Yes, there are lots of factors like this when comparing any two countries. USA does have uniquely high expenditure supporting your bloat claim. The point is ot

Yes, there are lots of factors like this when comparing any two countries. USA does have uniquely high expenditure supporting your bloat claim. The point is other countries e.g. France, Switzerland, Canada, UK, there are also not significant differences vs. countries with lower GDP per capita. I'm not saying this proves a relationship but it's a useful indicative signal, and the randomised studies cited by Hanson, combined with the health outcomes of American Amish all together make more more sceptical of the benefits of health expenditure. I'm not certain though and would love more info. If anyone has any evidence pointing in the opposite direction then would be really interested to see it.