A counter argument I see sometimes is that the reason Americans spend more on healthcare compared to other rich countries is that American consumers spend more on just about everything than most other rich countries (and also earn more money). I don’t really know how much merit the argument has.

And as a result we have bigger homes, bigger cars, bigger TVs.... but worse healthcare outcomes? Seems like some of that excess spending yields us more returns than others.

The things you mentioned are almost all inversely related to better healthcare outcomes, to grossly oversimplify a contributing factor.

* Bigger homes means you feel more comfortable being lazy and spending all your time indoors

* Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one

* Bigger TVs means you spend all day "watching the game" instead of going out and playing a sport.

Once again, these are grossly oversimplified, but should drive home the central point that spending on some things can actually worsen outcomes of others.

> Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one

For many (most?) people in the US, the idea of walking anywhere of consequence from their home is simply ludicrous. Restaurant, convenience store, grocery store, all are completely inaccessible except by car.

Suburb planning has explicitly disallowed that sort of living for most people. It has also made it nearly impossible to serve neighborhoods with any sort of reasonable public transit.

> Restaurant, convenience store, grocery store, all are completely inaccessible except by car.

This particular aspect of USA struck me as quite bizarre whenever I visited on business trips. More so as I’m from India where it’s almost a given that things that you need on a day to day basis (grocery, bakery, pharmacy, convenience store etc.,) are available within walking distance. Apart from an opportunity to get some fresh air it’s also a good way to interact with my neighborhood community.

I assumed this is how it’d be in any developed country until I moved to Netherlands. It’s not too different from India at all in that respect here.

So now I wonder, what factors lead to that kind of city planning in US. It was a real ordeal for me to get a meal outside in US, had to either walk for an hour or order taxi service (those were pre-Uber days).

> So now I wonder, what factors lead to that kind of city planning in US.

A car requirement (and hence minimum fuel purchasing requirement) helps keep lower socioeconomic classes out of higher socioeconomic classes’ neighborhoods. This results in marked improvements in economic performance of children in school, as the public school students are determined by the area they are in, and spacing things out results in a populace with a minimum level of financial security who can afford to travel further.

The original impetus may not have been exactly that, as people generally like their space anyway, but it’s affects are well known. Historically, I’m sure there was also a racial component to it, with white people moving to more expensive areas that non white people couldn’t afford.

Initially U.S cities were built according to a grid plan (grids being the most efficient means of urban planning at the time). This also made public transport easier. Grids however do not work well for cars. In response to increasing car ownership, T junctions were introduced to improve flow of traffic. The car also made it possible for people to live far from their place of work, thus the popularisation of suburbs. Other countries followed suit.

> Other countries followed suit.

What other countries? The US is very much an outlier. The only one I can think of is maybe Australia?

The UK and Republic of Ireland.

The way the country is designed you really need to drive to buy a simple thing.

* Bigger homes means you feel more comfortable being lazy and spending all your time indoors

I call BS on that. Accordingly to this logic homeless must be the healthiest people. That aside, rich people (who also happen to have bigger houses) actually exercise more than the poor.

* Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one

You telling that person with the smaller car would rather walk to the store (often VERY long walk in the US)? I call another BS here.

* Bigger TVs means you spend all day "watching the game" instead of going out and playing a sport.

Same argument as for size of the houses. I think you pulled these arguments right out of the place where the sun does not shine.

I think this is a reasonable criticism. The post you’re replying to appeals to common sense but I don’t see much reason to believe it would be borne out by facts

> And as a result we have bigger homes, bigger cars, bigger TVs.... but worse healthcare outcomes?

Not to put too fine a point on it, but maybe "bigger $things" and "worse outcome" are on the same side of the graph.

America spends 18% of GDP on healthcare, in the UK its about 9%. Arguably the UK could do with spending more but right now we get broadly similar outcomes for half the spending.

Here's a long data analysis making that argument: https://randomcriticalanalysis.com/why-conventional-wisdom-o....

What I got from that is that Americans are price-gouged more.

Or even more simply a stronger currency valuation.

> American consumers spend more on just about everything than most other rich countries

Do you have a source for that?

In my experience living and working in a slew of countries around the world, the USA has the cheapest alcohol, cigarettes, cars, electricity, clothing, electronics, gas (and diesel), food at the supermarket, food at the restaurant and many other things of any developed country.

Because taxes are so low, stuff in America is extremely cheap compared to countries with tax-funded healthcare, higher education, etc.

I’m not saying things are more expensive but that the total spent is more. What do you think Americans do with their relatively higher incomes? Evidence would suggest that for the most part they aren’t just putting the difference straight into their savings accounts.

They're spending it on healthcare, and education for starters.

But mostly they're buying the stuff I talked about above. Consumerism.

