[mandmandam]

> The manifesto claims that our health care system is responsible for our lower life expectancy, which is trivially falsifiable

No, it isn't. If you want to claim that all of those numbers are explained by heart attacks and guns, then you need to ask yourself how many of the gun deaths are due to poor mental health resources, and how many of the heart attacks could have been prevented with more equitable and affordable healthcare.

And if you still believe it's so "trivially falsifiable", then why do you think most Americans (and the rest of the world, for that matter) believe otherwise? US healthcare is undeniably a global laughing stock. We are the poster child for why capitalism in healthcare is an evil and stupid idea.

Our system works well for people with either a looooot of money, or premium insurance through their employment.

It doesn't work so well for the hundreds of thousands forced into medical bankruptcy each year, or the diabetics dying because they can't afford insulin, or the 27% of Americans who skipped medical care because they couldn't afford it last year [0]. 27%! That's utterly indefensible. No society can long withstand such stress.

It doesn't work so well for non-white infants dying in childbirth at shocking rates, or the families left destitute due to over-costed end of life care. Try telling the people who had their lives financially ruined because someone called a $4,000 ambulance for them that we outperform in healthcare.

Etc, etc.

> when it comes to the treatment of illness, we outperform.

On a dollar per dollar basis? Nope. To all citizens with any approximation of equality? Nope. If you have a high 7 figure net worth? Sure; glad you're alright Jack - but don't expect America to believe you when you say the system works.

0 - https://usafacts.org/articles/how-many-people-skip-medical-t...

[tptacek]

I think we have more gun deaths because we have vastly more guns than other countries, and more car deaths because we drive a lot more. I think researchers broadly agree with me. But you do you; this doesn't seem like an especially promising discussion.

[mandmandam]

> we have vastly more guns than other countries,

Yeah, most of the world sees that as a mental health issue. "Gun nuts" is the term most often used.

And, over half of all gun deaths are suicides, so I stand by my statement that better mental health services would greatly reduce the number of gun deaths.

> and more car deaths because we drive a lot more.

I didn't say anything about car deaths. That was you, and I didn't take issue with it. That said, the fact that road safety has fallen so far over the past couple decades doesn't speak well to our collective mental health.

> I think researchers broadly agree with me.

This is at least your fourth distinctly misleading appeal to authority in our short chat.

> you do you; this doesn't seem like an especially promising discussion.

I'm afraid not. I tried though.

[tptacek]

No, the stat I am working from is "homicides", not "gun deaths"; I'm just inferring that guns drive those homicides.

I will leave you with this: our health care system has the same structure in basically all 50 states. But CVD outcomes vary wildly among states: Minnesota, California, Massachusetts, and Colorado have outcomes that exceed those in the rest of the G8, while Oklahoma, Mississippi, and Alabama are so bad they drag the whole country down. Health insurers in Oregon and Rhode Island don't function differently than they do in Alabama.

No part of our life expectancy gap has anything to do with health insurance.

[mandmandam]

> No, the stat I am working from is "homicides", not "gun deaths"; I'm just inferring that guns drive those homicides.

If there's a huge, outlying number of homicides, but there's even more suicides by gun death, does that sound like a mental health system that's working? It's so weird that you'd think this strengthens your case somehow.

> our health care system has the same structure in basically all 50 states. But CVD outcomes vary wildly among states

As you would expect, because:

1. Not everyone in every state has equal access to coverage. States like Alabama and Mississippi have higher rates of uninsured people.

2. Wealthier states with better public health systems invest more in preventive care.

3. Poorer states may have fewer resources that discourage routine doctor visits. A hospital in Massachusetts might have state-of-the-art facilities and specialists, while rural hospitals in Alabama might lack funding or staff.

And, there's lots of other variations by state which could affect CVD outcomes; diet, smoking rates, pollution etc (which often lead back to healthcare, and access to it).

> No part of our life expectancy gap has anything to do with health insurance.

I urge you to reconsider this stance; not just because it's deeply wrong, but because it ignores and enables some really evil stuff. I've given you all the pieces you need to see that, because I know that you have all the intelligence necessary to put them together. I do hope you put them together.

[tptacek]

No, it isn't wrong. The difference between the approaches we have here is that I'm looking stuff up, and have actual information in front of me, and you're defending a narrative. If your narrative was supported by the facts, I'd be defending it too. I don't care about insurers. But it isn't; attacking insurers is problematic not just because murder is wrong (it deeply is), but also because it's not fixing the problem.

[life expectancy gap causal statistics]

[national health expenditure]

Two useful searches for you.

Insurers are simply not where the costs in our system come from. In fact: if you allowed Medicare to enroll patients of all ages, its administrative efficiency statistics would quickly regress to those of private insurers, for mathematically simple reasons.

[mandmandam]

> No, it isn't wrong.

It is though. It’s deeply and profoundly wrong; blatantly wrong; a child could see that it's wrong; every other country in the world can see that it's wrong; and most Americans see it as wrong despite deacdeas of unanimous corporate propaganda.

That’s why there have been many books and documentaries about how US insurers are a huge problem. Luigi's manifesto even called two out by name: Rosenthal [0] and Moore [1].

It would have been nice to see you acknowledge the weakness of your last argument instead of responding by accusing me of "defending a narrative" (that's called 'projection' btw). Asking me to google vague phrases is an even weaker line of argument.

> Insurers are simply not where the costs in our system come from.

Do you realize how many times now you've just stated something as if it were fact when there have been shelves of books written demonstrating the exact opposite? It's not normal tptacek, and intellectually incurious in the extreme.

This particular statement of yours is so obviously wrong it's hard to imagine where to begin: Where do those billions in profit come from? Why was the DoJ launching an antitrust investigation against United? Why were there credible accusations against Brian Thompson of insider trading? ... If you want hundreds more examples, try reading a book about this topic: Maybe 'Delay, Deny, Defend', or 'The Price We Pay: What Broke American Health Care—and How to Fix It'. There are dozens to choose from, and you don't seem to be able to even acknowledge that they exist; it's almost spooky.

At the very least, please, try to acknowledge that actually there might be something very wrong here. Plugging your fingers in your ears, and making outrageous and aggressive claims as if you were delivering mathematical proofs with certainty, is really disappointing stuff.

0 - https://stanmed.stanford.edu/how-health-insurance-changed-fr...

1 - https://watchdocumentaries.com/sicko/