Compare against the typical OCED nation, US spending ~18% gdp on health, about ~8% higher than OECD average, i.e. 2T+ rent extraction per year for net lifespan that is statistically worse than OECD average. 6 months of US excess health spending buys you entire HSR system in China that's frequently being panned as overbuilt and wasteful. Meanwhile look at recently built Brightline Florida, with ~120 deaths per billion passenger km, normalize that to EU, JP, PRC HSR billion passenger km, you'd get 15k, 50k, 310k fatalities per year. Imagine PRC losing Cincinnati every year due to rail deaths. Now Brightline extra dumpfire execution but just to highlight at some point there's too much red tape, and red tape doesn't always buy you value. Sometimes the system is so broken and you end up the worst of both world quadrants: high cost rent extraction & less than first world outcomes because the accumulation of redtape itself is leading to substandard outcomes. AKA premium medicore. Extra worse in some sectors when it's not simply opportunity cost inefficiencies, i.e. you lose on something else. A sclerosic money flow recycling maximizer can also makes the thing it's pumping money into worse than expected.