The Healthcare Crisis: What It Costs Us

Imagine walking into a hospital for emergency surgery. You do not see the price. You do not negotiate. You cannot afford not to have the procedure. Weeks later, you receive a bill for $150,000. Your insurance covers some of it—you do not know how much until you get dozens of bills from the hospital, the surgeon, the anesthesiologist, the pathologist, each billing separately at rates negotiated in secret. You end up owing $47,000. You have insurance. You thought you were protected. You were not.

This is the American healthcare system. The most expensive in the world. The least effective among wealthy nations. A system that bankrupts people while simultaneously making them sicker, slower, and poorer. A system where we pay the highest prices on Earth and receive the worst health in return. A system that is not just morally indefensible—it is economically catastrophic.

Here is what it actually costs us. And what we get in return.

We Pay the Most. We Get the Worst.

The United States spends $5.3 trillion annually on healthcare. That is $11,154 per person per year—nearly twice what Germany spends ($8,401), one and a half times what Canada spends ($7,301), and nearly twice what the United Kingdom spends ($6,200). Eighteen percent of the entire American economy goes to healthcare.

In return, we have the worst health outcomes of any wealthy nation.

Life expectancy in the United States is 79.0 years. In Germany, it is 82.6 years. In Canada, 82.3 years. In the UK, 81.5 years. Americans die, on average, 3.7 years sooner than people in comparable wealthy nations—despite spending thousands of dollars more per person per year.

Our infant mortality is a scandal. In the United States, 5.6 infants per 1,000 die before their first birthday. In Germany, it is 2.08. In Canada, 3.4. The US has the highest infant mortality rate of any wealthy nation. We are killing our babies at rates not seen in other rich countries.

Our maternal mortality is worse. The United States has a maternal mortality rate of 22.3 deaths per 100,000 pregnancies—more than 50 percent higher than the next closest peer nation. In 2023, the World Health Organization named the United States as one of only seven countries globally with rising maternal mortality since 2000. The other six are Venezuela, Cyprus, Greece, Mauritius, Belize, and Puerto Rico. That is the list America is on. That is what our most-expensive-in-the-world healthcare system produces.

Black women in America have maternal mortality rates more than double the national average. American women are dying in childbirth at rates that rival developing countries—while paying developed-world prices.

"We pay the most and get the worst. That is not a market failure. That is a system failure. That is a moral catastrophe with a price tag."

The Death We Cannot Prevent

The United States is experiencing a public health crisis that goes unmentioned in most policy debates. While every other wealthy nation reduces preventable deaths, America's are rising.

Between 2009 and 2019, avoidable mortality—deaths from causes that could be prevented by vaccines, detected early, or treated successfully—increased in every single U.S. state. The median increase was 29 deaths per 100,000 people. Meanwhile, in peer countries, avoidable mortality decreased by 14 deaths per 100,000. We are moving in the opposite direction from the rest of the wealthy world.

The preventable death rate in the United States is 217 per 100,000 people. In the average OECD country, it is 145. We have 50 percent more preventable deaths. We also have treatable deaths—people who could survive with timely, effective medical care. Our treatable death rate is 95 per 100,000 versus an OECD average of 77. We are worse at treating treatable conditions.

This is not a matter of lifestyle or genetics. Germany, Canada, and the UK have similar populations with similar health risks. The difference is the system.

So where does the money go? Hospitals and doctors take their cuts. Pharmaceutical companies charge ten times what the same drugs cost in Canada. Insurance companies employ hundreds of thousands of people whose job is to deny claims. And waste. Massive, systemic waste. One estimate suggests 25 percent of all healthcare spending—roughly $1.3 trillion per year—goes to administrative costs, billing complications, and fraud. That money does not buy a single dose of medication or pay for a single surgery. It is lost to bureaucracy and profit extraction.

America's Maternal and Infant Mortality Crisis

A pregnant American woman is more likely to die in childbirth than a woman in Germany, Canada, or the United Kingdom. A newborn American is more than 2.5 times more likely to die in infancy than a German baby.

