United States: Innovation at Full Price

Article 11 of 12

The United States spends more on health care than any country in the world — 18% of GDP in 2023, or roughly USD 14,570 per person, more than 2.5 times the high-income country average of USD 5,9301. For that spending, life expectancy stood at 78.5 years in 20231 — nearly three years below the 81.1-year high-income average — and the United States ranked last overall among ten peer nations on a 70-measure assessment of health system performance2. No other country profiled in this series spends this much to achieve this little.

The paradox is not a failure of medical capability. The United States trains one of the world’s largest physician workforces across 162 accredited medical schools1, hosts many of the world’s leading academic medical centers, and in 2024 accounted for roughly 53% of the global pharmaceutical prescription market1. The paradox is architectural: a financing system built from four largely uncoordinated pillars — employer-sponsored insurance, Medicare, Medicaid, and ACA marketplace plans — layered atop a residual population — 7.4% of Americans as of 2023 — with no coverage at all1. Where every other country in this series treats universal coverage as a baseline design constraint, the United States treats it as an unresolved policy question, six decades after Medicare and Medicaid were created to help answer it1.

1- Snapshot Overview

Coverage runs through a mix of employer-sponsored private insurance (about half the population), Medicare for those 65 and older or with qualifying disabilities (19% of the population), Medicaid and CHIP for low-income households (17%), ACA marketplace plans, and the 7.4% of the population with no coverage at all1. No central authority administers the system: the Department of Health and Human Services sets federal policy, but delivery is fragmented across 6,093 hospitals and thousands of private insurers, with substantial regulatory authority devolved to individual states1.

System Type

Fragmented multi-payer system combining employer-sponsored private insurance, individual/ACA marketplace plans, and public programs (Medicare, Medicaid, CHIP, VA, Indian Health Service). No single payer or unified regulatory structure; HHS, CMS, FDA, CDC, HRSA, NIH, and AHRQ share federal stewardship, with substantial authority devolved to states.1

Population Coverage

66% hold private insurance, about half through employers; 36% are covered by public programs — 19% Medicare, 17% Medicaid/CHIP, with overlap among dual-eligibles. Approximately 7.4% of the population was uninsured in 2023.1

Benefit Coverage

Varies by plan and program. Medicare covers hospital care (Part A), outpatient/physician services (Part B), and drugs (Part D), with substantial cost-sharing. Medicaid benefits are broader and less costly to enrollees but vary by state. Private plans must cover ACA-defined “essential health benefits,” but deductibles and networks vary widely.1

Health Spending

18% of GDP in 2023 — the highest in the world — at roughly USD 14,570 per capita, more than 2.5 times the USD 5,930 high-income country average.1 Government spending accounted for USD 2.7 trillion, or 55.5% of the total, in 2023.1

Provider Reimbursement

Mixed models: Medicare relies primarily on fee-for-service with growing use of bundled diagnosis-related-group payments and value-based Accountable Care Organizations; private insurers negotiate rates individually with providers, producing wide, often opaque price variation for identical services.1

Financing

General taxation, payroll taxes (Medicare), state and federal general revenue (Medicaid), employer and employee premium contributions, and out-of-pocket payments. Out-of-pocket spending totaled USD 506 billion — 7.2% of total health expenditure — in 2023.1

2- System Architecture

The U.S. system is best described not as managed pluralism, like Singapore, or universal social insurance, like Japan, but as accumulated pluralism: successive legislative layers — nonprofit Blue Cross and Blue Shield plans in the 1930s, employer-sponsored coverage in the 1940s, Medicare and Medicaid in 1965, managed care in the 1980s and 1990s, and the Affordable Care Act in 2010 — stacked on top of one another rather than replacing what came before1. Each layer solved a specific coverage gap for a specific population without ever consolidating into one coherent framework, and each new Congress can reshape major pieces of the system through budget reconciliation rather than durable statute, as the 2025 One Big Beautiful Bill Act’s USD 793 billion in Medicaid cuts demonstrated1.

