by Margaret Flowers

Healthcare in the United States is overly expensive, deeply unequal, and of poor quality. Most people in the U.S. have either experienced financial or other obstacles to getting the medical care they need, or have a close friend or family member who has had this experience. When compared to other wealthy nations, the U.S. is an outlier for spending the most per capita on healthcare while delivering the worst outcomes. In contrast, China spends less than 3% of what the U.S. spends per capita, while providing nearly universal coverage and improving health outcomes. These differences are largely due to opposing philosophies on the responsibility of governments to provide for their populations.

One distinctive difference between healthcare in the U.S. and China is that the U.S. does not have an actual healthcare system. Rather, the U.S. has a complicated mess of public systems, which are privatized in part or almost completely, and private insurance plans and health facilities, which largely do not communicate with each other or coordinate their activities to benefit the public. The healthcare sector is entirely market-driven and focused on making maximum profits for its corporate executives and shareholders. 

This fact was made tragically salient in December of 2024 when Brian Thompson, the CEO of United Healthcare, one of the major insurance companies, was murdered in New York City on his way to a meeting with investors. The public response to his death was less than sympathetic. Instead, many people criticized United Healthcare for its policies of denying coverage of lifesaving care for its enrollees. As United Healthcare attempted to make changes to its policies to recover its public image, shareholders in the corporation took the company to court,¹ claiming that its new “consumer-friendly” policies were hurting them financially. In the U.S., publicly-traded corporations, including those in the healthcare sector, have a legal responsibility to maximize profits for their shareholders even though it comes at a cost to human health and life.

Profiteering from healthcare in the U.S. began in the early 1970s under the Nixon Administration with the passage of the Health Maintenance Organization (HMO) Act, which permitted private investment in HMO plans and mandated employers to offer these plans to their employees. In the 1980s, healthcare privatization and profiteering took off as the government encouraged and trained private investment groups to enter the healthcare sector.² Another pivotal moment in U.S. healthcare history was the passage of the so-called Affordable Care Act in 2010. For the first time, a tiered healthcare system was codified into law, along with massive government subsidies for health insurance corporations. The law not only required people to buy health insurance or pay a penalty, but also created government-run marketplaces where government representatives sold private insurance. 

The mandate to purchase health insurance was a concession to the industry, purportedly in exchange for greater regulation. However, since 2010, to counter these regulations, healthcare corporations have increased their power through mergers, acquisitions, and “vertical integration” or ownership of multiple parts of the industry, from insurance to health facilities, including owning physician practices, laboratories, imaging centers, hospitals, and nursing homes. In this environment, private venture funds are now taking over. Hospitals are shuttering essential services such as obstetrics and pediatrics to open more lucrative specialty centers in orthopedics and cardiovascular interventions. Hospitals that don’t turn a profit, especially in rural communities and poor urban areas, are being closed down and either abandoned or converted into commercial spaces.

The Commonwealth Fund’s 2024 health insurance survey³ highlights some major failures of healthcare in the United States. They found that only 56% of working-age adults had adequate health insurance. Of those who had health insurance without adequate coverage, 57% “avoided getting needed health care because of its cost,” and 41% of these experienced a worsening of their health condition as a result. 44% of underinsured adults held medical or dental debt. In fact, in the U.S., medical illness is the leading cause of personal bankruptcy, and about three-fourths of those who go bankrupt had health insurance at the start of their illness.

Given this crisis, there is widespread public agreement that the United States requires a drastic change in how healthcare is financed and delivered. In fact, people in the U.S. have advocated for a national universal healthcare system for more than 100 years, but efforts to create such a system have been stopped by powerful, racist, right-wing professional and industry interest groups. Decades ago, it was the physicians’ group, the American Medical Association, and racists from the Southern U.S., particularly the “Southern Dixiecrats,” who blocked reform. More recently, think tanks affiliated with both major political parties and lobbyists with the medical-industrial complex have convinced members of Congress to reject even modest proposals such as “Medicare for All” legislation.

