New data from the West Health-Gallup Affordability Index reveals that only about 49% of U.S. adults consider themselves “cost-safe,” a notable drop from 56% in 2021.

Nearly three-quarters of American adults report that health care costs are a financial burden. Anxiety about being able to pay these costs has increased, with more than 50% expressing extreme concern about their ability to cover essential services in 2026.

“I had to start calculating if I could pay for tuition, books, living expenses and also continue to support my family,” Twannetta Weaver, 43, of Sanford, Florida, said in an interview with the Associated Press (AP). “It makes you feel helpless as a consumer.”

It is not an isolated case; Weaver's experience is familiar to a growing number of Americans, according to Gallup polling.

Inequalities in health care affordability

Data shows that health care affordability has decreased across several demographic groups, especially among young adults and women. Only one-third of Americans under age 30 consider themselves “cost-safe.”

Many adults have faced difficult decisions in managing their medical bills. About 2 in 10 respondents could not afford prescription medications, while 30% avoided seeking treatment due to costs. Stories like Xavier Chapa's illustrate the financial strains that affect families.

Paradox of health care in the US

The United States spends almost twice as much as the developed country average on health care, without achieving better health outcomes. In 2021, the US spent twice as much as the average of Organization for Economic Co-operation and Development (OECD) nations on health care, and its health spending was three to four times higher than that of countries such as New Zealand or Japan.

Per capita spending and percentage of GDP

The cost per person in the US is dramatically higher. In 2019, the United States spent approximately $11,100 per person on health care, the highest per capita cost in the OECD. Switzerland, the second-highest spending country, had about $7,700 per person, while the average for rich OECD countries (excluding the US) was just $5,500 per person. More recently, in 2023, Americans spent more than $12,000 per person, compared to $6,000 in Canada or $5,000 in Germany.

In terms of Gross Domestic Product, the US allocated 17.8% of its GDP to health, almost double that of other countries. Compared to the range of other countries, whose health expenditures represent between 96% of GDP (Australia) and 12.4% (Switzerland), the difference is abysmal.

Drug prices and administrative costs

The main reason for high spending lies in the disproportionate prices of drugs, medical devices and procedures. Each American spent an average of $1,443 on medications, compared to $749 per person in the rest of the countries in the study. Insulin can cost 10 times more in the US than in Canada.95 Additionally, the US spends about $940 per person on administrative costs, four times more than the average for other wealthy countries. These administrative costs represent 8% of GDP in the US, more than double the average of 3% of GDP in other countries.35

Health results

Despite this massive investment, the United States has the worst outcomes among high-income countries: lower life expectancy, higher infant mortality rates, and poorer overall health quality. The Commonwealth Fund consistently concludes that the US has the least efficient health care system of the high-income countries it analyzes.

Ultimately, U.S. citizens pay significantly more for health care—from MRIs to surgeries to medications—without receiving better quality of service or better health outcomes than their counterparts in Europe, Canada, Japan, or Australia.

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