The entire healthcare system seems to be built against the population.
I've come to see healthcare providers like doctors, nurses, technicians, and the like, as a conniving, essential part of the scheme. They're incentivized to make you wait hours unnecessarily, rush every visit, and involve as many different people as possible in your care. And then, in the end, send ridiculous bills to both your insurance provider and to you at home. The person who spends the most time with you is usually the one trying to collect the payment. It's absurd.
There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
There is absolutely no reason for a medical equipment provider to bill more than the retail price of a piece of equipment, especially after insurance has already paid more than the full cost of the equipment on each installment.
There is absolutely no reason for a family to receive a bill of almost one million dollars because their baby was premature and was in the NICU (see @thepasinins on instagram).
There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
There is a reason that doctors in the US make multiples of what doctors in Europe makes: the AMA lobbied the US CMS, back in the 1990s, to limit the number of residencies opened up every year, to avoid a "glut" of doctors. We have artificial scarcity of doctors.
That's part of the problem, but we also have a problem with limited medical schools in general and with those schools charging through the nose because of that scarcity.
I have a nephew training to be a doctor now. He's looking at $500k in student loan debt by the end. That's a major problem.
The standard GP consult fee in Ontario Canada is $77.15. (just over us$50). That's gross, the nurse, receptionist and rent have to be paid out of that.
Some doctors will do 4 of those an hour, but most will do 6. And they'll try and find ways to bill additional codes above the consult.
> There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
Yeah, it basically all comes down to the bureaucratic nightmare that ultimately benefits the owners of all things medical. Prices have nothing to do with the value of the good or service and everything to do with the maximum amount of profit that can be extracted from a 3rd party.
One of the worst moves in the last 30 years was Clinton adding private insurance options onto Medicare. In the last 60 years was making medicaid a state run program rather than a national program (or just medicare all together). It's actually crazy that we have 53 different government healthcare options. 1 for every state, medicare, and the VA. It's even more crazy that the government doesn't simply directly employ doctors and medical equipment. It's so crazy inefficient to involve 3rd and 4th parties into something that should be direct care.
The US remains one of the only wealthy nations in the world without nationalized healthcare. And we pay through it through the nose.
The US has half the number of medical school graduates compared to the average. Instead of creating a lunar base, maybe create more residencies to graduate doctors?
Quote:
“…has produced one of the lowest ratios of medical school graduates, 8.6 for every 100,000 people. This is far lower than the OECD average of nearly 15 graduates per 100,000 people.”
Zero mention of wait times in the US compared to other countries. Pretty sure that's the chief complaint in most countries that have free-ish healthcare.
You're exactly right but it runs contrary to the narrative being spun.
A quick search reveals the best ER wait times worldwide are in the US, Germany, and Switzerland, with most the rest of western Europe dead last along with Canada and Australia.
The average ER wait time in the US is 24 minutes. In France 2h21m. Italy 2h44m.
Everyone likes to say how great Canadian healthcare is, but talk to actual Canadians and the cracks start to show, you're waiting months for a CT scan, and most need employer-provided health insurance anyway to fill gaps in coverage.
Yeah but could this be because people are more likely to go to ER in countries with free healthcare?
I've been to the ER in my country because of abnormal stomach pain. Obviously I was triaged and had to wait hours because it was not considered life threatening. But in the end a doctor saw me for free. I think if I were in the USA and didn't have health insurance I would have just stayed home and avoided the risk of an expensive bill.
Wouldn't you expect to see that reflected in outcomes? TFA mentions that the only studied country with more avoidable mortality than the US was Mexico. If you aren't seeing it, maybe its not as big a problem as all the people who cannot afford any access to care at all while the country spends more per-person.
There’s not (typically) a regular measure of how much pain and disability a patient suffers while waiting for a hip replacement. It certainly would only show up in mortality statistics massively attenuated.
Oddly, the country with the expensive ineffective healthcare with lower wait times (citation needed) is also the one that doesn’t have guaranteed paid sick leave and other facilities that would make wait times less of a factor.
Anecdotally, I spend a lot more time literally in waiting rooms in Germany than I did in the US, but getting a specialist appointment is much faster here (getting a therapist absolutely excluded, but I was able to get a psychiatrist to write prescriptions for ADHD meds within a month).
I just moved from a medium sized US city and any specialist provider I contacted for myself or my parents was 5 months or more. It's not good everywhere.
I've experienced healthcare outside the US (in the UK) and it's on par with US healthcare in terms of wait times. Seeing a GP was same day with walk ins. When not busy, it was just a 5 minute wait.
Seeing a specialist can take time. I knew people that saw a 3 month wait to see a specialist in the UK. In the US, I just experienced a 3 year wait getting a specialist for my kid with autism. I had to go out of state to get the initial diagnosis, but to get local followup care I had to do that 3 year wait. After that, we were able to get a bunch of referrals to other issues.
What constrains wait time is how many doctors and specialists are working in a field. That has almost zero to do with the underlying payment system of a healthcare system.
I mean, in rural America short of a trip to the ER with whatever wait time they have, getting a primary care doctor is barely possible and only affordable if your employer provides medical care, which many many don't.
This is my favorite thought terminating cliche when the discussion of American healthcare comes up. Wanna see a specialist? You're waiting. Can't afford insurance? You are waiting even longer.
There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
No doctor makes this much for a 15 minute conversation. A small portion of that money is going to the doctor. Much of it goes to all the other aspects of healthcare. The facility, other people involved in care, etc.
And no 15 minute visit costs 1000 dollars to the patient as well. That’s a pretty big exaggeration.
I think generally Americans are happier dying. They want this differentiator between themselves and other countries. They genuinely enjoy the misery it brings to the poorer elements of their society. This is not accidental it appears to be designed that way. Investigating it is a waste of time and not going to change anything until Americans actually want change. (and not just "want" in terms of making facebook posts about wanting it)
As an American, no. Well aside from - yes a significant part thrives on seeing others than them suffer. Years ago, I spent multiple times a year at a B&B on the Hilo side of the big island. The host was one of the last "Grand Dame's" of Hilo. She was a cattle rancher that knew Roosevelt; her husband had been a friend of Linus Pauling. She did hikes in her 70s and 80s few in those ages can do now.
