America First? On Health, America’s Worst!

by John Dalton, Executive Director, Healing American Healthcare Coalition™

The past weekend’s news included reporting from CPAC touting former President Trump’s “America First” policy. When it comes to America’s health, that thought could hardly be further from the truth. Data released last week by the Commonwealth Fund1 shows America as the biggest spender with the poorest outcomes among the 11 industrialized members of the 37 member Organisation for Economic Co-operation and Development (OECD). Annually, the Fund updates performance for Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Here are the 2019 results:

  • The U.S. spent 17.0% of GDP on healthcare. Spending by the other ten countries ranged from 9.3% to 12.1% of GDP. Average for the entire OECD: 8.8%.
  • The U.S. spent $10,637 per capita compared with an OECD average of $4,224 and a range of $4,205-7,732 for the other ten.
  • U.S. average life expectancy of 78.7 years was 3.0 years less than the OECD average of 80.7 years and 5.1 years less than Switzerland.
  • The U.S. also was highest in the OECD for suicide rate/100,000 (14.5 vs. the OECD average of 11.2), adults with multiple chronic conditions (29.0% vs. the OECD average of 17.7%) and obesity (40% vs. the OECD average of 24%).

The sole indicator where the U.S. excels is in five-year net survival rates for breast cancer (2014-18). The Commonwealth Fund’s data precedes the COVID-19 pandemic where the U.S. performance has been among the worst in the OECD2. The U.S. is the only OECD member that does not recognize access to healthcare as a fundamental human right and provide universal healthcare. At February month-end, the U.S. fatality rate of 154.8/100,000 is 41.6 percent higher than the OECD average of 109.3/100,000.

Further proof: last month Lancet, the prestigious British medical journal, released the report of its Commission on Public Policy and Health in the Trump Era3. Noting that “the Trump administration policies posed a uniquely urgent threat to health,” the trilateral (U.K., U.S. and Canada) Commission’s aims included identifying major health-related policy actions in the Trump era (2017–20), evaluating emerging data on their effects and recommending alternative and more salutary policies to the next U.S. administration.

One key finding: “Trump’s mismanagement of the COVID-19 pandemic—compounded by his efforts to dismantle the USA’s already weakened public health infrastructure and the Affordable Care Act’s (ACA) coverage expansions—has caused tens of thousands of unnecessary deaths.” The report is critical of actions taken by the Trump administration prior to the pandemic including a 2017 hiring freeze at the CDC that left 700 positions vacant and halting OSHA’s development of airborne infection control standards for workplaces. He eliminated the National Security Council’s Global Health Security and Biodefense Directorate in 2018. Had the U.S. merely matched the average of the other G7 nations, 40% fewer lives would have been lost.

The report concludes: “The suffering and dislocation inflicted by COVID-19 has exposed the frailty of the US social and medical order, and the interconnectedness of society. A new politics is needed, whose appeal rests on a vision of shared prosperity and a kind society. Health-care workers have much to contribute in formulating and advancing that vision, and our patients, communities, and planet have much to gain from it.”

One such vision is described in detail in 2019’s “Healing American Healthcare: A Plan to Provide Quality Care for All, While Saving $1 Trillion a Year.” The Eichhorn-Hutchinson Allcare plan depicted therein provides a practical path to universal healthcare for all Americans. Like Bidencare, it builds on the strengths of the Affordable Care Act without the economic disruptions of Medicare-For-All. Allcare relies on competition and choice, and includes a public option based on Medicare.

It’s time for all Americans to unite behind moving America’s healthcare system from worst to first!

John Dalton, FHFMA, is Executive Director of the Healing American Healthcare Coalition and Editor of Three Minute ReadTM, its twice-monthly newsletter.


  1. Multinational Comparisons of Health Systems Data, 2020, Roosa Tikkanen and Katharine Fields, The Commonwealth Fund, February 25, 2021
  2. The COVID-19 Pandemic – How is the U.S. Doing? Part 3, Garden State Focus, vol 67 num 2, Winter 2021
  3. Public policy and health in the Trump era, multiple co-authors, The Lancet Commissions| Volume 397, ISSUE 10275, P705-753, February 20, 2021

Contact Information:

John J. Dalton, FHFMA, Executive Director

Healing American Healthcare Coalition

PO Box 3264

Mercerville New Jersey 08619-1927


Mobile: 732-310-8782

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