High healthcare costs remain a difficult political issue in the US. It was the disagreements over healthcare subsidies that were at the heart of the 43-day shutdown, and concerns about the high cost of living, including healthcare, hit US President Donald Trump's approval rating.
He has repeatedly promised to cut spending and was expected to announce a new plan these days regarding the possible extension of subsidies from the Affordable Care Act, often called "Obamacare". But the step was postponed. "Someone said I wanted to extend them [the subsidies – ed.] for two years. "But I don't want to extend them by two years - I'd rather not extend them at all," Trump said on November 25.
The US system is the most expensive
The ongoing debate has once again drawn attention to the US healthcare system, which is considered the most expensive in the world. According to the OECD's "Health at a Glance 2025" report, published in November 2025, the US spends the most on healthcare in the world per capita. The gap between the US and Switzerland, which comes in second, is wider than the gap between Switzerland and Italy, which ranks 23rd.
John McDonough, a professor of public health at the Harvard School of Public Health in Boston, says rising healthcare costs in the US have been a serious problem for decades. "If you've heard the metaphor of a frog boiling in slowly boiling water, that's exactly how people feel. They're like, 'Oh, it's getting hot in here.' And it's been like that for almost half a century," he told DW.
On the one hand, healthcare in the US is extremely expensive because it provides world-class services and a high level of innovation that has an impact around the world, experts say. But that's still too high a price, and we also have to take into account "the huge differences in the quality of the product provided to people with lower incomes, to African-Americans and Latinos," McDonough added. He agrees that on the one hand, excellent healthcare is provided with many innovations, but at the same time, the system is characterized by major gaps and shortcomings.
John Silas of the European Observatory on Health Systems and Policies in Brussels, Belgium, notes that a major factor in the high costs in the US is the high prices of insurance and other services, as well as the lack of transparency and control over the way prices are set.
"I don't think there is a clear answer to the question of why prices are so high, other than the fact that the market can bear them", he commented to DW. "There is a lack of transparency in prices. It is very difficult. In fact, in this system you cannot choose the price."
According to Klaus Hurelmann, senior professor of public health and education at the Hertie School in Berlin, the problem with high prices is rooted in the highly commercialized market ethic that underlies the US healthcare system. In an interview with DW, he notes that in the US, "market mechanisms dominate" and that people are primarily responsible for "securing their life opportunities." This includes healthcare as a "market good with selective state intervention."
McDonough agrees that Americans have allowed healthcare to become commercialized, "dominated by business and corporate ethics," which infect the system. "In many ways, the system is no longer about the patients, but about the shareholders, the owners, getting more out of it," he points out.
Too many systems, not enough health insurance coverage
The US system is not centralized - different forms of health care and insurance are offered.
The Medicare program covers people over the age of 65, while Medicaid is designed to help low-income families. There is also employer-sponsored health insurance, called Employer Sponsored Insurance (ESI), as well as separate programs for military veterans and for representatives of indigenous peoples. There is also the option of purchasing individual insurance from private insurers.
According to the latest data from the US Census Bureau and a recent National Survey by the Centers for Disease Control and Prevention (CDC), at least 8% of the population, i.e. over 25 million people have no health insurance coverage.
The private American foundation Commonwealth Fund, which regularly compares the efficiency of healthcare in the United States with that of other wealthy countries, systematically finds that the United States has the most inefficient healthcare system among the 10 countries it studies: in addition to the United States, these are also Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom.
A Look at Europe
Experts often speculate that the US could learn from some of the countries that have outperformed it in this study, especially in terms of accessibility and health insurance coverage.
Klaus Hurelmann gives the German system as an example, but emphasizes that "it is not easy to copy". Germany's complex system includes mandatory health insurance schemes and widely available services, and "important lessons can be learned from it, especially about the commitment to universal access and solidarity-based financing", says the representative of the Hertie School in Berlin.
"But this is not a plug-and-play model. It works because it corresponds to the specific philosophy of the welfare state and the political culture in Germany, which differ significantly from many other parts of the world," Hurelmann explains. He also points to some existing problems, such as affordability amid rising health insurance costs, which include so-called out-of-pocket payments.
John McDonough says he would accept the system of almost any other country. "They're just all better than ours," he says. "Right now in the United States we have huge non-profit organizations that are consolidating, growing, and dominating the system in a particularly cruel and harmful way, which is creating a lot of the chaos that we see."
Klaus Hurelmann also draws attention to another aspect: the huge difference between the way most European governments view healthcare and the one adopted by the US government. "In Europe, health is largely perceived as a social right, and in the US - very often as a personal responsibility. This has a profound impact on the design of the system, its funding and public expectations of it," the expert points out.
Author: Arthur Sullivan