How the U.S. health system compares to others around the world
Fact checked by Jim Lacy
More than half of the world’s countries guarantee a right to healthcare in their constitutions. The United States does not. No federal or state law explicitly safeguards citizens’ health or well-being as a guaranteed right.
Countries worldwide take varying approaches. The constitutions of the Netherlands, France, Sweden, Switzerland, and Germany guarantee some level of access to healthcare. Australia, the United Kingdom, New Zealand, and Canada provide universal, state-funded healthcare through legislation.
In the U.S., the government provides health coverage for people 65 and older through Medicare and for low-income individuals through Medicaid. Starting in 2027, some Medicaid and Supplemental Nutrition Assistance Program participants may need to meet work requirements to receive benefits and undergo reviews twice annually.
The nation’s long-standing narrative of rugged individualism has shaped the belief that people bear the responsibility for their own economic and physical well-being.
Yet this doesn’t make the U.S. a shining model of health or medical care. In a ranking of 10 health systems worldwide, the U.S. ranked last — and has ranked last in each of the Commonwealth Fund’s “Mirror, Mirror” reports since 2014. The nonprofit foundation has supported independent research on healthcare policy since 1918. Australia, the Netherlands, and the UK led recent rankings despite the U.S. spending more on healthcare than any other nation.
“When you make comparisons to Western Europe in particular, they have a system based on distributive justice. Everyone has a fair and just opportunity for a healthy life,” says Marshall Chin, MD, a professor of healthcare ethics at the University of Chicago. “We [in the U.S.] blame the individual if they are in a tough situation, as opposed to seeing every person as valuable and deserving dignity and opportunity.”
In the U.S., society often treats healthcare as a benefit reserved for those deemed deserving, says Lindsay Allen, PhD, economist and assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine.
“We don’t view all people as human beings,” she says. “We view some people as subhuman.”
The history of health systems
The structure of the American healthcare system reflects policy choices made decades ago. Employer-sponsored health insurance took root during World War II, when companies faced wage caps. Unable to offer higher salaries, employers began offering health insurance as a benefit. No job often meant no coverage.
President Franklin D. Roosevelt proposed healthcare as a human right in his 1944 State of the Union address as part of a Second Bill of Rights. He outlined economic and social guarantees, including the right to:
• A decent home and wage
• Freedom from unfair competition and monopoly domination
• Adequate medical care
• The opportunity to achieve and enjoy good health
• Protection from the economic fears of old age, sickness, accident, and unemployment
• A quality education
“Necessitous men are not free men,” Roosevelt said, arguing that hunger and unemployment make people more vulnerable to authoritarianism. He intended the Second Bill of Rights to apply to everyone. Lawmakers did not adopt it.
Eleanor Roosevelt later took the concept to the United Nations. In 1948, the UN’s Universal Declaration of Human Rights included the right to health. Although the right to health became part of international law through various treaties, the U.S. Senate signed but did not ratify those rights.
Healthcare doesn’t toggle with every administration. Too many of our current leaders do not vote for policies that maximize health and well-being.
Also in 1948, the UK launched the National Health Service, becoming the first European nation to guarantee free public healthcare for all residents. Parliament created the NHS under the National Health Service Act of 1946, following Sir William Beveridge’s 1942 report, which framed free healthcare as part of broader welfare reforms to reduce unemployment, poverty, and disease while expanding education.
Taxes primarily fund the NHS. Doctors receive negotiated salaries based on specialty, experience, hours, and on-call responsibilities.
NHS England oversees day-to-day operations. It allocates funding to regional bodies that coordinate and pay for local care delivery, while Parliament and the Secretary of State set legislation and policy.
Unlike Americans, Allen says, British residents can function as patients rather than consumers. Insurance companies do not determine coverage in the same way as they do in the U.S.
“In our free-market, mostly for-profit healthcare system, the individual loses agency over their health decisions as middlemen insurers decide what care an individual can or cannot receive. We also entrust doctors to have our best interest, while at the same time they are responsible for their financial interests,” Allen says.
A broader view of health
High deductibles often lead Americans to shop for care based on cost — if they have the time, knowledge, and resources to do so. “We aren’t supposed to be shopping for care,” Allen says.