Financing

Employer-sponsored insurance is the largest single coverage category, with premiums shared between firms and employees; average family premiums reached USD 27,000 in 20251. Medicare, funded through payroll taxes and premiums, covers 19% of the population — those 65 and older along with people with qualifying disabilities — through four parts: Part A (hospital), Part B (outpatient), Part C/Medicare Advantage (a private-plan alternative that now covers more than half of beneficiaries), and Part D (drugs)1.

 

Medicaid, a joint federal-state program funded through general taxation, covers low-income households; eligibility thresholds are set state by state, producing wide coverage variation across the country1. Some 70.8 million people were enrolled in Medicaid and 7.2 million in CHIP as of May 20251. The 2025 Medicaid cuts are projected by the Congressional Budget Office to add 7.8 million people to the uninsured rolls8.

Coverage

Benefit design varies enormously by payer. Medicaid, somewhat counterintuitively, offers the most comprehensive and least costly coverage of any U.S. program for those who qualify, including long-term nursing home care that Medicare excludes1. Medicare beneficiaries face an annual deductible (USD 257 in 2025) and 20% coinsurance on outpatient services, with Medicare Advantage cost-sharing varying by plan1. Private employer plans averaged USD 1,735 in deductibles for single coverage in 20231.

 

Ten states have not adopted the ACA’s Medicaid expansion,7leaving roughly 1.4 million low-income adults in a coverage gap — earning too much for traditional Medicaid but too little for marketplace subsidies17. This is a uniquely American feature: no other country in this series has a population that is simultaneously too poor and too well-off to qualify for public coverage.

Provider Mix

The United States operates 6,093 hospitals, roughly 80% nonprofit or public and 20% investor-owned1. Consolidation has accelerated: the share of community hospitals belonging to multihospital systems rose from 10% in 1970 to 67% in 20191. Hospital bed capacity, at 266 per 100,000 people in 2025, is roughly half the high-income country average of 5371 — a system built for high-throughput, high-cost acute care rather than bed-based capacity.

Primary care physicians number 37 per 100,000 people — less than a third of the physician workforce — while specialists number 196 per 100,0001. The imbalance is structural: payment models reward specialty procedures over cognitive, preventive primary care, discouraging new graduates from entering generalist fields1. Nearly one in four Americans lives in an area with insufficient primary care access1, and international medical graduates make up about a quarter of the physician workforce, reflecting reliance on foreign-trained doctors to fill domestic gaps1.

Payment Models

Fee-for-service remains dominant, particularly in the private sector, incentivizing volume over value1. Medicare has pushed incrementally toward alternatives: Accountable Care Organizations, which tie reimbursement to quality and cost outcomes, covered 11 million beneficiaries and saved USD 1.8 billion in 2022 through the Medicare Shared Savings Program1. Hospital care is frequently reimbursed through diagnosis-related-group bundled payments1. Capitation and value-based care reimbursement methodologies are also used.  However, no uniform national payment framework exists — prices are negotiated bilaterally between thousands of insurers and tens of thousands of providers, producing the wide, often indefensible price variation for identical procedures that is a hallmark of the U.S. system.

Technology & Data Infrastructure

Electronic health record adoption is near-universal following the 2009 HITECH Act, with 73% of patients offered online access to their records in 20221. The 21st Century Cures Act (2016) and the 2022 Trusted Exchange Framework promote data interoperability, and Qualified Health Information Networks now connect most hospitals1. CMS has announced plans for a national Digital Health Ecosystem, and HHS published a strategic plan for AI deployment in clinical care in 20251.

 

Artificial intelligence adoption is advancing rapidly: a 2024 McKinsey survey found more than 85% of health care leaders had already adopted AI or were exploring use cases1. Wearable health technology revenue is forecast to triple between 2025 and 20321, and telehealth, expanded during the COVID-19 pandemic, remains widely used in behavioral health and rural care1. On raw technological capacity, the United States is arguably the most advanced system profiled in this series — the gap lies not in the tools, but in the coordination needed to deploy them equitably.

