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universal 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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As Mexico Enacts Universal Healthcare, Advocate Says Insurers' 'Stranglehold' Is Moving US in 'Opposite Direction'
Medicare for All advocate Wendell Potter said it's "both inspiring and frustrating" to see other nations advance their public healthcare systems while the US dismantles its own.
Apr 10, 2026
As Mexican President Claudia Sheinbaum moves forward with a plan to enact universal healthcare for her country’s more than 130 million people, a longtime advocate for Medicare for All in the US called the development “both inspiring and frustrating.”
"Inspiring because it shows what is possible," Wendell Potter, a former insurance company communications director who has become a leading critic of the industry, told Common Dreams. "Frustrating because here in the US we are going in the opposite direction."
Earlier this week, Sheinbaum announced a decree that she called "a historic step" for Mexico.
Beginning in 2027, her government plans to unify Mexico's public health institutions into a single Universal Health Service, allowing patients across the country to receive care from the Mexican Social Security Institute (IMSS), the Social Security Institute and Social Services of Workers of the State (ISSSTE), and the IMSS‑Bienestar program, which provides free services to those without employer-provided insurance.
According to TeleSur, universal access would be rolled out gradually, with universal emergency care and continuity of treatment, free of financial constraints, beginning in January. Specialized services such as radiotherapy, laboratory tests, and imaging studies would be phased in later that year, and universal prescription fulfillment and hospitalization would also be added to the program in 2028.
"The goal is that when we leave the government [in 2030], any Mexican man or woman can go to any health institution for treatment for any ailment and be received," Sheinbaum said.
Mexico has expanded its annual healthcare budget in recent years, but Sheinbaum's government hopes that consolidating all of Mexico's health services into a single program will eliminate bureaucratic bloat and create a more cost-effective system that saves money over time.
Potter described the plan as “just another example of countries around the world lapping the US when it comes to healthcare policy.”
While tens of millions more previously uninsured Mexicans have become eligible for free care under the healthcare expansion efforts of Sheinbaum and her predecessor, Andrés Manuel López Obrador, the US under President Donald Trump is in the process of shredding public healthcare programs and subsidies.
Following the One Big Beautiful Bill Act, signed into law by Trump last year, 11.8 million Americans are expected to lose Medicaid and other coverage, and more than 20 million are projected to see higher premiums after insurance subsidies under the Affordable Care Act were allowed to expire.
"Due to the stranglehold Big Insurance has on too many politicians in this country, instead of expanding care and lowering costs, we are simply helping Big Insurance make more and more money," Potter said. "It is totally backwards."
"We must continue to keep Medicare for All as our north star here. But also acknowledge the reality that we need to change so much about our current political environment to make it possible," he said. "And that has to start with breaking up Big Insurance's stranglehold on Washington."
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Trump, Extreme Wealth Concentration, and Our Societal Crisis
The US government simply has not done enough to ensure that the livelihoods of all Americans are protected or improved in this new Gilded Age. What it has done is made sure the rich get richer by the minute and more politically powerful year after year.
Feb 09, 2026
The decline of Keynesian economic theory in the 1970s marked a tipping point in the evolution of capitalism in the United States. Beginning with the Great Depression, Keynesian economic policy facilitated the expansion of social welfare programs to mitigate the social inequities of the nation's economic system. In the last quarter of the 20th century, however, rising political conservatism targeted public expenditures for social services. Cuts in education and health, including reductions in social welfare programs and the weakening of the social safety network for the poor, were then and continue today to be goals of political conservatives. Conservatives, furthermore, argue that cutting taxes for the wealthy and corporations promotes investment, economic growth and job creation; and that smaller government and less regulation of market forces distributes wealth the most equitably. These ideas are variously known as supply-side economics, neoliberal economics or simply “trickle-down theory.” Historically, though, trickle-down theory has failed to benefit American working families. In fact, during the course of the last several decades this market strategy has encouraged vast accumulation of private wealth and accelerated its concentration on both a national and global scale. Tragically, it has had deeply injurious social consequences. The societal crisis America finds itself in today relates directly to extreme concentration of wealth.
