Despite the size of US healthcare, it does little to contribute to positive economic outcomes.

Efficiency in the United States relative to single-payer countries: While the United States spends more per capita on health care than any other OECD country, the additional spending contributes little value from either an economic or a health outcomes perspective.[3,5,10] Countries with SP spend less while their populations live longer, healthier lives.[11] The average life expectancy and the burden of adverse health outcomes for almost all major chronic illnesses (apart from cancer treatments) in the United States also fall short of the OECD median.[7,10,11] As far back as 2003, administrative costs of health care (including insurance, reimbursement, and other administrative tasks) accounted for nearly a third (31%) of the U.S. NHE.[12,13] By 2011, the country still spent more of its NHE on the administrative costs of the reimbursement system than any other country (8%–18% of health care spending).[4,5,14] Analyses between countries with a variety of health insurance systems showed that both SP (most optimal) and “two-tiered” systems, such as those in France and Japan, operated with lower administrative costs than the insurance-mandated systems of the United States and Switzerland.[5] A two-tiered system involves a public insurance-and-delivery system and another based on private health insurance. Notably, the Swiss system (with the second highest NHE per capita of OECD countries) demonstrated significantly lower administrative costs than the United States, indicating that there is room for correction even within public-private systems.[5] According to one analysis updating the 2003 analysis through 2017, excess administrative costs in the United States relative to Canada (SP) have persisted and still account for 17% of the NHE.[15]