Despite spending a staggering $4.5 trillion—more than any other nation on earth—on healthcare in 2022, Americans face a system where soaring costs, medical debt, and delayed treatments reveal a profound disconnect between price and outcomes.
Key Takeaways
- In 2022, U.S. national health expenditures totaled $4.5 trillion, representing 17.3 percent of Gross Domestic Product (GDP)
- Per capita health spending in the U.S. reached $12,914 in 2022, more than double the average of comparable OECD countries
- Prescription drug spending accounted for 9% of total national health expenditures in 2022, totaling $405.5 billion
- In 2023, 8.6% of Americans under 65 were uninsured, down from 9.2% pre-ACA
- Medicaid covered 94.1 million people in FY2023, 28% of U.S. population
- Medicare enrolled 65.7 million beneficiaries in 2023, including 6.4 million dual eligibles
- Life expectancy at birth was 77.5 years in 2023, up from 76.4 in 2021 but below 78.9 pre-pandemic
- Infant mortality rate was 5.44 per 1,000 live births in 2022
- Maternal mortality ratio reached 32.9 deaths per 100,000 live births in 2021, highest among high-income nations
- Active physicians numbered 1,077,794 in 2023, 33.8 per 10,000 population
- Nurse practitioners totaled 355,000 in 2022, up 9% from 2019
- Registered nurses workforce 3.3 million in 2022, shortage projected 200,000 by 2030
- Cardiovascular disease prevalence 48% among adults 18+ in 2023
- Hypertension affected 119.9 million adults (47%) in 2020
- Arthritis impacts 53 million adults (23%) annually
America spends the most on healthcare yet leaves millions struggling with costs and access.
Costs and Spending
- In 2022, U.S. national health expenditures totaled $4.5 trillion, representing 17.3 percent of Gross Domestic Product (GDP)
- Per capita health spending in the U.S. reached $12,914 in 2022, more than double the average of comparable OECD countries
- Prescription drug spending accounted for 9% of total national health expenditures in 2022, totaling $405.5 billion
- Hospital care expenditures grew 6.5% to $1.4 trillion in 2022, driven by increased utilization post-COVID
- Medicare spending increased 6.7% to $944.3 billion in 2022, representing 21% of total NHE
- Private health insurance spending rose 6.4% to $1.3 trillion in 2022, covering 28% of NHE
- Out-of-pocket spending by Americans was $505.7 billion in 2022, 11% of total health expenditures
- U.S. health spending per capita was $12,555 in 2021, highest among OECD nations at 16.6% of GDP
- Administrative costs in U.S. healthcare consumed $496 billion in 2019, or 12% of total spending
- Physician and clinical services spending hit $834.5 billion in 2022, up 5.8% from prior year
- Nursing care facilities spending grew 5.2% to $204.4 billion in 2022 amid aging population
- Home health care expenditures reached $133.0 billion in 2022, increasing 7.9% year-over-year
- Durable medical equipment spending was $65.0 billion in 2022, up 4.5%
- Average family health insurance premium was $22,463 in 2022, up 3% from 2021
- Single coverage premium averaged $8,435 in 2022, with workers paying 18% of family premiums
- U.S. spent $449 billion on hospital care in 2019, 31% of total health spending
- Health spending growth averaged 5.1% annually from 2018-2022
- Government health spending was 37% of total NHE in 2022 at $1.7 trillion
- Retail prescription drugs cost $359 billion in 2019
- High-deductible plans covered 29% of workers in 2022, averaging $2,000 deductible
- In 2021, 66% of Americans delayed care due to costs
- Medical debt affected 41% of U.S. adults in 2022, totaling over $88 billion
- Average cost of childbirth in U.S. was $13,024 in 2022 without complications
- Cancer treatment costs averaged $83,000 per patient annually in 2020
- Dialysis costs $90,000 per patient per year for end-stage renal disease
- Emergency room visit average cost was $2,356 in 2021
- Hip replacement surgery costs averaged $28,054 in 2022
- MRI scan national average cost was $1,325 in 2022, varying by location
- In 2023, employer-sponsored insurance premiums rose 7% to $25,572 for families
- Uninsured adults under 65 faced average medical bills of $1,500+ in 2022
Costs and Spending Interpretation
We've built the world's most expensive healthcare machine, but a distressingly large number of Americans are left standing outside, holding the bill and wondering if the astronomical cost of entry is actually buying them a ticket to better health.