3- Performance Across the Five Core Domains

Access to Care

On access, the United States finished last among ten peer nations in the Commonwealth Fund’s 2024 Mirror, Mirror comparison2. Approximately 7.4% of the population was uninsured in 2023, and cost-related barriers are pervasive: 7.3% of adults reported forgoing needed medical care due to cost in 2024, and 7.7% skipped or rationed medication for the same reason1. Four in ten adults carried health care debt in 2022, and more than 40% of those had exhausted most or all of their savings as a result1.

The ACA cut the uninsured rate from roughly 16% in 2010 to 9% by 2016, but progress has since plateaued1, and the 2025 Medicaid cuts are projected to push the uninsured population up by another 7.8 million8. No other country in this series treats going without coverage as a live outcome for tens of millions of its citizens; in Singapore, Sweden, Japan, and Canada, the debate is about the depth of coverage, not whether it exists at all.

Care Process

This is the domain where the U.S. system earns genuine credit: it ranked second of ten nations on care process in Mirror, Mirror 2024, behind only New Zealand2, reflecting strong performance on preventive services such as mammography and influenza vaccination and vigorous pay-for-performance incentives embedded in Medicare Advantage and fee-for-service pilot programs2. Adverse hospital events for heart attack, heart failure, pneumonia, and major surgery have declined markedly since 20102.

The catch is that this strength is conditional on access. Care-process excellence benefits people who are already inside the system; it does little for the uninsured or underinsured, who never reach the point of receiving the preventive mammogram or benefiting from the hospital safety improvement. The United States does excellent medicine for those who can get in the door — a genuinely different problem from the door itself.

Administrative Efficiency

The United States ranked ninth of ten nations on administrative efficiency, ahead of only Switzerland2, driven by the time patients and physicians spend on billing disputes, prior authorization, and paperwork tied to a multiplicity of insurance plans and government programs2. Estimates of total administrative spending — billing, insurance management, and hospital overhead combined — range from 15% to 30% of total health expenditure4,5, a figure so large that even the low end represents roughly double what the country spends on cardiovascular disease care and triple its spending on cancer care4.

Hospitals alone report administrative costs accounting for more than 40% of total expenses incurred in delivering patient care, per 2024 data from Strata Decision Technology cited in the report3. A 2024 American Medical Association survey of 1,000 physicians found that practices completed an average of 39 prior authorization requests per physician per week, with physicians and their staff spending 13 hours weekly processing them15. No other country profiled in this series carries anything close to this administrative burden — Singapore’s entire multi-layered S+3Ms system runs efficiently enough to keep total health spending under 5% of GDP16; the United States spends more than that on administration alone, before a single patient is treated.

Equity

Equity is the United States’ worst-scoring domain relative to peers, effectively tied for last with New Zealand2. Life expectancy varies by more than eleven years by race: 70.1 years for American Indian and Alaska Native people, 74.0 for Black Americans, 78.4 for white Americans, and 81.3 for Hispanic Americans as of 20231. State-level performance varies just as sharply — Massachusetts ranks highest and Mississippi lowest on the Commonwealth Fund’s 2025 State Scorecard9, meaning a person’s zip code can matter as much as their income or insurance status.

Ten states’ refusal to expand Medicaid leaves roughly 1.4 million adults in the coverage gap described above7,17, and the burden falls hardest on rural and low-income communities already facing physician shortages1. Unlike Singapore’s nonresident exclusion — a bounded, identifiable population outside the system by policy design — U.S. inequity is diffuse, correlated with race, income, geography, and state of residence simultaneously, which makes it both larger in aggregate and harder to solve with a single policy lever.

