The U.S. Health Care System Is Broken. It's Time for Real Reform | Opinion

Americans pride themselves on leading the world in innovation, freedom, and opportunity. Yet, when it comes to health, the numbers tell a damning story.

Life expectancy in the United States is 79.25 years, ranking a dismal 40th globally—well below its wealthy peers. A report published in the prestigious journal The Lancet, authored by 622 international researchers and forecasting health trends for the U.S. from 2022 to 2050, offers an even grimmer outlook. By 2050, the U.S. is predicted to plumment to 66th place in life expectancy rankings. Despite spending an astronomical $4.5 trillion on health care, the U.S. trails other high-income nations like Japan, Switzerland, and Australia, underscoring the profound failure of the country's health care system to deliver on its most basic promise: improving health outcomes. How did it come to this?

The U.S. health care system is in disarray. Despite spending nearly 18 percent of its GDP on health—the highest among high-income countries—the United States ranks last in outcomes such as life expectancy and preventable deaths, according to both The Lancet and the Commonwealth Fund's Mirror, Mirror 2024 report. Administrative inefficiencies, fragmented care, and inequities exacerbate the problem. Preventable risk factors such as obesity, poor diet, and substance use drive a significant portion of these poor outcomes. If ignored, these issues will cost the U.S. a staggering four years of potential life expectancy gains by 2050, while more than 12 million preventable deaths accumulate. These trends underscore systemic failures, an indictment of a system that prioritizes profit over people.

This broken system needs radical change. The challenges extend far beyond inefficiencies. Chronic diseases dominate the landscape, disproportionately crushing low-income and marginalized communities. Health disparities are not just statistics; they are daily tragedies exposing a moral and economic crisis. Other nations achieve better results with fewer resources, yet Americans endure higher rates of suffering and preventable deaths. Addressing these issues requires a radical transformation, prioritizing evidence-based public health strategies and policies that tackle root causes rather than symptoms. Universal access to affordable, high-quality care must become a reality, not just an aspiration.

American health care is a paradox: The developed world's most expensive health system delivers some of its worst results. Even as expenditures continue to soar, millions of Americans delay or forgo care due to unaffordable costs. This dysfunction disproportionately harms low-income populations, worsening inequities and further straining an already overburdened system. Rural states like West Virginia have life expectancies akin to those in developing nations, while wealthier states like California boast outcomes comparable to European ones. These inequities are morally indefensible and economically unsustainable, demanding systemic reform to ensure equitable, high-quality care for all.

Reforming the U.S. health system is no small feat. The country's size, diversity, and entrenched political divisions present unique challenges. Public distrust of government, amplified by industry lobbies, fuels resistance to policies like health taxes. Worse, the shifting priorities of new administrations often undermine long-term, evidence-informed policymaking. Yet, the alternatives—rising costs, worsening disparities, and a continued decline in global health rankings—are unacceptable.

Reform should begin at the heart of the U.S. health crisis: chronic diseases and preventable risks like smoking, obesity, poor diet, and substance abuse. The Lancet emphasizes that reducing such preventable risks could substantially improve outcomes, adding nearly four years to American life expectancy by 2050. Effective strategies include health taxes on harmful products like tobacco, sugary beverages, and alcohol. Such taxes, proven effective worldwide, reduce consumption while generating revenue for public health initiatives. Yet industries producing these products thrive, protected by political lobbying and weak regulation. Tobacco, sugary drink, and alcohol companies rake in massive profits while their products lead to preventable deaths. The time for timid policy is over. Bold, unflinching interventions are necessary to curb these risks and shift the trajectory of public health.

The United States stands at a crossroads. The projections are clear: without intervention, life expectancy will continue to stagnate, health disparities will widen, and the country's global rankings will nosedive. Lessons from nations with better-performing health systems are abundant. Addressing health inequities, reducing preventable risks, and ensuring universal access to care are not impossible tasks. Public health must take its rightful place as a cornerstone of national policy, insulated from political whims and guided by science. The evidence is clear, the stakes are enormous, and the time to act is now. America's health crisis is not inevitable—unless we choose to ignore it.

Habib Benzian is a professor at New York University's Dental College, Co-Director of a WHO Collaborating Center, and a Public Voices Fellow of the OpEd Project.

The views expressed in this article are the writer's own.