Yup, Medicaid and SNAP are extremely efficient. Social Security is almost completely disbursement charges but those disbursements aren't means tested so even quite wealthy individuals receive them. Additionally you mentioned that Medicare gets money to medical providers but I suspect that was meant to mean medical insurance providers - rather than health care providers (like doctors) since the system is partially direct payments but mostly runs through intermediary privatized companies and, of extreme note here, is that Medicare is famously barred from cost negotiations so while our Canadian healthcare system can talk to a pharma manufacturer and tell them "The price for this drug is unreasonable, we won't cover it unless it's cost competitive to biosimilars" Medicare just needs to roll over and accept whatever made up numbers it's given.

The benefits that are intended to go exclusively to the impoverished though, those are extremely means-tested and often have work requirements or other hoops to jump through.

Non-profit doesn't mean money-hating, though

My daughter’s classmate’s father is a head of a non-profit hospital.

They have a 6k sqft house with a basketball court, pool and a pool house in the prime location in West Los Angeles.

They had to join two lots to build to their liking.

>Only ~20% of hospitals are for profit institutions for example.

And the other 80% are little to no more efficient in terms of dollars input vs services rendered.

It's quite true. Take Medicaid grants to states for example, which then goes out to 50 different systems of disbursement to private entities. Enrollees on plans are often done so through private insurers, many hospitals are run as for-profit including being owned by PE groups, etc.

And the intermediaries? And admin?

> We also spend a ton on lifestyles diseases because no one walks and culturally we eat like shit on average.

And there's a pretty straight line between that and government subsidies for sugar and processed foods in general, not to mention car-based infrastructure, although the latter doesn't stop other countries from not having crippling obesity rates.

The graph shows both public and private expenditure. If you only consider the public per-capita expenditure it's more than every other nation on the graphs public + private per-capita spending.

The media narrative is a factor too. Like I have extended family, friends, and work colleagues in the US, many of whom are wealthy and well-traveled and even a lot of them will still loudly assert obviously disprovable untruths like "well at least we don't die in waiting rooms like in Canada" or "at least we don't have death panels deciding who gets to have life-saving treatment" or worst of all "ehh I mean I have good insurance, and outcomes are much better here for top-5%ers, so I don't really care about the rest of the system." All while decades of TV hospital dramas depict a well-oiled medical system delivering effective and efficient care to people with nary a whisper about how it's getting paid for.

It's got to be desperately frustrating trying to fight this kind of thinking when you've got whole communities who have never even thought to question it.

My main hope at this point is with bottom-up type efforts. Let Mamdani show people that an effective city government can fill potholes and operate a few at-cost supermarkets. Let that be the start of citizens expecting more than chainsaw-waving and twitter meltdowns for their tax dollars.

The distinction is in whether there's a value judgment. Is healthcare and welfare something we assume is part of the package living in a developed nation, or is it an indulgent extra, subject to suspicion and scrutiny above and beyond what essentials like military spending get?

I would say that the mainstream Canadian view is the opposite of this. We expect healthcare funding and many are supportive of the strikes when it gets cut, but we are much more likely to treat military budget as the purchase of a lot of unnecessary toys.