Health Outcomes

On outcomes, the U.S. also finished last of ten nations2. Life expectancy was 78.5 years in 2023, nearly three years below the 81.1-year high-income average1. Avoidable mortality — deaths that better prevention or treatment could have averted — stood at 312 per 100,000 in 20221.

Maternal mortality was 19 deaths per 100,000 live births in 20231, and infant mortality was six per 1,000 live births, half again higher than the four-per-1,000 high-income average1, with the starkest disparities among Black and Indigenous mothers and infants10. Adult obesity reached 42% in 2022, versus a 26% high-income average1, and 12% of adults had a diabetes diagnosis in 20211.

Mental health and public health crises compound the outcomes gap: 19% of the population had a mental health disorder in 2021, versus 16% across high-income countries1; the suicide rate was 15.3 per 100,000 in 2023, above the 12-per-100,000 high-income average1; and firearms killed 14 people per 100,000 in 2023, nearly triple the five-per-100,000 high-income average1 — a cause of death with no real analogue anywhere else in this series.

4- How the United States Compares

With nine countries now profiled, the United States enters this series in a role no other country has played: not a model to weigh against the others, but the outlier against which the other nine implicitly measure their own performance. Its per-capita spending is the highest of any country profiled — more than double Canada’s and nearly triple Singapore’s — while its outcomes trail all nine.

United States and Canada

Both countries divide health authority between federal and provincial or state governments, and both struggle with primary care access and rural shortages. But Canada’s single-payer Medicare guarantees universal coverage with near-zero copayments for insured services, funded through general taxation. The United States has no equivalent guarantee: 7.4% of the population remains uninsured, and Medicaid eligibility varies state by state in a way Canadian provincial health plans do not1. Canada’s per-capita health spending of approximately is less than half of the United States while Canada’s life expectancy exceeds the U.S. figure by several years.

United States and Sweden: Public Investment Versus Market Fragmentation

Sweden is fully tax-funded and delivers care through a nationally governed, regionally administered public system, spending 11.2% of GDP on health14. The United States spends 18% of GDP — a larger share of a far larger economy — yet Sweden’s life expectancy and outcomes measures consistently outperform the U.S. figures. Sweden’s out-of-pocket burden runs around 13% of total health expenditure, close to the internationally comparable U.S. figure of 11.1%1,14, but Swedish patients face that cost-sharing atop a universal coverage guarantee; American patients often face it as a substitute for one.

United States and Japan: Universal Social Insurance Versus Voluntary Coverage

Japan’s Bismarck-style mandatory social insurance achieves universal coverage at 10.6% of GDP14, delivering a life expectancy of 84.1 years in 2023 — nearly six years longer than the U.S. figure14. The contrast is instructive because Japan, like the United States, relies heavily on private insurers and private hospital ownership; the difference is that Japanese insurance is mandatory and community-rated, while U.S. insurance remains voluntary and can leave tens of millions uncovered. Universal coverage, in other words, does not require abandoning a private-insurer model — it requires making participation mandatory rather than optional.

United States and Singapore: Deliberate Cost-Sharing Versus Accidental Cost-Sharing

Singapore deliberately built cost-sharing into its system through MediSave, MediShield Life, and means-tested subsidies, achieving life expectancy of 83.5 years at just 4.9% of GDP.16  The United States also relies heavily on cost-sharing — copayments, deductibles, coinsurance — but without Singapore’s income-stratified subsidy architecture or MediFund-style safety net to absorb the burden for the poorest. The result is that Singapore’s 25.4% out-of-pocket share16produces little catastrophic hardship, protected by layered subsidies, while the United States’ lower out-of-pocket share by percentage1 still coincides with medical debt for four in ten adults1 in absolute dollar terms, because overall costs are so much higher and the safety net beneath the cost-sharing is so much thinner.

