The US has the best healthcare in the world

The claim

America leads the world in medical research, pharmaceutical innovation, technology, and specialist care. The best hospitals, the best doctors, the best treatments are in the United States. High costs reflect high quality. Those who can access the system receive superior care.

The mechanism

The claim contains a partial truth: the US does lead in specific metrics — pharmaceutical and biotechnology patent applications, certain cancer survival rates for insured patients (particularly 5-year survival for breast cancer and prostate cancer), cutting-edge medical device development, and Nobel Prizes in physiology or medicine. The Commonwealth Fund’s 2023 Mirror Mirror report, which ranks 10 peer nations on 71 health system metrics, gives the US its highest marks on “Care Process” — meaning the technical quality of care when received.

The failure is access, not technical quality. The US healthcare system delivers excellent care to a subset of the population and fails to provide adequate care to tens of millions of others. When outcomes are measured across the full population — not just the insured or the affluent — the US ranks last.

Administrative overhead: Himmelstein et al. (2020), published in the New England Journal of Medicine, found that healthcare administration consumed 34.2% of total US healthcare spending in 2019 ($950 billion), compared to 12.4% in Canada. The difference — 21.8 percentage points applied to the US health spending base — represents approximately $612 billion per year in administrative costs that produce no clinical outcomes. This overhead arises from the multi-payer system: hospitals, clinics, and physicians maintain billing departments to navigate hundreds of different insurer contracts, prior authorization requirements, coding systems, and claims processes. Canada’s single-payer system eliminates most of this complexity.

Drug pricing: The same pharmaceutical compound sold in the US costs 3–10× what it costs in peer countries with reference pricing or negotiated national formularies. A 2021 RAND Corporation analysis found US drug prices were 256% of the average of 32 peer countries. This differential does not reflect US consumers funding global R&D — pharmaceutical companies are profitable in countries with reference pricing; they extract less rent but still invest. The KFF has documented specific examples: Humira (adalimumab) costs approximately $90,000/year in the US; the UK pays approximately $16,000. Both countries receive the drug.

Outcome data across the full population:

Sources: OECD Health at a Glance 2023; CDC NVSS; WHO Global Health Observatory; Commonwealth Fund Mirror Mirror 2023.

The Commonwealth Fund Mirror Mirror (2023): The Fund ranked Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK, and US across 71 indicators in five domains. US rankings:

• Equity: #11 (last)
• Health outcomes: #10
• Access to care: #11 (last)
• Care process: #1
• Administrative efficiency: #11 (last)
• Overall: #11 (last)

The US ranks first only on care process — the technical quality of clinical care when received. On every domain that involves access, equity, or outcomes across the population, the US ranks last or near-last.

Who benefits

The US healthcare system’s administrative complexity is not an accident — it is a product. Insurance companies employ tens of thousands of employees to manage utilization (prior authorizations, denials). Hospital systems employ billing departments larger than clinical teams. Pharmaceutical companies charge US consumers prices not achievable in regulated markets. The administrative complexity is profit.

The lobbying expenditure to maintain this structure is among the largest in Washington. The healthcare sector spent $677 million lobbying Congress in 2022 (OpenSecrets), exceeding every other industry. The pharmaceutical and health products sector spent $373 million; hospitals and nursing homes spent $151 million; health insurance: $90 million. These expenditures are targeted specifically at preventing reference pricing, a public option, and Medicare negotiation authority — the policy tools used by peer countries to reduce costs.

The data

The CMS National Health Expenditure Accounts (published annually) is the authoritative source for US healthcare spending. The 2022 figure: $4.49 trillion total, $12,555 per capita. The OECD Health Statistics database (OECD.Stat) provides comparable per-capita figures adjusted for purchasing power parity across member countries.

The maternal mortality figure deserves particular attention. The US rate of 32.9/100,000 in 2021 was the highest among wealthy countries and trending upward (it was 23.8 in 2020 and 20.1 in 2019). The rate for Black women specifically was 69.9/100,000 in 2021 — more than 2.6× the rate for white women (26.6). The causes are documented: lack of access to prenatal care, implicit bias in pain assessment, higher rates of uninsured and underinsured status, and conditions like hypertension and diabetes that are undertreated due to cost barriers.

Comparators

Germany’s statutory health insurance (SHI) system covers all citizens and permanent residents through competing non-profit Krankenkassen (health funds), with the government setting the benefit package and contribution rates. Administrative overhead is approximately 5.6% of spending (OECD 2023). Life expectancy: 80.6 years. Maternal mortality: 4.6/100,000. Total spending: €517 billion in 2022 ($7,100 per capita PPP-adjusted). Germany spends roughly 57% of what the US spends per capita and achieves better outcomes on most population-level metrics.

Japan spends approximately $4,800 per capita (2022 OECD) and has a life expectancy of 84.3 years — 7.9 years longer than the US. Japan’s universal insurance system uses fee schedules set by the government; there are no deductibles; cost-sharing is capped by income.

The counter

The innovation argument has genuine merit: the US system’s high prices do fund pharmaceutical and medical device R&D that benefits the world. NIH funding (public) and private pharmaceutical investment (sustained partly by high US margins) have produced treatments for conditions that had previously been untreatable. The question is not whether innovation occurs under the US system — it does — but whether it requires charging US patients 3–10× foreign prices. The answer is no: AstraZeneca, Pfizer, and Novartis are profitable in countries with reference pricing; they accept lower prices there rather than forgoing those markets. The access problem in the US — patients not filling prescriptions due to cost — also reduces the population-level benefit of innovations developed here.

References

Commonwealth Fund. (2023). Mirror, mirror 2023: A portrait of the failing U.S. health system. https://www.commonwealthfund.org/publications/fund-reports/2023/jan/mirror-mirror-2023

Centers for Disease Control and Prevention. (2023). National vital statistics reports: Mortality in the United States, 2021 (Vol. 72, No. 1). National Center for Health Statistics. https://www.cdc.gov/nchs/products/nvsr.htm

Centers for Medicare & Medicaid Services. (2023). National health expenditure data: Historical. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical

Himmelstein, D. U., Campbell, T., & Woolhandler, S. (2020). Health care administrative costs in the United States and Canada, 2017. New England Journal of Medicine, 382(15), 1483–1490. https://doi.org/10.1056/NEJMsa1910395

OECD. (2023). Health at a glance 2023: OECD indicators. OECD Publishing. https://doi.org/10.1787/7a7afb35-en

Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States and other high-income countries. JAMA, 319(10), 1024–1039. https://doi.org/10.1001/jama.2018.1150

RAND Corporation. (2021). Prescription drug prices in the United States are 2.56 times those in other countries. https://www.rand.org/pubs/research_reports/RR2956.html

World Health Organization. (2023). Global health observatory: Maternal mortality ratio [Data portal]. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/maternal-mortality-ratio-(per-100-000-live-births)