23-country evidence brief
The United States pays more and lives shorter.
Outcomes, capture, name-brand drugs, and devices — USA first, then the next-most-expensive market. Substitutes are labeled, never swapped in silence.
Get involved
The evidence is free. The alternative has to be built.
Everything here is open to read, copy, and cite. The thing it argues for — a clinic that posts its prices, an employer that pays them directly, insurance kept for the catastrophic — does not exist yet. The first step is a list of people who want it, and a clear idea of what each of them can do.
Visitor directory
The hospital
Every floor, posted. Pick a department, then a SKU — cash vs Medicaid vs Medicare vs insured.
Walk the floorsPublic cases
They did not fail a budget. The budget failed them.
Lowest heart, cancer, lung disease, dementia — worldwide
Not limited to this site's Top 20. Rankings use approximate age-standardized death rates per 100,000(GBD / WHO / OECD-style), so a young country isn't “winning” just because people die of infections first. Dementia lows in Africa are often under-counting — flagged below.
| # | Country | ASDR / 100k | vs US | Why | Flag |
|---|---|---|---|---|---|
| 1 | San Marino | 28 | 0.33× | Tiny, rich, Mediterranean lifestyle + excellent care access; small-N rates swing easily (microstate caveat). | microstate |
| 2 | Japan | 32 | 0.38× | Decades of lower saturated-fat / higher-fish diet, lower average cholesterol historically; coronaries stayed rare while stroke/salt was the bigger problem. Cheap frequent visits help catch BP early. | solid |
| 3 | South Korea | 35 | 0.41× | Same East-Asian low-IHD pattern plus a fast drop as care and BP control scaled; diet still less “corn-oil + mega-portion” than the US. | solid |
| 4 | France | 38 | 0.45× | “French paradox”: wine/olive-oil/food pattern + historically lower obesity than US; strong ambulatory care. Not magic wine — risk-factor profile + culture. | solid |
| 5 | Portugal | 40 | 0.47× | Southern Europe diet pattern + sharp IHD mortality declines as smoking and acute cardiac care improved. | solid |
| 6 | Spain | 42 | 0.49× | Mediterranean diet pattern, later obesity wave than the US, and solid infarct care networks. | solid |
| 7 | Italy | 45 | 0.53× | Same Mediterranean cluster: diet, olive oil, walking culture historically; regional gaps but national IHD ASDR stays low vs Anglo/Eastern Europe. | solid |
| 8 | Peru | 48 | 0.56× | Lower average cholesterol/obesity historically than US; more infection/other deaths in poorer regions — but ASDR still shows relatively low coronary deaths. | solid |
| 9 | Chile | 52 | 0.61× | Latin America mid-tier: not Eastern-Europe vodka-IHD levels; improving secondary prevention pulls ASDR down. | solid |
| 10 | Israel | 55 | 0.65× | High-tech cardiac care + Mediterranean-influenced diet in parts of the population; younger mix than Japan but IHD controlled for SDI. | solid |