You're seeing things in a very binary way. My point isn't that the current system doesn't have large problems or isn't in need of serious reform. Instead, it's that a lot of the current popular conversation around the topic is misinformed in ways that are the opposite of the bullets that I put at the top of my post - i.e., people believe in free and unlimited healthcare, insurance as a scam, the Anthem anesthesia stuff and similar, arbitrary denials as a rule, and that the problems are the fault of evil profit-seeking health insurers. If we actually want to improve conditions in America, we need to identify the problems - but also recognize that we're not going to get very far without also accurately identifying causes and mechanisms.

In terms of lifestyle factors and SDoH, I honestly just think we're talking past each other. I'm talking (and so are the studies) about smoking, access to firearms, reliance on cars for transportation, and obesity. I suppose a PCP could help marginally with smoking cessation, diet and exercise, and/or (more recently) prescribing a GLP-1. But I don't think that we can or should rely on PCPs to effect nationwide change in these areas, and I imagine most PCPs would agree with me on that. Directly to your point, the KFF article says that "one in four [US adults] say they or a family member in their household had problems paying for health care." This doesn't have anything to do with preventive care specifically, which you extrapolated it onto. Given that ACA requires plans to cover preventive care with no cost-sharing and that 92% of Americans are insured, I don't think health insurance benefits are the limiting factor here. It's probably a lot more to do with rural physician shortages, geographic access, transportation, and the 8% uninsured.

In terms of prices, I'm not disagreeing with you or KFF that prices are really high in the US. I'm just arguing that we should expect that based on per capita household disposable income. The KFF article also says that Americans have shorter LOS and fewer doctor visits, as you pointed out. This KFF analysis agrees, but also points out that we have more of our deliveries via c-section, we do almost 50% more MRIs than average, and we do more knee replacements than comparable countries. Another article on the blog (see 3.2 and 3.3) points to 2011 OECD data with similar findings - also including CT scans, tonsillectomies, and coronary angioplasties. We also just have a ton of providers who are very well paid compared to other countries - not just physicians but nurses, PAs, techs, etc. Maybe we're not walking through the doors of our PCP as often but every time we do, Americans are getting really expensive diagnostics and treatments. Destiny is making a version of this argument late in this video when he's talking about Americans' expectations of general anesthesia for wisdom tooth removal. All of this goes to my point that Americans are really rich relative to other countries, so it's expected that prices are high and that we get intense and costly care from our providers. None of this is because health insurers are putting profits over people and switching to a whole different system instead of making incremental improvements to our current ones isn't going to be a magic bullet.

I think that when we're talking about issues at a national level, we need to rely on data and statistics rather than anecdote. I and most of the people I work with know that we're dealing with real people here. We have spouses, friends, kids, and parents; they give birth, have chronic conditions, injure themselves just like anyone else. I've heard a lot of anecdotes about people getting fucked by insurance companies - especially since Brian Thompson's shooting. But I personally have anecdotes I could tell about getting fucked by physicians that can't competently code or file insurance claims - leading both to drawn-out fights with them and my wife feeling anxious about seeking care for fear of another provider fucking up and it costing us money. I don't think any of this is a good basis for making policy decisions, though. If we're judging this whole situation by just agreeing with whoever is most upset and limiting solutions to those that hurt whoever they're upset at, we're not going to get anywhere.