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healthcare
Report Highlights 'Uniquely Poor Performance' of US For-Profit Health System Compared to Other Nations
"We know what high-performing health systems look like—other countries have them and are building them. It’s high time the US did better.”
May 28, 2026
An annual analysis that examines healthcare systems across nearly two dozen wealthy countries around the world once again highlighted the United States' "uniquely poor performance relative to its peers," with this year's US Health Care from a Global Perspective report focusing on "insurance coverage and access to care, affordability of care, delivery of care, and equity of health outcomes."
As advocates for expanding the US Medicare system to the entire population have long warned, the country's for-profit healthcare system—which ties the ability to get care to one's employment and allows insurance companies to boost profits by denying care to patients—"The US, on average, has the poorest health outcomes of any high-income country," the Commonwealth Fund's report reads.
The report examines the US system compared with other countries in the Organization for Economic Cooperation and Development (OECD), including the United Kingdom, France, New Zealand, Japan, and Mexico.
It finds that the US spent 18% of its gross domestic product on healthcare in 2024—nearly twice the OECD average.
Life expectancy in the US reached an all-time high in 2024, but was still among the shortest when compared to the 19 other countries, nearly five years shorter than Japan, Spain, and Switzerland, and longer than the average lifespan in Turkey and Mexico.
While the US and Mexico also both rank high on the list in terms of preventable deaths, the latter nation announced last month that it would soon be joining every other country included in the analysis by shifting to a universal, government-run healthcare system.
In the United States, the for-profit health sector—which spent a record $877.69 million on lobbying last year—contributes to the high number of avoidable deaths, which stands at 312 per 100,000 people. About 27 million Americans are still uninsured, more than 16 years after the passage of the Affordable Care Act, and the Republican Party's refusal to continue ACA subsidies last year as well as its $1 trillion in Medicaid cuts over the next decade, according to Thursday's report, are "projected to increase the number of uninsured Americans by an additional 17 million by 2034, potentially leading to more than 50,000 additional preventable deaths annually."
"By contrast, Mexico’s recently established Universal Health Service will provide all residents with access to free care at any public health institute, starting in 2027," the report states. "The US is one of the only countries to have enacted policies that reduce coverage."
High out-of-pocket costs may also contribute to poor outcomes and the high number of preventable deaths in the US, the Commonwealth Fund suggests. Americans spend $400 per person, per year, on out-of-pocket costs for prescription drugs, while people in France spend $100.
"The US is one of the only countries to have enacted policies that reduce coverage."
"In the US, where approximately 8% of the population is uninsured and one-quarter has coverage that comes with high out-of-pocket costs or deductibles, people are far more likely to forgo needed care because of costs than people in peer countries," reads the report. "This can mean not filling prescriptions, not obtaining diagnostic tests, treatment, or follow-up care, or being unable to adhere to clinician-recommended care plans."
The report also identifies the US as a country that lags behind its peers in producing new doctors, contributing to a crisis in primary care, with the US having the fewest number of primary care providers per 1,000 people. The country also has the "highest medical tuition fees of any country in our analysis," said the Commonwealth Fund.
The organization also found that in 2023, the US had nearly 19 maternal deaths for every 100,000 live births, representing a decline for the country that has long had "among the highest rates of maternal deaths related to complications of pregnancy and childbirth."
"By contrast, in 11 of the 18 countries we studied there were less than five maternal deaths per 100,000 live births," reads the report, which also notes that in the US, maternal mortality is "exceptionally high" among Black women, at 50 deaths per 100,000 live births.
"This far exceeds national maternal mortality in any of the other countries," the report states. "Inequities in access to care and patients’ care experiences—often rooted in discrimination and clinician bias—may be prime contributing factors."
Dr. Joseph Betancourt, president of the Commonwealth Fund, noted that "the US has long prided itself on having the best healthcare in the world, but the population benefits from this excellence unevenly, and it remains largely out of reach for many Americans."
"We spend more than any other nation on healthcare, so our poorer health outcomes aren’t due to a lack of resources—it is about how we choose to use them," said Betancourt. "We know what high-performing health systems look like—other countries have them and are building them. It’s high time the US did better."
"Other countries have shown that alternatives work. What’s striking isn’t the absence of solutions; it’s our reluctance to implement them."
