I don't think it's settled fact that the US has worse health outcomes. In fact, most data I see points to the opposite. Some people point out very lazy metrics like life expectancy while ignoring that 72% of Americans are overweight or obese according to the CDC. Rearrange healthcare/government insurance models all you want; it can't fix that.

Life expectancy is still lower in the US than in western Europe.

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.

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.

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).

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

> Americans intuit that it’s not

Any evidence for this?

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.

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

Uhhhhh obviously managing chronic disease burden is a core feature of a functional healthcare system.

One of the strongest levers we have to improve the “inputs” you’re describing is a better primary care system. America’s has been absolutely gutted over the last 20 years by interactions of various economic and regulatory dynamics including (notably) the anti-competitive vertical integration of pay-viders and pay-vider+PBMs like UnitedHealth Group.

It is absolutely not true there aren’t system-level changes we can make in healthcare and insurance to help address this.

Yes managing chronic disease is good and important but there is no healthcare system that is so good it can outrun an obese population. The healthy population will always do better than infinity spending and care on a sick one.

It seems like you’re either ignorant of some basic facts about healthcare or are willfully missing the point (true to the username I guess) so I’ll be more explicit:

Having access to doctors helps to manage disease.

Obesity is a disease.

In particular, having access to PCPs helps to manage obesity.

Our healthcare system yields poor access to healthcare.

In particular, it yields poor access to PCPs.

Ergo the obese population is in part an output of and not an external input into the design of our healthcare system.

Ergo changes to the healthcare system absolutely can — and in fact should have as a key goal to — yield changes to levels of obesity.

> “ Rearrange healthcare/government insurance models all you want; it can't fix that.”

This claim is false. The mental model of an obese population being exclusively an input into our healthcare system does not track with what we know about the relationship between healthcare and obesity.

I think we should add that the outcomes are worse at _all_ socioeconomic levels. The rich get screwed over as well in this system as well. It's unfortunate that so many of them have better overall outcomes and/or myopic experiences that many are emotionally invested in being _able_ to pay exorbitant amounts for more personalized care - regardless of the societal consequences - as an interpretation of "freedom."

But hey, it's not like the US is a democracy exactly given that public opinion generally doesn't translate into policy changes anymore.