An NHS patient would not call ahead tocompare prices for a procedure. They might inquire about wait times, but Americans also deal with wait times, Allen says.
Increasingly in the U.S., insurance companies also own urgent care clinics, clinics where patients receive treatments, and pharmaceutical companies that dispense medications.
At a January congressional testimony, New York State Rep. Alexandria Ocasio-Cortez questioned CVS Health Group CEO David Joyner on CVS Health’s strategy. The company owns virtually every step of a potential patient’s healthcare transaction: from Aetna, the health insurance company, to the Oak Street Health medical clinics, to CVS pharmacies, to CVS Caremark, the pharmacy benefit manager that approves prescriptions for coverage.
Ocasio-Cortez said at the hearing that she was following one of CVS’ recent investor calls, where the company described its approach, called a captive strategy in business terms.
Ocasio-Cortez said, CVS used the example of a patient known as Kate. “Kate has an Aetna health insurance plan, which is owned by CVS Health. She then goes to a CVS pharmacy. She’s connected to an Oak Street Health medical clinic. She sees a doctor at Oak Street Health who prescribes her medication. And then she goes to fill that prescription at the CVS Pharmacy. So the price Kate pays for that medication is dictated by Aetna, CVS Caremark, and they also own the drug manufacturer, Cordavis.”
Ocasio-Cortez continued, “So the health insurance gets a cut, the pharmacy benefits manager gets a cut, the drug manufacturer gets a cut, and the patient gets screwed. I think the Federal Trade Commission has also found that healthcare conglomerates like CVS Health charge more for medications filled at their pharmacies. We’re talking about thousand percent markups on medications for cancer and HIV.”
Many U.S. healthcare providers, frustrated by the system, support a single-payer system, often called Medicare for All, in which the government acts as the primary payer.
Countries that rank highest in healthcare approaches and outcomes take a broader view of health. They treat health as interconnected with housing, education, employment, environment, and the economy. The U.S. does not.
“They’re looking at everything as a system,” Allen says of countries that take the broader view.
U.S. public policy rarely frames transportation, education, housing, or healthcare as rights. The view here: If you don’t have one or more of these, it’s due to a personal failure, Allen says.
“Financially, it makes more sense to have everyone healthy,” she says. “It costs taxpayers and the government less. Of course, eventually we will have to pay for end-of-life care, but we won’t need to pay for chronic conditions along the way. Good health means more people contributing.” Working, volunteerism, getting an education, paying taxes, and raising a family — all contribute to a thriving society.
Beyond economics, Allen points to overall well-being. Nordic countries and Switzerland consistently rank high in measures of happiness and health.
Nordic nations tend to emphasize work-life balance, preventative care, mental health services, and active lifestyles. Residents commonly bike, hike, and swim. Clean air and water, social safety nets, and access to nutritious food also contribute to longer lives. Life expectancy reflects those differences.
Chin says that Rev. Martin Luther King, Jr., also tied health to justice and prosperity. In 1966, King said, “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”
If the U.S. is going to catch up, Chin says meaningful reform requires long-term thinking rather than short-term profit considerations.
“In other countries, healthcare is outside of politics because of the philosophy underlying the system,” he says. “Healthcare doesn’t toggle with every administration. Too many of our current leaders do not vote for policies that maximize health and well-being.
Too many of our political leaders find some group to demonize and say, ‘They’re not worthy of these opportunities.’”
Chin would like to see all U.S. policies, rules, and regulations held to the litmus test: Does it improve the health and well-being of all Americans?
Allen encourages people to pay attention and reflect on their own experiences.
“Are you satisfied with the care you’re receiving? Can you afford it? Are you comfortable navigating the healthcare system on your own?” she asks. “If not, the system needs to change. Health is not political. It is a moral issue and an economic issue. You do not gamble and play political theater with people’s healthcare.”
Originally published in the Spring/Summer 2026 print issue.
Kathleen Aharoni is a movement and life coach, forest bathing guide, and author of the award-winning book I breathe my own breath! She has served on the faculties of Northwestern University and Columbia College.