The report does not explicitly call on the US to shift to a universal, government-funded healthcare system, but studies have shown that expanding Medicare to the entire US population, as lawmakers including Sen. Bernie Sanders (I-Vt.) and Reps. Pramila Jayapal (D-Wash.) and Alexandria Ocasio-Cortez (D-NY) have consistently demanded, would address many of the problems listed in the report.
Studies by the Congressional Budget Office and Yale University have shown that Medicare for All would save an estimated $650 billion and prevent 68,000 avoidable deaths each year.
The policy, which has been proposed in Congress numerous times, is also broadly popular; 65% of US voters—including 78% of Democrats, 71% of Independents, and 49% of Republicans—support creating a national, government-run healthcare program, according to a Data for Progress poll last year.
Despite this, both Republican and Democratic lawmakers continue to insist the proposal is unpopular and too expensive, with Michigan state Sen. Mallory McMorrow (D-8), who is running against vehement Medicare for All advocate Abdul El-Sayed in the Democratic US Senate primary, insisting recently that "the support for a true single-payer system isn't there yet."
Reginald Williams II, senior vice president at Commonwealth Fund, emphasized that it is "not inevitable" that "Americans pay more for healthcare and get less in return."
"It’s the result of different choices," he said. "Other countries have shown that alternatives work. What’s striking isn’t the absence of solutions; it’s our reluctance to implement them. The failure of the US health system is not a failure of ideas. It’s a failure of will to act on them.”
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An Ebola Outbreak Made More Deadly and Dangerous Thanks to Trump
We lived through another pandemic nightmare with this president, but the warnings about what he was unleashing with his 2025 assault on USAID and CDC were not heeded. Once again, people are paying with their lives.
May 27, 2026
The current, rapidly metastasizing Ebola outbreak in East and Central Africa is a sobering reminder of how unprepared we remain for the inevitability of the next pandemic that is always sure to come. Especially when the US continues to hamstring the global efforts needed to contain deadly eruptions.
As of Sunday, May 24, there were 231 deaths and more than 1,000 cases reported, primarily in the Democratic Republic of Congo (DRC), though 10 African countries are now considered at risk. “You cannot cut the systems that detect and stop outbreaks early— then act shocked when they spiral. Pathogens exploit weak systems,” said Krutika Kuppalli, MD FIDSA, in a post on Sunday.
On Monday, Dr. Tedros Ghebreyesus, director-general of the World Health Organization (WHO), told the world that the outbreak was “outpacing us."
The Trump administration, previously the WHO's largest funder, is the biggest reason of these failures and need to play catch up. Assistance from the US to the DRC reportedly fell from $1.4 billion in 2024 to just $21 million in 2026, said Kuppalli.
“Many of the international systems created or strengthened after earlier Ebola crises have been weakened,” the Washington Post reported last week. While the US once "played a central coordinating role in previous Ebola response efforts,” the newspaper noted, "that infrastructure has been significantly diminished following Trump administration cuts" in early 2025.
With the US pulling out of the WHO and eviscerating the US Agency for International Development (USAID), which routed money and supplies quickly, the ability to help organizations on the ground pivot from prevention "to contact tracing and communications" has vanished, said Stephanie Psaki, US coordinator for global health security in the Biden administration.
The Trump administration has even barred key infectious disease officials from communicating with the WHO. “The whole disaster response capability at USAID no longer exists,” said Jeremy Konyndyk, the former lead of USAID’s Ebola response team.
On May 20, National Nurses United, issued a statement admonishing the Trump administration for making everyone less safe in the face of the outbreak.
“Nurses understand the life-or-death importance of prevention, and when it comes to infectious diseases, that means having strong infrastructure in place to rapidly detect and respond to new outbreaks before they are out of control," said NNU. "The Trump administration has purposely taken a sledgehammer to that infrastructure over the past year.”
Nurses are prominent among the health workers, and health policy researchers, who have long warned of the danger of sudden outbreaks that can lead to massive, deadly pandemics.
“The arrival of the next great pandemic has always been a ‘when,’ not an ‘if,’ and firewalls for stopping it are getting thinner,” journalists Conn Hallinan and Carl Bloice wrote in 2005 in the California Nurses Association’s Revolution magazine. That piece was written amid concern for the spreading of avian flu, but the warning signs of a failing prevention and response system were already evident. “Public health budgets in this nation and across the globe are being systematically starved of funding,” they wrote.
