Since the statement they're fact checking is "twice as much... than any other nation," averages don't apply; the smallest ratio is the strongest counterexample. Politicians can avoid being fact checked like this by using less absolute statements in their rhetoric.

They are also using exchange rate $ equivalent instead of PPP, the ratio then is 1.93 for the Netherlands to the US.

This is a lie by the fact checkers. One that pushes an agenda that's obvious to see for everyone who cares to look.

What agenda is that?

(Additionally, PPP is a model someone can use, but it's hardly agreed upon universally as the correct model for equivalent spend value. It's a "basket of goods" model, influenced by the goods chosen. At worst, Politifact is guilty of making a judgement call based on a choice of metric that reasonable people can disagree on, which is hardly "a lie" that "pushes an agenda").

The Netherlands PPP conversion factor is less than 1, and was in 2009 as well. This means that each Euro spent by the Netherlands goes further than the exchange rate equivalent number of dollars would go in the US.

Wouldn't adjusting for PPP bring their healthcare spending up, not down, making Sanders less correct, not more?