Of all the oddities of the U.S. health care system, one stands out: we spend far more on health care per person than other industrialized nations yet have no better health outcomes. Understanding why isn't easy. A 2012 paper by the Commonwealth Fund found that among 13 industrialized countries studied, the U.S. has the highest rate of obesity, which is usually a factor in higher health care costs. Yet, the U.S. ranks far behind many other countries in our rates of citizens who smoke or are over 55, two other strong indicators of increased spending.