Not that your thesis isn't correct but be careful there. You're combining the cost of care for the people who get care with an average outcome that includes people who don't get care. The quality of care for Americans who can afford care is excellent.
As a Canadian who knows many Americans, works for a US company and has extended US family, this is not quite true.
Most Americans "who can afford care", maximum 70%, have access to medical care that is on par with Canadian health care, but is fraught with peril; "booby traps" such as out of network costs, high co-pay fees that can bankrupt, surprise billing (though 2022 is starting to deal with that). Care may be excellent, but losing your house if you get cancer seems unnecessary.
A few percent of Americans (the rich and the very well insured; FANNG/MAMAA, investment bank employees, etc.) have access to the possibly best health care in the world.
20% of Americans are uninsured or under-insured and have access to the worst healthcare in the G20.
I think it's strange to want to only include the first two categories in the outcome calculation. Strange may not be the right word here ...
Well that's the point, I think everybody should be taken into account in order to paint a comprehensive picture of the quality of the system at country level. The resulting stats reflect the health of a society as a whole not just of the part that can afford it. Not having universal healthcare is still part of the system, even if we don't like it.
I get it that health outcomes of those left out are probably very different. But leaving those numbers out of the comparison doesn't really work with these type of statistics.
At that point how could you compare it to the other countries that take everyone into consideration? The stats are GDP/capita percentages, should I remove the ones who can't afford healthcare from the GDP stats as well to not skew the ratio? I don't really like where I might end up taking this route.
I don't have any experience with US healthcare and I'm sure the quality of the services is really high, but the fact that you need to afford basic healthcare and it's not guaranteed by the government for everyone makes me see it as closer to just another "consumer product" compared to other systems.
There is a sad trend where the small doctors -- who can't survive without group power -- join conglomerates, the conglomerates buy hospitals, and finally the conglomerates close the less performant facilities. You get large states with vast underserved geographies.
The OP headline is we are careening towards a luxury retail arrangement like Trader Joes: they will only have "outlets" in the richest areas. There's no regulation around closing hospitals so this is coming fast. Two in my county closed this year and I am far from rural.
You can't just say you can't close this hospital, you have to find a way to pay the bills on it.