A short pieces by David Freedman in The Atlantic this month posits that none of the health care systems of our peer countries, systems that currently provide health care for everyone with significantly better outcomes and lower costs than our own, would work in the US because the citizenry is too unruly.

Unruly is my word, not the author’s.

One obvious difference he mentions is Americans’ unhealthy lifestyles: we are sedentary and like to eat items most of the world would not identify as food. In the most successful countries health-wise, getting exercise and eating healthfully are shared community values, and in the US, counties in which that is true tend to have healthier residents.

Check out this map* from a couple of years ago:

Being the healthiest state (Hawaii) in a country of bad health may not be saying much, but I could make a case for most of the healthier states having more of an outdoor lifestyle, farmer’s market vibe. I’m not sure how California slipped into the second quintile, probably because we are just so big, harboring 10% of the US population, so pretty much every lifestyle is represented.

Side note: According to Wikipedia, California became the world’s 5th largest economy in 2018, surpassing the UK and approaching Germany.

Americans are not interested in preventative health care. We are interested is taking a pill that allows us to live long on a diet of Freedom Fries and ice cream, and getting replacement parts when ours erode. Routine checkups are so, well, routine; specialists make us feel special, and the ER is always there for us. Death is something to be deferred for even the shortest time at any cost, and I do mean any cost.

I don’t disagree with these observations, and to write a short piece, you have to defend a limited thesis, but I think the main reason for our ineffective health care system is that it is the only one that is for-profit, as in, 10-20% of the spending is siphoned off for shareholders, and value growth arises from selling increasing amounts of expensive drugs and procedures. Preventative medicine is particularly bad for profit, since people who aren’t sick don’t spend a lot on health treatments, though the burgeoning supplement industry is working to address this. Even “eating right” has enemies in the processed food and big-Ag sectors.

As a group, Americans also deserve this. We consistently celebrate both rich individuals and massive companies, and oppose limits on accumulation of wealth. After all, though it’s likelier I will have to sell my house to pay for my major illness, it’s possible I will win the hundred-million dollar lottery!

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* Credit to United Health Foundation via CBS