She was grandfathered under a form of medical insurance - I think older Blue Cross/Blue Shield - none can access now. At one point, the US did have better health care than we do at the moment. The fcking idiot boomers (including my parents) bought into the BS from Nixon, Reagan, etc. Hey - (good or bad) - let's stop allowing one to write off debt, but allow companies to do so, etc.
This country does have it's head up it's ass and a significant number blame everyone but themselves and how they vote.
We pay more (as a country) by a lot* and get significantly less for our medical coverage. Want to go self employed with a family of 3? Want a PPO? $4-6k/mo in California right now. Deductibles will be high.
In California, if you have insurance, you’re paying for everyone else that doesn’t. Homeless guy wants to spend half his time in the ER for fake claims? You’re paying. Some methhead has a fast heartbeat? Roll an ambulance and rush him to the ER.
California is high, because illegal immigration is embraced, and doctors and the ER are overwhelmed.
Once this issue is fixed, costs will decrease.
Insurance companies are another matter. A middle man only in increases costs.
The free market should be used for common procedures, to bring costs down and insurace should only be used for rare surgeries that won't result in decreased prices.
Basic exams cost $100K? Citation definitely needed. You either have a wild idea of “basic” or have no clue.
The ACA baseline plan has to cover a yearly checkup, basic screenings for things like blood pressure and cholesterol, and even more in depth screenings like colonoscopies or pap smears; all at 0 out of pocket cost.
The main problem the US has is food. As a Spaniard myself, every time I go to the US it is really hard for me to eat well. Good quality food is extremely expensive and inconvenient (full of friction) compared to Japan or Europe.
The solution are not better Hospitals to deal with your diabetes or cancer after all your food has sugars it should not have like corn syrup because sugar is cheap. You have so much additives in your food for preservation. Meat is full of Hormones.
Antibiotics on your vegetables that destroy your microbiota. Genetically Modified to fill the fields with pesticides.
Now Americans are obese as they process the growth hormones from their meat and their microbiota dies from the antibiotics they eat in their vegetables and their meat.
Waiting until your children has autism or asthma or cancer is not the solution.
I've been overweight in my life and I hate it. You know how I lost weight and kept if off? I ate healthier, I walk a lot (to the grocery store, for example). US grocery stores have all the same healthy foods as every other country. You can eat healthy at restaurants too, if you must.
It's just people don't. There's nothing inehrently bad about food in the US. We at eat too much and don't exericse (walk). Now, if you'll look at all the other countries joining us in this because it isn't a US thing anymore.
You've added all these extra explanations (corn syrup, antibiotics, growth hormones) but it really isn't that complicated. BTW, I'm sure if you ate konbini foods every day in Japan and didn't exercise enough you'd get fat, too. There's nothing different about that food than a lot of junk/fast food in the US, it's just the Japanese seem to walk a lot more and I don't know how many people only eat out of 7/11.
Everything you address makes sense. I’m not a Texan by birth but most of my life here, have traveled overseas, learned French language, culture, and cuisine. The issue is, unfortunately, profit drives everything here. Now it’s driving the most successful post-war boom economy into debt, because, well, Boomers.
The saying is the US doesn’t have “health care” we have “sick care.” Preventing diseases? Not profitable. Giving people diseases then charging them for treatment? Profitable.
Fortunately the obesity epidemic has a cliff like tail end, as those people tend to eat themselves into an early grave and lack the resources to pay to prolong their participation in Planet Earth.
Unfortunately I don’t think your last point is true. The chronically sick, diabetic, unhealthy obese people (to say nothing of our plethora of druggies) limp along for dozens of years, racking up healthcare costs all along the way.
American food has issues, but obesity in America comes down to the simple fact that people eat too much and do too little.
Calories in > calories out.
The great news is that when you eat less, it brings down the relative costs of better food. Instead of pounds of low quality ground beef, 3 packs of Twinkies, and a case of beer; buy some higher quality organic chicken, or even better, some organic vegetables.
> The main problem the US has is food. As a Spaniard myself, every time I go to the US it is really hard for me to eat well. Good quality food is extremely expensive and inconvenient
What inherently prevents you from cooking a tortilla or baking bread in the US vs Spain? Do frying pans and ovens work differently? Has the US outlawed paella?
This doesn't ring true coming from the UK. I like in the US now and the healthcare is not comparable.
The UK health care system is an absolute joke, it's a running joke among a lot of the population. It's not free for a start, the taxes the population have to pay are eye watering. You have to wait weeks, if not months for a specialist, hospital beds are few, there is no accountability for regular fuck ups (I've been on the bad end of a horrific one).
The US system from what I have seen so far is a dream. It's cheaper and the service is top notch.
For context I've moved from the Midlands in the UK to the Research Triangle in North Carolina.
A thing people in the US have trouble keeping a bead on is that net compensation (after taxes) in Europe tends to be sharply lower in the US, so that white collar professionals with employer-provided insurance are generally coming out significantly ahead of where people in the NHS are, financially.
There are many examples of for-profit systems that don’t have this problem, it’s really the heavily regulated for-profit systems that have this “cost disease” issue. It seems to happen whenever there isn’t a transparent market, like the tuition price of a university, the cost of your surgery, or the cost the government will pay for some infrastructure. The buyer doesn’t know what they’ll pay or what product they’ll get for it, so it’s basically not a free market at its most fundamental level.
Healthcare insurance markets are fundamentally broken due to information asymmetry. The situation is aggravated in the USA by vertical consolidation among providers and regulatory failures. (https://www.nber.org/papers/w34928)
It’s also a pretty inelastic good(most people don’t want to die or be sick ever) and decisions can be made without your consent if you are unconscious, sometimes even when you are conscious but it’s been decided that you aren’t competent at the moment.
1. way too many regulations and lobbies that prevent any relaxation by scaremongering
2. unions that artifically constrain labor supply. doctors lobby to keep number of doctors low and regulatory capture preventing forign doctors from entering workforce. Uk for example imports doctors from india.
both political parties have their own agenda to not disrupt above . democrats love regulation and unions. republicans love corporate profits from regulatory capture.
healthcare is exterme opposite of freemarket despite the veneer
Every country has for-profit elements in their healthcare system. The USA is uniquely dysfunctional in its governance. There is regulatory capture at every level.
> Every country has for-profit elements in their healthcare system
You’re right. The Swiss system is deeply privatized, down to compulsory private insurance [1]. It just isn’t as opaque and corrupt as the American one.
