The United States healthcare system has been ranked last among 10 wealthy nations in a new report by the Commonwealth Fund. Despite Americans spending nearly double on healthcare compared to other countries, the system falls short in areas like health equity, access to care, and overall health outcomes.

"I see the human toll of these shortcomings on a daily basis," remarked Dr. Joseph Betancourt, president of the Commonwealth Fund, which focuses on healthcare policy and research.

Betancourt highlighted instances, where patients couldn't afford essential medications and elderly individuals, arrived in critical condition after years without insurance. "It’s time we finally build a health system that delivers quality, affordable healthcare for all Americans," he emphasised.

Healthcare costs remain a major issue for Americans, even as other economic concerns like inflation take centre stage. Neither Kamala Harris nor Donald Trump has made significant healthcare reform a priority in their campaigns. The Democratic nominee has promised relief from medical debt and highlighted achievements like Medicare drug price negotiations, while the Republican nominee has not yet provided detailed plans. Conservative groups like Project 2025 have suggested reducing public health infrastructure.

Polling by the Kaiser Family Foundation reveals that healthcare costs are a top concern for voters across party lines, with 42% of Democrats and 45% of Republicans identifying the cost of medical services—such as doctor visits, medications, and insurance—as their primary issue. Annually, Americans spend an astonishing $4.5 trillion on healthcare, with the average individual paying over $13,000 per year, according to federal data.

The Commonwealth Fund's report, part of its “Mirror, Mirror” series, compared the US healthcare system to those of nine other wealthy democracies, including Australia, Canada, and the UK. The findings depict a “failing US health system,” with the US ranking last or second-last in nearly all key areas, except for care processes, which encompass measures like medication reconciliation.

"Other countries don’t make their health systems work as hard as we do," said Reginald D Williams II, the fund’s vice president. "In the US, too many individuals face a lifetime of inequity. It doesn’t have to be this way."

Williams also highlighted that countries with better support for basic needs such as housing and food can reduce strain on their healthcare systems.

Recommendations to improve the US health system’s performance include expanding insurance coverage, reducing out-of-pocket costs, simplifying insurance plan structures, strengthening primary care, and investing in social welfare programmes. However, significant reform is expected to take time.

"The American electorate makes choices about which direction to move in," said Dr David Blumenthal, the fund’s former president and co-author of the report. "And that is very much an issue in this election," he added.

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