What Does a Fear-Based Healthcare System Produce?

In my last post, I shared a conversation with a doctor friend who told me that from the start, doctors are trained to lead with fear. That conversation left me with a question. What does a fear-based healthcare system actually produce?

So I looked at the numbers. In 2024, the United States spent an estimated $13,432 per person on healthcare. That's the highest in the world. The average for the other nine wealthy countries in the comparison was around $6,000. We spend roughly twice as much.

You'd think that kind of spending would buy better results. It doesn't. The Commonwealth Fund's 2024 "Mirror, Mirror" report ranked the US dead last among ten high-income countries. Lower life expectancy. Higher rates of preventable death. Worse outcomes across nearly every category.

Here's the paradox. The US actually ranked second in the quality of care delivery itself. When people can get to the care, we're good at providing it. But we ranked last in access and last in outcomes. The system delivers good care to those who can reach it, then blocks too many people from getting there.

It gets deeper. Every other country in the comparison has achieved universal coverage. The US is the only one that separates people into classes and rations care based on ability to pay. And a 2025 study in the New England Journal of Medicine found that even the wealthiest Americans have survival rates on par with the poorest Europeans in western countries.

The system built on fear can't even deliver for the wealthy what systems built on equity deliver for everyone.

Read the full piece on Substack.

Learn more about the adventure at www.heart-strong.org