When looking at statistics like this, it’s somewhat unhelpful to consider the US one country. Because of the low density of the population + essentially no federal government, the US is really a few different regions with vastly different outcomes.
Also, you're forgetting all the money that flows directly back into your states, through infrastructure spending, federal services, federal share of funding state services, etc. (Which is a convoluted way of moving money from 'have' states into 'have-not' states.)
How many Americans have been killed in the past 20 years during military operations? Approximately 10,000. If that's all the young American deaths we get for trillions of dollars in spending, that is not a great bang for your buck at all. Hell, more than twice that amount died in one day on September 17, 1862.
In case anyone is curious, this refers to "the bloodiest day in all of American history" https://en.wikipedia.org/wiki/Battle_of_Antietam where it appears fewer than 8,000 people died.
From a policy point of view, US states have more power than the feds.
> essentially no federal government
Seriously? How big does the federal government have to be before it counts?
it is one country, and no amount of clever word play or stat juking will change that.
"ah well, states are the real government" is always a great way to dodge problems.
"gun laws are strict in chicago but people still die from gun violence!"
That's not relevant to the point. As a geographic feature, the US is disparate and even the urban centers persist under wildly different conditions. Looking at it from a perspective OTHER than how humans classify their societies, might give some insight. Generally scientists are interested in data in aggregate that ignore the arbitrary lines drawn generations ago for human edification.
That's how you could graciously interpret the gp's comment, even if you disagree that it's a useful viewpoint.
I think this is true in the same way that it is unhelpful to talk about the mean net worth of 10 individuals in a room if one of them is Elon Musk.
And, in fact, treating the US as "different countries" is exactly what the author does - by pointing out that it is low-income Americans who actually suffer the burden of lower life expectancy rather than an across the board radical lowering of life expectancy for all Americans compared to other rich nations.
And just one more example into why its not 1 healthcare country - to be able to pass the ACA, some provisions had to be "opt in" for state legislators to adopt. So if you were born in the wrong state, even when the ACA passed, you still didnt get some of its positives effects