Can US well being care clear up its value disaster by copying Europe? – DW – 11/27/2025 | EUROtoday

The steep value of well being care stays a thorny political situation within the United States.

Disagreement over the extension of well being care subsidies was on the heart of the current 43-day authorities shutdown. And President Donald Trump’s approval rankings have been severely hit by value of dwelling issues, together with on the hovering value of well being care.

Trump has persistently promised to chop prices and this week was anticipated to announce particulars of a brand new plan concerning the attainable extension of subsidies from the Affordable Care Act, sometimes called Obamacare.

However, the announcement was postponed amid uncertainty over exactly what he’s planning.

“Somebody said I want to extend them [subsidies] for two years,” Trump mentioned on November 25. “I don’t want to extend them for two years. I’d rather not extend them at all.”

The ongoing debate has as soon as once more drawn consideration to the US well being care system, generally thought to be the costliest on the earth.

Is the US system the costliest?

According to an OECD report entitled Health at a Glance 2025launched in November 2025, the US spends probably the most on well being care on the earth by a distance, per capita. The hole between the US per-capita spending and second-placed Switzerland is bigger than the hole between Switzerland and Italy in twenty third place.

John McDonough, professor of public well being follow on the Harvard T.H. Chan School of Public Health in Boston, USA, says the rising value of well being care within the US has been a critical situation for many years.

“If you’ve heard the overused metaphor in the United States: this is the frog in the slowly heating water, where the temperature keeps growing and people just say, ‘my, it’s getting hot in here'” he advised DW. “This has been going on for almost half a century now.”

Experts say that on one degree, US well being care is extraordinarily costly as a result of it offers world-class providers and excessive ranges of innovation, influential the world over.

However, this comes at such a excessive value, says McDonough, together with “vast disparities in outcomes and quality for people who are lower income, for African-Americans and Latinos.”

“So, yeah, there’s a lot of good stuff. There’s a lot of good innovation. There’s a lot of excellent care that is provided. And there are major, major flaws and  shortcomings in this system,” he added.

Jon Cylus from the European Observatory on Health Systems and Policies in Brussels, Belgium, says a serious driver of excessive prices within the US is excessive costs for insurance coverage and different providers, with a scarcity of transparency and controls on how costs are set.

“I don’t think there’s a clear answer to why prices are so high, aside from the fact that it’s a market that will bear it,” he advised DW. “There’s a lack of price transparency. It’s very difficult. You can’t really shop around in the system.”

According to Klaus Hurrelmann, senior professor of public well being and training on the Hertie School in Berlin, the problem of excessive costs is rooted in a extremely commercialized market ethos that underpins the US system of healthcare.

Speaking with DW, he famous that within the US “market mechanisms dominate” and people are primarily chargeable for “securing their life opportunities.” This consists of well being care as a “market good with selective state intervention.”

McDonough strongly agrees, saying that Americans had allowed well being care to be “too dominated by business and corporate ethics,” together with an excessive amount of “financialization  and commercialization” infecting the system.

“The system, in many ways, it’s no longer about the patient. It’s about maximizing shareholder value for the people who are the owners.”

Too many programs and never sufficient protection

The US system isn’t centralized, with a number of types of well being care provision and insurance coverage obtainable.

The Medicare program covers folks aged 65 and over, whereas Medicaid goals to assist low-income households. There can be employer-provided medical insurance referred to as Employer Sponsored Insurance (ESI) and separate packages for navy veterans and for Native Americans. There can be the choice of shopping for particular person insurance coverage from non-public insurers.

However, in accordance with current estimates from the US Census Bureau and the CDC’s National Health Interview Surveyat the least 8% of the inhabitants — greater than 25 million folks — haven’t any medical insurance protection.

The Commonwealth Fund, a personal American basis which commonly measures US well being care efficiency towards that of different rich nations, routinely finds that the US has the worst-performing well being care system total amongst 10 high-income nations it profiles.

The different nations it profiles are Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom.

Looking to Europe

Health coverage analysts usually speculate about the potential for the US taking classes from a few of the nations that outperform it in these survey, notably on the subject of the problems of affordability and protection.

Klaus Hurrelmann says that whereas the German system has qualities that make it a world reference level, “it is not a simple blueprint to be copied.”

Germany’s advanced system entails obligatory medical insurance schemes and widespread entry to providers, which, in accordance with Hurrelmann, gives “important lessons, especially the commitment to universal access and solidarity-based financing.”

“But it is not a plug-and-play model,” he burdened. “It works because it fits a specific welfare-state philosophy and political culture that differ significantly from many other parts of the world.”

Hurrelmann additionally factors to affordability points amid rising insurance coverage prices which embody so-called out-of-pocket further funds for sufferers.

John McDonough doesn’t mince his phrases when requested if he would really like the US to have a German or Swiss mannequin of well being care. “I would take almost any other nation’s system. It’s just that they’re all better than what we do,” he mentioned.

He believes  the important thing to these programs’ success is an ethos of nonprofit and the truth that they must function underneath constant guidelines.

“In the United States right now, we have massive for-profit entities that have been consolidating and growing and dominating the system in particularly harsh and harmful ways that is creating a lot of the chaos that we see,” mentioned McDonough.

For Hurrelmann there’s a profound philosophical distinction between how most European governments see well being care and the way the US authorities sees it.

“In Europe, health is widely seen as a social right. In the US, it is much more often seen as a private responsibility. This deeply influences system design, financing, and public expectations,” he argued.

Edited by: Uwe Hessler