Midterms, Healthcare, and Medicare for All
Part One of Three: What we spend on healthcare and what we get
As we approach the 2026 midterms, Medicare for All (MFA) has reemerged in several Democratic Party campaigns as a response to the cost of and access to healthcare in the U.S. How should we think about it?
Unfortunately, the details underlying MFA proposals are in short supply. I reviewed two dozen campaign websites of candidates in contested districts and found little specificity about what MFA means or how to pay for it.
This series examines American healthcare in the international context, in an effort to help readers distinguish realistic proposals from political sound bites.
Given the complexity of the analysis, I have broken the subject into three parts: Part One: What we spend and what we get; Part Two examines other countries’ systems, and Part Three considers possible U.S. reforms.
How I compare countries
Whenever possible, I use the Peterson-Kaiser Foundations’ 11 country-comparator group: Australia, Austria, Belgium, Canada, France, Germany, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom. I call it the “peer group.” When the peer group data are unavailable, I use the OECD average.
A note on the data: Comparable figures are not available for every measure in the same year. I have simplified definitions when doing so does not change the direction of the findings.
What we spend
In 2024, the U.S. spent $14,775 per person on healthcare. The average across the peer group countries was $7,860. We spend roughly twice what they spend. We also spent nearly $5,000 more per person than Switzerland, the next-highest spender.
When spending is measured against the size of the economy, the result is the same. Healthcare consumed 17.2 percent of U.S. GDP in 2024. The peer average was 11.2 percent. Switzerland, again second, spent 12.0 percent.
This was not always the case. In 1970, we spent 6.0 percent of GDP on healthcare while our peers spent 4.9 percent. The disparity widened during the 1980s and has never narrowed.
Hospital Procedures:
The price differences measured by Medicare in 2022 of a sampling of inpatient procedures were substantial.
Coronaryangioplasty: U.S. Medicare paid 2.9 times the peer average; U.S. private insurers paid 3.1 to 10.3 times peer rates, depending on the country.
Coronary bypass surgery: U.S. Medicare averaged $44,149 versus $24,847 among peer systems.
Gallbladder removal: U.S. Medicare ran 1.4 to 3.4 times peer rates.
Hip replacement: peer systems paid 38 percent less on average than U.S. Medicare.
(It is important to note that Medicare data excludes physician fees so the gap is likely understated.)
Prescription Drugs:
Prescription drugs are another area where we spend more than other OECD countries. Using data from 33 of them gathered in 2022, the Department of Health and Human Services found that U.S. manufacturer gross prices across all drugs were 278 percent of what other countries paid. The primary driver of the differential is brand-name drugs, which account for 87 percent of all spending and costs 422 percent of what the comparative countries pay. Interestingly, 90 percent of drug consumption in the U.S. is generic, which is priced at 67 percent of the average price in OECD countries.
Even after the recent authorization that Medicare received to negotiate certain drug prices, prices for the first 10 drugs negotiated were still 2.8 times the average price of peer countries.
What we get
Do we get better outcomes?
While the data are clear that Americans pay far more for healthcare than their peers, you could assume that it is an expression of Americans’ preference for what they consume. Perhaps we consume more and better healthcare and, therefore, pay more for it?
Unfortunately, that is not the case.
Life expectancy at birth in the U.S. reached 79.0 years in 2024, an all-time high, up from 78.4 the year before. The peer average was 82.7 years. We are 3.7 years behind.
A measure that is perhaps more important than how long we live is how often we die of things that could be “mainly avoided through effective prevention or timely treatment.” The OECD splits these into two kinds: preventable deaths and treatable ones.
On the first, the U.S. records 217 deaths per 100,000 against an OECD average of 145. On the second, it is 95 against 77.
Infant mortality in the U.S. was 5.52 deaths per 1,000 live births in 2024. The OECD average was 4.0 deaths per 1,000. Japan and Finland have rates below 2.0.
In the category of maternal mortality, the U.S. rate was 18.6 deaths per 100,000 live births in 2023. The peer average was 5.1.
Another measure is “avoidable hospital admissions,” meaning stays for conditions that routine care should have managed. (Conditions like diabetes and congestive heart failure.) Here the U.S. registered 733 per 100,000 against an OECD average of 473
In contrast to these results, after having a heart attack or stroke, your thirty-day mortality risk in the U.S. is 5.2 percent and 4.5 percent, respectively, against an OECD average of 6.5 percent and 7.7 percent.
Do we get better access?
Another natural question is whether we spend more because we have greater access to care? Again, the answer appears to be no.
The U.S. had 0.6 general practitioners per 1,000 people in 2022 against a peer average of 1.3. As of 2024, 53 percent of Americans lived in a designated primary care shortage area. We have 2.8 hospital beds per 1,000 people against an OECD average of 4.2.
Americans see a doctor in person about half as often as people in peer countries.
Peer countries averaged 57 percent more hospital discharges per capita than we did, and when Americans are admitted they stay 6.5 days against a peer average of 9.7. (Hospitals report discharges, not admissions.) This means that there is far more inpatient hospital usage in the peer countries than in the U.S.
In 2024, about one in six adults, 17 percent, reported that they delayed or went without medical care, prescription drugs, or mental health care because of the price. Among the uninsured the number was 38 percent. 45 percent of all adults say they worry about paying a medical bill if they get sick or have an accident. Among the uninsured, that number rises to 74 percent. We do not have comparable data for peer countries but since universal healthcare is a staple of the peer countries it is unlikely that price is a significant factor in determining access.
What about wait times?
A common objection in the U.S. to the universal systems of the peer countries is that patients are believed to wait months for elective surgeries. Unfortunately, comparable data is insufficient to enable me to reach a fair conclusion.
The OECD collects waiting time data from roughly seventeen countries, whereas the U.S. does not. We have only survey data to rely on. The best conclusion I can reach is that countries ration care in different ways – waiting time, price, availability within insurance programs, deductibles, etc. but I cannot prove or disprove the question of wait times.
The bottom line
I’m sorry to say that the American exceptionalism story we tell ourselves here doesn’t survive an analysis of the data. We are spending more than our peers and we are not buying better outcomes or longer lives. Higher prices - not higher utilization - explain most of the spending gap.
Next Week: Part two in the series: How other countries do it