[jerf]

No, he's not assuming anything like that. He's observing that if the US is slightly worse on average (for the sake of argument), but you have what you claim are a large number of people being actively harmed by the system, then to make up for it you must have a large number of being receiving unbelievably good outcomes, or you can't end up with "slightly worse on average" in the end. It's a very simple mathematical point.

I'd observe that in general, the complaint with the US medical system is that it is too expensive, or that for what we pour into it it ought to be clearly the best everywhere across all measures instead of merely near the top. (Which is rather more accurate; it isn't "slightly below average", it's "slightly behind best", and there are rather a lot of individual measures in which it is the best.) It isn't that it's a terrible system in general. You have to game stats pretty hard to make it an actively bad system in terms of raw outcome.

[danielweber]

Simpson's Paradox says you can have rich people country A outperform rich people in country B and poor people in country A outperform poor people in country B and have country B outperform country A when both groups are put together.

This is probably not the case, but since this is hacker news I'm being a dork about the math.