Why Does U.S. Healthcare Cost So Much? The Case for Lifestyle as the Hidden Driver

The United States stands alone among developed nations in the extraordinary amount it spends on healthcare. In 2023, healthcare expenditures in the U.S. reached approximately $14,570 per person. That figure is more than twice the average of other wealthy countries in the OECD, where health spending per capita hovers around $7,400. Despite this outsized spending, Americans are not significantly healthier. In fact, they experience worse outcomes by many measures.
 
Life expectancy in the U.S. is currently about 77 years, more than five years lower than in countries like Japan and Switzerland, and nearly three years behind Australia. Rates of infant mortality, preventable hospitalizations, and deaths from treatable conditions are all higher in the United States than in its peer nations.
 
Traditional explanations for these disparities focus on the American healthcare system’s inefficiencies. Critics often point to the administrative bloat and price-gouging by insurance companies, hospitals, and pharmaceutical firms. About 25% of U.S. health spending is swallowed by administrative costs, compared to roughly 10–15% in countries with single-payer or tightly regulated systems. In addition, prices for medical services, devices, and drugs are significantly higher in the U.S. A standard MRI costs over $1,100 in America, while in Australia the same scan costs about $215. A month’s supply of insulin that might run $300 or more in the U.S. can be had for $35 or less in Germany or the UK.
 
But there is another angle worth examining: one that receives far less attention in the national discourse. The American healthcare crisis may be less about how care is delivered and more about why it is needed in the first place. Specifically, Americans suffer from disproportionately high rates of chronic diseases that are closely tied to lifestyle factors such as diet, alcohol use, stress, and physical inactivity. These upstream contributors generate enormous downstream costs, making the entire system more expensive regardless of how efficiently it is managed.
 
Consider obesity. According to the Centers for Disease Control and Prevention (CDC), more than 42% of American adults are classified as obese. This is more than double the obesity rate of countries like Japan (4%) or South Korea (6%). Obesity is a leading risk factor for diabetes, heart disease, stroke, and certain cancers. The estimated medical cost of obesity in the U.S. was nearly $173 billion in 2019. Individuals with obesity incur medical costs that are $1,861 higher per year than those of normal weight.
 
Much of this obesity crisis is driven by diet, specifically, the overwhelming prevalence of ultra-processed foods in the American food supply. A 2021 study in the journal BMJ Open found that over 57% of calories consumed by the average American come from ultra-processed foods, compared to 14% in France and just 10% in Italy. These foods, engineered to be hyper-palatable and shelf-stable, are linked not only to weight gain but also to increased risks of type 2 diabetes, hypertension, depression, and all-cause mortality.
 
In an NIH-funded clinical trial in 2019, participants who were fed ultra-processed diets consumed an average of 500 more calories per day than when they were on a minimally processed diet, despite both diets being matched for macronutrients, sugar, and fiber. The weight gain occurred rapidly—about two pounds in just two weeks.
 
Alcohol use further compounds the problem. While moderate drinking is culturally normalized, the U.S. has seen a marked rise in alcohol-related disease and death. Between 1999 and 2020, alcohol-related deaths in the United States doubled, reaching more than 99,000 annually. That figure now exceeds the number of deaths from drug overdoses involving opioids.
 
Alcohol contributes to more than 200 health conditions, including liver cirrhosis, multiple cancers, high blood pressure, and psychiatric disorders. The National Institute on Alcohol Abuse and Alcoholism estimates that alcohol misuse costs the U.S. economy over $249 billion annually, primarily due to healthcare expenses and lost productivity.
 
Chronic stress is another underappreciated factor driving up medical demand. Americans report some of the highest stress levels in the developed world, with nearly 27% of adults saying they are so stressed most days that they cannot function, according to a 2022 survey by the American Psychological Association.
 
Chronic stress contributes to a cascade of health issues, including cardiovascular disease, gastrointestinal disorders, autoimmune disease flare-ups, and mental health conditions like anxiety and depression. It also drives unhealthy coping behaviors such as increased consumption of alcohol and processed foods, creating a feedback loop of poor health and elevated medical needs.
 
When these lifestyle-driven conditions are combined with socioeconomic inequality and limited access to preventive care, the result is a massive burden of chronic disease that no efficient insurance model can contain. More than 60% of American adults have at least one chronic health condition, and 42% have two or more. Chronic diseases account for 90% of the nation’s $4.5 trillion in annual healthcare expenditures. These costs are not driven by elective procedures or excess administrative staff alone; they are driven by an overwhelming demand for ongoing treatment of avoidable diseases.
 
The implication is clear: any serious attempt to reduce American healthcare spending must address not just inefficiencies in delivery but also the structural and cultural patterns that produce poor health outcomes in the first place. That means investing more heavily in public health measures aimed at reducing consumption of ultra-processed foods, limiting alcohol marketing, supporting healthier urban design and transportation systems, and addressing income inequality and workplace stress.
 
Other countries have demonstrated the effectiveness of such interventions. Mexico has implemented taxes on sugar-sweetened beverages and high-calorie snack foods, which resulted in significant declines in consumption. Chile has adopted strict front-of-package labeling laws that have shifted both consumer behavior and product formulation. France, Japan, and South Korea have long maintained robust school meal programs and food education policies that preserve traditional diets and discourage processed food dominance.
 
In contrast, the United States spends less than 3% of its healthcare budget on public health and prevention. The rest is poured into treatment, into managing disease states that are often preventable with upstream action. A more balanced approach, one that treats healthcare as a function of environmental and behavioral inputs as much as medical ones, could help bring costs under control while improving quality of life.
 
In conclusion, the sky-high cost of healthcare in the U.S. is not simply a failure of policy or pricing. It is a reflection of a population increasingly burdened by preventable illness tied to diet, stress, and behavior. Unless these lifestyle issues are addressed head-on through coordinated public health interventions, no amount of efficiency reform will meaningfully alter the economic trajectory of the American healthcare system.