By NextBestFitWorse outcomes than peer countries despite the highest spending
The U.S. has the lowest life expectancy among high-income peers and ranked last overall in the Commonwealth Fund's 2024 comparison, while spending about twice as much per person.
Evidence
- U.S. last among 10 high-income countries.Sources: The Commonwealth Fund (2024)
Who's affected
Who is hurt
- Low- and middle-income households: Poor health outcomes especially affect low-income and minority communities.
- Black, Hispanic, and Native communities: Poor health outcomes especially affect low-income and minority communities.
Who gains while it lasts
None identified.
Under your mix of paths
Paths that fix or soften it
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Root causes
- Access barriers
- Chronic disease
- Social factors (obesity, overdoses, guns, cars)
Related costs
Open questions
- Which outcomes should the system be held accountable for, and how?
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Set a target share of spending for primary care (e.g., 10–12%).
- +Worse outcomes than peer countries despite the highest spending
- −Reduces income or business for affected groups
- −Targets and quality metrics invite gaming
Spend on housing, nutrition, and public health, which drive much of the outcome gap.
- +Worse outcomes than peer countries despite the highest spending
- +Housing, food, and transportation drive health, but health care isn't designed for them
- +Prevention and public health are underfunded
- −Adds paperwork, coordination, or complexity
- −Takes years, or money up front, before it pays off
Also addressed by paths for other problems
Raise primary care pay relative to specialtiesPhysician shortage, especially in primary careChosen
Shifting payments toward primary care rewards the care most linked to better outcomes.