Four years later, H1NI, also known as swine flu, brought the fears to life. The Centers for Disease Control and Prevention (CDC) estimated there were 60.8 million cases and an estimated range of between 151,700 to 575,400 deaths worldwide its first year alone. Deborah Burger, RN, then president of the California Nurses Association, warned, “We should learn the lessons of the 1918-1919 flu pandemic, one of which was the enormous mitigating effect on mortality of adequate nursing care.”
Those working on the frontlines to care for infected patients are particularly vulnerable. Speaking to Hallinan and Bloice, University of Minnesota researcher Michael Osterholm predicted back in 2005 that “health care workers would become ill and die at rates similar to, or even higher than in the general public" in the face of a pandemic.
On July 17, 2009, Karen Ann Hays, a cancer care RN at Mercy San Juan Medical Center in Carmichael, CA near Sacramento, and a healthy triathlete and marathon runner, became the first health care worker in California to die of H1N1. Only after the union announced plans for a one-day strike affecting 16,000 RNs in California and Nevada, did then-Gov. Schwarzenegger and major hospitals implement new safety protocols.
In March 2014, the largest outbreak of the deadly Ebola virus was reported in West Africa. By August, the WHO declared a public health emergency as it spread in Africa, and reached Europe and the US. As noted, the outbreak was particularly dangerous for healthcare workers exposed to Ebola patients.
Recalling the spread of H1N1, NNU urged federal, state, and local officials to adhere to strict infectious disease guidelines to protect patients, healthcare workers, and the public. Seeing little done by September 2014, more than 1,000 nurses held a march and die-in during a convention in Las Vegas to alert the public to inadequate US preparations to stop the spread of Ebola and similar pandemics.
Days later, a patient recently returned to the US from Liberia, was diagnosed with Ebola in a Dallas hospital and died. Within two weeks, two Dallas nurses in that hospital, Nina Pham and Amber Vincent, were infected. NNU called on President Barack Obama to “invoke his executive authority” to order all US hospitals to meet the highest “uniform, national standards and protocols” to “safely protect patients, all healthcare workers and the public.”
Burger testified to the House Committee on Oversight and Government Reform on the lack of mandated protections for nurses and patients. “The risk of exposure to the population at large merely starts with front-line caregivers like registered nurses, physicians and other healthcare workers—it does not end there," Burger told lawmakers. "If we cannot protect our nurses and other healthcare workers, we cannot protect anyone.”
A two-day strike the next month at 86 hospitals and clinics over the lack of Ebola preparedness again helped spur needed measures. Within weeks, the federal government, and some states, including California, enacted reforms to improve pandemic protections in US facilities, and as NNU was also urging, escalated support for global protections in West Africa.
Cuba was in the forefront of providing direct frontline care in West Africa in 2014, sending 165 Cuban nurses and doctors, risking their own lives. At a time today with the US threatening an invasion of Cuba following months of an illegal blockade that has had a debilitating impact on its health care system, it’s worth recalling that as recently as 2024, Cuba had dispatched more than 20,000 medical staff to more than 50 countries in humanitarian missions.
When Trump first came into office, he ignored the preparedness lessons. Beginning the morning after his 2017 inauguration, Trump systematically dismantled a pandemic infrastructure response program put in place by Obama. By January 2020, when the WHO had begun warning of the outbreak known as Covid-19, the Trump administration was caught flatfooted. As the initial US infections appeared, Trump’s first public statement that month was this: “We have it totally under control. It’s one person coming in from China. It’s going to be just fine.”
In contrast, NNU had already begun to press Trump to implement national and safety protocols and measures, with public accountability. Instead, Trump’s response was months of denials, deflections, and promotion of false cures while dismissing the best protective measures. By June 2020, with 110,000 dead Americans, Trump insisted, “It is dying out, it’s going to fade away.”
By February 2024, the US counted nearly 7 million cases, and over 1.1 million deaths. So many lives could have been saved with advance preparedness and rapid implementation of the proper safety measures.
Hospital employers and numerous state governments, especially in GOP-controlled states, took their lead from the Trump administration to slow walk or ignore critical protections. Workers in essential front-line occupations, from public transportation to nursing homes and hospitals, as well as lower income jobs in grocery and drug stores, poultry and other meat processing, and service industries generally, paid a high price, especially workers of color.
Through August 2023, the Covid death count hit 5,753 for health care workers overall, including 501 RNs. Filipinos, 4 percent of all RNs, accounted for 21 percent of the deaths among nurses.
