My point is that there's very little to suggest US healthcare is uniquely ineffective. There rapidly diminishing returns to health spending and US outcomes are badly handicapped by factors like obesity and homicide.

Maybe try actually reading it though?

"Maybe try actually reading it though?"

Your first sentence is "In the popular telling, there is a strong and reasonably constant relationship between health spending and life expectancy.". My comment was that I am not aware of this being the popular telling. But instead from what I can tell most people agree that the US doesn't deliver better results despite much higher spending.

Otherwise I think you have dug up a good and useful amount of data although I think some of your conclusions are debatable. This is probably to be expected if you analyze such a complex system.

it IS a popular thing, only here on hacker news I've read at least 10 articles on this issue, i.e. that US is wasting money on health.

(I think you get downvoted here, because it is a long read and while extremely well argued on data, it could benefit from more of a narrative at times. I often felt a tad lost even though it was a great read)

The question that arises for me from the article is: what should society shift spending towards/away from healthcare to receive the most life expectancy gains? Fight obesity, transport safety, drugs? Is any areas of those amicable to be solved by spending?

Why optimize for life expectancy? Why not remove the social stigma from suicide? Let people live as they want and drop out whenever.

I followedany of your arguments, but I definitely started skimming at times to gather the main points. It would have been nice to have you main points with the most informative charts that illustrate your conclusions in the article, with links to sub-articles on each particular step of your argument that contain the additional analysis to support your conclusions.

Donu you also suggest that high levels of health care spending are more effective than we might expect since the wealth that allows more spending also come with higher obesity and larger overdose risks?

Is there one of your charts that indicates which countries have seen the best returns from higher levels of health care spending?

I think the controversial idea is that the USA healthcare system is operating on the same efficiency curve as other developed nations.

That is to say, a socialized healthcare system with the same spending is unlikely to provide any improvements in life expectancy.

I think you're drawing a slightly wrong conclusion. The point is not that the US system is actually nearly as good as others, the point is that other factors make it look much worse than it is (as far as the metric of life expectancy is concerned).

If those other factors were corrected, the comparison could be made fairly. Maybe it would turn out to be good enough, and maybe it would not.

> That is to say, a socialized healthcare system with the same spending is unlikely to provide any improvements in life expectancy.

Few countries actually have a wholly socialized healthcare _system._ The UK and Canada do, but it's a completely different stories in other developed countries. In France the health insurance system is mostly socialized, while delivery (doctors, pharmacies, hospitals ...) is mostly though not entirely private. In Switzerland and Germany, if I remember correctly, insurers are private but operating similarly to utilities in the US, i.e. within strict government guidelines.

> socialized healthcare system with the same spending is unlikely to provide any improvements in life expectancy.

That's probably not true, because as the author pointed out, Obesity is considered an "external factor" but many countries with socialized medicine have programs to tackle these issues. Americans lack "preventive maintenance" programs that are a given in Europe. I think we all agree throwing money at the problem will not lead to enhanced outcomes, but to extrapolate that to mean that socialized medicine won't lead to a different outcome is not correct.

A classic example is physical rehab. In the US, getting insurers to pay for physical therapy is difficult and often capped. This in turn reduces long term mobility and leads to issues down the road. In Europe, it's far easier to get physical therapy leading to better long term quality of life.

US also has "programs" and generally spends more on preventative medicine. Further, actual medical evidence suggests medicine doesn't have good treatments for obesity (getting people to lose much weight and keep it off), save the surgical inventions (which aren't used often enough to explain much). It's also clear that obesity rates are rising throughout the developed world despite rising spending.

https://i1.wp.com/randomcriticalanalysis.com/wp-content/uplo...

> US also has "programs" and generally spends more on preventative medicine.

These programs are often implemented by insurers with already healthy populations, such as large corporations. Hardly the populations that medicare supports. It's not surprising that Microsoft has good support for smoking cessation (and spends lots of $$$), but a mother of two working multiple jobs has no such access or funding.

> Further, actual medical evidence suggests medicine doesn't have good treatments for obesity

Depends on how you define "medicine". Are societal programs like healthy school lunches and subsidized healthy meals part of public health plans? Europe would agree, the US would disagree. Part of the issue is the US scope of interest isn't holistic.

One can come up with a narrative to support almost any argument. The question is, do you have data to support it, is it credible, and how much can it actually explain? The truth is richer countries tend to be significantly fatter countries and countries are getting fatter, even though these same countries also spend significantly (increasingly) more money on healthcare and a variety of other social services. These are empirically verifiable points that actually explain things and make quite a lot of sense theoretically.

The high average caloric consumption in the US is likely substantially explained by our income levels. Humans are not genetically adapted to living in an age of cheap, plentiful, readily available, and highly palatable food. Above and beyond high average income levels and particularly affordable food prices, countries also differ in a number of other dimensions. For example, it's quite clear the US escaped the malthusian trap long before most of Europe because of the ample amount of fertile land settlers had at their disposal. Americans were taller and fatter than Europeans in Europe long before the development of the welfare state. This is also verifiable. It's quite possible such differences lingering effects on dietary preferences, serving sizes, and other variables that impact food consumption.

Further, there are clearly large spatial differences in the United States and they're unlikely to be well explained by the sorts of policy you mentioned. Parts of the US settled by people that migrated from periphery of the UK (Scotland, N. Ireland, Wales, and Northern England) suffer from these issues much more than most Americans and more than can be explained by observables like income, education, and the like. This residual also seems to play out in the UK today

https://www.bmj.com/content/342/bmj.d508.full.pdf+html

I've done my own analysis and found this maps well to genetic population structure (not yet published), but whether this is genetic or some sort of subtle cultural phenomenon is a different question.

While I'm quite skeptical that existing non-medical programs of that sort have significant effects (evidence?) or even vary nearly as much as you seem to believe (US affluence has implications for purchasing power of all households, even allowing for somewhat higher inqequality, and size of welfare state often underestimated), I think you need to explain how it is that these higher income, higher spending countries with larger welfare states achieve results no better (probably somewhat worse) than much poorer countries.

https://i1.wp.com/randomcriticalanalysis.com/wp-content/uplo...

Also, you should probably also be able to explain why it is that socioeconomic gaps in life expectancy and other health outcomes are probably at least as large in Finland, Norway, and the like.

https://twitter.com/RCAFDM/status/1203715358152167424

What about the financial costs to the patients? Are other countries able to get the same outcomes at lower costs to the patient?

Broadly speaking, yes. The post suggests that we are operating in a regime where outcomes are insensitive to cost.