In the United States, 5.6 infants per 1,000 die before their first birthday. In Germany, the rate is 2.08. In Canada, 3.4. The U.S. has the highest infant mortality rate among wealthy nations. For Black infants, the rate is 7.4 per 1,000—more than triple the rate for Asian American infants (2.7 per 1,000). The system is not just failing infants. It is failing some infants catastrophically.

Maternal mortality tells the same story. The United States has a maternal mortality rate of 22.3 deaths per 100,000 pregnancies. This is 50 percent higher than the next-worst peer nation. Black women in the US have maternal mortality rates above 40 per 100,000—more than double the national average and comparable to rates in countries with 1/10th the per-capita healthcare spending.

In 2023, the World Health Organization identified the United States as one of only seven countries in the world with rising maternal mortality since 2000. The other six are Venezuela, Cyprus, Greece, Mauritius, Belize, and Puerto Rico. That is the category America occupies. A country where maternal death is increasing, not decreasing, despite spending more on healthcare than any nation on Earth.

Most of these deaths are preventable. Studies show that 60 percent of maternal deaths in the US are due to conditions that could be avoided through better prenatal care, equitable access, and systemic support. But the American system does not provide equitable access. It provides access to those who can pay.

The Chronic Disease Epidemic

Three out of ten Americans report having two or more chronic conditions—the highest rate in any wealthy nation. We are more obese (42.8 percent of adults vs. 21 percent in peer countries), more depressed, more diabetic, more sick. We have more of every chronic condition that money and healthcare systems typically address.

Yet despite this disease burden—or perhaps because of it—we live shorter lives and suffer more preventable deaths.

Germany, Canada, and the UK have similar age structures, similar genetic pools, and similar environmental exposures. The difference is not biology. The difference is that their healthcare systems catch disease early. Their preventive care works. They treat conditions effectively. Their systems are designed to keep people alive. The American system is designed to extract revenue from sick people.

The result: we are chronically ill and chronically dying.

The Cost to Individuals: Bankruptcy and Desperation

Gross spending—the $11,154 per capita figure—obscures what individual Americans actually pay. The average American spends $1,425 per year out of pocket on healthcare. In the United Kingdom, it is $764. In other wealthy countries, it is similar or lower.

But that out-of-pocket figure only captures the visible costs. Americans also pay premiums for employer-provided insurance—premiums that average $26,993 per year for family coverage and grow 6-9 percent annually. Workers see little of this cost, but it represents lost wages. Employers could be paying you $27,000 more per year instead of buying health insurance that is increasingly inadequate.

Twenty-three percent of insured Americans are "underinsured"—they have insurance but cannot afford to use it. They have deductibles so high that they skip medications, avoid going to the doctor, and let conditions worsen rather than face catastrophic bills.

The result: 17 percent of Americans with healthcare debt have had to declare bankruptcy or lose their homes. Medical debt is the #1 cause of personal bankruptcy in America. Every year, 250,000 medical fundraisers are launched on GoFundMe, raising $650 million annually from people desperate to pay for healthcare their insurance should cover. This is not a side effect of the system. This is the system working as designed—shifting the costs of illness from the wealthy to the poor, from the healthy to the sick.

The Business Problem: Healthcare Draining Profits and Innovation

Companies are drowning in healthcare costs. The average employer family health insurance premium is $26,993 per year. Growing 6-9 percent annually. This is money that does not go to wages. Does not go to hiring. Does not go to investment or innovation. It goes to insurance companies.

Sixty-eight percent of small business owners cite healthcare costs as their number one concern. Larger companies absorb these costs but pass them on to workers through lower wage growth. Productivity is lost when workers are stressed about healthcare bills, or when they are sick but cannot afford to see a doctor, or when they stay in jobs they hate because they need the insurance.

Now compare this to every other wealthy country. In Germany, a business pays roughly 7.5 percent of payroll as a health insurance contribution. That is it. Everyone is covered. The business does not negotiate with insurers. Does not deal with denials. Does not file claims. Employees do not worry about whether a procedure will be covered. They go to the doctor. They get treated. They get better.

The American system is grotesquely inefficient from a business perspective. Businesses in other countries are not wasting money on healthcare administration. They are spending that money on expansion, research, wages, and hiring.

