In 2024, the United States spent $14,885 per person on healthcare - the highest of any nation on earth. Switzerland was the second-highest spending country at $9,963 per capita, while the average for comparable wealthy nations, excluding the US, was $7,371 per person.
So what are we buying?
This is the only question that matters in this conversation. Because if spending more than any nation in history on healthcare produced a healthier population, we could debate the price. We could argue about efficiency and infrastructure and the cost of innovation. But it is not producing a healthier population. The gap between what we spend and what we get is a structural indictment.
The numbers, plainly stated
Life expectancy at birth in the US reached its highest level ever in 2024, 79.0 years. The average life expectancy in comparable countries, however, was 82.7 years. The US sits third-lowest among all OECD (Organization for Economic Cooperation and Development- a consortium of 38 “developed, democratic countries” across the globe) countries, ahead of only Mexico and Turkey. Life expectancy is highest in Switzerland at 84.3 years, Japan at 84.1, and Spain at 84.0.
We spend twice as much per person as those countries. We die 4 years earlier.
Americans spent $8,353 per person on inpatient and outpatient care compared to $3,636 in peer countries on average. That $4,717 per-person gap does not reflect more care. Health care utilization in the US including everything from doctor visits to surgeries, is generally lower than in other wealthy countries. We are not getting more medicine for our money. We are paying more for the same or less medicine, delivered through a system that consumes an extraordinary percentage of every dollar before it reaches anyone in a clinical setting.
Spending on health administration in the US runs $925 per capita compared to $245 in comparable countries. This difference of $680 per person produces zero clinical outcome. Sweden spends 22 times the amount on long-term care as it does on administrative costs. The United States spends approximately the same amount on both.
This is not inefficiency. It is a system in which extraction is not a flaw. It is the function.
The maternal mortality number that should end the debate
I want to spend a moment on one metric specifically because it speaks most directly to the women this series is written for and about, and because it is the most irrefutable evidence that what we are spending our $14,885 on is not, in any meaningful sense, the health of women.
The US maternal mortality rate fell to 17.9 deaths per 100,000 live births in 2024 - the lowest it has been since 2018. The CDC framed this as progress. And in the narrowest sense, a number moving in the right direction is better than one moving in the wrong direction.
But context is everything.
Nearly every demographic group of American mothers dies at a higher rate than all mothers in peer nations. The maternal mortality rate for Black women in 2024 was 44.8 deaths per 100,000 live births. This is significantly higher than rates for white women (14.2), Hispanic women (12.1), and Asian women (18.1). The 2025 March of Dimes Report Card shows that American Indian/Alaska Native women had the highest rate of all, at 60.8 per 100,000.
And then there is this: more than 80% of pregnancy-related deaths in the United States have been deemed preventable. Not unavoidable tragedies. Not the outer limits of medical knowledge. Preventable. Deaths that did not have to happen, in the wealthiest healthcare-spending nation on earth, and that happened anyway - disproportionately to women of color, and not only in communities with inadequate access to the prenatal care, the postpartum monitoring, the specialist availability that might have caught the warning signs in time.
We are spending $14,885 per person and failing to prevent the deaths of women in childbirth. If that is not the definition of a values failure, I do not know what is.
Why the price is high and the outcomes are low
The gap between US spending and US outcomes is not primarily explained by the cost of medical technology, the complexity of an aging population, or the price of pharmaceutical innovation. Despite spending twice as much on healthcare per capita, utilization rates for many services in the United States are lower than other wealthy OECD countries. Prices, therefore, appear to be the main driver of the cost difference. We are not buying more healthcare. We are paying more for it. And a significant portion of what we pay does not go to care at all. It goes to the layer that sits between care and the people who need it.
I have spent Parts 1 through 3 of this series mapping that layer. The RVU system that pays physicians by volume and undervalues the time-intensive, relationship-based work of ( women’s, but really all preventive and good primary care) health. The administrative infrastructure that consumes nearly two dollars for every dollar of direct patient care. The AI systems being deployed not to improve care but to deny it faster. The insurance companies whose profit depends on the distance between what they collect in premiums and what they actually pay out.
All of that is the intermediary layer. The US has the highest rate of preventable and treatable deaths for all ages among comparable wealthy nations, the shortest lives, and the most avoidable deaths. And the intermediary layer is the primary mechanism producing that outcome.