Part of the problem with the American system is everyone is cynical with respect to reform, and has a singular bogeyman they’re convinced explains all of the problem, with zero room for multiple causation.
> and has a singular bogeyman they’re convinced explains all of the problem, with zero room for multiple causation
Not sure about that. But each person tends to have something like a single sentinel flag. E.g.: does medicare negotiate drug prices? And if there's a change for the better, they won't believe it's anything but a short term grift until they read it back as "true" from at least 16 different threads over the course of, say, 9 consecutive years.
Given that their representatives currently use phrases like "medicare advantage" to mean "off traditional medicare and on private insurance," that caution seems warranted.
This is an obtuse comment because it doesn't mean anything. Yes we all know that every country has for-profit elements. We also all know that every country has social elements in their system. And non-profit elements.
You know you're in trouble with all these kinds of analyses when they try to square up cost of care with life expectancy.
The principal components in life expectancy difference between the US and the other OECDs are car accidents, homicides, and CVD. Obviously, accidents and homicides aren't a function of the health care system; they're a function of the atypical dependence the US has on cars and its wildly atypical availability of firearms. Though: it is worth noting that the OECD definition of "preventable deaths" includes vehicular accidents!
But even the CVD statistics are misleading in a comparison like this. CVD outcomes are heavily regionalized in the US. The New England states have CVD outcomes comparable to western Europe. But go to Mississippi and Alabama and we look like a developing country. There's a lot of stuff going into that difference, but the key thing here is that the structural design of the health system is the same in both regions.
There's a lot not to like about the US system of employer-paid health insurance. But these kinds of critiques are frustrating and a little unserious, and it annoys me that this article assumes its readers won't dig into the crosstabs and will just take the comparison on faith. That's disrespectful to readers.
US healthcare industry needs to drop more non-essential workers, and invest more in workers that produce value. the industry is so bloated no wonder its costs are high. Just to get my ears checked i had to be processed by 6 different people including phone systems doing precheck-ins. one person does the actual work!
That's almost entirely due to how our private insurance industry works.
Any given health provider has to deal with thousands of different insurers, and it's not uncommon for individual patients to have primary, secondary, tertiary, and even quaternary insurers the provider then has to deal with to get paid for a procedure.
To keep health care workers focused on providing health care, providers hire a bunch of administrative workers whose job is to offload the work of haggling with insurance onto cheaper workers, but because there's so many insurers, and patients have so many layers of insurance, you end up with something close to 10 administrators per doctor.
Alas, because there's so much money sloshing around in the system, and because the US government is so thoroughly corrupt with bribes from special interests, there's no movement to correct the problem. The system is unsustainable, though, so it will inevitably collapse in on itself at some point, causing a lot of misery and probably death before anything is fixed.
We know this isn't true, because CMS publishes annual numbers of the net costs of all these functions, and the total cost of service delivery absolutely dominates everything else. There is definitely annoying and pointless insurance overhead; anyone who has ever gone to the doctor for a followup appointment has seen that happen. It's just not where all the money is going.
A thing that's always worth keeping in mind: retail clinical practice for non-geriatric adults is a very small fraction of all health care costs in the US, and end-of-life care is a very large fraction. Most of us only have exposure to the former, and we generalize from it, but that's not giving us an accurate picture.
> US healthcare industry needs to drop more non-essential workers, and invest more in workers that produce value.
Only problem is you can’t destroy the jobs program. Someone pointed out to me that the job market is propped up nearly by healthcare alone.
For someone without and particular skills, credentials, network, medical industry jobs provide one of the last few steps to a stable, middle class life that’s also accessible to working class. In other words, it’s one of the last vessels for any sort of social mobility.
Right, most of those 6 are not medical staff, they are probably there for insurance and billing. And compared to Europe we don't even have a lot of doctors, US has fewer per capita. So the money is going to the billing layer, not to actual care.
Medical assistants and nurses work with you before the doctor to increase billable events for the doctor. You could describe this as saving money, but it's not the goal.
Phone and front desk stuff is just administrative burden, scheduling the appointment and making a paper trail.
It will not change on your time horizon. If you want better healthcare, move to a developed country today. It will take a half decade or more for US healthcare to improve in any meaningful capacity, assuming the necessary events take place to enable improvement in the system.
(to improve US healthcare, laws will need to change; when those laws change is a function of election outcomes and cadence; those election outcomes are a function of the electorate, who they vote for, and the rate of cohort turnover; think in systems)
Mamdani has moved fast in NYC [1], faster change is possible when the motivated are in positions of leverage. I admit a five year time horizon is aspirational and dependent on “everything going right” with regards to election outcomes and the policy pipeline, from introduction to bill signing. I’m open to more realistic suggestions so I’m more accurate when I speak publicly on this topic (I help a non profit help US residents get out of the US).
I want to agree with this, but these studies usually make a big mistake - they don't control out for the non healthcare reasons for low life expectancy.
Americans drive cars and most live in unwalkable places. These impart significant risks that the healthcare system, no matter how good, wouldn't impact.
Has anyone dug into this to identify whether they tried to account for built environment? Or food system?
If you research "amenable", "avoidable", "preventable", and "treatable" mortality, you will find similar conclusions from studies that focus on specific aspects of the effects of healthcare on mortality.
> The US had the second-highest avoidable mortality rate—deaths caused by conditions that can be prevented with primary care or treated with timely medical intervention. Only Mexico had higher avoidable mortality. Similarly, the US also had the second-highest rating on years of potential life lost, a measure used to estimate premature death. Again, only Mexico had a higher rating.
About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.
Driving everywhere has the collateral effect of ensuring that people get less exercise. Mexico has an astonishingly high obesity rate (a bit higher than the USA last time I checked), and this increases the risks of many non-car-related causes of death (and illness).
Yeah, I’d buy that car-dependence is a problem there, especially for older people.
Though, in Ireland, for instance, the worst parts of the country for car dependency would be close to as bad as the US. Their life expectancy is a little lower than the national one, but it’s not dramatic, and certainly not as low as the US one. There’s something else going on.
In additional to the car dependency (and related issues), the USA still has many immigrants (legal and illegal) from poor countries, who likely have health issues that pre-exist their US residency.
