[WhatWorkingOn]

A war machine can be built once and maintained for a long time. Medical care is a personal and time consuming process with multiple parties and tests that need to be coordinated across. All of this is expensive because for every person being given that time of day, there's someone else that needs it. There aren't enough hours in the day and smart people in the country to scale up healthcare.

Contrary to what we would like to believe, there is a scarcity of intelligent people willing to devote their entire lives to the study of medicine across specialties.

If you cannot afford it, the US healthcare is terrible. If you have the means to afford it, the US healthcare system is one of if not the best in the world.

[lantry]

> If you have the means to afford it, the US healthcare system is one of if not the best in the world.

That's unfortunately not even the case. Americans spend more money on healthcare AND have worse outcomes.

https://jamanetwork.com/journals/jama/article-abstract/27843...

https://www.healthsystemtracker.org/chart-collection/quality...

https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare...

[TexanFeller]

A big part of why we spend more is cultural and environmental. The government incentives encourage unhealthy food to be everywhere and subsidizes things like adding corn syrup products to everything. Policy also encourages driving instead of walking. And we've made it culturally acceptable to be fat. There are big movements trying to convince people their weight is not a problem, not something they have control over, and you can be "healthy at any size". Many doctors have stopped warning patients about their obesity because of social pressure not to fat shame! I started with a doctor like that when facing blood pressure and related issues and have since ditched them. Caring more about sensitivity, being accused of fat shaming, and expediency than my health is malpractice in my book.

[leereeves]

All of those sources are discussing average outcomes across the entire population.

None discuss outcomes among only those who "have the means to afford it" so none of them refute GP's claim.

[bombcar]

Correct, where do the princes and sheiks of the Middle East head when they need the best medical care money can buy?

[kashunstva]

I’m not at all convinced they look carefully at health outcome and cost efficiency metrics before deciding where to point their private jets. Instead, I’ll bet (in part) they use high cost as a surrogate for quality. And the immediate availability of any test or consultation they desire.

[hedora]

> If you have the means to afford it, the US healthcare system is one of if not the best in the world.

This is untrue according to all metrics I have seen (such as life expectancy). Do you have any evidence to back this statement up?

[nradov]

It depends on which metric you look at. The USA is at or near the top in 5-year survival rates for most types of cancer. We also have unrivalled trauma care. In other metrics we're well many behind other developed countries.

Many of our worse outcomes though have nothing to do with the healthcare system. The decrease in life expectancy is being driven by factors like obesity, substance abuse, sedentary lifestyles, vehicle crashes, suicide, and violence.

[adgjlsfhk1]

survival rates are a pretty bad metric because you can easily change them by changing the amount of screening without making people live longer or healthier. when you compare cancer mortality rates, the US is not doing well.

[nradov]

Nope. Certain types of cancer screening are helpful in making people live longer and healthier. It is much easier to treat cancer when it is caught early.

[adgjlsfhk1]

Absolutely, but 5 survival rates are still a really bad metric because they make things look better even for uncurable cancer (or cancer that was curable but treatment was given up on because of price). Also, if a 90 year old gets a slow growing cancer that doesn't require treatment (cause they'll be dead before it's a problem), screening for it will increase survival rates even though you didn't actually treat anything.

[shuckles]

The drivers of poor US life expectancy is mostly guns and cars. Cars are the #1 killer of Americans between 5 and 45 (approximately). That doesn’t have much to do with the medical system.

[andsoitis]

Leading causes of death in the US: https://www.healthline.com/health/leading-causes-of-death

10 of the leading 12 causes of death are diseases, with the first non-disease cause coming in at #4.

[nradov]

You missed the point. Cancer and heart disease primary kill people when they're already old. Treatment of those diseases, while important and necessary, doesn't impact average life expectancy much either way. Whereas fentanyl overdoses are now the leading cause of death for adults 18 - 45. That has a huge impact on average life expectancy because those people would have otherwise lived many more years.

https://www.gbhoh.com/fentanyl-becomes-leading-cause-of-deat...

[andsoitis]

OK, here are the leading causes of dying at various age groups: https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_dea... and unintentional injuries comprising: https://www.cdc.gov/injury/wisqars/leadingcauses.html

I still fail to see cars and guns being the leading cause of death.

Do you see something I don't?

[nradov]

Your information is outdated. The rate of accidental death among younger adults due to opioid poisonings has increased significantly in just the last few years.

https://peterattiamd.com/anthonyhipolito/

https://www.statesman.com/story/news/politics/politifact/202...

[shuckles]

Someone dying a few years earlier than otherwise has a smaller impact on _life expectancy_ than someone dying young. Furthermore, the #1 cause is correlated with lifestyle factors which medical treatment has little control over.

You can see the breakdown of life expectancy reducing factors here, none of which are attributable to "limited specialized treatment": https://ourworldindata.org/us-life-expectancy-low

[jrajav]

> A war machine can be built once and maintained for a long time.

This might be true in theory but is somewhat irrelevant here given the gargantuan levels of waste in US military spending.

There is also gargantuan waste in healthcare costs, but those are spread out via insurance, not taxes.

The presence of gargantuan waste in both sectors and the different avenues of spending both make any after-the-fact, simplified explanation of why one costs more than the other kind of moot.

The presence of gargantuan waste should also be addressed before implying that the costs of healthcare are all presumed necessary.

[triceratops]

> Contrary to what we would like to believe, there is a scarcity of intelligent people willing to devote their entire lives to the study of medicine across specialties

Why? Are money and social status insufficient motivators? Or is there another reason?