Disease and Chronic Conditions
- Cardiovascular disease prevalence 48% among adults 18+ in 2023
- Hypertension affected 119.9 million adults (47%) in 2020
- Arthritis impacts 53 million adults (23%) annually
- Chronic kidney disease in 37 million (15%) adults
- Depression diagnosed in 21% of adults in 2022
- COPD prevalence 6.5% or 16 million adults in 2023
- HIV prevalence 1.2 million living with in 2021
- Osteoporosis 12.6% women over 50, 4% men in 2022
- Autism spectrum disorder 1 in 36 children aged 8 in 2020
- Alzheimer's affects 6.7 million Americans 65+ in 2023
- Multiple sclerosis 1 million adults diagnosed
- Parkinson's disease 1 million living with, 90,000 new cases yearly
- Sickle cell disease 100,000 Americans, mostly Black
- Cystic fibrosis 39,000 diagnosed in 2023
- Rheumatoid arthritis 1.5 million adults
- Hepatitis C chronic 2.4 million in 2022
- Endometriosis 11% reproductive-age women, 6.5 million
- Fibromyalgia 4 million adults (2%)
- Lupus 1.5 million Americans, 90% women
- Glaucoma 3 million diagnosed, 80 million global risk
- Macular degeneration 20 million over 50
- Chronic back pain 39% adults yearly
- Migraine 1 in 6 Americans
- PTSD 6% adults lifetime prevalence
- Bipolar disorder 2.8% adults
- Schizophrenia 1.5 million adults
- Epilepsy 3.4 million, 1 in 26 lifetime risk
- ALS 30,000 living with
Disease and Chronic Conditions Interpretation
America's health landscape is a sprawling, morbid theme park where the most popular attractions are chronic conditions, and the only fast pass is to be outrageously lucky.
Health Outcomes and Mortality
- Life expectancy at birth was 77.5 years in 2023, up from 76.4 in 2021 but below 78.9 pre-pandemic
- Infant mortality rate was 5.44 per 1,000 live births in 2022
- Maternal mortality ratio reached 32.9 deaths per 100,000 live births in 2021, highest among high-income nations
- Age-adjusted cancer death rate fell to 144.2 per 100,000 in 2022 from 203.1 in 2000
- Heart disease remained leading cause of death, 695,000 deaths or 1 in 5 in 2022
- Drug overdose deaths hit record 107,941 in 2022, 80% involving opioids
- Obesity prevalence 42.4% among adults in 2017-2020
- Diabetes affected 38.4 million (11.6%) in 2021
- Suicide rate 14.2 per 100,000 in 2022, 49,369 deaths
- COVID-19 caused 1.1 million deaths since 2020 through 2023
- Avoidable deaths under 75 per 100,000 was 88 in U.S. vs 65 OECD average in 2020
- Breast cancer mortality declined 43% since 1989, to 19.7 per 100,000 in 2022
- Stroke death rate dropped to 40.4 per 100,000 in 2022
- Alzheimer's disease deaths 119,399 in 2021, 4th leading cause for women
- Gun violence caused 48,830 deaths in 2021, 54% suicides
- Premature birth rate 10.41% in 2022
- Life expectancy gap Black-White 3.6 years in 2022
- Colorectal cancer screening 67.3% among adults 45-75 in 2021
- Chronic lower respiratory diseases killed 147,382 in 2022
- Homicide rate 7.8 per 100,000 in 2022, highest in decades
- Kidney disease death rate 14.5 per 100,000 in 2022
- U.S. ranked 45th globally in life expectancy at 76.1 years in 2021
- Pediatric cancer survival rate 85% for 5-year post-diagnosis in 2023
- Sepsis hospitalization mortality 15.9% in 2019
Health Outcomes and Mortality Interpretation
The American healthcare story is one of remarkable medical triumphs battling against a tide of preventable crises, where we excel at saving lives from cancer yet falter at keeping them safe from despair, drugs, and our own systemic failures.