The Emerging Pattern

The series has consistently found that financing architecture — tax-based, insurance-based, or savings-based — matters less than the depth of protection for the most vulnerable and the alignment of provider incentives with population health. The United States is the clearest test of that finding, and the result is unambiguous: it is the one country in this series that has neither chosen a financing architecture deliberately nor built a floor beneath it. Cost-sharing exists, but without Singapore’s subsidy scaffolding. Private insurance exists, but without Japan’s mandate. Federalism exists, but without Canada’s provincial guarantee. Wealth exists, but without Sweden’s redistribution. Each element, borrowed piecemeal from approaches that work elsewhere when implemented completely, functions here as a fragment of a system rather than a system.

5- Challenges and Pressure Points

Coverage Instability: A Safety Net Rewritten Every Election Cycle

Unlike the universal guarantees in Canada, Japan, Sweden, or Singapore, U.S. coverage levels shift with the political cycle. The ACA cut the uninsured rate nearly in half between 2010 and 20161, coverage gains then plateaued1, and the 2025 One Big Beautiful Bill Act’s USD 793 billion in Medicaid cuts are projected to add 7.8 million people to the uninsured rolls8. No other country in this series has seen its basic coverage architecture subject to this degree of legislative volatility.

Administrative Complexity: The World's Most Expensive Paperwork

Administrative spending consumes an estimated 15–30% of total health expenditure4,5 — a burden with no parallel among the other countries profiled. A 2024 American Medical Association survey found practices completed an average of 39 prior authorization requests per physician per week, consuming 13 hours of staff time weekly15. This is not merely a byproduct of a fragmented system; for many analysts, it is the direct, quantifiable cost of maintaining thousands of separate payers with separate rules rather than one.

Pharmaceutical and Hospital Pricing: Consolidation Without Countervailing Power

The United States is one of the only high-income countries without direct government price controls on most prescription drugs1, and per-capita outpatient drug spending, at USD 1,227 in 2022, is the highest in the OECD1. The 2022 Inflation Reduction Act allows Medicare to negotiate prices on ten high-cost drugs beginning in 2026, an estimated USD 6 billion in annual savings1 — a meaningful but narrow first step relative to the scale of the pricing problem. Hospital consolidation compounds the issue: the share of community hospitals in multihospital systems rose from 10% to 67% between 1970 and 20191, concentrating negotiating leverage in ways that tend to raise, not lower, prices.

Primary Care Erosion: A System That Pays for Procedures, Not Prevention

Primary care physicians make up less than a third of the physician workforce1, nearly a quarter of Americans live in areas with insufficient primary care access1, and payment structures continue to reward specialty procedures over the cognitive, preventive work that could manage chronic disease more cheaply upstream1. This is the same imbalance the series has documented in Canada and Singapore, but the U.S. version is sharper: with no assigned-patient or capitation model at national scale, there is no structural counterweight pulling investment back toward primary care.

Mental Health and Public Health Crises: Outcomes Diverging From Peers

Mental health disorder prevalence (19%), suicide rates (15.3 per 100,000), firearm deaths (14 per 100,000), and adult obesity (42%) all exceed high-income country averages by wide margins1, and only 47.2% of adults with a diagnosed mental illness received care as of 20211. These are not primarily financing problems — they are public health crises for which the fragmented coverage system provides an inconsistent, geographically uneven response.

6. What Other Countries Can Learn from the United States

Care-Process Excellence Is Achievable Even Inside a Fragmented System

Despite finishing last overall, the U.S. ranked second of ten nations on care process2, driven by aggressive pay-for-performance incentives in Medicare Advantage and measurable gains in hospital patient safety since 20102. For countries seeking to improve care quality without redesigning their entire financing architecture, the U.S. experience shows that targeted, well-funded performance incentives can move clinical quality metrics substantially — the caveat is that this excellence means little without the access needed to reach it.

