America is ready for an honest conversation about health care policy before more people suffer and we go broke waiting for it to happen. Fully one-third of Americans report that in the past 12 months they have skipped or postponed getting needed health care because of the cost. Thirty percent say that they or a family member had problems paying for health care in the past year, and 41 percent of Americans report they have incurred significant medical debt. Very simply, too many people cannot afford the health care that they desperately need.
Most policymakers recognize that America’s approach to health care is too expensive. In 2024, the bill ran to $5.3 trillion, some $15,474 per person and 18 percent of our Gross Domestic Product. Moreover, costs are expected to grow far faster than inflation. Last year it was up 7.2 percent from the year before, and by 2033, it is expected to consume 20.3 percent of GDP: $8.6 trillion overall or $24,200 per person.
Americans are not happy with partisan posturing over health care, which resulted in last year’s government shutdown, the longest in our history, but accomplished nothing. Fixing our health care system is the top priority for 43 percent of Americans, surpassing housing (35 percent), jobs (31 percent), immigration (24 percent), and crime (21 percent).
Congress and the Administration could start by establishing a truly bipartisan Blue Ribbon Health Reform Commission, similar to the 9/11 Commission. It should begin with three initiatives:
1. Demand transparency from the medical community
First, it needs to task the medical community itself with understanding and candidly explaining why the American approach to health care is so much more expensive than those of other first-world nations while often producing significantly worse outcomes.
For example, consider Switzerland, whose health care expenditures are second behind the U.S. They spend just 72 percent of what America does, per capita, but their maternal mortality rate is dramatically better: just 2.5 deaths per 100,000 live births, compared to the United States with 18.6. Or Sweden, which spends just 56 percent per capita of what the U.S. does but has an average life expectancy of 84.3 years compared to America’s 78.4 years. Canada, which spends about half per capita of what the U.S. spends, has 94.1 hospital admissions per 100,000 for unmanaged diabetes compared to America’s 230.9. Not every outcome measure is a stark, but too many are.
Similarly, medical professionals can best explain why the average length of an inpatient hospital stay is 6.8 days in the U.S. whereas in France and Germany it is about nine days. And yet the cost in the U.S. is far higher: An appendectomy performed in Germany costs 29 percent of what it does in the U.S. A hip replacement in the U.K. costs 51 percent of what it costs in the U.S. The use of certain procedures, like coronary angioplasties, is even more frequent in countries like Germany, Switzerland, and France than in the U.S., but cost far less. The cost in Switzerland, for example, is $9,347 per procedure, while the public insurance (Medicare) cost in the U.S. is $17,183. Private insurance pays even more: $34,504.
The medical community has experience addressing tough questions and making dramatic changes. In 1982, after a spate of bad publicity triggered by large malpractice verdicts, the American Society of Anesthesiologists conducted a comprehensive assessment of what had been injuring patients. They then revamped their procedures, established mandatory monitoring, improved training, limited the number of hours anesthesiologists could work without rest, redesigned machines, and outfitted others with safety devices. Within ten years, the mortality rate from anesthesia dropped from one in 6,000 administrations to one in 200,000. And anesthesiologists’ malpractice insurance rates fell to among the lowest of any specialty.
2. Reform the health insurance industry
Second, the Commission needs to tell the health insurance industry that it can no longer be part of the problem but part of the solution. Most studies estimate that between 15 percent and 30 percent of the cost of the American health care system is insurance administrative burden and profit; and health outcomes, because of prior authorization, are worse. Alternatively, it can go the way of Blockbuster. But the gravy train it has enjoyed for decades, since the advent of Obamacare, the top five health insurance companies have seen their combined profit rise from about $12 billion to more than $50 billion annually, is over.
3. Lower pharmaceutical costs
Third, the Commission should task the pharmaceutical industry with bringing the cost of drugs down, comparable to what they cost in other nations. Drug costs account for about nine percent of total health care costs in the U.S. As a major study by the RAND Corporation found in 2024, the price of drugs in the U.S. is 2.78 times those seen in 33 other nations. And the price of generic drugs, which account for 90 percent of prescription volume in the United States, are about one-third more expensive in the U.S. than in the comparison nations.
Health care accessibility and affordability go hand in hand. It is an embarrassment that what used to be known as the greatest country in the world cannot even discuss the challenge honestly. And until we do, we cannot solve it.
Steve Cohen is an attorney and can be reached on LinkedIn. Steve’s practice epitomizes the intersection of law, policy, and journalism—with the realities of politics thrown in for good measure. For 35 years before going to law school, Steve was a successful publishing executive—including at Time and Scholastic—best-selling author and CEO of three internet start-ups. Since teaming up with Adam Pollock in 2018, he has learned to bring that unusual background, diversity of experience, and skills to the law.