The most expensive conditions in terms of direct health care costs are diabetes, Alzheimer’s, and osteoarthritis. The most common chronic health conditions in the U.S. are hypertension (high blood pressure), dyslipidemia, and osteoarthritis. Obesity is by far the greatest risk factor contributing to the burden of chronic diseases in the U.S. [1]

1. https://milkeninstitute.org/reports/costs-chronic-disease-us....

If we fixed our diet problems, I’m not sure if we’d either have e or healthcare costs, or if the industry would find other ways to fill in the gap

I'd argue it's unfixable for low income workers. Excessive sugar in all the cheap food is a trap they can't avoid. They don't have money to buy better food and don't have time to shop and cook for themselves. That's assuming they recognize this problem at all.

Vegetables are cheap. Beans are cheap. Chicken and turkey are cheap.

McDonalds is not cheap, but it’s easy. It astounds me how many people eat out almost every meal.

Beans and all that isn't cheap overall: it takes will, effort and time to figure out what to buy and how to cook it. If that was packaged into cheap ready to eat burgers, spiced with something to make it more tolerable, then poor folks would switch to it. This approach isn't economically sound, though: it has 0 profit margins and it cuts deep into the fastfood & healthcare owners.

They are cheap if bought in bulk (which many poor people can't do because of upfront cost or lack of freezer space) and if there actually is a place to buy at least decent-quality vegs.

Check out https://en.wikipedia.org/wiki/Food_desert

Quality vegetables aren't cheap. At least not for the consumer.

More than 40 million Americans are on food stamps (govt food support). In reality, many food basics like milk, rice and beans are healthy and affordable.

Plenty of people are low income or otherwise cash poor by reasonable standards, but not low enough to qualify for food stamps.

Affordable, yes, but require more time and skill to cook a meal that hits the same reward centers as the edible junk sold in cheap restaurant chains... often both short in supply among those on food stamps.

Milk is not healthy, rice barely can qualify but I guess it's food. Beans are.

A) don’t subsidise sugar B) tax sugar

You assume good faith here. I'd argue that the "system" is intentionally set up this way.

> B

It was tried and rolled back in chicago because it was deemed as unfairly targeting the poor.

Since there is a higher incidence of smoking among poorer folks[0], couldn't the same argument apply to the massive sin tax on cigarettes? We justify such sin taxes as being to the benefit of discouraging a harmful health behavior and personally I see the same link with higher sugar consumption.

[0] https://truthinitiative.org/research-resources/targeted-comm...

> It was tried and rolled back in chicago because it was deemed as unfairly targeting the poor.

There's no reason why you couldn't pair taxing sugar with price-subsidies on non-sugary foods. The US already knows how to subsidize food production. Just stop subsidizing corn syrup and shift the subsidies to something less clearly destructive.

> price-subsidies on non-sugary foods.

That makes a big assumption that people aren't buying more spinach because of price of spinach.

beans and rice are already super cheap. Much healthier and cheaper option than mcdonalds.

> beans and rice are already super cheap. Much healthier and cheaper option than mcdonalds.

Why are you slyly shifting from "sugar" to "mcdonalds"? Minus drinks and desserts, McDonalds' offerings are not high in sugar.

> That makes a big assumption that people aren't buying more spinach because of price of spinach.

The price per calorie of spinach is extremely high. Micronutrients are great and all, but you can't live off micronutrients alone.

> Why are you slyly shifting from "sugar" to "mcdonalds"? Minus drinks and desserts, McDonalds' offerings are not high in sugar.

Aren't carbohydrates sugar though?

Why is the distinction between sugar in drinks and sugar is burger buns relevant to the discussion.

> Micronutrients are great and all, but you can't live off micronutrients alone.

Why did you slyly ignore 'beans and rice' in my comment. I wasn't suggesting people get their calories from spinach, what a weird interpretation.

my mexican family of 5 ate this combo every single day ,growing up. spinach + rice+ beans and occasional meat was afforable on one gardner's salary.

I think a multipronged approach is needed. Many families in the food deserts lost the know how to cook properly. But it’s very unfortunate that the most subsidised crop is corn. If beans were, I am sure it would be perverted too somehow but maybe not as bad.

My general point is that the incentives today are all wrong. Many things need to be fixed and subsidies of corn syrup is one egregious thing.

Did Chicago stop corn subsidies in the US?

no? but wouldn't it have the same effect of burdening the poor more?

No

We pay way more per procedure than other countries, we get more procedures, and we get more expensive procedures.

I doubt obesity makes a very large difference because even though it increases morbidity I think it has a larger effect on mortality. If you're obese you might have to retire a few years early, but you'll also die even earlier missing out on years of being taken care of in a nursing home while you suffer from Alzheimer's.

Agreed. Look at the CDC's leading causes of premature death. A significant number are preventable (i.e., diet and lifestyle). Interesting enough, many of these are diseases that Covid 19 does well to exploit. If you are in good health, the chances of being taken to the grave by Covid 19 are rare.

What's odd is that the concept of comorbidies has been abandoned in the C19 era. There is little transparency when it comes to C19's co-conspirators.