Main headline figure is life expectancy at birth, which doesn’t _really_ account for immigration. In any case, a number of rich countries (Ireland, UK, Canada, the Netherlands, most of the Nordics) have higher immigration rates than the US, so, again, probably not that.
40% of Americans are obese and 75% are overweight. This is largely outside of the control of the medical system, but has a significant impact on mortality and life expectancy.
> This is largely outside of the control of the medical system
I assure you that preventative medicine does exist, even in the USA. Moreover, healthcare interventions for people with "lifestyle" diseases such as obesity have been extremely effective in reducing mortality from downstream causes such cardiovascular disease (e.g. statins).
The problem we are discussing here is mortality, and statins definitely have an effect on mortality.
Obesity can be prevented, can be treated, and its effects on health can be managed. We are actually living through something of a miracle in the treatment of lifestyle diseases. For example, the proportion of total deaths among adults with diabetes from vascular causes (heart disease) declined from 48% in 1988–94 to 34% in 2010–15 (https://sci-hub.st/10.1016/S0140-6736(18)30314-3).
The USA is not some kind of global outlier with a uniquely unhealthy population. The problem is *very obviously* something to do with how healthcare is provided here.
>The USA is not some kind of outlier with a uniquely unhealthy population.
It is, actually. Our obesity rates are the highest in the world at 41%. This is nearly double many European countries, and five times higher than Japan or South Korea. Only a handful of tiny Polynesian islands have us beat.
Better treatments for diabetes are great, but what's even better is not getting diabetes at all by losing weight.
As a sibling comment pointed out, the medical community consider prevention part of the medical system. It took me a while to understand what I thought was some weird (and potentially intrusive[1]) behavior of some doctors/clinics that they indeed do feel it is within their purview.
Not just discussions with a patient, but advising the government, pushing for regulation on things related to obesity, working with schools, etc.
Arguably, the problem in the US isn't that these are outside the control of the medical system, but that most Americans believe they should be outside the control of the medical system.
In (some) other countries, your comment would be a real "WTF?"
[1] Throwing in questions like "Is there a firearm in your house?" and "Is there a swimming pool in your house" intermixed with "normal" medical questions.
I find it remarkable that most comments either criticizing the US healthcare system or expressing bewilderment at how Americans seemingly accept this have already been downvoted into dead territory.
It's hard not to see those downvotes as copium or cognitive dissonance given no arguments have been presented to the contrary.
It continues to baffle me that Americans put up with such an inferior and expensive system.
There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.
The French riot in the streets if a single day of their extremely generous (by US standards) leave is taken away. Meanwhile Americand can’t get off the couch to protest, or are afraid of their own government if they do.
There are plenty of American protests happening all the time (see the ICE protests for a recent, well-known example). Americans aren't lazy about protesting, they just have a different understanding of merits protesting. Like it or not (I don't), a right to quality healthcare isn't one of the freedoms in our constitution or bill of rights, and therefore isn't going to get people turning out to protest.
Our country is captured by the top 1% of wealthy donors who are making a killing off the healthcare industry. Americans as a population aren’t putting up with anything, they just have no control. A citizen shot a healthcare executive in the street a couple years ago, that’s what people are resorting to now.
>There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.
What's new is that health insurance is about to become an even bigger problem.
24 million Americans are insured under ACA. The current president has issued several executive orders that undermine the provision of ACA insurance and increase its cost. Millions are dropping coverage as the increases kick in. (https://www.nytimes.com/2026/05/01/business/obamacare-enroll...)
That "stupidly expensive" system provides extremely nice campaign donations, executives bonuses, stock appreciation, dividend checks, and paychecks to a stupidly large number of insiders. Even when they're (say) just medical billing clerks, who'll spend their entire careers arguing with the Denial Departments at various insurance companies, without every seeing an actual patient.
The system is bad but the average American is obese, out of shape, and pre-diabetic, an atrocious diets and very little exercise. That doesn’t explain everything, but it does strain the system, which has to treat a lot more disease than a similar system with a fit population.
There’s a fascinating case study on how this happens - Mexico had population much less overweight than USA until NAFTA was agreed to and cheap USA processed foods began inroads so that now Mexico has close to the same obesity issue that the USA has.
The entire healthcare system seems to be built against the population. I've come to see healthcare providers like doctors, nurses, technicians, and the like, as a conniving, essential part of the scheme. They're incentivized to make you wait hours unnecessarily, rush every visit, and involve as many different people as possible in your care. And then, in the end, send ridiculous bills to both your insurance provider and to you at home. The person who spends the most time with you is usually the one trying to collect the payment. It's absurd.
There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
There is absolutely no reason for a medical equipment provider to bill more than the retail price of a piece of equipment, especially after insurance has already paid more than the full cost of the equipment on each installment.
There is absolutely no reason for a family to receive a bill of almost one million dollars because their baby was premature and was in the NICU (see @thepasinins on instagram).
There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
There is a reason that doctors in the US make multiples of what doctors in Europe makes: the AMA lobbied the US CMS, back in the 1990s, to limit the number of residencies opened up every year, to avoid a "glut" of doctors. We have artificial scarcity of doctors.
That's part of the problem, but we also have a problem with limited medical schools in general and with those schools charging through the nose because of that scarcity.
I have a nephew training to be a doctor now. He's looking at $500k in student loan debt by the end. That's a major problem.
That's why I have ahrd time getting mad at doctors. What else are they supposed to do besides charge absurd rates?
The standard GP consult fee in Ontario Canada is $77.15. (just over us$50). That's gross, the nurse, receptionist and rent have to be paid out of that.
Some doctors will do 4 of those an hour, but most will do 6. And they'll try and find ways to bill additional codes above the consult.
> There are too many layers in the system making a fortune off the public's back while adding little to no actual value.
Yeah, it basically all comes down to the bureaucratic nightmare that ultimately benefits the owners of all things medical. Prices have nothing to do with the value of the good or service and everything to do with the maximum amount of profit that can be extracted from a 3rd party.
One of the worst moves in the last 30 years was Clinton adding private insurance options onto Medicare. In the last 60 years was making medicaid a state run program rather than a national program (or just medicare all together). It's actually crazy that we have 53 different government healthcare options. 1 for every state, medicare, and the VA. It's even more crazy that the government doesn't simply directly employ doctors and medical equipment. It's so crazy inefficient to involve 3rd and 4th parties into something that should be direct care.
