If the healthCARE system cannot be factored into how poor the health of its citizens is, then what’s the point of it?

The truth is that the healthcare system in the US is a massive source of revenue. There is little preventative practices going on because those don’t make money. If you don’t think healthcare is a part of the problem in the US, you must never have participated in it.

> There is little preventative practices going on because those don’t make money

Source? Testing and preventative care is both profitable and widespread in America. (It's not universal.)

"The < 30 crowd, particularly the 12-20 crowd is fatter and more American shaped."

I am going to rid my vocabulary of the word "fat" and just refer to people as "American Shaped" from now on...

This is an article that is largely about how the life expectancy gap in the US isn't defined by health outcomes, but rather drugs, guns, and, most especially, cars.

I understand that, but when talking about where our priorities should be, I believe it should be on assessing lifestyle and options first.

It's also a matter of quality of life vs pure "life expectancy" being worth consideration. Dying unexpectedly, even in large numbers is unfortunate. But a majority of the population living lower quality lives for reasons which can be addressed is more of a priority.

And it could be that addressing the real health issues will also involve improving some of the issues which lead to early death.

For example, with alcohol, why is alcohol use high? Could it be somewhat due to the insane amount of advertising and promotion by the alcohol industry? Could it be because, as people's lives tend to be less happy or lower quality, they seek easy distraction and escape?

Same with cars; cities built for humans instead of for cars will mean less car deaths and healthier people.

By the end of this comment, you're talking about the same stuff that Yglesias is, but most of the preceding comment that I responded to was about health outcomes, and part of the thrust of the article is that health outcomes aren't determinative of the life expectancy gap in the US, because that gap is dominated by drugs, guns, and, most especially, cars.

I agree with what you're saying at the end of this comment: if your policy goal is to reduce the life expectancy gap, interventions in health care and nutrition aren't likely to pay off, but interventions in urban design or economic mobility (to combat the drugs and guns) likely will. Which is why, if you believe what this article is saying, you should probably flinch when people write long comments about potato chip advertising in response to it.

While accountability on people to change their lifestyles would be ideal, the truth is that marketing as a domain has such a deep understanding of how to get humans to go towards something. And that something is almost never the healthy and happy thing. You don’t see ads for broccoli. And policy is driven by billions of dollars in lobby money, no way of turning that tide.

> no way of turning that tide

Indeed, I don't see an obvious solution other than through pain and suffering (where some number of generations get worse and worse until they reach a breaking point, and after the dust settles there might be a large mind shift).

Drugs and guns are a lifestyle decision though...

Not always. You're making the mistake of assuming that drugs and guns are being chosen by the person that's potentially shortening their life.

People die all the time due to other people's choices of embracing drugs and using guns. In a car with someone who's afraid of being caught with a little cocaine? Getting shot by someone who can't aim? There, you're now a victim of drugs or guns without making a lifestyle choice.