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Will the U.S. Ever Be a Leader in Health Care? A Public Health Expert Weighs In

illustration of the United States broken up with images of health care

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Meghan Fitzgerald, RN, MPH, DrPH, is an adjunct associate professor with the Columbia University Mailman School of Public Health and a private equity investor. She has decades of experience working in the healthcare field, ranging from frontline patient care to advising prominent healthcare firms. Here, she shares her view on what it will take to improve the rank of the United States when it comes to offering accessible, quality health care.

Compared to its high-income peers, the United States has placed last again when it comes to health care affordability, equity, and outcomes, according to new data released by the Commonwealth Fund.

While COVID-19 was not considered in the August 4 rankings, the U.S. holds a commanding lead on cumulative COVID deaths.

The debate around access to affordable, quality health care has been lost in the pandemic news cycle but remains a major issue for Americans, especially the 32.8 million who remain uninsured. Pandemic-related job loss means many people lost their employer-sponsored healthcare coverage at a time when they needed it most.

Health care is an expensive endeavor in the U.S., where the average person spends more than $11,000 per year on health care according to the most recent estimates from the Centers for Medicare and Medicaid Services.

There is a healthcare reckoning coming to a fragile system. Millions who survive COVID are likely to have long-term health problems, including respiratory, cardiac, and mental health issues. We also know one in five people delayed medical care during the pandemic due to concerns about going into a doctor's office. In short, the healthcare system will continue to be pushed to its limit.

What Makes a Good Health Care System?

We can learn from our global peers who consistently earn positive ratings for their health care. There are several attributes of a top-performing healthcare system, including:

  • Good health care coverage and access
  • Preventative care funding
  • Social safety net for high-risk groups (including children)

Given the U.S. system is funded nationally but often managed locally, we can also learn from states who are delivering good health care. And they do exist. Researchers from WalletHub compared the 50 states (and the District of Columbia) across 44 measures of cost, accessibility, and health outcomes, ultimately ranking Massachusetts as the top state for health care. The results, published on August 2, incorporate COVID-19 cases, deaths, and vaccination rates into a state's performance.

States With the Best Health Care Had the Best COVID-19 Response

One good test of a health care system is how it helps patients in a crisis. So it's not surprising that a quick review of state-level data suggests top states for health care fared better in terms of COVID-19 vaccination efforts and successful public health measures for curbing the pandemic.

The top-ranked states for health care have higher vaccination rates than the national average, which hovers just below 50% of the whole U.S. population. On average, the top five states with the best health care have fully vaccinated 58.6% of their populations (which includes people who are not yet eligible for vaccination, like those under the age of 12).

This vaccination effort is saving lives. There is now a direct correlation with vaccination rates and case rates. In Massachusetts, where 64% of the population is fully vaccinated, just 100 of the nearly 4.3 million people who are fully vaccinated have died of COVID-19—a rate of 0.002%—according to state data on breakthrough cases published this week.

States with strong health care programs follow many of the tenets seen among strong global peers with a mix of prevention and access strategies.

  • Maryland ranks first for having the least expensive health care
  • Massachusetts ranks highest on insured adults and children while maintaining some of the highest number of physicians per capita
  • Minnesota has many programs in place to use advanced practice providers—like nurse practitioners and physician assistants—to deliver care in rural areas
  • Vermont, which WalletHub ranks sixth overall, ranks particularly well for insurance coverage and infant survival

The U.S. ranking last in health care in the Commonwealth Fund report is painful. If we can develop a vaccine in a year, then we can make a dent in health care access. If there were ever a catalyzing event to force action, it's the pandemic and its pending aftermath.

American health care is expensive, personal, and therefore, highly political. As a country, we should follow the example of states who have found a way to make health care a priority—a proven benefit as they navigated COVID-19.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Schneider EC, Shah A, Doty MM, Tikkanen R, Fields K, Williams RD. Mirror, mirror 2021: reflecting poorly - health care in the U.S. compared to other high-income countries. The Commonwealth Fund. August 4, 2021.

  2. World Health Organization. WHO Coronavirus Dashboard - situation by region, country, territory & area. August 6, 2020.

  3. Centers for Disease Control and Prevention. Health insurance coverage. Updated June 11, 2021.

  4. Findling MG, Blendon RJ, Benson JM. Delayed care with harmful health consequences—reported experiences from national surveys during coronavirus disease 2019JAMA Health Forum. Published online December 14, 2020. doi:10.1001/jamahealthforum.2020.1463

  5. Centers for Disease Control and Prevention. COVID-19 vaccinations in the United States. Updated August 6, 2021.