Open Secrets, a lobbyist watchdog group, reports that in 2024,⁴ the pharmaceutical and healthcare sector was the industry that spent the most on lobbying politicians. The insurance sector ranked third highest in spending. Studies have found that private health insurance lobby groups also spend large amounts of money—more than $100 million each year—to influence voters through social media campaigns that erode trust in public healthcare systems.⁵ Common falsehoods promoted by the industries are that a universal public healthcare system would be more expensive, limit people’s choices, and diminish the quality of healthcare. Of course, data from nations that actually have universal healthcare systems prove otherwise.

The medical-industrial complex also works to convince voters that the United States is too big and too diverse for a “one size fits all” healthcare system. China stands out as a shining example that proves the foolishness of such thinking. China has a landmass similar in size to the U.S. and a highly diverse population, roughly four times larger than the U.S. population. After the People’s Republic of China (PRC) was founded in 1949, it took on the task of building a national universal healthcare system as part of its social and economic programs with impressive success.

Political analyst K. J. Noh reports that at the start of the Chinese Revolution, China was a poor country where, because of the West’s Opium Wars, 10-20% of the population was addicted to opium. In a major public health victory, addiction was eradicated within four years.⁶ Another impressive public health accomplishment is that through a forty-year effort, China succeeded in ending extreme poverty, which impacted almost 800 million people. The World Bank reports that China accounts for nearly three-quarters of the global reduction in extreme poverty.⁷

China has accomplished these impressive feats because its fundamental approach is to prioritize basic public needs rather than corporate profits. Noh explains that China uses a framework of “one income, two assurances and three guarantees”: everyone has an income, they are assured food and clothing, and they are guaranteed basic medical care, safe housing, and an education.

Through a centralized healthcare system that includes both Traditional Chinese Medicine and Western medicine, China has attained nearly universal healthcare coverage. The Chinese National Healthcare Security Administration reports that for the past four years, more than 95% of Chinese residents were enrolled in their basic medical insurance program. For the low-income and rural populations, the percentage covered is 99%.⁸

Health outcomes have dramatically improved over the past 76 years. The average life expectancy in China was around 43.5 years in 1950, and rose to almost 78 years in 2024.⁹ Life expectancy in China rose by almost seven years between 2000 and 2021, while life expectancy in the United States fell during that same time period. In China, neonatal and maternal mortality rates are lower than those in the United States and are still declining, while the rates in the U.S. are increasing. The homicide rate in China is roughly one-sixth, and the suicide rate is roughly one-half, of what they are in the U.S.

A study published by the United States National Institutes of Health called the impressive rise in life expectancy during the first 30 years of the Chinese revolution one of “the most rapid sustained increases in documented global history.”¹⁰ The authors credit four reasons for this: an expansion of primary care services and public health programs, investment in basic infrastructure to provide clean water and other sanitation needs, improved nutrition, and better education.

China has made these achievements while spending a fraction of what the U.S. spends on healthcare. In 2024, China spent $356 per person on healthcare,¹¹ which is 5.78% of its Gross Domestic Product (GDP), while the U.S. spent $15,610 per person,¹² which is more than 18% of its GDP. Healthcare spending in the U.S. is an outlier even among other wealthy Western nations due in large part to high administrative costs, lack of control over the prices of goods and services, and the profit margins baked into the industry.

A big difference between China and the United States is that China controls the medical corporations, while in the U.S., medical corporations use campaign donations and offers of high-paying jobs in the private sector to buy influence over politicians and government officials. A look at the pharmaceutical sector demonstrates the difference this makes: in China, the national government keeps the costs of medications low by purchasing them in bulk and using this leverage to negotiate fair prices, while in the U.S., pharmaceutical lobbyists have prevented this practice. 

An example of this was the national fight over drug prices for Medicare enrollees in 2003. Instead of promoting bulk purchasing, the head of the Center for Medicare and Medicaid Services (CMS), Thomas Scully, pushed an insurance scheme to cover drugs and hid the true cost of the proposal from Congress. Following the passage of a law to allow this insurance, referred to as Part D of Medicare, Scully resigned from CMS and took a lucrative position as a pharmaceutical lobbyist.¹³ What this did was allow pharmaceutical prices to continue to rise unchecked while creating a new insurance product that seniors could purchase, a win for both the drug and insurance corporations. The high cost of medication continues to be a crisis in the U.S., where patients routinely forgo filling prescriptions or skip doses to save money.¹⁴

