[robertlagrant]

But engage with the point OP's making. That is despite spending far more on healthcare, so maybe the problem isn't the healthcare?

Life expectancy in general in the US could also be due to the amount of gun violence, as well. Nothing to do with the quality of healthcare.

[thrance]

In western Europe, governments have a vested interest in the good health of their citizens, because a healthy citizen costs less to the healthcare system.

The US government does not care that much about obesity, gun violence and all that jazz because it is not the one paying for the damages it does.

All these factors contribute to the comparatively poorer life expectancy of Americans, which is, I agree, only a surface metric.

[llamaimperative]

The government does end up paying for this via Medicare and Medicaid but doesn’t have good levers to solve it directly.

The more important dynamic you’re pointing to is that private insurers don’t care because our insurance is tied to our employers and therefore is expected (by insurers) to churn every 4 years or so.

It literally makes zero sense for a private insurer to invest in an American’s healthcare results more than 3 or so years down the road.

Surprise surprise, we have best-in-class care for emergencies and complex acute cases, and absolutely atrocious management of early disease and lifestyle problems (which is when it’s most cost-effective to solve health problems).

[llamaimperative]

Managing chronic disease burden is a component of healthcare

The fact that Americans intuit that it’s not is a worrying sign of just how broken our system is

[robertlagrant]

> Americans intuit that it’s not

Any evidence for this?

[llamaimperative]

GP’s comment? It’s predicated on separating “high chronic disease burden” from “poor healthcare system performance.”

I don’t think this is a broadly held belief, I think it’s the “eeehhrm actually…” contrarian belief that’s trying to discredit the consensus view that our healthcare system gets very poor results for the money. So it shows up in places like this exact HN thread.

[robertlagrant]

Sounds as though you're now not saying that Americans as a group think that. That's good.