. – it must also be borne in part by the employer. Percentage-wise, the burden falls most heavily on small businesses. Even before passage of the Big Ugly Bill, JP Morgan Chase reported in June 2024 that “insurance premiums [for small businesses] may be a material portion of their cost of conducting business. Among small employers that do not offer health insurance, 65 percent cited cost as the most important reason.” This is not a problem in our sister nations, generally speaking, because of the ways that health care is managed by those countries.
- Several studies have demonstrated a link between high medical costs and poor mental health.
According to a Biden-Harris-era report from the National Institutes of Health, “A substantial proportion of U.S. adults experience the financial burdens of paying for health care. Among adults with mental disorders, financial barriers” also tend to prevent patients with psychological challenges from accessing mental health care, creating a vicious cycle. As might be expected, such financial barriers “are particularly acute for individuals with a greater burden of illness, lower income, or public insurance.” These negatives even exist despite improvements under the Affordable Care Act and the 2008 Mental Health Parity and Addiction Equity Act.
Given these liabilities related to our sub-par healthcare system, let us now look at some areas of our culture and everyday lives that would improve if we could develop a better system more like those enjoyed by people around the world. (Healthcare reform is admittedly not easy, but the problem is not the absence of workable ideas and professionals to implement them but rather the lack of will on the part of those who prefer the dysfunctional status quo, whether for ideological reasons or out of self-interest.)
Bankruptcy. If we developed a new, more efficient and comprehensive healthcare system, we would almost certainly see a reduction of incidents of bankruptcy due to healthcare expenses.
Mental health. A new healthcare system, if well-conceived and -funded, would go a long way to address problems related to mental health and high medical costs. At the most basic level, a drastic reduction in healthcare costs would at least reduce anxiety levels.
Hunger and food insecurity. In the wealthiest country in the world, approximately 47 million Americans, including 20 percent of our children, are food insecure. This is directly related to our healthcare system if those families are paying so much to cover their families’ medical needs that they do not have enough money for food. According to a 2024 NIH report, “Ill-health causes poverty. 
The effect runs through multiple mechanisms that span lifetimes and cross generations. Health systems can reduce poverty by improving health and weakening links from ill-health to poverty.”
Homelessness. A 2019 study by the National Health Care for the Homeless Council made the explicit point that poor health is a major cause of homelessness in the US. (Most of us probably already know that those who experience homelessness often have very poor health outcomes.) The 2019 study continued, “An injury or illness can start out as a health condition, but quickly lead to an employment problem due to missing too much time from work; exhausting sick leave; and/or not being able to maintain a regular schedule or perform work functions.” It then becomes a vicious cycle. But the converse, providing excellent health care to all Americans (combined, of course, with affordable housing and paid sick leave), could drastically reduce homelessness. We would spend our wages or Social Security income on shelter rather than medical expenses.
Small businesses. If a small business did not have to spend a significant proportion of its profits on health care for its employees, it could conceivably 1) hire more employees and/or 2) raise their workers’ wages.
Medicare. Fixing our healthcare system might provide us with the opportunity to overhaul Medicare. The Medicare program, which primarily provides health care for Americans over age 65, is one of the largest expenses in the federal budget. 
It is supported by tax dollars. Republicans and their allies have largely opposed Medicare since its inception 60 years ago. Without it, however, senior citizens would quickly move into poverty – which is what was often happening before Medicare was created. Even now, however, Americans enrolled in the program must still cover certain costs, and recipients who have Plans A and B plus a Medigap plan pay for that plan to cover the 20 percent of expenses that Medicare does not cover. (Note that Medicare Advantage plans, or Part C, are administered by companies and often have hidden costs of which the subscriber may not be aware until they receive a huge bill.) How might Medicare be reformed if we created a new healthcare system more along the lines of those of our sister nations? We can begin to ponder the possibilities.
Crime. A study by the Brookings Institution found the following: “Jails and prisons provide some treatment services, but what if we increased access to treatment in communities so that people could get help before they get into trouble? New research shows that offering broad access to treatment for these problems is not only compassionate, but also a cost-effective way to reduce crime rates. The authors found that an increase in the number of treatment facilities causes a reduction in both violent and financially-motivated crime.” The benefits of adding treatment facilities “far exceed the costs.” Relatedly, as might be expected in our country, “many people who need treatment don’t have health insurance, and so the care they need – even when available nearby – is unaffordable.” If we all had “health insurance…”
Emergency room visits. Studies in the US, and the experience of our sister nations, show that a single-payer healthcare system or something similar reduces trips to the Emergency Room. This would benefit not only the individuals involved but our entire country.
Healthcare workers. We have long known that there is a severe shortage of qualified healthcare workers in the US. 
According to a 2025 report by Kaiser Permanente, this shortage “will continue for the foreseeable future. Too few workers are entering the health care field. More health care professionals are leaving their jobs due to retirement or burnout.” Some of the policy initiatives laid out by KP to improve the situation could well be folded into the creation of a universal healthcare system, in part because overall costs would decrease. Some of these suggestions include investing in team-based and integrated care to create efficiencies and prevent burnout and streamlining licensing requirements to avoid practitioners having to meet different requirements in different states. It is highly probable that the development of a universal healthcare system would also lead to at least two other positive outcomes: lower costs of medical education and more favorable workplace conditions.
Medical-related charities and nonprofits. 
The US has dozens of nonprofit organizations that raise funds for various healthcare situations. We are very proud of our generosity in this way. However, as we argued earlier, charitable giving allows us, as individuals, to pick and choose what we want to fund, leaving many citizens, communities, sectors and initiatives to fall through the cracks. Despite enormous efforts by these nonprofits, our society never truly solves the healthcare situation. An efficient, cost-effective, fair and equitable healthcare system would go a long way toward changing this situation. Many charities might then end up closing – but there will always be the need for charities for other causes.
Ability to save. Americans save considerably less than our EU counterparts. We can reasonably conclude that reducing our medical costs through an improved healthcare system would allow us to put more away in savings accounts.
Conclusions
Given that millions of people around the world in advanced nations have significantly better healthcare systems than we do – as evidenced by any number of variables and outcomes – we must ask, “How bad do things have to get in our country before we jettison our decades-old practices and beliefs and put in place something that actually works?”
What will it take to convince Americans to discard their cherished but wrong-headed ideologies and elect instead legislators who will use the skills, talents and resources available to them to craft a brave new system that resembles systems that have proven highly successful in other nations for at least four generations?
What level of courage, dedication and energy will it take to make that first step – then the next step, and the next – to find a solution that will truly benefit our citizens and of which we can all be proud?