Absent effective public regulation of economic activities, government and law protect investors and corporations in their aggressive pursuit of wealth. The distribution of wealth in the U.S. is a primary indicator of who benefits most from the political and legal organization of American society. In the third quarter of 2025, according to Federal Reserve data, the top 1% of Americans held 31.7% of all wealth while the bottom 50% held 2.5% (Federal Reserve 2025). That is the highest concentration of wealth in the post-WWII era (Economic Inequality), greater than almost any other developed country. Another indicator of the government's weak support for workers and their families is the federal minimum wage. It is $7.25/hour. At forty hours per week this represents a monthly income of $1160 and a yearly income of $13,920. In 2025, the federal poverty level for individuals was $15,650 and $32,150 for families of four (Poverty Level). These dismal figures show how dire wages are for many millions of Americans. In real terms (inflation-adjusted) the average wage of American workers peaked 48 years ago in 1978 (Wages Peaked).
If one takes a closer look at wealth concentration and the average American’s opportunity to accrue wealth since the 1970s and 1980s, it offers more evidence of how the last few decades of capitalism's development have denied workers a fair share of the tremendous wealth that has been generated. Indeed, a 2023 Rand Corporation analysis revealed that, since 1975, $79 trillion in wealth had been transferred from the bottom 90% to the top 1%. (Massive Wealth Transfer ). This massive redistribution of wealth continues today. In 2023 alone, $3.9 trillion in wealth was siphoned from working Americans to the richest Americans, enough to give every full-time worker in the bottom 90% a $32,000 raise for the year (2023 Wealth Transfer). When it comes to gaining wealth for the average working American, owning a home is the principal path. Home ownership, however, is completely out of reach for the poor and millions more in today's middle class find it unattainable. The median home price to annual income ratio was 5 in 2025. In other words, the median price of a home was equal to 5 years of salary. The ratio was 3.7 in 1985 when a median-price home was $82,800. Today a median-price home is $416,900. Not only is the distribution of wealth radically unequal, the pathway to increased wealth in home ownership has narrowed dramatically.
The political division and violence in America today stems in large measure from a political system whose policies have encouraged radical disparities in incomes and wealth.
These data amply illustrate the crisis poor and increasingly middle income people in the United States face. The poorest Americans, the bottom 20%, simply do not have enough money to meet their daily needs. Nearly a third of all households lives on less than $50,000 annual income (Household Income). In the richest country in the world 36.8 million Americans live in poverty (Poverty), including 9 million children without adequate access to food, shelter and healthcare (Children). At the same time, the more than 900 billionaires in the U.S. have a collective wealth of $6.9 trillion, their wealth increasing 18% in 2025 alone (Fortune). As reported in Forbes, Elon Musk, the richest man in the world, now has wealth of $778 billion (Elon Musk). It would take the average American worker 16 million years to make that much (Extrapolated).
The US government simply has not done enough to ensure that the livelihoods of all Americans are protected in this new Gilded Age. In fact, the government actually provides 40% more benefits to the wealthy than to the impoverished. In his 2023 book Poverty, By America, Pulitzer Prize-winning author Matthew Desmond draws attention to this fact. From recent government data “compiling spending on social insurance, means-tested programs, tax benefits, and financial aid for higher education,” Desmond calculates that the top 20% of income earners on average receives $35,363 in government benefits and individuals in the bottom 20% receive an average $25,733 (p. 99). This reality is a result of policies, policies that benefit wealthy Americans and corporations at the expense of working people. Public policy, in turn, is shaped by corporate lobbying and political contributions as well as professional research that supports goals of the wealthiest and most influential: smaller government, broad corporate deregulation, limited worker protections, and tax breaks favoring the wealthy over working Americans.