Innovation Capacity Rewards Concentrated Investment

The U.S. share of global pharmaceutical revenue (53%)1, its physician-training capacity (162 accredited medical schools)1, and its rapid AI adoption in clinical settings (more than 85% of health leaders engaged as of 2024)1 demonstrate what sustained, concentrated capital investment in medical research and technology can produce. For countries with smaller health economies, the lesson is less about replicating U.S. scale than about recognizing that innovation capacity and equitable access are separable design choices — a country can build one without the other, and the United States is the clearest demonstration that building only the first is not sufficient.

Voluntary Coverage Systems Require a Mandate to Reach Universality

The comparison with Japan is the sharpest lesson here: both countries rely heavily on private insurers, yet Japan achieves universal coverage because participation is mandatory and community-rated, while U.S. participation remains voluntary and, in parts of the individual market, medically underwritten. Countries building private-insurer-based systems from scratch should treat the mandate, not the insurer model itself, as the load-bearing design element.

Political Durability Matters as Much as Program Design

The ACA’s coverage gains were real but were achieved through legislation that a subsequent Congress can unwind through budget reconciliation, as the 2025 Medicaid cuts demonstrate8. Countries designing new coverage expansions should consider not only the policy mechanics but the constitutional or legislative durability of the guarantee — a lesson visible nowhere else in this series, because no other profiled country has built and then partially dismantled a coverage expansion within a single generation.

Closing Perspective

The United States is, in one sense, the most instructive country in this series precisely because it is the negative case: it shows what happens when a health system accumulates capability without ever resolving the question of who that capability is for. It has the world’s most advanced medicine, the world’s highest spending, and outcomes that trail every other high-income country profiled here. Each individual policy failure — the uninsured population, the administrative burden, the primary care shortage, the racial and geographic gaps in outcomes — has an identifiable cause and, in most cases, an identifiable fix that some other country in this series has already implemented in some form.

What the United States has not done, and what distinguishes it from the other nine countries in this series, is choose. Singapore chose deliberate cost-sharing wrapped in subsidy. Sweden chose tax-funded universalism. Japan chose mandatory private insurance. Canada chose federated single-payer. The United States has, so far, chosen pieces of all of them and the coherence of none — and its 78.5-year life expectancy1 is the bill for that indecision.

7. Summary Box

Strengths
  • Second of ten nations on care process — strong preventive-care delivery and hospital patient-safety gains since 20102
  • World-leading medical innovation: 53% of the global pharmaceutical prescription market1, 162 accredited medical schools1, and rapid clinical AI adoption1
  • Near-universal electronic health record adoption and growing interoperability infrastructure1
  • Medicaid and CHIP provide comprehensive, low-cost coverage to roughly 78 million low-income enrollees where eligibility is met1
  • Medicare drug-price negotiation under the 2022 Inflation Reduction Act begins delivering savings in 20261
Challenges
  • Last of ten nations overall, in access to care, and in health outcomes; effectively last in equity2
  • Approximately 7.4% of the population uninsured1, with 7.8 million more projected following the 2025 Medicaid cuts8
  • Highest health spending in the world — 18% of GDP, USD 14,570 per capita — more than double the high-income average1
  • Administrative costs estimated at 15–30% of total health spending, the highest burden of any country in this series4,5
  • Life expectancy gap of more than 11 years by race, and a 3-year national gap versus high-income peers1
Surprising Fact

On care process — the domain measuring preventive screenings, chronic disease management, and hospital safety — the United States ranks second among ten peer nations, trailing only New Zealand2. The country that finishes dead last overall does some of the best clinical medicine in the developed world for the patients who make it inside the system. The failure is not medical; it is architectural.

Takeaway

The United States shows that spending and outcomes can move in opposite directions when a system optimizes for treatment intensity rather than universal access. Its greatest achievement is the depth of medical capability available to those who are covered. Its greatest failure is that, alone among the ten countries in the Commonwealth Fund’s comparison and the nine other countries profiled in this series, it has never resolved whether that capability is a right or a privilege — and the millions of uninsured Americans live with the consequences of that unresolved question every day.1,2

Sources:

This country profile draws on comparative health system analyses from the Commonwealth Fund, the Centers for Medicare and Medicaid Services, the OECD, the Kaiser Family Foundation, the American Hospital Association, and peer-reviewed and government sources. Data reflect the most recent publications available as of 2024–2026.