The US remains one of the only wealthy nations in the world without nationalized healthcare. And we pay through it through the nose.
The US has half the number of medical school graduates compared to the average. Instead of creating a lunar base, maybe create more residencies to graduate doctors?
Quote:
Zero mention of wait times in the US compared to other countries. Pretty sure that's the chief complaint in most countries that have free-ish healthcare.
You're exactly right but it runs contrary to the narrative being spun.
A quick search reveals the best ER wait times worldwide are in the US, Germany, and Switzerland, with most the rest of western Europe dead last along with Canada and Australia.
The average ER wait time in the US is 24 minutes. In France 2h21m. Italy 2h44m.
Everyone likes to say how great Canadian healthcare is, but talk to actual Canadians and the cracks start to show, you're waiting months for a CT scan, and most need employer-provided health insurance anyway to fill gaps in coverage.
Yeah but could this be because people are more likely to go to ER in countries with free healthcare?
I've been to the ER in my country because of abnormal stomach pain. Obviously I was triaged and had to wait hours because it was not considered life threatening. But in the end a doctor saw me for free. I think if I were in the USA and didn't have health insurance I would have just stayed home and avoided the risk of an expensive bill.
Wouldn't you expect to see that reflected in outcomes? TFA mentions that the only studied country with more avoidable mortality than the US was Mexico. If you aren't seeing it, maybe its not as big a problem as all the people who cannot afford any access to care at all while the country spends more per-person.
There’s not (typically) a regular measure of how much pain and disability a patient suffers while waiting for a hip replacement. It certainly would only show up in mortality statistics massively attenuated.
Oddly, the country with the expensive ineffective healthcare with lower wait times (citation needed) is also the one that doesn’t have guaranteed paid sick leave and other facilities that would make wait times less of a factor.
US healthcare is generally superior as long as you can afford it.
Anecdotally, I spend a lot more time literally in waiting rooms in Germany than I did in the US, but getting a specialist appointment is much faster here (getting a therapist absolutely excluded, but I was able to get a psychiatrist to write prescriptions for ADHD meds within a month).
I just moved from a medium sized US city and any specialist provider I contacted for myself or my parents was 5 months or more. It's not good everywhere.
It's the chief complaint put forward by fox news.
It's just a blatant lie.
I've experienced healthcare outside the US (in the UK) and it's on par with US healthcare in terms of wait times. Seeing a GP was same day with walk ins. When not busy, it was just a 5 minute wait.
Seeing a specialist can take time. I knew people that saw a 3 month wait to see a specialist in the UK. In the US, I just experienced a 3 year wait getting a specialist for my kid with autism. I had to go out of state to get the initial diagnosis, but to get local followup care I had to do that 3 year wait. After that, we were able to get a bunch of referrals to other issues.
What constrains wait time is how many doctors and specialists are working in a field. That has almost zero to do with the underlying payment system of a healthcare system.
US wait time for many: infinity. why? because current system is profitable.
I mean, in rural America short of a trip to the ER with whatever wait time they have, getting a primary care doctor is barely possible and only affordable if your employer provides medical care, which many many don't.
This is my favorite thought terminating cliche when the discussion of American healthcare comes up. Wanna see a specialist? You're waiting. Can't afford insurance? You are waiting even longer.
There is absolutely no reason for a doctor to make over $1000 for a 15 minute conversation.
No doctor makes this much for a 15 minute conversation. A small portion of that money is going to the doctor. Much of it goes to all the other aspects of healthcare. The facility, other people involved in care, etc.
And no 15 minute visit costs 1000 dollars to the patient as well. That’s a pretty big exaggeration.
The market can't solve healthcare. It must be public. Americans shouldn't need to kill healthcare CEOs.
But prisoners have socialized medicine?
I think generally Americans are happier dying. They want this differentiator between themselves and other countries. They genuinely enjoy the misery it brings to the poorer elements of their society. This is not accidental it appears to be designed that way. Investigating it is a waste of time and not going to change anything until Americans actually want change. (and not just "want" in terms of making facebook posts about wanting it)
Among many, there is a zero sum attitude. This goes back to the founding and slave owning in the south.
As an American, no. Well aside from - yes a significant part thrives on seeing others than them suffer. Years ago, I spent multiple times a year at a B&B on the Hilo side of the big island. The host was one of the last "Grand Dame's" of Hilo. She was a cattle rancher that knew Roosevelt; her husband had been a friend of Linus Pauling. She did hikes in her 70s and 80s few in those ages can do now.
She was grandfathered under a form of medical insurance - I think older Blue Cross/Blue Shield - none can access now. At one point, the US did have better health care than we do at the moment. The fcking idiot boomers (including my parents) bought into the BS from Nixon, Reagan, etc. Hey - (good or bad) - let's stop allowing one to write off debt, but allow companies to do so, etc.
This country does have it's head up it's ass and a significant number blame everyone but themselves and how they vote.
We pay more (as a country) by a lot* and get significantly less for our medical coverage. Want to go self employed with a family of 3? Want a PPO? $4-6k/mo in California right now. Deductibles will be high.
In California, if you have insurance, you’re paying for everyone else that doesn’t. Homeless guy wants to spend half his time in the ER for fake claims? You’re paying. Some methhead has a fast heartbeat? Roll an ambulance and rush him to the ER.
California is high, because illegal immigration is embraced, and doctors and the ER are overwhelmed.
Once this issue is fixed, costs will decrease.
Insurance companies are another matter. A middle man only in increases costs.
The free market should be used for common procedures, to bring costs down and insurace should only be used for rare surgeries that won't result in decreased prices.
you seem jealous at american stock market and high tech salaries. european?
I challenge you to be more obvious with your attempt at baiting
europoors coping on us healthcare posts is nothing new
Yeah but have you considered how good it is for the US gdp!
USA population will never know peace.
When basic exams cost them easily US$100k, you know the system is broken.
Health system is a business model in the US, and people who are organ donor are literally being murdered to have their organs removed.
Don't trust my owners, you won't need much to find that out.
Basic exams cost $100K? Citation definitely needed. You either have a wild idea of “basic” or have no clue.
The ACA baseline plan has to cover a yearly checkup, basic screenings for things like blood pressure and cholesterol, and even more in depth screenings like colonoscopies or pap smears; all at 0 out of pocket cost.
