“Our private, profit-driven system means that we are paying more for less,” said one progressive activist.

A report out Thursday shows that the United States’ for-profit healthcare system still ranks dead last among peer nations on key metrics, including access to care and health outcomes such as life expectancy at birth.

The new analysis from the Commonwealth Fund is the latest indictment of a corporate-dominated system that leaves tens of millions of people uninsured or underinsured and unable to afford life-saving medications without rationing doses or going into debt.

“Despite spending a lot on healthcare, the United States is not meeting one of the principal obligations of a nation: to protect the health and welfare of its residents,” the report states. “Most of the countries we compared are providing this protection, even though each can learn a good deal from its peers. The U.S., in failing this ultimate test of a successful nation, remains an outlier.”

People in the U.S., which spends roughly twice as much per capita on healthcare as other rich nations, “live the shortest lives and have the most avoidable deaths,” Commonwealth noted, pointing to frequent “denials of services by insurance companies” and other systematic defects of the American system, including massive administrative costs.

Meanwhile, insurance giants and pharmaceutical companies are raking in huge profits, benefiting in particular from the growing privatization of Medicare. More than half of the Medicare-eligible population in the U.S. is currently on a privately run Medicare Advantage plan.

“Our private, profit-driven system means that we are paying more for less,” progressive activist Jonathan Cohn wrote in response to the Commonwealth report.

The Commonwealth Fund’s findings bolster progressives’ case for transitioning to a Medicare for All system that would provide comprehensive coverage to everyone in the country for free at the point of service. Studies have repeatedly shown that such a program would cost less than the immensely wasteful for-profit system—which is set to drive national healthcare spending to $7.7 trillion per year by 2032—while saving lives.

Commonwealth observed Thursday that while affordability “is a pervasive problem” in the U.S., Australia “offers free care in all public hospitals, and the nation’s universal Medicare system provides all Australians with coverage for all or part of the cost of [general practitioners] and specialist consultations and diagnostic tests, with additional subsidies available for private hospital care.”

“The U.S. continues to be in a class by itself in the underperformance of its healthcare sector,” the report continues. “While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.”

With the U.S. presidential election less than two months away, neither 2024 candidate for the two major parties has outlined a detailed healthcare proposal thus far.

Former President Donald Trump, the Republican nominee, said during last week’s debate in Philadelphia that he merely has “the concepts of a plan,” while Harris—who once co-sponsored Medicare for All legislation in the Senate—said she “absolutely” supports “private healthcare options” and wants to “maintain and grow the Affordable Care Act.”

Just days after the debate, Sen. JD Vance (R-Ohio)—Trump’s running mate—said the Republican nominee prefers a system in which “a young American” and a “65-year-old American with a chronic condition” are not placed in “the same risk pools,” suggesting a rollback of the ACA’s protections for people with preexisting conditions.

“You can’t really say people with preexisting conditions are protected if they are in a separate insurance risk pool and can be charged exorbitant premiums,” Larry Levitt, executive vice president for health policy at the research group KFF, wrote in response to Vance’s comments.

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