Sharon Goldfarb, the speaker at a recent LWVBAE health care and equity meeting and the organization’s Co-President, emphasized powerful but often overlooked truths about health care systems.

Health care is a fundamental part of any society, shaping the well-being and quality of life of its citizens, Goldfarb explained. Around the world, nations have developed different types of health care systems based on their social values and political structures, producing models that differ in how they are organized and how they deliver care. Countries like the United Kingdom and Australia rely on government-financed systems that provide care largely free at the point of use, funded by taxes. Others, such as Germany, France, and Japan, use multi-payer systems funded by employers and employees, combining universal coverage with private providers.

The United States is unique in how it has constructed its system. It operates on a heavily privatized model with significant out-of-pocket payment and a mix of employer-based and government insurance. Major public programs include Medicare and Medi-Cal, while major private players include UnitedHealth Group and Kaiser Permanente. The result is that millions of Americans remain uninsured, and many more struggle with high health care costs.

There are many differences between the U.S. system and the rest of the world, and one of the most important is cost. Countries like the United Kingdom and Canada provide universal coverage while spending far less per person. In 2024, U.S. health care spending reached $5.3 trillion, or about $15,474 per person, and accounted for 18 percent of the economy. This far exceeds the figures of peer nations, yet Americans still have worse health outcomes, ranking last among wealthy countries in several reputable cross-national analyses.

The U.S. spends roughly twice the OECD (Organization for Economic Co-operation and Development) average per person yet still struggles to deliver quality care. Life expectancy at birth in the U.S. rose to 79.0 years in 2024, but the average among comparable countries was about 82.7 years—roughly 3.7 years longer. Japan, among the world leaders, reached about 85 years.

Another major issue is health equity. In the United States, access to care is shaped heavily by income, race, and geographic location. Low-income people are more likely to delay care because of cost, and medical bills remain a leading driver of debt in America. Prescription drugs are a related problem: because the U.S. does not negotiate drug prices at the national level, prices can run far higher than abroad, leading millions to skip or ration their medications.

Despite these challenges, the U.S. system excels in other ways. It is a global leader in medical research, innovation, and advanced treatment, and it leads in cancer research and five-year cancer survival rates. The U.S. plays an integral role in developing new technologies and medications that benefit patients worldwide.

No system is perfect, and there is always room for improvement. In the U.S., reforms are clearly needed, especially in affordability and accessibility, which are often intertwined. Ultimately, the health of its citizens should be a central priority of any nation. While the U.S. may lead in innovation, it has a long way to go in providing universal, affordable, high-quality care to all its residents.

–Himansu Shrestha and Zoe Cloak