vida: extract claims from 2026-04-23-oecd-health-at-a-glance-2025-us

- Source: inbox/queue/2026-04-23-oecd-health-at-a-glance-2025-us.md
- Domain: health
- Claims: 1, Entities: 0
- Enrichments: 3
- Extracted by: pipeline ingest (OpenRouter anthropic/claude-sonnet-4.5)

Pentagon-Agent: Vida <PIPELINE>

domains/health/us-healthcare-ranks-last-among-peer-nations-despite-highest-spending-because-access-and-equity-failures-override-clinical-quality.md

@@ -1,16 +1,14 @@
 ---
 type: claim
 domain: health
-description: "Commonwealth Fund's 2024 international comparison shows US last overall among 10 peer nations despite ranking second in care process quality, proving structural failures override clinical excellence"
+description: Commonwealth Fund's 2024 international comparison shows US last overall among 10 peer nations despite ranking second in care process quality, proving structural failures override clinical excellence
 confidence: proven
-source: "Commonwealth Fund Mirror Mirror 2024 report (Blumenthal et al, 2024-09-19)"
+source: Commonwealth Fund Mirror Mirror 2024 report (Blumenthal et al, 2024-09-19)
 created: 2026-03-11
-supports:
+supports: ["The US has the world's largest healthspan-lifespan gap (12.4 years) despite highest per-capita healthcare spending, indicating structural system failure rather than resource scarcity"]
-- The US has the world's largest healthspan-lifespan gap (12.4 years) despite highest per-capita healthcare spending, indicating structural system failure rather than resource scarcity
+reweave_edges: ["The US has the world's largest healthspan-lifespan gap (12.4 years) despite highest per-capita healthcare spending, indicating structural system failure rather than resource scarcity|supports|2026-04-07"]
-reweave_edges:
+sourced_from: ["inbox/archive/health/2024-09-19-commonwealth-fund-mirror-mirror-2024.md"]
-- The US has the world's largest healthspan-lifespan gap (12.4 years) despite highest per-capita healthcare spending, indicating structural system failure rather than resource scarcity|supports|2026-04-07
+related: ["us-healthcare-ranks-last-among-peer-nations-despite-highest-spending-because-access-and-equity-failures-override-clinical-quality", "nhs-demonstrates-universal-coverage-without-adequate-funding-produces-excellent-primary-care-but-catastrophic-specialty-access", "us-healthspan-lifespan-gap-largest-globally-despite-highest-spending"]
-sourced_from:
-- inbox/archive/health/2024-09-19-commonwealth-fund-mirror-mirror-2024.md
 ---
 
 # US healthcare ranks last among peer nations despite highest spending because access and equity failures override clinical quality
@@ -56,4 +54,10 @@ Relevant Notes:
 - [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]]
 
 Topics:
-- domains/health/_map
+- domains/health/_map
+
+## Extending Evidence
+
+**Source:** OECD Health at a Glance 2025, US country profile
+
+OECD 2025 shows US clinical quality is not just adequate but world-leading for acute care (30-day AMI mortality 5.2% vs. OECD 6.5%, stroke 4.5% vs. 7.7%). The ranking failure is driven by preventable mortality (50% worse than OECD) and treatable mortality (23% worse despite highest spending), indicating the problem is prevention infrastructure and access to existing excellent care, not clinical capability.

domains/health/us-healthcare-spending-outcome-paradox-confirms-non-clinical-factors-dominate-population-health.md

@@ -0,0 +1,19 @@
+---
+type: claim
+domain: health
+description: "International comparison shows US excels at clinical intervention (AMI/stroke mortality 21% better than OECD) while failing at prevention (preventable mortality 50% worse), despite spending 2.5x the OECD average"
+confidence: proven
+source: OECD Health at a Glance 2025, United States country profile
+created: 2026-04-23
+title: The US healthcare spending/outcome paradox — world-class acute care outcomes with dramatically worse preventable mortality — is the strongest empirical confirmation that non-clinical factors dominate population health
+agent: vida
+sourced_from: health/2026-04-23-oecd-health-at-a-glance-2025-us.md
+scope: causal
+sourcer: OECD
+supports: ["medical-care-explains-only-10-20-percent-of-health-outcomes-because-behavioral-social-and-genetic-factors-dominate-as-four-independent-methodologies-confirm"]
+related: ["medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm", "us-healthcare-ranks-last-among-peer-nations-despite-highest-spending-because-access-and-equity-failures-override-clinical-quality", "us-healthspan-lifespan-gap-largest-globally-despite-highest-spending"]
+---
+
+# The US healthcare spending/outcome paradox — world-class acute care outcomes with dramatically worse preventable mortality — is the strongest empirical confirmation that non-clinical factors dominate population health
+
+The US spends $14,885 per capita on healthcare (2.5x the OECD average of $5,967) and 17.2% of GDP (vs. OECD average 9.3%), yet achieves life expectancy 4.3 years below peer countries (78.4 vs. 82.7 years). The critical finding is the SPLIT in outcomes: the US outperforms on acute clinical care — 30-day AMI mortality is 5.2% vs. OECD average 6.5% (21% better), and 30-day stroke mortality is 4.5% vs. 7.7% (42% better). However, preventable mortality (deaths from conditions where behavioral/environmental intervention works) is 217 per 100,000 vs. OECD average 145 (50% worse), and treatable mortality (deaths where timely clinical care should save lives) is 95 vs. 77 (23% worse). This pattern is exactly what the non-clinical factors hypothesis predicts: excellent clinical performance cannot compensate for structural failures in the behavioral, social, and environmental determinants of health. The US system is optimized for — and excels at — clinical intervention, but this is the wrong lever for improving population health outcomes. The spending is directed almost entirely at clinical care, with minimal investment in prevention and social infrastructure, creating a system that is world-class at treating disease but catastrophically bad at preventing it. The 23% worse treatable mortality despite being the highest spender also suggests access failures prevent even the excellent clinical care from reaching all populations.

inbox/archive/health/2026-04-23-oecd-health-at-a-glance-2025-us.md

@@ -7,9 +7,12 @@ date: 2025-11-01
 domain: health
 secondary_domains: []
 format: statistical report
-status: unprocessed
+status: processed
+processed_by: vida
+processed_date: 2026-04-23
 priority: high
 tags: [OECD, international-comparison, health-spending, outcomes, life-expectancy, preventable-mortality, clinical-effectiveness, US-health-system]
+extraction_model: "anthropic/claude-sonnet-4.5"
 ---
 
 ## Content