I basically agree that the quoted statement supports the idea of a dysfunctional system, the system is crazy. But it should also be acknowledged that it’s prett

I basically agree that the quoted statement supports the idea of a dysfunctional system, the system is crazy. But it should also be acknowledged that it’s pretty rational for a country to spend more on health care as it becomes wealthier. Beyond basic health needs you notice all sorts of expensive marginal conveniences that get bundled into healthcare costs. One example is the ubiquity of motorized wheelchairs in the US. It’s really hard to go a day without seeing at least one in any US city, while I don’t recall ever seeing one in Berlin over a couple of years. People who couldn’t walk either used cheap old-fashioned wheelchairs, crutches, or presumably stayed indoors. I’m not really making a judgement on which approach leads to better health because I don’t have that data, but one costs thousands more. Comprehensive health insurance in the US may also cover modifications to a vehicle or hole to accommodate a motorized wheelchair, again thousands of dollars. Another example: someone who has trouble concentrating at work in the US might spend (out of pocket, or through insurance) $1000 a year on an Adderall prescription Where in Germany it’s quite unusual to get an adult ADHD diagnosis, and even harder to get medication. People are more likely to just live with their genetics on this issue, or make non-medical accommodations, and their problems holding down a job or a relationship never become a medical cost on any spreadsheet. Again, I’m not saying one is better than the other, but culturally speaking, a larger number of personal problems faced by Americans are medicalized than in other countries.