Someone born in the United States today has a life expectancy of 79 years, according to the Centers for Disease Control and Prevention (CDC). That is the highest in the nation’s history. However, it only ranks 38th among countries with a population of one million or more.
Research published in The Milbank Quarterly shows that the mortality gap between the U.S. and other high- and middle-income countries has expanded over time and continues to grow. That widening divide is “driven in particular by rising mortality rates that threaten the probability that youth can survive to middle age, or even adulthood,” notes the report authored by Dr. Stephen Woolf of Virginia Commonwealth University.
Woolf identifies several causes of rising mortality, such as poor diet, drug overdoses, problem drinking, homicide, suicide, and chronic diseases such as cardiometabolic, neurologic, and genitourinary diseases, among others.
However, he also lays blame on “deficiencies in the health care system, adverse socioeconomic conditions,” as well as government policies.
A Downward Trend
America’s decline in mortality relative to other countries is not a new development. Dr. Woolf has been issuing reports for almost a decade. In addition, other researchers have been reaching similar findings.
America’s standing has generally declined since ranking 14th in 1980, with drops to 40th in 2019 and 46th in 2020. A 2023 report based on data from the Organization for Economic Co-Operation and Development (OECD) ranked the U.S. 32nd out of 38 countries in life expectancy.
The Commonwealth Fund, in its 2024 Mirror, Mirror series, tracks the healthcare performance of 10 high-income countries. It singled out America’s substandard track record.
“The U.S. continues to be in a class by itself in the underperformance of its health care sector,” noted the report. “While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.”
A Systemic Problem – Not A Money Problem
“As a health economist, I find this particularly troubling,” Dr. Matt Hasan, founder of The AI Humanist Movement, stated to SavingAdvice. “We spend more on medical care than any other country, but spending is heavily concentrated on treating disease rather than preventing it. Our fragmented healthcare system, weak preventive infrastructure, and inadequate social support produce an expensive but inefficient approach to population health.”
Dr. Michael Genovese, chief medical advisor of Ascendant NY, agrees that the emphasis on treatment rather than prevention, both in practice as well as funding, is a key factor in America’s poor mortality rate.
“Receiving care only after an illness has worsened, or getting inadequate continuity of care, can contribute to poorer health outcomes, including higher morbidity and mortality, as well as greater costs,” Genovese informed SavingAdvice. “However, gaps in clinical care are only part of the problem. Underinvestment in public health, prevention, and social support can also affect life expectancy.”
Is The U.S. Healthcare System Built To Fail?
Woolf’s report declares a need “to address structural factors that systematically compromise the health of Americans, such as deficiencies in the health care system, adverse socioeconomic conditions, threats from the physical and social environment, and public policies that do not prioritize the health and safety of the population or that perpetuate health inequities.”
Hasan and Genovese see similar problems in the nation’s healthcare system and government policies.
“I see structural factors as the primary driver,” noted Hasan. “Individual behavior doesn’t happen in a vacuum. Income, education, housing, food affordability, and access to healthcare all influence personal choices and health outcomes. We cannot expect behavioral changes to compensate for systemic failures.”
“I would place greater weight on structural factors because they influence both individual health behaviors and access to treatment,” added Genovese. “Policy determines whether people with illness or addiction can receive timely treatment.”
Financial Disparity
Financial security is another factor in determining who gets quality medical treatment, according to Genovese.
“At-risk populations are also more likely to encounter access barriers, experience care of lower quality due to well-documented disparities, have multiple social risks, and have fewer resources to navigate the health system,” observed Genovese. “In contrast, people with better access to care may be less exposed to these risks when seeking treatment.”
Can The Trend Be Reversed?
Woolf and the health experts we spoke with agree that America has something to learn from the relative success of other nations.
“We know how to solve this,” according to Woolf. “Other countries that have outperformed the United States for decades have demonstrated that better health outcomes are possible. What we lack in the United States is not solutions but political will.”
Universal healthcare is employed in every industrialized country in the world, except the United States. Here, we rely on a hodgepodge of private insurance, employer health plans, and government programs such as Medicare and Medicaid.
Canada, the U. K. and European countries use government funding to guarantee care for everyone. Mexico is the newest country to adopt this model. It will begin phasing in universal healthcare in January. The healthcare professionals we talked to think it might help to examine that approach.
“Countries such as the United Kingdom and Germany provide universal health coverage and have established paid sick leave protections,” Genovese points out. “The U.S. could draw lessons from these approaches by expanding access to affordable primary care and preventive services and strengthening worker protections.”
“Other developed countries offer useful lessons. Universal access to primary care, stronger preventive services, paid medical leave, and more effective social protection are all worth examining,” observed Hasan. “We don’t need to replicate another country’s healthcare system. We need to adopt policies that have demonstrated results and adapt them to American circumstances.”
Need For A Unified National Strategy
Health professionals SavingAdvice contacted indicated that a major failing of America’s healthcare system is its segmented nature.
Dr. Raymond Douglas, MD, PhD, is a professor at Cedars-Sinai Medical Center. He also researches the development of the autoimmune disease TED (Thyroid Eye Disease). As such, he acknowledges the value of specialization. However, he also considers that this kind of approach is more on the reactive side.
“If we only treat each of these health threats in isolation, we’ll inevitably miss the bigger picture, and I think that’s one of the major faults of our health policies. Yes, funding for disease-specific intervention is good, but it’s at best a band-aid solution without a unified national strategy to root out the cause. At worst, we’re actively bleeding out money to treat these preventable conditions when we can be more proactive and invest in community-based public health efforts.”
Economic Disparities and Public Policy
“Economic insecurity has direct health consequences,” noted Hasan. “Financial stress contributes to hypertension, depression, poor sleep, and other conditions. Food insecurity affects nutrition and metabolic health. Housing instability disrupts treatment and increases psychological stress.”
“These pressures accumulate, creating burden and distress long before appearing in mortality statistics,” added Genovese. “When financial stress becomes overwhelming, your mind and body can pay a heavy price. Some health effects of prolonged stress may persist even after the original stressor has been removed.”
“My central concern is that we’ve built a very expensive system for managing illness without creating an equally effective system for maintaining health,” argues Hasan. “The economic consequences go well beyond medical costs. Premature mortality reduces productivity, household wealth, and economic participation while increasing caregiver burdens.”
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Max K. Erkiletian is a seasoned journalist and analytical reporter with nearly 40 years of experience. He has been nominated for several honors and was part of a team that won the Missouri Press Association’s Community Service Award.
His experience has included covering a wide range of topics, from crime reporting to politics and music. His interview subjects have included U.S. Senators, such as Tom Eagleton; economists, such as Arthur Laffer; former Fed Chair Paul Volcker; and musicians, such as Muddy Waters and B. B. King.
Today, he focuses on personal finance, consumer protection, economic shifts, and investment trends. His reporting aims to make complex issues understood and show how events impact consumers’ wallets.
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