Singapore numbers ignore their underclass, which is significant. But you're right, if you're a westerner, Singapore's great.

Singapore is the beneficiary of a neighboring impoverished itinerant workforce to supplement its own collapsing demographics with artificially cheap services. It’s hardly replicable most places.

Health outcomes in the US are affected by higher levels of obesity. If anything, the higher health spending keeps that from being worse. I expect Ozempic and the like to have a significant impact on this.

Your statement prompted me to look at immigration options in Singapore. It seems it is pretty reasonable to get a visa as a foreign technologist.

Europe is also excellent in my experience, specifically Portugal and Spain. My health insurance cost for a family of four in Spain is ~$2k/year as someone on a visa. In the US on an employer plan, it was ~$20k/year (premiums, copays, etc).

The US has around 4x the obesity rate of Singapore, which significantly reduces healthcare costs.

> Health outcomes amongst the three countries are comparable. If anything, Singapore is healthier.

healthcare is not for health. Its for sickness. Going to hospital doesnt make you "healthy" . We dont have any medicines to restore health to ppl suffering for diseases majority of healthcare spend goes to.

Maybe those countries dont have sickly population in the first palce like usa where a majority have metabolic diseases.

Singapore has severe consequences for executives who violate the public trust. That makes it hard for sociopaths to rig the system for the elites.

"The only way to get as close as possible to "good" healthcare is to have enough money to pay for everything out of pocket."

This isn't possible. Healthcare is a finite resource and having universal, government care not only puts your life into the hands of the government (see the UK for an example where parents are not allowed to take their children out of the hospital) but offers worse outcomes.

When you are young and healthy, it's great. As you age, life-or-death surgeries have long wait times. This can be seen in any country with universal care. My aging relatives in Canada are going through this right now and have been forced to come to the US to get surgery in months rather than waiting years.

MAID has been great for healthcare costs in Canada. Many people that would otherwise have been costing the system money, are now a benefit. The sad realization is that government-run programs need MAID to cut down on costs.

I know lots of expats living in Asia that are now getting older. They have to go elsewhere to get any surgeries done, because of this exact reason.

To make it better, we should only have insurance for surgeries that can't benefit from the free market and are relatively rare. Common surgeries and procedures should have no insurance. The prices would eventually fall to levels that were affordable.

The masses don't want plans like this. They like easy solutions that sound good when you say them and don't take a whole lot of thought besides an elementary school level of thinking.

There are already better systems of healthcare. The US one is only good if you're wealthy

I don't really need to live forever, I just don't want to have to think about whether bleeding out in a cab is a better deal than an ambulance.

Or if that random doctor who just walked in is out of network and going to charge $30,000 for my stitches when $3,000 was already egregious.

There will never be a perfect healthcare system, sure, but the US healthcare system is just bad, and can be improved. We pay more for worse outcomes on average compared to most developed countries. Obviously it's just not working, I think it's indisputable at this point.

> the true cost of fixing a body more often than not far exceeds the value that body produces

i softly agree but also think that a body does not need to generate value to pay for the costs in order for the whole process to sustain itself. Monitoring the stars for asteroids heading towards earth provides no market value, for example, but we can still afford to do it. so it's a matter of cost and available expenditure. the market is not net 0, so its possible to generate enough value to have enough to afford healthcare as an expense as a society

what are the costs of fixing a body? The residency pipeline is a bottleneck on labor, but assuming that gets sorted out and AI is capable of guiding any reasonable person through the process, why cant the cost of labor for a doctor drop dramatically?

i would guess limited resources are the biggest blockage, but i dont know how to break down a $20k hospital bill for giving birth into its actual costs. its hard to believe that really needs to be $20k.

I actually think its the opposite. there is so much friction with healthcare and the process of healing is slow enough that costs are inflated because the overall operating cost for the entire facility including rent, ER, having people on standby, who knows what else, all need to be recovered through whatever volume they process and they arent processing as quickly as the resources are able.

healthcare needs do not subscribe to a neat work schedule, and so we have to pay a lot of market prices to have the right availability at all times. but thats not a true cost, it is a result of accounting and underutilization

Redundancy is robustness is expensive.

And yet so much stick built instead of manufactured, for example.

And I agree that the standards have been rising such as better R-values, car charging, AC, cat5 etc.

No, I mean on an age-corrected basis, throughout the spectrum of ages.

i.e. young americans are spending more on health care than young americans used to, even if it's also true that there are fewer young americans now, and more old americans.

It isn't just aging.

Americans are spending a lot more on quality-of-life medical interventions, many of which are outside the normal standard of care that would be covered by healthcare systems. It is a booming business in the US and many people seem to have no trouble paying for it.

Just as an anecdote, I’m an older Millennial (1982) and since my late 30s I’ve been spending my HDHP cap in health services that my parents wouldn’t have bothered with, such as allergy shots and niche diagnostic blood tests based on the latest science, some of which have been covered here such as HSCRP. I’ve also had LASIK and had laser skin treatments done. I’m not a health nut, I just realized I don’t have to look and feel like crap in my 40s like my progenitors.

It's my hypothesis that boomers passing away + GLPs largely ending obesity will result in a sharp drop in total healthcare spending in the next decade or two

My main caveat / counter point is that preventative care may actually increase as more and more people jump on the live for ever, dont die, longevity hacking trend.