The journey to improve American healthcare doesn’t necessarily require reinventing the wheel—sometimes, it means looking beyond our borders for proven solutions. Throughout my career as a physician and healthcare executive, I’ve studied diverse healthcare systems worldwide, from developing regions in India, Armenia and Guatemala to more established models in Spain, Portugal, Japan and Korea. What has struck me most is not just the differences in approaches but the fundamental values that drive these systems—values that could transform how we deliver care in the United States.
Healthcare as a Moral Imperative, not a Political Issue
The most profound difference I’ve observed across healthcare systems is philosophical. In Spain and Portugal, universal healthcare coverage isn’t an economic or political issue—it’s viewed as a moral imperative. Every citizen, resident and even visitor is entitled to care. I witnessed similar attitudes in Korea and Japan, where healthcare access is considered a fundamental right.
Even India, the most populous country in the most populous country in the world, has some basic essential healthcare coverage for vulnerable populations. When comparing approaches globally, the U.S. appears behind other developed countries in how we conceptualize healthcare access. This moral foundation shapes everything from policy to patient care. In America, we tend to approach healthcare as a business transaction or political bargaining chip rather than a human right. Finding our own hybrid approach—not necessarily “socialized medicine,” which carries political baggage—begins with agreeing that everyone deserves healthcare access. Only then can we build systems that truly serve people rather than profits.
Prevention vs. Treatment: A Fundamental Shift
Another critical difference is how healthcare is conceptualized and approached. In the U.S., we’ve built an industrialized medical system focused on treating disease after it occurs. As I observed in Europe, healthcare extends far beyond hospital walls—it encompasses diet, physical activity, social connection and community design.
Our approach often treats symptoms rather than causes. We manage conditions like diabetes and hypertension with medications, when many cases could be addressed through lifestyle changes. We put band-aids on diseases with pharmaceuticals instead of addressing root causes. Even with public health challenges like HIV prevention, we spend enormous resources on lifetime treatment drugs while underfunding education and prevention programs.
The European approach integrates medical care with broader lifestyle factors. Cities designed for walking, Mediterranean diets, longer social meals and strong community bonds all contribute to better health outcomes despite lower healthcare spending. Our narrow focus on acute care misses these preventive opportunities that could dramatically reduce both suffering and costs.
Contrasting Approaches in the U.S. and Europe: End-of-Life Care
End-of-life care highlights another sharp divide between the U.S. and Europe. In the United States, care in the final year of life is marked by high spending and aggressive hospital-based interventions. Americans spend about $80,000 per person in the last year of life, with 57.6% of those costs going to hospital care in the final three months. Nearly 27% of Medicare’s annual budget is spent on patients in their last year.
In contrast, countries like Denmark and the Netherlands spend more than $60,000 per person, but only 44.2% of those costs go to hospital care in the last three months. These countries invest more heavily in long-term care—almost 3% of GDP in the Netherlands and Sweden, compared to just 0.9% in the U.S.
This difference reflects broader values. European systems prioritize comfort, dignity and community-based support, often favoring home or hospice care over repeated hospitalizations. The U.S. model relies more on intensive hospital interventions, sometimes prolonging suffering without improving outcomes.
Ultimately, these contrasting approaches show that end-of-life care is about more than cost; it’s about aligning care with patient values. By learning from European models that emphasize dignity and long-term care, the U.S. could improve both the quality and efficiency of care in life’s final chapter.
Administrative Burdens: The True Source of Burnout
When I asked physicians in Spain and Portugal about burnout, they uniformly cited being underpaid compared to their American counterparts. Yet they often have more weeks of vacation and virtually no educational debt. The contrast is striking—American physician burnout stems less from compensation and more from administrative demands.
