And enormous amounts of money being spent in the last six months of life is also a regular, universally consumed service. Death in America is inevitably incredibly expensive and I'm not talking about the funeral director racket. Admittedly half the money is not spent in the last couple months of life.

Combined with the USA no longer being a "wealthy western nation" for a variety of reasons revolving around extreme income inequality, massive demographic changes, etc. Europe is no longer a peer. America is demographically no longer a euro nation and the long term trends indicate something vaguely "South African" in our future. A peer to the USA in 2017 or in the future, would be found in South America or Africa. Compared to those real peers, we're doing a great job in medical and educational fields. Yes we suck compared to Germans but "we americans" are not Germans, not anymore, so whats the point of that observation exactly? If our Africans are the best educated and healthiest Africans on the planet, if our South Americans are the best educated and healthiest South Americans on the planet, whats the problem exactly? Even legacy races like whites, USA has some of the best educated white people on the planet. Our averages might be dismal for various human biological differences reasons, but broken out into hyphenated-american groups, all our groups kick butt individually.

With respect to people not understanding the politics, according to the BLS there's only 100M full time employees over 25 years of age of which most but not all have bennies such as health insurance. Google claims the USA population is 319M. Pondering why the winners of a democratic election would screw over employees with bennies is like being surprised at the result of two wolves and a sheep voting on dinner.

Combining this, some of the numbers are insane. Every working person has to pay in their insurance and taxes enough money for roughly three likely incredibly expensive deaths. Very theoretically in some kind of pre-historic Egyptian sense a culture can afford a middle class lifetime income level cost of death/medical care on a 1:1 basis without creating too much of a pyramid inflation scheme. However if a nation intentionally wipes out its middle class like the USA replacing with struggling working class you can't expect each working class lifetime income to fund three middle class financial scale deaths.

The medical system has to match the economic system. Either the medical system has to be collapsed to South American or African levels, or the economic system has to be improved to Euro levels. "F you I've got mine" utterly eliminates any possibility of economic improvement, income inequality will increase permanently no matter what. That means medical care must collapse to, on average, African or South American levels. To insist otherwise is to risk sounding like one of those old people in the 70s who assumed we would never destroy our own industrial base intentionally, so surely the factories will reopen soon. I am curious what the hospital/health care equivalent is of the "rust belt" meme, because health care today is like a labor intensive assembly line factory in the USA in 1970, you may as well start counting the months until the jobs are gone and the buildings are abandoned to urban explorers, there literally is no alternative.

I'm not sure this is necessarily bad. Most lifespan improvement and quality of life improvement over the last centuries in western and formerly western countries came from civil engineers who had their glory stolen by the medical complex. Don't get me wrong, I'm sure it'll be bad, but unless we go "pol pot" on the civil engineers, we're not going back to 1800s era death rates. If we do that, then we're really doomed.

https://www.bls.gov/cps/cpsaat08.htm