The U.S. spent $3.8 trillion on healthcare in 2019, accounting for 17.7% of gross domestic product, according to the Centers for Medicare & Medicaid Services (CMS), and significantly outpaces all peer nations in per-capita spending. In 2019, the U.S. spent $10,948 per person, far more than any other OECD nation and 168% more than the Organization for Economic Cooperation and Development average of $4,087. Switzerland, the second-highest per capita spending nation, pays a third less at $7,138. And this divide is likely going to grow. Current projections by CMS have total health expenditures increasing an average of 5.5% per year through 2028, growing to nearly $6.2 trillion and a stunning 19.7% of total GDP by that time.

The startlingly high cost of healthcare in the U.S. is not abstract; it is leaving millions of American families to make painful tradeoffs to maintain their health -- or go without care. Over the past three years, dozens of national surveys and in-depth analyses have revealed that American adults -- regardless of age, race, gender, income level or political affiliation -- are increasingly feeling strained by the cost of healthcare. Looking forward, 42% of adults report that they are either "concerned" or "very concerned" that their household will be unable to pay for needed healthcare services in the next 12 months, and another 30% report the same regarding prescription drugs. Future prospects, in turn, are viewed grimly, with about half of Americans reporting significant concern that the cost of healthcare services and the cost of prescription drugs will continue to rise in the future to the point that they will no longer be able to afford them. These fears likely contribute to wide support of government action to curtail the trends.

Dovetailing with these concerns are the very real fears of financial ruin in the wake of a catastrophic health event in the household. Half (50%) of surveyed adults reported significant levels of concern about bankruptcy due to a health event, including 64% of people of color. Accompanying these findings were 15% who reported currently carrying medical debt that they would be unable to repay in the next 12 months; another 26% indicated that they would be required to borrow money to pay a $500 medical bill. As such, the real-life consequences of the cost of care and medicine run deep.

The notion among some that high healthcare costs are justified by the quality of care received is unsupported by these public opinion data. Nearly three-quarters of adults do not believe that the quality of their care is worth the cost, a sentiment that is consistent across demographic subgroups including age, gender, race, ethnicity and household income.

Amid these realities, the West Health-Gallup Healthcare Affordability Index and the Healthcare Value Index will serve as ongoing, high-level indicators of the U.S. healthcare system and the American experience. West Health and Gallup will continue to track these indices, providing governmental and healthcare leadership with critical assessments of American opinion as policy options are weighed to lower costs and improve outcomes.