It has not always been this way. Between 1947 and 1979, the period when Keynesian economic theory and policies prevailed, “hourly wages grew 2.2 percent. From 1979 to the present, average growth in hourly wages fell to 0.7 percent per year, only one-third of the average rate in the earlier postwar period” (Economic Policy Institute). In the first three decades after WWII labor unions tripled weekly earnings of manufacturing workers across the nation. Collective bargaining gained “for union workers an unprecedented measure of security against old age, illness and unemployment, and, through contractual protections, greatly strengthening their right to fair treatment at the workplace” (Labor Unions). Significantly, one-third of workers (32.3% in 1959) were unionized in this post-war period (Bureau of Labor Statistics ). By 2024, the percentage of wage and salary workers in unions fell to 9.9 percent (Bureau of Labor Statistics). Concentrated wealth, particularly corporate wealth, and government failure to protect workers dampened wages. Also, in the 1950s the statutory taxes on U.S.corporate and personal wealth were much higher, though the effective tax rate was considerably lower due to corporate tax loopholes and rich taxpayers recategorizing income as derived from investments (Tax Rates). The statutory corporate income tax was over 50 percent (Economic Policy Institute). Today it is 21 percent (Corporate Tax). While it is difficult to determine the percentage of taxes actually paid by wealthy individuals and corporations in the early post-war era, it is clear that the statutory personal and corporate income tax is lower today than it was 70 years ago. Of course, enforcement of steeply progressive taxation would make billions of dollars, even trillions, available to fund social programs that distribute income and wealth more fairly.
The pro-democracy citizenry must organize around a political vision that emphasizes several political projects: a just, progressive taxation system; a guaranteed household income; universal healthcare; quality public education; free preschool education; and scientific and technological initiatives for a sustainable economy.
A society riven by such income and wealth inequality is inherently unstable. The political division and violence in America today stems in large measure from a political system whose policies have encouraged radical disparities in incomes and wealth. The loss of 6.5 million manufacturing jobs since 1979 (1979 and 2025), for example, has been facilitated by trade agreements that enable corporations to chase the cheapest wages throughout the world. Runaway companies have gutted industrial towns without consequence, leaving behind poorer communities of people with limited resources to rebuild their lives and neighborhoods. The federal government, moreover, has done virtually nothing to force corporations to pay reparations for the social disintegration left in their wake. As the coastal regions and large metropolitan centers of the nation were generally integrated into the surging commerce of unbridled globalization, distant rural regions experienced economic stagnation and decline. It is little wonder that an authoritarian political figure that exploits these divisions has risen to the presidency of the United States.
In his seminal book Capital in the Twenty-First Century, French economist Thomas Piketty provides an analysis of capitalism in which he notes that “the history of the distribution of wealth has always been deeply political” (p. 20). Reduction of taxes that favors the wealthy is one political determination reflecting the unstemmed power of concentrated wealth. While this political maneuver undermines a primary income and wealth distributive mechanism (taxation system), it further restricts the resources for funding other re-distributive projects such as social welfare, public education and healthcare. Smaller government and privatization of public services are corollary results.
A principal dynamic factor in the process of wealth accumulation and concentration over the last several decades is the growth of profits as the economic growth rate has slowed down. Put another way, the wealthy are taking a larger and larger slice of diminishing income and wealth production. As the vast inequalities in the distribution of income and wealth deny the provision of basic living necessities to tens of millions and circumscribe opportunity for most Americans, social instability and political division and violence escalate. In response, an authoritarian regime consolidates its power around armed force to repress those protesting its anti-democratic policies. Its armed repression inevitably leads to bloodshed.
The pro-democracy citizenry must organize around a political vision that emphasizes several political projects: a just, progressive taxation system; a guaranteed household income; universal healthcare; quality public education; free preschool education; and scientific and technological initiatives for a sustainable economy. These political goals stand in stark contrast to an authoritarian regime that advances the interests of the one percent. They offer a view of the future that is constructive and inspirational, one that generates broad social justice and appeals to the vast majority of Americans.
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