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Comment by jackothy | Hacker News Reader

Building one hospital costs the same no matter how many hospitals are already in the country, or am I wrong? Because of this, if the USA has 23 times as much money as the Netherlands they should be able to build 23 times as many hospitals as the Netherlands. (Or am I wrong??)

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The issue is that you need to build more than 23 times as many hospitals - if you only build 23x the hospitals in a country that's over 200x larger in terms of geographic size, that means a huge number of people will be hours away from the closest hospital. The majority of those people will be in very rural areas, who are already generally underserved by social and other government services and who are often quite poor.

Yes, it will be a drain on the US economy that the rural areas will require very high $/person to provide government services.

However, the US still has a higher GDP per land area than countries such as Norway, Sweden, Canada and Australia.

Furthermore, you would think that economies of scale should be quite beneficial for countries as large as the United States.

The countries you mentioned probably have a higher % of uninhabited land.

Given this example, the ratio in square miles US to NL is approximately 237 / 1. So 23x the money and 237x the size leads to one order of magnitude less money per square mile when comparing the two situations.

Good argument. So it's not about the total population size at all. But comparing GDP/square mile actually makes sense.

But at the same time, the situation is nowhere near 10x worse in the US since you mostly just need hospitals close to the urban centers anyways.

(Though I do grant you that quality of life for people in very rural areas will be a bit worse since they need to travel far)

Where have you ever seen engineering and cost scale like this?

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