> Most Asians exercise much more, eat healthier, AND smoke and drink less.

Tobacco consumption in Asia is incredibly high: https://en.wikipedia.org/wiki/Tobacco_consumption_by_country

Alcohol consumption is fairly high too.

https://worldpopulationreview.com/country-rankings/alcohol-c...

Though I suppose China and India, which combined probably comprise the biggest block of population, are a slightly better shade of red than the US and Europe.

That's a good point, life style does play a major part.

But I think this point also opens another subject, preventive healthcare. Many modern healthcare systems are starting to focus on prevention for 2 main reasons: increase quality of life and reduce long-term healthcare costs.

For example, in Finland public tobacco smoking is(was?) considered a public health issue. The government got actively involved to reduce consumption and this resulted in better overall outcomes in their healthcare systems for diseases caused or exacerbated by smoking.

IMO, obesity is a problem affecting the healthcare systems of many developed countries (Vietnam is not yet considered a developed country) arguably not at the same levels as in the US. But this again is part of how government chooses to get involved in fixing the healthcare system by enforcing policies or passing laws that help with prevention.

The "metabo law" in Japan appears to have been somewhat successful in preventing obesity. But it probably wouldn't be politically acceptable in the USA.

https://www.theatlantic.com/health/archive/2012/09/big-gover...

Spot on.

My father is getting old and our healthcare system has done a great job at keeping him alive while he can still eat shit loads of pizza, drink beer and be a 80lbs overweight.

All this medication and treatment he takes is not just to keep him alive but to keep him alive without having to change a single bad habit.

This is a good point, and it's important to also remember that these ideas aren't independent. How people interact with the healthcare system over their lifetimes has an impact on how they think about their health, and the health impacting decisions in their lives.

Just look north. Canadians are basically the same people, eat the same diet, but they have free health care, and live 3-4 years longer on average.

Maybe you want to control for the cold weather too?

Not basically the same people. Canadian and US culture aren't the same. And the racial makeup is quite different.

57% of the USA is white, compared to 73% of Canada. Nearly 20% of the USA is hispanic, compared to 1% of Canada. There are many more Asians in Canada and much less people of African origin.

I don't reasonably consider that we can attribute black people and hispanic people simply existing to an additional 8% of GDP in healthcare consumption. That seems like a huge claim with no evidence provided.

I'd like to first see evidence that people of different race has a causality effect on healthcare consumption.

I'm not blaming races, I'm just saying the people are different. Even white Americans and Canadians are not the same.

Per the CDC:

Among men, the prevalence of obesity was over 8 percentage points lower in Canada than in the United States (24.3% compared with 32.6%) and among women, more than 12 percentage points lower (23.9% compared with 36.2%)

In the United States, the majority of the nonwhite population is black or Hispanic for whom the prevalence of obesity is higher than it is for the white population (3). Among nonwhite Canadians, the largest group is comprised of East/Southeast Asian persons for whom the prevalence of obesity is lower than it is for the white population

Canadians don't eat the same diet. The obesity rate is 36% in the USA but only 29% in Canada. I suspect that the difference in life expectancy is influenced more by obesity than by the healthcare system.

And yes we absolutely should control for climate, or at least for incidence of extreme heat waves. It's well known that heat waves kill a lot of frail elderly people.

There is so much wrong with the US healthcare system, from physical therapy centers, ambulance companies and prosthetists, to hospitals and surgery centers, to doctors, to insurance companies, to drug companies, to laws, patents, and the US government. Maybe you don't know the system well?

Obesity is also very high in the United Kingdom (~27 % versus ~35 % ) and not the same problems ( https://www.bbc.com/news/uk-42950587 ).

US is also a super bad infant mortality rate compared to other countries:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844390/

I am so sick of null hypothesis studies and random statistic slinging. It means nothing. Average obesity rates do not tell the whole story (even so an 8% increase is HUGE). You have to look at variance. If the U.S. has a much wider variance then there would be a greater amount of people with extreme obesity which would definitely affect health care outcomes.

> US is also a super bad infant mortality rate compared to other countries:

Access to healthcare is quite low in the US compared to most of the 50 countries ahead of us. We also have higher levels of poverty, ESPECIALLY for a lot of parents/children.

GDP is irrelevant. The paper says:

> In 2013, the US infant mortality rate (IMR) ranked 51st internationally, comparable to Croatia, despite an almost three-fold di erence in GDP per capita

If you have high GDP per capita, and more poor people per capita, and health care is not free - you're going to have more people not accessing health care and suffering the consequences.

In this world - I would expect infant mortality to be much higher even when the healthcare systems are equal.

which too seems like it's probably a complicated issue, from one of your papers.

> Consistent with past evidence that has focused on comparing the US with Scandinavian countries, we find that birth weight can explain around 75% of the US IMR disadvantage relative to Finland or Belgium. However, birth weight can only explain 30% of the US IMR disadvantage relative to Austria or the UK

> This never seems to be a talking point. Have the statisticians controlled for all this when they come to these conclusions??

I never see this as a talking point of folks who are in favor of universal / state-funded healthcare, but it is often a talking point for those who are opposed. They point to the links between state-funded healthcare and the soda tax in the UK as an example of how allowing the government to control your healthcare results in more aggressive and manipulative social policy to control health outcomes societally. Many people opposed to state-funded healthcare feel rather strongly that you should be able to do pretty much whatever you like with your body as long as you're paying for it yourself. I consider this take to be missing quite a lot, but it does seem to be a common one. I am personally in favor of universal single-payer healthcare systems, so I've had this conversation a lot due to my surroundings and have heard just such this argument many times.