In the U.S., physician burnout is largely a byproduct of a system that prioritizes the commerce of healthcare over the calling of healing. Unlike other countries, where professional dissatisfaction may stem from resource scarcity or clinical demands, American providers are overwhelmed by paperwork, insurance red tape and the tyranny of electronic health records. The root of burnout isn’t medicine—it’s the machinery of the medical-industrial complex. When healthcare becomes a business first, clinicians become clerks, and purpose gets buried beneath prior authorizations.
What European physicians don’t experience is the moral injury that happens when American doctors want to provide compassionate care but are constrained by bureaucratic demands. I recall a pediatric attending from my medical school days who consistently ran behind schedule because he gave each child the time they needed. His patients willingly waited because they valued that level of attention. That pediatrician was professionally satisfied and full of joy in knowing that he provided the care that his patients needed, sometimes it took him 15 minutes, and sometimes it took him an hour. He always did what was right for his patients. I often wonder how he would navigate today’s pressures—where the art of healing is expected to fit neatly into 15-minute appointment slots.
Clinicians are often faced with the challenge of navigating complex systems to ensure their patients receive timely, necessary care. That can mean advocating persistently, expediting referrals, or navigating documentation requirements—all in service of doing what’s right for the patient. These efforts aren’t about bending the rules but bridging the gap between system limitations and human needs.
The Human Connection in Healthcare
During my hospital visits abroad, I noticed how socialization and human connection remain central to healthcare delivery. In Spain and Portugal, our hosts apologized for scheduling only an hour for lunch—”an American lunch,” they called it—explaining that they typically enjoy longer social meals.
The aspect of loneliness and social isolation that exists in the U.S. is noticeably less present in Europe. Hospital staff routinely gathered at cafés or pubs after work, maintaining connections that build resilience and prevent burnout.
These social supports extend to patients as well. When my mother was in the ICU with only hours to live, compassionate doctors bent visitation rules to allow our family to be at her bedside. These moments of human connection, when providers can transcend rigid systems to meet deeper needs, address burnout by reconnecting healthcare professionals with their fundamental purpose.
Operational Excellence: Enabling the Clinical Relationship
No healthcare system is perfect—each has its challenges and trade-offs. In Korea, I observed physicians seeing 40-50 patients daily, driven by volume-based payment models. Yet what impressed me most was a hospital in Portugal led by a CEO with an engineering background.
Her focus was ensuring smooth operations so patients and doctors could spend quality time together at the bedside without disruption from systemic inefficiencies. This operational excellence is essential to supporting the clinical relationship.
Consistent training and adequate staffing are foundational to quality care in any healthcare setting. When healthcare teams are properly trained and supported, they deliver more consistent, effective care. However, short staffing, variable training standards and high turnover create systemic inefficiencies that compromise provider satisfaction and patient outcomes. Investing in excellent training and consistent staffing models ensures that every patient receives the same high standard of care regardless of which team members are on duty.
The Cost of Bureaucracy
Our healthcare system wastes enormous resources navigating bureaucracy. Patients worry that insurance changes will interrupt their care, leading to requests for earlier procedures or extra medication refills before coverage changes.
Our outcomes are worse despite paying twice the percentage of GDP on healthcare compared to countries like Spain and Portugal. Research from the Journal of the American Medical Association estimates that administrative costs account for approximately 34.2% of healthcare expenditures in the United States, twice the percentage found in Canada and significantly higher than in European systems. This additional spending largely goes to administrative and bureaucratic processes—insurance authorizations, copayments, prior authorization denials and other non-clinical activities. These inefficiencies not only increase costs but also create barriers to timely care.
A Path Forward
If I could implement one reform without budget or political constraints, I would ensure universal access to a minimum level of healthcare for everyone, with options for private insurance for additional services, similar to models in Denmark and Norway.
My goal as a healthcare leader is to address operational inefficiencies so that when doctor and patient are together, they can focus entirely on that healing relationship. By learning from global examples while adapting solutions to US context, we can create a more humane, efficient and effective healthcare system—one that remembers that, at its core, medicine is fundamentally about human connection and care.
