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Journal Article


Better Health Care: A Way Forward

doctor patient health insurance


Whether measured against international or domestic standards, the U.S. health care system could perform much better than it does. For example, if health care costs had increased since 1980 at the rate they did in Switzerland, the United States could have saved nearly enough—about $15.9 trillion—to retire the national debt. And if the national rate of health insurance coverage were the same as the average of the five U.S. states with the highest rates, an estimated 20 million more Americans would have been insured in 2014.

What the Study Found

Writing in the Journal of the American Medical Association, Commonwealth Fund President David Blumenthal, M.D., looks at three areas where the U.S. can make large improvements yielding great benefits to the American people.

  • Expanding access to health care services. Because of the Affordable Care Act, the uninsured rate stands at a historic low of 9 percent. But continued gains would be possible by broadening the Medicaid expansion to additional states; by ensuring the viability of the insurance marketplaces by reaching out to a diverse population of enrollees; and by maintaining the law’s individual mandate.
  • Controlling the costs of care. The last five years have been marked by modest health care cost growth. Maintaining this low growth rate will require a move away from fee-for-service reimbursement and toward approaches like accountable care organizations and bundled payment. It will also be important to find a way to control the cost of prescription drugs, potentially by allowing Medicare and Medicaid to negotiate with pharmaceutical companies. 
  • Improving quality of care. Reforming payment to reflect—and reward—the quality of care delivered will require simplified measurement systems, data collection that can deliver feedback in close to real time, and the ability for medical information to follow patients through the health care system.


Changing our massive, complex health system will be a difficult challenge. But domestic and international models show it is possible. “The means to improve exist, if the political will exists to seize them,” concludes the author.

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


D. Blumenthal, "Better Health Care: A Way Forward," Journal of the American Medical Association, published online March 3, 2016.