Editorial: It troubles me when article after article about the high price is insulin fails to mention demand; and that close to all the demand created by Type 2 is avoidable.

Might there be manufacturer price gouging? Perhaps. But it's universally agreed that demand will increase price.

2 nights at the hospital for delivering a healthy baby may cost $50k-$100k to the insurance for healthy baby and mom.

The fact that hospital/physicians charge as much and insurance accepts to pay is not due to some unhealthy habits or chronic diseases in the US.

Edit: of course your point stands and the higher rate of chronic diseases makes it worse.

> 2 nights at the hospital for delivering a healthy baby may cost $50k-$100k to the insurance for healthy baby and mom.

Maybe I'm misremembering, but we had a ridiculous high deductible ($10k?) when we had our first kid, and I don't think we met it.

That said, I complain about the price of healthcare and insurance to anyone who will listen, and I hope someday it gets sorted out. So far the only solution I've found is to get a better paying job, which isn't a solution for most people.

Private hospital in NYC: Just the hospital "room and board" line is north of $40k: $13k per night of "enhanced nursery" for the newborn and around $10k per night for Mom. That's before all the doctors add their services.

No idea how you can make it lower than $10k :) Where was that?

Iowa. I think the base rate here is about $1k / night. Could be wrong on that though. Our oldest is four and half now, so it's been a while. It's possible I just didn't read the bills correctly. Either way I'm sure it was less than what you describe.

My experience in one of the most expensive suburbs of NYC, at the most highly rated hospital in the state, a baby with standard 2 night stay and delivery and no complications cost $20k or so all together with about $5k out of pocket on a gold HSA plan a couple years ago.

We only paid $6k from HSA (maxing out the out-of-pocket) but that Mt Sinai hospital charges $80k (after adjustments) and the insurance pays the rest. I should add there was a C-secyion that barely added $10k to the bill.

I know, couldn't believe it either

Personally I'm way more inclined to believe Americans are unhealthy because their health care system is too expensive, rather than the other way around. Obesity is treatable.

> Obesity is treatable.

How?

By fixing nutrition and adding some physical exercises. Though it’s slow, count 1 kg weight loss/week in average.

I assumed that was in reference to solving obesity at society level not individual level.

I would say, unhealthy food must be taxed, so that healthy stuff is the cheaper choice too.

This is repeated a lot but if you actually look at the research you find that physical exercise has very little effect(except maybe as a preventative). That nutrition in general has a small effect. And dieting has a larger effect but is only temporary, and no dietary interventions have shown any real success over the long term.

Bariatric surgery is currently the only real effective treatment. With GLP agonists like semaglutide having similar effects at least in the near term.

> This is repeated a lot but if you actually look at the research you find that physical exercise has very little effect(except maybe as a preventative).

This baseless assertion is simply outright wrong, and utterly absurd on so many levels.

* https://www.acpjournals.org/doi/abs/10.7326/0003-4819-133-2-...

* https://www.nature.com/articles/0800499

Please don't spread misinformation.

Sorry there was some confusion. By long term I meant 3-10 year follow ups.

Weight loss from diet/exercise will definitely persist for a year or even a couple.

Also specifically about exercise your study says "[Weight] did not change in the exercise without weight loss [group]"

> Sorry there was some confusion. By long term I meant 3-10 year follow ups.

That only happens if the patient relapses into his previous unhealthy lifestyle.

You can't simply follow a poor high calory diet and a sedentary lifestyle and still expect zero consequences from your actions. If your problem is behavioral then you fix it by fixing the problems in your behavior.

I lost recently 70 lbs without any surgery. Talking about extreme cases I have no idea, never met any people above 300 lbs. I can only guess, that start is always the same. Personally I am not a friend of surgical interventions.

Oh sorry I'm not arguing that it never happens, just that in every clinical trial I've seen that followed participants for 5 years it was so rare to keep the weight off that the average weight loss for the group was insignificant(clinically not statistically).

That’s probably the same effect as with Weight Watchers where long time success is rather limited. I have been there too. After couple years old habits return, one starts eating bad things, something happens (let’s take some illness) and exercising ends. Pounds are coming back and cycle starts again.

Colonoscopies in the US cost about $2,500 out-of-pocket, even with insurance. Most other countries are under $1,000 for the same procedure.

$1,000 sounds high. I just had one this morning in Russia at a very nice modern private clinic. The entire thing including anesthesiologist was under $75 completely out of pocket. It was amazing to me compared to my experience with healthcare in the US (I'm an American) - they gave us a price up front.

No idea how much my public insurance paid my doctor, but in Germany these things are free for the patient.

Obesity, CHF, smoking, poisoned by air pollution or ground water waste, cancer due to the above...sedentary lifestyle, non examined mental life, glued to the TV and basing all opinions on cable news, no exercise and crappy diets...it's not a good way that many americans live.