  1. Commonwealth Fund. International Health Care System Profile: United States. Commonwealth Fund, May 2026. https://www.commonwealthfund.org/international-health-policy-center/countries/united-states
  2. Blumenthal D, Gumas E, Shah A, et al. Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System — Comparing Performance in 10 Nations. Commonwealth Fund, September 2024. https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
  3. American Hospital Association. Skyrocketing Hospital Administrative Costs, Burdensome Commercial Insurer Policies Impacting Patient Care. AHA, September 10, 2024. https://www.aha.org/guidesreports/2024-09-10-skyrocketing-hospital-administrative-costs-burdensome-commercial-insurer-policies-are-impacting
  4. Health Affairs. The Role of Administrative Waste in Excess U.S. Health Spending. Health Affairs Research Brief, October 6, 2022. https://www.healthaffairs.org/do/10.1377/hpb20220909.830296/
  5. Center for American Progress. Excess Administrative Costs Burden the U.S. Health Care System. CAP, November 2, 2021. https://www.americanprogress.org/article/excess-administrative-costs-burden-u-s-health-care-system/
  6. Bunch LN, Ketema H. Health Insurance Coverage in the United States: 2024. United States Census Bureau, September 9, 2025. https://www.census.gov/library/publications/2025/demo/p60-288.html
  7. Kaiser Family Foundation. Status of State Medicaid Expansion Decisions. KFF, September 29, 2025. https://www.kff.org/status-of-state-medicaid-expansion-decisions/
  8. Euhus R, et al. Allocating CBO’s Estimates of Federal Medicaid Spending Reductions and Enrollment Loss Across the States: House Reconciliation Bill. Kaiser Family Foundation, June 4, 2025. https://www.kff.org/medicaid/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/
  9. Radley DC, et al. 2025 Scorecard on State Health System Performance: Fragile Progress, Continuing Disparities. Commonwealth Fund, June 18, 2025. https://www.commonwealthfund.org/publications/scorecard/2025/jun/2025-scorecard-state-health-system-performance
  10. Gunja MZ, et al. Insights Into the U.S. Maternal Mortality Crisis: An International Comparison. Commonwealth Fund, June 4, 2024. https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison
  11. Niasse A. US Health Insurance Premiums Rose to $27,000 for Families in 2025. Reuters, October 22, 2025. https://www.reuters.com/legal/litigation/us-health-insurance-premiums-rose-27000-families-2025-2025-10-22/
  12. National Institute of Mental Health. Mental Illness. NIMH, last updated September 2024. https://www.nimh.nih.gov/health/statistics/mental-illness
  13. National Center for Health Statistics. Leading Causes of Death. CDC, last updated September 17, 2025. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
  14. Health at a Glance 2025 and OECD Data Explorer: Health Expenditure and Life Expectancy. OECD. https://data-explorer.oecd.org/
  15. American Medical Association. 2024 AMA Prior Authorization Physician Survey. AMA, 2025. https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
  16. Commonwealth Fund. International Health Care System Profile: Singapore. Commonwealth Fund, May 2026. https://www.commonwealthfund.org/international-health-policy-center/countries/singapore
  17. Kaiser Family Foundation. How Many Uninsured Are in the Coverage Gap and How Many Could Be Eligible if All States Adopted the Medicaid Expansion? KFF, February 26, 2025. https://www.kff.org/medicaid/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/

AI Disclosure: This article was researched and drafted with AI assistance (primarily Claude, with ChatGPT and Copilot in supporting roles). All content was reviewed, fact-checked, and edited by the author before publication.