Another big difference is transparency in prices. When patients walk into a hospital in China, they can look up the cost of tests and treatments on a computer screen.¹⁵ They know exactly how much they will be charged. This would be impossible in the U.S. under the current arrangement because the cost of a test or treatment can vary widely depending on whether a patient has health insurance (prices are higher for the uninsured) and what type of insurance the patient has (each company negotiates prices with the hospital).¹⁶ Patients in the U.S. also face high out-of-pocket costs, which vary depending on which insurance plan they have and whether or not the facility where they go is in their covered network or not.¹⁷ Often, information about which facilities are covered is out of date, and patients may go to a “covered” facility only to find that the department where they received care was subcontracted to a private entity that is not in their network. If the facility is not part of their insurance network, patients are responsible for the full cost of care.

Healthcare in the United States is complicated and opaque, which benefits the corporations but creates great uncertainty and stress for patients, while patients in China have an efficient and transparent system, which provides them with greater choices for care and the security that their medical needs will be taken care of without leaving them financially destitute. This is the difference between a capitalist economy in the U.S. and an economic system that China refers to as “socialism with Chinese characteristics”. In the U.S., society competes with corporations for basic necessities such as healthcare, housing, and education, while in China, basic necessities are viewed, according to Noh, as “a whole-of-society responsibility requiring a whole-of-society response.”

Given the propaganda about China in the United States, it may come as a surprise to learn that China is a deeply democratic society where the political power of the wealthy is restricted. The PRC’s Constitution places all state power in the hands of the people through local and national people’s congresses. The Communist Party of China (CPC), which leads the government, creates five-year plans for social and economic development. These five-year plans are developed through a process of extensive public input. Each year, the National People’s Congress, which has almost 3,000 delegates, meets to review the country’s progress and make decisions about changes that need to be made.

It is through these five-year plans that China has successfully eradicated poverty, built a high-quality education system, constructed an extensive and efficient transportation system, and become a world leader in renewable energy. People in China experience significant material gains in their quality of life, unlike in the United States, where the social safety net is unraveling and infrastructure is failing, as documented in China’s annual report on human rights violations in the U.S.¹⁸

In the 2024 report, China found that both wealth and social inequalities are worsening in the United States. More than 40 million people live in poverty. Credit card debt and defaults on loans are at record highs. Food insecurity impacts 13.5% of households. More than 700,000 people in the US do not have a home, and that number is rising at record rates. Rather than housing people who need it, more cities are making the problem worse by implementing policies that criminalize homelessness. It is common for city governments to order police to dismantle homeless encampments, confiscating and discarding people’s possessions in the process, including medications and personal documents. 

China’s human rights report notes that the United States is the only wealthy nation that does not have a universal healthcare system. In the U.S., there are also gross disparities in health outcomes based on race. According to the report, “African Americans have a life expectancy nearly five years shorter than that of white Americans, an infant mortality rate more than twice as high, and a maternal mortality rate nearly three times greater.”

While people in China are experiencing improvements in their quality of life, the United States is a country in decline. In fact, one could argue that the much-vaunted “American Dream” is being realized in China, while people in the U.S. are living a nightmare. Perhaps this is some of the impetus behind U.S. belligerence toward China; the U.S. has a history of targeting nations that are succeeding in order to maintain its own dominance.

However, the world is changing. A multipolar world is rising alongside a growing demand for a new form of world governance based on cooperation, diplomacy, and respect for international law. These are fundamental changes that are required to tackle the many crises in the world, and China is one of the countries working to put the world on this new path.

Demands for change are growing in the United States. As people organize to create a new society and new systems in the U.S., it will be important to learn from others around the world about how to solve our many crises. China provides time-tested examples of solutions to the healthcare crisis and more. Rather than invest trillions in new weapons in an attempt to defeat China militarily, people in the U.S. would do well to demand those dollars be invested in addressing our many needs at home. Rather than cut connections to China through greater tariffs and policies that restrict academic collaboration, people in the U.S. would benefit from greater cooperation with China. We have much to learn and gain by doing so.

______________________

¹Josh Russel, “UnitedHealth sued over plummeting share price in the wake of CEO’s murder,” Courthouse News Service, May 7, 2025, https://www.courthousenews.com/unitedhealth-sued-over-plummeting-share-price-in-the-wake-of-ceos-murder/.