The main problem the US has is food. As a Spaniard myself, every time I go to the US it is really hard for me to eat well. Good quality food is extremely expensive and inconvenient (full of friction) compared to Japan or Europe.
The solution are not better Hospitals to deal with your diabetes or cancer after all your food has sugars it should not have like corn syrup because sugar is cheap. You have so much additives in your food for preservation. Meat is full of Hormones.
Antibiotics on your vegetables that destroy your microbiota. Genetically Modified to fill the fields with pesticides.
Now Americans are obese as they process the growth hormones from their meat and their microbiota dies from the antibiotics they eat in their vegetables and their meat.
Waiting until your children has autism or asthma or cancer is not the solution.
I really don't think this is the issue.
I've been overweight in my life and I hate it. You know how I lost weight and kept if off? I ate healthier, I walk a lot (to the grocery store, for example). US grocery stores have all the same healthy foods as every other country. You can eat healthy at restaurants too, if you must.
It's just people don't. There's nothing inehrently bad about food in the US. We at eat too much and don't exericse (walk). Now, if you'll look at all the other countries joining us in this because it isn't a US thing anymore.
You've added all these extra explanations (corn syrup, antibiotics, growth hormones) but it really isn't that complicated. BTW, I'm sure if you ate konbini foods every day in Japan and didn't exercise enough you'd get fat, too. There's nothing different about that food than a lot of junk/fast food in the US, it's just the Japanese seem to walk a lot more and I don't know how many people only eat out of 7/11.
Bro I don't think food causes autism but ok - I hear you about our food quality. Again it just goes to money for the corporations
> Waiting until your children has autism or asthma or cancer is not the solution.
One of these is not like the other.
Everything you address makes sense. I’m not a Texan by birth but most of my life here, have traveled overseas, learned French language, culture, and cuisine. The issue is, unfortunately, profit drives everything here. Now it’s driving the most successful post-war boom economy into debt, because, well, Boomers.
The saying is the US doesn’t have “health care” we have “sick care.” Preventing diseases? Not profitable. Giving people diseases then charging them for treatment? Profitable.
Fortunately the obesity epidemic has a cliff like tail end, as those people tend to eat themselves into an early grave and lack the resources to pay to prolong their participation in Planet Earth.
Unfortunately I don’t think your last point is true. The chronically sick, diabetic, unhealthy obese people (to say nothing of our plethora of druggies) limp along for dozens of years, racking up healthcare costs all along the way.
American food has issues, but obesity in America comes down to the simple fact that people eat too much and do too little.
Calories in > calories out.
The great news is that when you eat less, it brings down the relative costs of better food. Instead of pounds of low quality ground beef, 3 packs of Twinkies, and a case of beer; buy some higher quality organic chicken, or even better, some organic vegetables.
> The main problem the US has is food. As a Spaniard myself, every time I go to the US it is really hard for me to eat well. Good quality food is extremely expensive and inconvenient
What inherently prevents you from cooking a tortilla or baking bread in the US vs Spain? Do frying pans and ovens work differently? Has the US outlawed paella?
This doesn't ring true coming from the UK. I like in the US now and the healthcare is not comparable.
The UK health care system is an absolute joke, it's a running joke among a lot of the population. It's not free for a start, the taxes the population have to pay are eye watering. You have to wait weeks, if not months for a specialist, hospital beds are few, there is no accountability for regular fuck ups (I've been on the bad end of a horrific one).
The US system from what I have seen so far is a dream. It's cheaper and the service is top notch.
For context I've moved from the Midlands in the UK to the Research Triangle in North Carolina.
A thing people in the US have trouble keeping a bead on is that net compensation (after taxes) in Europe tends to be sharply lower in the US, so that white collar professionals with employer-provided insurance are generally coming out significantly ahead of where people in the NHS are, financially.
It's to be expected from a for-profit system.
There are many examples of for-profit systems that don’t have this problem, it’s really the heavily regulated for-profit systems that have this “cost disease” issue. It seems to happen whenever there isn’t a transparent market, like the tuition price of a university, the cost of your surgery, or the cost the government will pay for some infrastructure. The buyer doesn’t know what they’ll pay or what product they’ll get for it, so it’s basically not a free market at its most fundamental level.
If it's expensive and in a for profit system, why aren't competitors on the supply side undercutting each other to increase sales?
Healthcare insurance markets are fundamentally broken due to information asymmetry. The situation is aggravated in the USA by vertical consolidation among providers and regulatory failures. (https://www.nber.org/papers/w34928)
It’s also a pretty inelastic good(most people don’t want to die or be sick ever) and decisions can be made without your consent if you are unconscious, sometimes even when you are conscious but it’s been decided that you aren’t competent at the moment.
Because that holds true only for efficient markets.
Barriers to entry are real
many different things. to cite a few
1. way too many regulations and lobbies that prevent any relaxation by scaremongering
2. unions that artifically constrain labor supply. doctors lobby to keep number of doctors low and regulatory capture preventing forign doctors from entering workforce. Uk for example imports doctors from india.
both political parties have their own agenda to not disrupt above . democrats love regulation and unions. republicans love corporate profits from regulatory capture.
healthcare is exterme opposite of freemarket despite the veneer
Not every for-profit system is this way so it doesn't fully explain it.
It is tge fact that Health care consuming demand is inelastic. Most "for profit" systems have elastic supply and demand.
But "suppliers" know that demand has bo choice but swallow the prices and services.
Kind of like "cable companies" oligopolies but worse (see southpark espisode).
Health care should not be for profit.
Every country has for-profit elements in their healthcare system. The USA is uniquely dysfunctional in its governance. There is regulatory capture at every level.
> Every country has for-profit elements in their healthcare system
You’re right. The Swiss system is deeply privatized, down to compulsory private insurance [1]. It just isn’t as opaque and corrupt as the American one.
Part of the problem with the American system is everyone is cynical with respect to reform, and has a singular bogeyman they’re convinced explains all of the problem, with zero room for multiple causation.
[1] https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
> and has a singular bogeyman they’re convinced explains all of the problem, with zero room for multiple causation
Not sure about that. But each person tends to have something like a single sentinel flag. E.g.: does medicare negotiate drug prices? And if there's a change for the better, they won't believe it's anything but a short term grift until they read it back as "true" from at least 16 different threads over the course of, say, 9 consecutive years.
