Does the US actually fall behind other nations in health outcomes? The US has two big factors working against them: much more widespread obesity (and the level of morbid obesity) and the insurance bureaucracy. These two factors should negatively impact health statistics without the treatments being worse.
> Does the US actually fall behind other nations in health outcomes?
For the world's richest people you couldn't do better than to be a patient in America. For most Americans though, the US healthcare system is failing them. America does worse compared to other nations in some very basic measures like having a lower average life expectancy, a higher infant morality rate, more obesity and congestive heart failure and more hospital/pharmacy screw ups. A child or teenager in the US is less likely to live to adulthood compared to those in other developed countries. It's not any better when it comes to mental health either. The US is one of the worst nations when it comes to mental health outcomes and suicide and drug related deaths are higher in the US. Over thirty percent of the US population has been forced to put off getting the care they need due to the cost and preventative care is usually the first thing that people cut back on leading to bigger problems that could have been avoided entirely.
If you adjust by factors like obesity, state and drug use US is quite close or more or less on the same level as Western European countries.
Even if you don’t do that there is a higher variance in life expectancy between different US states than inside the EU. e.g. California is about on par with the Netherlands, Germany, Britain while Mississippi and West Virginia are slightly below Bulgaria (of course mainly because of drugs..). IMHO that kinds of makes generalized comparisons semi-meaningless.
"Yeah, but just unimportant people from flyover states. We have to divide our analysis of the United States: Over here in California - you now were the people we care about live - life is just as good as in these other fancy European countries we don't look down upon."
People who can't do basic math and skip prevention are responsible for their own shit outcome.
People in Portugal, where healthcare is "free", i.e. the government pays for it, frequently wait for years before being able to see a specialist due to long waitlists. The obvious outcome is that only poor people use the system and if you can you use private healthcare.
People in Czechia with single payer healthcare system with e.g. average wage of 2000 USD pay from 100 euros a month for health insurance (unemployed) to e.g. 500 euros (with 4000 USD salary) or more if you make more. You get the same shitty service (something like 20 years behid the US), you just pay a lot more if you make anything resembling a US salary.
There's no such thing as free healthcare. Can you make a single payer healthcare system that works better? Sure, it's just hard and even if everything is ideal you get maybe 50% discount. The main way to make healthcare cheaper is to drop coverage for diseases that are expensive to treat.
- 90% of Americans have health insurance - I would say it works for more than half (most) of Americans. Granted, not all health insurance is created equally.
- The obesity and congestive heart failure issues is a function of poor dietary choices most Americans make (choosing fast/process food over cooking/making healthy foods), and not a function of healthcare access
Clearly having health insurance isn't enough to make healthcare affordable or prevent patient outcomes from being worse for Americans than patients in other nations.
> The obesity and congestive heart failure issues is a function of poor dietary choices
I also suspect that obesity and congestive heart failure issues are heavily influenced by diet, although I think that "choices" might be misleading here and that being unable to afford basic and preventative healthcare likely does have a major impact in healthcare outcomes even when the problems come from obesity and heart failure.
It's certainly not as if people in other nations don't also enjoy ultra-processed foods or are any less fond of sugar, fat, and salt. They just often have better access to healthier foods, and more stringent regulations concerning what companies are and aren't allowed to put in foods, what they are allowed to advertise, and how they are sold.
There is a huge difference between the number of people in the US who have little to no access to healthy foods when compared to those in other developed nations. Sometimes it's physical access (food deserts) and sometimes it's a matter of costs, but I don't think there's anything inherent to Americans that forces them to make bad choices. I'm guessing that instead Americans tend to have less choice and fewer opportunities for healthy foods in the first place, while having unhealthy ultra-processed foods that would be banned in other countries readily available, easily affordable, and heavily advertised to them.
I call bs on the second part. It's not unhealthy food that makes you gain weight, it's how much food you have.
On top of that, the healthiest foods are among the cheapest foods you can buy. Milk, oatmeal, potatoes, rice, macaroni, chicken are all cheap compared to most foods you can get. This stuff is available almost everywhere.
>but I don't think there's anything inherent to Americans that forces them to make bad choices.
It's partly cultural. But this isn't a uniquely American problem. It's just worse in the US. 72% of Americans are obese or overweight.
On top of that there was a recent study that found that BMR has decreased in the last ~30 years. Among men it was even up to 7%. That's a big enough difference to take someone from barely overweight to obese over a lifetime. But this is only a single study so far.
> On top of that, the healthiest foods are among the cheapest foods you can buy.
The usual argument here calls out "bulk beans and rice" instead of potatoes and chicken, but in both cases you aren't going to find that in a gas station or convince store which for many Americans (some 40+ million) is the only place they can get groceries. If they're getting chicken it's not going to be whole and uncooked. It'll be sold in a plastic bag leaching PFAS into the food and be coated in high fructose corn syrup (most packaged lunch meats have sugar or HFCS added). Those kinds of places tend to have very little fresh fruit and veg as well.
If you're looking at cost per calorie unhealthy food will often win out as less costly, not just in terms of money but also time and effort. Someone who works two jobs and spends hours sitting on or walking to/from the bus isn't always going to have the energy or time to roast a chicken. It's easy to see why they'd choose what's fastest, highly satisfying, requires less preparation and clean up, and is inexpensive.
Not that I'm suggesting that the 72% of Americans who are obese/overweight have those kinds of problems... just that you'll find more Americans who are in that position than you'll find somewhere like the UK.
I found the study on the decrease in BMR. That's pretty wild and if true, I wouldn't be surprised if it was a factor in the obesity problem.
>If you're looking at cost per calorie unhealthy food will often win out as less costly
What you should be looking for is cost per gram of protein. That's the only macro nutrient you need large amounts of. Calories per gram of protein are important too - oatmeal and dried pasta are the cheapest protein/$, but their protein/kcal is too low.
I think it comes down to 'not caring enough' to try to get it under control. All the obfuscation and noise around nutrition ("healthy food") doesn't help either, but it's doable.
>I found the study on the decrease in BMR. That's pretty wild and if true, I wouldn't be surprised if it was a factor in the obesity problem.
It might even be the main part, at least for men. If your normal TDEE is 2136 kcal and you eat at maintenance, but then your BMR drops by 7.7% (165 kcal) then you'll gain weight until your TDEE is at 2136 kcal again. During this you would go from ~80 kg to ~95 kg taking you from 24.7 BMI to 29.3.
An argument against the study is that it could be due to different measuring techniques. On the other hand, we have found that the average temperature of humans is slowly decreasing, so maybe it's true.
It's not all roses. I'm sure that even the wealthy who get healthcare in the US do have to deal with things like over-treatment, a lack of regulations, excessive costs, etc. It doesn't seem to hurt their outcomes enough to offset the fact that they'll have far more options, greater access to the best avilable technology/treatments, and that they'll be treated like absolute royalty.