²Donald L. Barlett and James B. Steele, Critical Condition: How Health Care in America Became Big Business—and Bad Medicine (Crown, 2005).

³Sara R. Collins and Avni Gupta, The State of Health Insurance Coverage in the U.S., The Commonwealth Fund, November 21, 2024,  https://www.commonwealthfund.org/publications/surveys/2024/nov/state-health-insurance-coverage-us-2024-biennial-survey.

⁴ Open Secrets, “Industries,” https://www.opensecrets.org/federal-lobbying/industries?cycle=2024

⁵Kendra Chow et al., “Generating Opposition to Universal Health Care Policies in the United States: An Analysis of Private Health Industry Advertising on Meta Platforms,” PLOS Global Public Health 5, no. 7 (2025): e0003244, https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0003244.

⁶Margaret Flowers, “The West Would Rather Burn The Planet Than Let China Shine,” Popular Resistance, October 15, 2024, https://popularresistance.org/the-west-would-rather-burn-the-planet-than-let-china-shine/.

⁷The World Bank and the Development Research Center of the State Council, People’s Republic of China, Four Decades of Poverty Reduction in China: Drivers, Insights for the World, and the Way Ahead, The World Bank Group, July 20, 2022, https://openknowledge.worldbank.org/entities/publication/c0d9423b-f682-5f14-b40b-22b99af80b97.

⁸ Xinhua, “China’s basic medical insurance covers 95 pct of population,” State Council of the People’s Republic of China, July 24, 2025, https://english.www.gov.cn/news/202507/24/content_WS6881c72cc6d0868f4e8f463b.html.

⁹Macrotrends, “China Life Expectancy (1950-2025),” https://www.macrotrends.net/global-metrics/countries/chn/china/life-expectancy.

¹⁰Kimberly Singer Babiarz et al., “An exploration of China’s mortality decline under Mao: A provincial analysis, 1950-80,” Population studies 69, no. 1 (2015): 39-56:10.1080/00324728.2014.972432, https://pmc.ncbi.nlm.nih.gov/articles/PMC4331212/.

¹¹CEIC, “China Consumption Expenditure per Capita: Health Care and Medical Services,” https://www.ceicdata.com/en/china/expenditure-per-capita/consumption-expenditure-per-capita-health-care-and-medical-services.

¹²Sean P. Keehan et al., “National Health Expenditure Projections, 2024–33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDP,” Health Affairs 44, no. 7 (2025): 776–87, https://www.healthaffairs.org/doi/10.1377/hlthaff.2025.00545.

¹³ Olga Pierce, “Medicare Drug Planners Now Lobbyists, With Billions at Stake,” ProPublica, October 20, 2009, https://www.propublica.org/article/medicare-drug-planners-now-lobbyists-with-billions-at-stake-1020.

¹⁴Emily Harris, “Survey: Millions of People in the US Forgo Medications to Reduce Costs,” JAMA 330, no. 1 (2023): 13–13, https://doi.org/10.1001/jama.2023.10395.

¹⁵People vs Profits: China and US Health Care Systems Compared, BreakThrough News, 2025, https://www.youtube.com/watch?v=T12WJ2AlITw.

¹⁶Preethi Rao et al., “Barriers to Price and Quality Transparency in Health Care Markets,” Rand health quarterly 9, no. 3 (June 30, 2022): 1, https://pmc.ncbi.nlm.nih.gov/articles/PMC9242565/.

¹⁷The Brookings Institution, “Everything you need to know about surprise billing,” https://www.brookings.edu/collection/everything-you-need-to-know-about-surprise-billing/.

¹⁸Xinhua, Full text: The Report on Human Rights Violations in the United States in 2024, State Council Information Office of the People’s Republic of China, August 17, 2025, http://english.scio.gov.cn/m/scionews/2025-08/17/content_118029304.html.

***

Margaret Flowers, M.D., is a retired pediatrician and Physicians for a National Health Program (PNHP) advisory board member. In 2009-10, Flowers volunteered as a Congressional Fellow for PNHP. She co-founded the Health Over Profit for Everyone campaign and the Maryland Health Care is a Human Right campaign. Flowers writes about health policy, and is also the director of Popular Resistance, where she advocates for a wide range of social, economic, and environmental issues and hosts the radio program Clearing the FOG.