By most measurable outcomes, the average European healthcare system outperforms the United States, despite the US spending far more per person. The US ranked dead last among ten high-income nations in the Commonwealth Fund’s 2024 Mirror, Mirror report, finishing behind Australia, the Netherlands, the United Kingdom, and every other European country assessed. But the picture is more nuanced than a single ranking suggests. The US leads in some areas, particularly speed of drug approvals and access to cutting-edge treatments, while falling behind on life expectancy, affordability, and equity.
What the US Spends vs. What It Gets
The spending gap is staggering. In 2024, the United States spent over $14,880 per person on healthcare, roughly 2.5 times the OECD average of about $6,000. Even the next-highest spenders in Europe, Switzerland and Germany, came in at $9,300 to $10,000 per person, about two-thirds of the US level.
That extra money does not translate into better population health. US life expectancy hit a record high of 79.0 years in 2024, but that still trailed comparable wealthy nations by 3.7 years (their average was 82.7). The rate of deaths from treatable causes, conditions where timely medical care should prevent death, tells a similar story. The OECD average is 77 deaths per 100,000 people. Switzerland, the top European performer, sees fewer than 45. The US consistently lands well above that average. In other words, Americans are more likely to die from conditions that good healthcare should catch and treat.
Affordability and Access
This is where the gap between the US and Europe is widest. More than one in four Americans report skipping doctor visits, tests, treatments, or follow-up care because of cost. Twenty-one percent skip medications for the same reason. And these aren’t just uninsured people: only about 9% of the US population lacks insurance. The majority of those skipping care have coverage but still can’t afford to use it, thanks to high deductibles, copays, and out-of-pocket costs.
European countries with universal coverage still see some cost-related barriers, but at far lower rates. The structural difference is straightforward: most European systems cap what patients pay out of pocket, either through national health services (like the UK’s NHS) or regulated insurance markets (like Germany and the Netherlands). Medical debt as a widespread financial crisis is essentially an American phenomenon.
Wait Times: The US Advantage That’s Overstated
The most common argument in favor of US healthcare is speed. Americans often assume European systems force patients into long queues for specialists and surgeries. There’s some truth to this, but it’s exaggerated and inconsistent across countries.
Across OECD nations, about 52% of patients wait a month or longer for a specialist appointment. Canada and the UK are the worst performers, with more than 10% of patients waiting over a year. But Germany, the Netherlands, and Switzerland generally have shorter specialist wait times that are competitive with the US. The “long European wait times” stereotype applies more to the UK and Scandinavian countries than to continental Europe’s insurance-based systems.
The US does offer faster access for patients who can pay, particularly for elective procedures and specialist consultations. But for the millions who delay or skip care entirely because of cost, speed is irrelevant. A system you can’t afford to enter has an infinite wait time.
Managing Chronic Conditions
Hypertension is a useful benchmark because it’s common, measurable, and directly affected by how well a health system manages ongoing care. The US actually performs reasonably well here. About 73% of American women and 66% of American men with high blood pressure receive treatment, comparable to top European performers like Iceland (72% for women, 71% for men) and Portugal (71% for women). Germany trails slightly for men at 61%.
This reflects a genuine strength of the US system: once patients are inside it and receiving care, clinical quality can be very high. American hospitals and physician practices often follow aggressive treatment protocols, and the country’s investment in medical technology is unmatched. The problem is that access to this high-quality care is unevenly distributed by income, insurance status, geography, and race.
Drug Approvals and Innovation
The US leads the world in pharmaceutical innovation and speed of access to new therapies. The FDA typically approves new drugs faster than its European counterpart, the EMA. For cancer drugs approved between 2010 and 2020, the median gap was 227 days, meaning European patients waited roughly seven and a half months longer to access the same treatment after FDA approval.
This advantage is real and meaningful, especially for patients with serious or rare diseases. The US market’s willingness to pay high drug prices creates strong financial incentives for pharmaceutical companies to develop new treatments and launch them in America first. Europeans benefit from this innovation eventually, but with a delay. The tradeoff is that Americans pay dramatically more for those same drugs, and many can’t afford them even after approval.
How the Rankings Break Down
The Commonwealth Fund’s 2024 report compared ten nations across multiple dimensions. The US ranked last overall and last on four of five health outcome measures. The top three performers were Australia, the Netherlands, and the United Kingdom. France, Germany, Sweden, and Switzerland all placed ahead of the US as well.
It’s worth noting what these rankings measure. They weight equity and access heavily, areas where universal coverage systems have a built-in structural advantage. On measures like care process quality (whether doctors follow evidence-based guidelines, how well care is coordinated), the US performs closer to the middle of the pack. The rankings don’t capture everything. They can’t easily account for the experience of a well-insured American at a top academic medical center, which is arguably the best care available anywhere in the world. But a health system serves a population, not just its luckiest members.
What Each System Does Better
- European systems generally excel at: universal coverage, financial protection, population-level outcomes like life expectancy, fewer deaths from treatable conditions, and more equitable access regardless of income.
- The US system generally excels at: speed of access to new drugs and technologies, clinical quality for insured patients, shorter wait times for those who can pay, and driving global pharmaceutical innovation.
The core difference isn’t really about medical skill or technology. European doctors are not better trained than American ones, and American hospitals are not better equipped in any way that matters for routine care. The difference is structural. European countries treat healthcare as a public system that everyone pays into and everyone can use. The US treats it more like a market, which produces excellence at the top and significant gaps everywhere else. Whether that tradeoff makes one “better” depends on what you value, but on the metrics that matter most for a whole population, European systems consistently come out ahead.