Given that their representatives currently use phrases like "medicare advantage" to mean "off traditional medicare and on private insurance," that caution seems warranted.
This is an obtuse comment because it doesn't mean anything. Yes we all know that every country has for-profit elements. We also all know that every country has social elements in their system. And non-profit elements.
Correct. My comment is in reply to an assertion that is uninformative for exactly this reason.
You know you're in trouble with all these kinds of analyses when they try to square up cost of care with life expectancy.
The principal components in life expectancy difference between the US and the other OECDs are car accidents, homicides, and CVD. Obviously, accidents and homicides aren't a function of the health care system; they're a function of the atypical dependence the US has on cars and its wildly atypical availability of firearms. Though: it is worth noting that the OECD definition of "preventable deaths" includes vehicular accidents!
But even the CVD statistics are misleading in a comparison like this. CVD outcomes are heavily regionalized in the US. The New England states have CVD outcomes comparable to western Europe. But go to Mississippi and Alabama and we look like a developing country. There's a lot of stuff going into that difference, but the key thing here is that the structural design of the health system is the same in both regions.
There's a lot not to like about the US system of employer-paid health insurance. But these kinds of critiques are frustrating and a little unserious, and it annoys me that this article assumes its readers won't dig into the crosstabs and will just take the comparison on faith. That's disrespectful to readers.
US healthcare industry needs to drop more non-essential workers, and invest more in workers that produce value. the industry is so bloated no wonder its costs are high. Just to get my ears checked i had to be processed by 6 different people including phone systems doing precheck-ins. one person does the actual work!
That's almost entirely due to how our private insurance industry works.
Any given health provider has to deal with thousands of different insurers, and it's not uncommon for individual patients to have primary, secondary, tertiary, and even quaternary insurers the provider then has to deal with to get paid for a procedure.
To keep health care workers focused on providing health care, providers hire a bunch of administrative workers whose job is to offload the work of haggling with insurance onto cheaper workers, but because there's so many insurers, and patients have so many layers of insurance, you end up with something close to 10 administrators per doctor.
Alas, because there's so much money sloshing around in the system, and because the US government is so thoroughly corrupt with bribes from special interests, there's no movement to correct the problem. The system is unsustainable, though, so it will inevitably collapse in on itself at some point, causing a lot of misery and probably death before anything is fixed.
We know this isn't true, because CMS publishes annual numbers of the net costs of all these functions, and the total cost of service delivery absolutely dominates everything else. There is definitely annoying and pointless insurance overhead; anyone who has ever gone to the doctor for a followup appointment has seen that happen. It's just not where all the money is going.
A thing that's always worth keeping in mind: retail clinical practice for non-geriatric adults is a very small fraction of all health care costs in the US, and end-of-life care is a very large fraction. Most of us only have exposure to the former, and we generalize from it, but that's not giving us an accurate picture.
> US healthcare industry needs to drop more non-essential workers, and invest more in workers that produce value.
Only problem is you can’t destroy the jobs program. Someone pointed out to me that the job market is propped up nearly by healthcare alone.
For someone without and particular skills, credentials, network, medical industry jobs provide one of the last few steps to a stable, middle class life that’s also accessible to working class. In other words, it’s one of the last vessels for any sort of social mobility.
Right, most of those 6 are not medical staff, they are probably there for insurance and billing. And compared to Europe we don't even have a lot of doctors, US has fewer per capita. So the money is going to the billing layer, not to actual care.
Those people may actually be saving money by offloading work from a $250/hr doctor to a $25/hr secretary.
Medical assistants and nurses work with you before the doctor to increase billable events for the doctor. You could describe this as saving money, but it's not the goal.
Phone and front desk stuff is just administrative burden, scheduling the appointment and making a paper trail.
Except the work saved should not be done at all.
I think the industry itself would be more than happy to classify nurses and doctors as non-essential and drop them.
Imagine the profit margins where you don't have to pay salaries to them.
Probably 3 of them just working to prevent you from going.
It will not change on your time horizon. If you want better healthcare, move to a developed country today. It will take a half decade or more for US healthcare to improve in any meaningful capacity, assuming the necessary events take place to enable improvement in the system.
(to improve US healthcare, laws will need to change; when those laws change is a function of election outcomes and cadence; those election outcomes are a function of the electorate, who they vote for, and the rate of cohort turnover; think in systems)
> It will take a half decade or more for US healthcare to improve in any meaningful capacity,
This timeline seems wildly optimistic
Mamdani has moved fast in NYC [1], faster change is possible when the motivated are in positions of leverage. I admit a five year time horizon is aspirational and dependent on “everything going right” with regards to election outcomes and the policy pipeline, from introduction to bill signing. I’m open to more realistic suggestions so I’m more accurate when I speak publicly on this topic (I help a non profit help US residents get out of the US).
[1] https://www.mamdanibulletin.com/
Did you mean half a century? Meaningful change in 5 years would be pretty amazing.
I want to agree with this, but these studies usually make a big mistake - they don't control out for the non healthcare reasons for low life expectancy.
Americans drive cars and most live in unwalkable places. These impart significant risks that the healthcare system, no matter how good, wouldn't impact.
Has anyone dug into this to identify whether they tried to account for built environment? Or food system?
If you research "amenable", "avoidable", "preventable", and "treatable" mortality, you will find similar conclusions from studies that focus on specific aspects of the effects of healthcare on mortality.
The results are not all that different. The USA lags other rich nations, and even middle income nations like Costa Rica and Chile. https://www.oecd.org/en/publications/health-at-a-glance-2023...
> The US had the second-highest avoidable mortality rate—deaths caused by conditions that can be prevented with primary care or treated with timely medical intervention. Only Mexico had higher avoidable mortality. Similarly, the US also had the second-highest rating on years of potential life lost, a measure used to estimate premature death. Again, only Mexico had a higher rating.
About 41k people die on the road in the US per year. While this is very high, and worse than pretty much any other developed country, it’s not going to move the needle _that_ much.
Driving everywhere has the collateral effect of ensuring that people get less exercise. Mexico has an astonishingly high obesity rate (a bit higher than the USA last time I checked), and this increases the risks of many non-car-related causes of death (and illness).
Yeah, I’d buy that car-dependence is a problem there, especially for older people.