Healthcare Workforce
- Active physicians numbered 1,077,794 in 2023, 33.8 per 10,000 population
- Nurse practitioners totaled 355,000 in 2022, up 9% from 2019
- Registered nurses workforce 3.3 million in 2022, shortage projected 200,000 by 2030
- Primary care physicians 93.9 per 100,000 in 2023, rural areas 39.8 vs urban 101.5
- Dentists numbered 200,626 in 2022, 61 per 100,000 population
- Pharmacists totaled 323,100 in 2022
- Physician assistants 148,000 in 2022, growing 27% by 2031 projected
- Hospitals employed 6.4 million staff in 2023
- Nurse turnover rate 27.2% in 2022, highest on record
- International medical graduates 26% of U.S. physicians in 2023
- Rural physician shortage affected 60 million Americans, 20% fewer providers
- Emergency medicine physicians 44,684 in 2022
- OB/GYNs totaled 19,680 in 2023, shortage projected 8,000 by 2034
- Anesthesiologists 50,126 in 2022
- Psychiatrists 29,000 active in 2023, 1 per 12,000 adults shortage
- Surgical specialists 20% of physician workforce but 50% of shortages
- Nursing faculty shortage led to 91,000 qualified applicants turned away in 2022
- Home health aides 4.1 million in 2022, fastest growing occupation
- Medical assistants 683,370 in 2022, projected 16% growth
- Burnout affected 62% of physicians in 2022
- Residency positions 40,375 filled in 2023 Match, 92.4% U.S. seniors
- CRNAs numbered 45,000 in 2022
- Physical therapists 258,000 in 2023
- Optometrists 41,000 in 2022
- Veterinarians in human health? Wait, no: Radiologic technologists 228,000 in 2022
- Licensed practical nurses 657,000 in 2022
Healthcare Workforce Interpretation
America's healthcare system is a paradox of impressive scale and terrifying shortages, where we simultaneously employ millions while burning out the critical few, leaving vast swaths of the country desperately underserved by a machine that is both growing and crumbling at once.
Insurance and Coverage
- In 2023, 8.6% of Americans under 65 were uninsured, down from 9.2% pre-ACA
- Medicaid covered 94.1 million people in FY2023, 28% of U.S. population
- Medicare enrolled 65.7 million beneficiaries in 2023, including 6.4 million dual eligibles
- Employer-sponsored insurance covered 153.5 million non-elderly in 2022, 62% of population
- ACA Marketplaces enrolled 21.3 million in 2024, with 80% receiving premium tax credits
- CHIP covered 9.1 million children in FY2022
- 26.4 million non-elderly uninsured in 2023, disproportionately Hispanic (31%) and Black (11%)
- Medicaid expansion states had uninsured rates 5.4 percentage points lower in 2023 vs non-expansion
- TRICARE covered 9.4 million active duty and retirees in 2022
- VA health system served 9.2 million veterans enrolled in 2023
- Short-term limited duration insurance plans grew to cover 1 million in 2022 post-ACA rules change
- 92% of marketplace enrollees had incomes <400% FPL in 2023, qualifying for subsidies
- Medicaid covers 40% of U.S. births annually, 2 million infants in 2022
- Employer coverage stable at 49% of population in 2022, but declining for small firms
- Uninsured rate for children dropped to 5.8% in 2023 from 16.4% pre-ACA
- Direct primary care subscriptions grew 20% yearly, covering 2 million by 2023 estimate
- Medicare Advantage plans enrolled 31 million (54%) of beneficiaries in 2024
- Medicaid disenrollments post-pandemic reached 18 million by mid-2024
- 44% of adults 18-64 uninsured at some point in 2022
- ACA reduced uninsured by 20 million from 2010-2016, stabilizing at 8-9%
- Rural uninsured rate 12.5% vs 10.2% urban in 2022
- Gig workers uninsured at 18% rate in 2023
Insurance and Coverage Interpretation
While the ACA has cobbled together a remarkably leaky safety net—shrinking the uninsured rate to a still-wild 8.6% and making Medicaid the nation's largest insurer—America's healthcare system remains a fragmented, precarious patchwork where your coverage, or lack thereof, is largely determined by your employer, your state, your income, and your luck.
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