In the 2014 outbreak, 881 doctors, nurses, and midwives were infected in West Africa, and 513 died. The crisis created a severe shortage of healthcare workers across the region.
By May 21 in the current Ebola outbreak, at least four health worker deaths have been reported in the DRC. Three Red Cross volunteers have also died. One doctor evacuated from the DRC, waiting in a specialized hospital room in Prague to see whether he has Ebola, said his former colleagues in the DRC are beginning to die of the deadly disease.
The International Rescue Committee warned on Tuesady that thus outbreak is spreading faster than responders can contain it and risks becoming "the deadliest on record."
As the NNU warned last week, neither the nation nor the world can afford another public health mismanagement disaster from the like of Trump. “Nurses have already lived through one bungled, global health emergency response during the first Trump administration," said the union, "and we are appalled to know that when it comes to Ebola, hantavirus, or any other infectious disease, the United States under Donald Trump is now even less prepared than in 2020."
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Rights Groups Warn of Disaster as Trump-GOP Work Requirements Risk Mass Medicaid Loss
“These work requirements address a problem that doesn’t exist," said one researcher. "They just strip healthcare from millions of low-income people by making it harder for them to prove they qualify.”
May 26, 2026
A pair of leading humanitarian groups warned Tuesday that millions of people will soon be "at risk of an avoidable loss of healthcare coverage" as states move to implement new Medicaid work requirements, which were at the center of the reconciliation package enacted by congressional Republicans and President Donald Trump last year.
Oxfam America and Human Rights Watch (HRW) warned in a joint letter to top federal health officials that the work requirements—which mostly target adults in states that expanded Medicaid under the Affordable Care Act—will result in a massive surge in the uninsured population if concrete steps aren't taken to mitigate coverage losses.
The groups point to a Congressional Budget Office analysis projecting the Trump-GOP budget law "will cause roughly 10 million people to lose health insurance coverage by 2034," increasing "the number of uninsured people in the US by nearly 50%, exposing millions of people to high drug and hospital costs, and forcing many to forgo or ration healthcare."
Under the 2025 law, people subject to the work requirements must document 80 hours per month of work or another qualifying activity.
"Work requirements are sold as sensible, pragmatic reforms, but the lived reality couldn’t be more different."
Analysts have warned that the new work reporting mandates—which account for around $326 billion of the Trump-GOP law's total cuts to Medicaid—will create massive administrative hurdles and burdens for Medicaid recipients and for states. Given that most Medicaid recipients already work, experts say coverage loss from the new mandates will largely be attributable to enrollees' failure to comply with byzantine reporting procedures.
“Work requirements are sold as sensible, pragmatic reforms, but the lived reality couldn’t be more different,” said Jackson Gandour, senior policy advisor for economic justice at Oxfam America. “In practice, evidence shows they can create unfair and effectively insurmountable barriers for people who need coverage and are making every effort to meet the requirements.”
The federal work requirements are set to formally take effect in most states by January 2027—though some states are rushing forward with the mandates ahead of schedule, heightening fears of chaos and large-scale coverage loss. By June 1, federal agencies must issue guidance to states on how to implement the new Medicaid work requirements.
Oxfam and HRW urged the Trump administration to do all it can to mitigate coverage loss, including by "reducing documentation requirements, broadly interpreting exemptions, and recognizing a wide range of qualifying activities that reflect real labor conditions, including gig work, unpaid caregiving, and seasonal employment."
A 36-year-old woman in Atlanta, Georgia—which has state-level work requirements that predate the Trump-GOP mandates—told the humanitarian groups that she lost Medicaid and nutrition assistance after her child was born late last year, despite working sufficient hours to comply with Georgia's requirements.
“After I had the baby, my Medicaid and food stamps were turned off,” she said. “[They] said that I failed to report that I was working."
The woman said she's spent months trying to restore her coverage, encountering chaos and administrative barriers.
“It’s hectic,” she said. “You’re not able to reach anybody.”
The Urban Institute has estimated that even if strong mitigation measures are put in place, around 3 million people could lose Medicaid coverage due to the new federal work requirements.
“These work requirements address a problem that doesn’t exist since most Medicaid recipients are already working,” said Matt McConnell, economic justice and rights researcher at Human Rights Watch. “They won’t fix the budget. They just strip healthcare from millions of low-income people by making it harder for them to prove they qualify.”
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