Though, in Ireland, for instance, the worst parts of the country for car dependency would be close to as bad as the US. Their life expectancy is a little lower than the national one, but it’s not dramatic, and certainly not as low as the US one. There’s something else going on.
In additional to the car dependency (and related issues), the USA still has many immigrants (legal and illegal) from poor countries, who likely have health issues that pre-exist their US residency.
Main headline figure is life expectancy at birth, which doesn’t _really_ account for immigration. In any case, a number of rich countries (Ireland, UK, Canada, the Netherlands, most of the Nordics) have higher immigration rates than the US, so, again, probably not that.
Not car accidents; obesity from lack of exercise.
40% of Americans are obese and 75% are overweight. This is largely outside of the control of the medical system, but has a significant impact on mortality and life expectancy.
> This is largely outside of the control of the medical system
I assure you that preventative medicine does exist, even in the USA. Moreover, healthcare interventions for people with "lifestyle" diseases such as obesity have been extremely effective in reducing mortality from downstream causes such cardiovascular disease (e.g. statins).
Statins help a bit (and are widely prescribed in the US) but they don't fix the problem.
Diet and exercise are huge health variables that doctors don't really have the tools to do anything about.
The problem we are discussing here is mortality, and statins definitely have an effect on mortality.
Obesity can be prevented, can be treated, and its effects on health can be managed. We are actually living through something of a miracle in the treatment of lifestyle diseases. For example, the proportion of total deaths among adults with diabetes from vascular causes (heart disease) declined from 48% in 1988–94 to 34% in 2010–15 (https://sci-hub.st/10.1016/S0140-6736(18)30314-3).
The USA is not some kind of global outlier with a uniquely unhealthy population. The problem is *very obviously* something to do with how healthcare is provided here.
>The USA is not some kind of outlier with a uniquely unhealthy population.
It is, actually. Our obesity rates are the highest in the world at 41%. This is nearly double many European countries, and five times higher than Japan or South Korea. Only a handful of tiny Polynesian islands have us beat.
Better treatments for diabetes are great, but what's even better is not getting diabetes at all by losing weight.
As a sibling comment pointed out, the medical community consider prevention part of the medical system. It took me a while to understand what I thought was some weird (and potentially intrusive[1]) behavior of some doctors/clinics that they indeed do feel it is within their purview.
Not just discussions with a patient, but advising the government, pushing for regulation on things related to obesity, working with schools, etc.
Arguably, the problem in the US isn't that these are outside the control of the medical system, but that most Americans believe they should be outside the control of the medical system.
In (some) other countries, your comment would be a real "WTF?"
[1] Throwing in questions like "Is there a firearm in your house?" and "Is there a swimming pool in your house" intermixed with "normal" medical questions.
I find it remarkable that most comments either criticizing the US healthcare system or expressing bewilderment at how Americans seemingly accept this have already been downvoted into dead territory.
It's hard not to see those downvotes as copium or cognitive dissonance given no arguments have been presented to the contrary.
It continues to baffle me that Americans put up with such an inferior and expensive system.
There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.
The French riot in the streets if a single day of their extremely generous (by US standards) leave is taken away. Meanwhile Americand can’t get off the couch to protest, or are afraid of their own government if they do.
To be fair, the French riot in the streets when one of their teams win the Champions League[0]. I'm not sure it's a good metric.
[0] https://www.bbc.com/news/articles/c0r2ejg1w9xo
Eagles fans riot when they win the super bowl (2022, 2025) and also when they lose the super bowl (2023).
The issue is not that Americans are insufficiently violent.
There are plenty of American protests happening all the time (see the ICE protests for a recent, well-known example). Americans aren't lazy about protesting, they just have a different understanding of merits protesting. Like it or not (I don't), a right to quality healthcare isn't one of the freedoms in our constitution or bill of rights, and therefore isn't going to get people turning out to protest.
> that Americans put up with such an inferior and expensive system
I agree but what is the alternative? Not buying health insurance? Moving to a different country? Please don't say voting (That has solved nothing.)
I forget who said it, but Obamacare is a Big Fucking Deal.
Our country is captured by the top 1% of wealthy donors who are making a killing off the healthcare industry. Americans as a population aren’t putting up with anything, they just have no control. A citizen shot a healthcare executive in the street a couple years ago, that’s what people are resorting to now.
Correction: Americans as a population have been led to believe they have no control. They've forgotten what "we the people" means
> Americans as a population aren’t putting up with anything, they just have no control
So do something to get control.
Americans have been conned that they live in the greatest country and that nothing needs to improve. And now you say they have no control.
They are the workers. A six month general strike would literally change everything about the entire country, forever. They just lack the will.
>There’s always talk of freedoms and being brave and being the best country in the world to live in, but very, very little effort of action to improve anything.
Its all just talk.
Did someone do something that made people think that was going to change any time soon?
What's new is that health insurance is about to become an even bigger problem.
24 million Americans are insured under ACA. The current president has issued several executive orders that undermine the provision of ACA insurance and increase its cost. Millions are dropping coverage as the increases kick in. (https://www.nytimes.com/2026/05/01/business/obamacare-enroll...)
That "stupidly expensive" system provides extremely nice campaign donations, executives bonuses, stock appreciation, dividend checks, and paychecks to a stupidly large number of insiders. Even when they're (say) just medical billing clerks, who'll spend their entire careers arguing with the Denial Departments at various insurance companies, without every seeing an actual patient.
The system is bad but the average American is obese, out of shape, and pre-diabetic, an atrocious diets and very little exercise. That doesn’t explain everything, but it does strain the system, which has to treat a lot more disease than a similar system with a fit population.
And not just the US healthcare, but the US education also...
Until the obesity problem is solved nothing will change. You can spend an unlimited amount of money - if people are morbidly obese it's game over.
Americans blame everyone but themselves. Americans who do not have high rates of obesity have similar mortality to western europe.
Take Massachusetts who has one of the lowest rates of obesity- similar to Japan.
Sadly this line of thinking makes people angry.
Which only leads us to another problem: food.
You can't have a healthy society if all policies are dictated by corporations.
There’s a fascinating case study on how this happens - Mexico had population much less overweight than USA until NAFTA was agreed to and cheap USA processed foods began inroads so that now Mexico has close to the same obesity issue that the USA has.
Could it also be highest per-capita calories from sugary drinks?