As an example, rich people getting lots of testing done increases spending, but it's driven by their wealth as much as it is by doctors enthusiastic to increase revenues. And if they are healthy, it isn't going to provide them much value.

Couple this with the attempts to centrally plan capacity and you get a cost spiral.

In a sanely administered system, you wouldn’t send every five year old that ran into some furniture to get a CAT scan. You’d just accept the infinitesimal risk of some hidden injury that couldn’t be caught with physical contact examination but could be caught with a CAT scan.

In another example, my wife’s grandmother had a stroke at 87. They medevacced her out of her house in rural Oregon to Portland. Then the doctors wanted to do a bunch of expensive procedures until she passed away a few days later. She was a lovely lady, but no European country would’ve greenlit these procedures on an 87 year old woman who had a quarter of her long missing due to lung cancer in her 60s.

The more you drill down into health indicators to distinguish the effect of medical care from other factors, the less it seems like US outcomes are worse. US overall indicators, like life expectancy, are worse. But those factor in many things that have nothing to do with the health system, such as homicide, car accidents, demographic, obesity, etc.

For example, Americans eat a truly disgusting amount of food compared to europeans. I’m a relatively low resource consumption asian, and even I was always hungry when we visited Paris because the portion sizes were so small.