The National Debt Catastrophe

Here is where healthcare becomes not just a moral crisis or a business problem—it becomes an existential fiscal threat to the country.

Federal government spending on healthcare (Medicare, Medicaid, and ACA subsidies) is $2.4 trillion per year. That is 48 percent of all healthcare spending in America. By 2036, it is projected to reach $3.1 trillion. By 2055, healthcare will consume 30 percent of all federal spending—more than defense, education, and all infrastructure combined.

Meanwhile, the federal government is already running $1.9 trillion deficits. By 2036, deficits are projected to reach $3.1 trillion. The national debt is rising from 101 percent of GDP today to 120 percent by 2036. Interest payments on that debt are already over $1 trillion per year and growing.

Healthcare is the single largest driver of this debt trajectory. As the population ages, Medicare enrollment grows. As medical costs rise faster than the economy, per-beneficiary costs explode. There is no scenario under current law where the federal government gets its budget balanced without controlling healthcare costs.

"Healthcare is not a business in the American sense. It is a public utility. If you do not have reliable electricity, you cannot run a business. If you do not have reliable healthcare, you cannot have a functioning society. A society that rations healthcare by price is a society that will fail economically and morally."

What Medicare for All Would Actually Cost

The estimates vary depending on assumptions, but they cluster around one finding: Medicare for All would cost roughly what we already spend, but would be spent more efficiently and would cover everyone.

The RAND Corporation estimates total spending would increase by 1.8 percent overall because of increased demand for care—people would get more healthcare because they would not have to choose between paying rent and seeing a doctor. But federal spending would be redirected from private insurers to the government program.

The Congressional Budget Office found roughly $400 billion in annual savings primarily from administrative simplification. Traditional Medicare's administrative costs are 2 percent of spending. Private insurance is 13-14 percent. Move everyone to a single-payer system and those administrative costs collapse. That money goes to actual care instead of to processing denials and negotiating with providers.

Pharmaceutical prices would fall because the government, as a single buyer, could negotiate. Estimates suggest $219 billion in savings just from better drug pricing. Fraud detection would improve. Billing simplification would free up resources. Over ten years, the estimates suggest Medicare for All would be revenue-neutral to slightly cheaper than the current system, while providing universal coverage and eliminating out-of-pocket bankruptcy.

Crucially: businesses would save money. Employers would not pay $26,993 per employee for health insurance. They would pay a 7.5 percent payroll tax—roughly $7,500 per employee on a $100,000 salary. Savings of nearly $20,000 per employee that could go to wages, hiring, or investment.

The Choice

We have two paths. The first: continue the current system. Healthcare spending grows. Federal spending explodes. Debt spirals. By 2055, debt reaches 175 percent of GDP. Interest payments consume all discretionary revenue. The government cannot invest in infrastructure, education, or research. The country enters a slow decline.

Meanwhile, people continue to die from treatable diseases. Businesses continue to waste money on healthcare administration. Workers continue to stay in jobs they hate because they need insurance. Young people continue to avoid getting treatment because they cannot afford deductibles. Medical bankruptcies continue to destroy families.

The second path: Medicare for All. Universal coverage. Administrative waste eliminated. Pharmaceutical prices negotiated. Federal spending stabilized. Debt trajectory shifts from unsustainable to manageable. Businesses save money that goes to wages and hiring. People get treated when they are sick. Medical bankruptcies disappear.

The math is not close. The current system is unsustainable fiscally. It is already failing morally. It is killing people while bankrupting the country and draining business productivity.

This is not a choice between markets and government. The current system has government involvement in all the worst ways—subsidizing insurance companies, managing a massive Medicare bureaucracy, regulating prices ineffectively. It is government-managed capitalism at its most corrupt.

Medicare for All is not socialism. It is what every other wealthy country does. It is paying for a public utility the same way we pay for roads and national defense. You do not negotiate the price of the Interstate Highway System with your neighbor. You do not shop for the cheapest fire department. You do not ration military protection by price. Healthcare is the same. Once you understand that, the choice becomes simple.