This bit struck home for me: Some have also suggested that unfavorable US performance is explained by higher risk of iatrogenic disease, drug toxic

This bit struck home for me: Some have also suggested that unfavorable US performance is explained by higher risk of iatrogenic disease, drug toxicity, hospital-acquired infection, and a cultural preference to “do more,” with a bias toward new technology, for which risks are understated and benefits are unknown. I know some people who use both the US and the Israeli health systems to some degree, and one contrast I've heard is that Americans (patients as well as doctors) tend to prefer newer, less well-tested (because newer), and more expensive (because still patent-protected and brand-name) drugs even when the new drugs have the same or worse performance than decades-old alternatives. I'm not sure if the health drawbacks of this approach are significant, but the economic ones are stupendous; the newer brand-name drugs can be ten times more expensive than the old ones.