What other systems have figured out that we have not
Listen, Canada, the UK, Germany do not have perfect healthcare systems. Every system on earth has waiting times, rationing decisions, inequities, and failures. Let’s not romanticize what exists elsewhere.
But those systems have something that we don’t. It is a decision.
Every other wealthy democracy has made a decision - argued over, imperfect, continuously renegotiated - that your ability to access healthcare should not be primarily determined by how much money you have. That is it. No magic involved. That is THE structural difference. Not whether it’s single-payer or multi-payer or a national health service. The mechanism is almost beside the point. The decision is what matters.
And the US has not made it.
What we have instead is a system in which the price of care is set not by what care costs to deliver but by what the market will bear. We are committed to a system in which a sprawling intermediary layer of insurers, administrators, pharmacy benefit managers, and billing departments extracts value at every point between the patient who needs care and the clinician trained to provide it. Other wealthy nations have mechanisms that constrain that layer. We have built our entire system around it.
The results are not ambiguous. The Commonwealth Fund has compared health system performance across ten wealthy nations. The US ranks last across virtually every measure of quality, access, equity, and outcomes. The countries that outperform us are not outliers, they are the norm. We are the outlier.
It has been estimated that universal health care could have saved 212,000 lives in 2020 alone. Not over a decade. In a single year. 212,000 people. That body count is an indictment. And it is the direct consequence of a choice this country has made, and keeps making, to treat healthcare as a commodity rather than a right.
Who paid the price? The people this system has always served least: communities of color, low-income families, rural populations, uninsured and underinsured workers, and as this entire series has documented, women whose bodies, symptoms, and biological transitions have been systematically undervalued by the financial architecture of American medicine from the beginning.
We spend $5.3 trillion a year on healthcare. We are a wealthy country that can afford to do better. We are country that has chosen not to.
The menopause lens
Menopause affects approximately 1.3 million women per year in the United States. It is a universal biological transition affecting half the population for an average of seven to ten years and /3 to ½ of our lives, with documented impacts on cardiovascular health, bone density, cognitive function, mental health, sexual health, sleep, and overall quality of life. It is not a niche condition. It may actually be the most universal health experience on earth.
And yet the US healthcare system has no dedicated reimbursement infrastructure for menopause care. No required clinical training standard. No prevention-focused payment model that rewards a physician for the time it takes to do a comprehensive menopause evaluation, build a treatment plan, and follow a patient through a decade of hormonal transition and beyond. In major US cities, the typical waiting period for new patients to secure an appointment with a physician varies between 27 and 70 days. From what I hear locally, the UCLA Menopause Center is not even keeping a waitlist and it takes up to a year to be seen there.
The structural constraints that make menopause care so inadequate in the US are not inevitable features of any healthcare system. They are specific choices made by this one.
The question we keep avoiding
Every time this conversation approaches the obvious conclusion, that the US needs structural reform of how healthcare is financed and delivered, a familiar set of objections arrives. Frenzied cries of “Socialized medicine!”” Government overreach!” “The destruction of innovation!”” The end of patient choice!”
I will not litigate those objections here. But I will say this: the country that leads the world in healthcare spending, trails its peers on every major health outcome metric, allows the preventable deaths of women in childbirth at rates that peer nations find unconscionable, and has built a billing and denial infrastructure that consumes as many resources as actual care delivery is a country that has already made its values choices. The current system is not a neutral market outcome. It is the result of specific policy decisions, made and remade over decades, that consistently prioritized the financial interests of intermediaries over the health interests of patients.
The question is not whether we have the finances to support an innovative approach, it is whether we have the political will to stop paying the people who process care and start paying the people who deliver it.
That is a political question and it is also a moral one. And it is the one that the menopause generation - the most educated, most professionally networked, most economically powerful cohort of midlife women in American history - is uniquely positioned to force into the center of the conversation.
We are not asking for more than other wealthy nations already provide their citizens.We are asking for what $14,885 per person should already be buying.
Up next → Part Five: The Revolution Will Be Relationship-Based — what we are already building, why it works, and what it will take to scale it.
Dr. Suzanne Gilberg is a board-certified OB/GYN, integrative medicine physician, Chief Clinical Officer at MonarchMD, and founder of the Menopause Boot Camp. She is the author of Menopause Bootcamp and the forthcoming Plant Medicine: A Modern, Science-Based Guide to Ancient Wisdom, Medicinal Herbs, and Healing Plants. Find her at @askdrsuzanne and @themenopausebootcamp.