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Comment by idopmstuff | Hacker News Reader

It's not just about dollars per person - the difference in size of the countries makes country-wide solutions much more challenging. The Netherlands are about 16,000 square miles. The US is 3.8 million square miles.

Taking something like medical treatment as an example, it's not just that you have to scale up the number of beds and doctors in each hospital - you need to build many, many more hospitals, staff them, ensure they have critical infrastructure, etc.

That's not to say that the US is doing even close to enough, but the fact that GDP per capita doesn't do anything to capture the differences in magnitudes of solutions required by the two countries.

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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??)

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)

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.

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

I’m not hearing concrete evidence of a gulf that can’t be bridged by money.

> > It's not just about dollars per person - the difference in size of the countries makes country-wide solutions much more challenging. The Netherlands are about 16,000 square miles. The US is 3.8 million square miles.

> I’m not hearing concrete evidence of a gulf that can’t be bridged by money.

The land area differences provided is part of the concrete evidence: I can invest a lot of value onto a small plot of land, but it will take many times more money in order to do the same for an area the size of a small town. The costs for infrastructure skyrockets as the amount of land in need of servicing increases. 15% more money per person is relatively useless if the people are spread thousands of miles apart.

Over 80% of the US population lives in urban areas.

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