Do you find this list surprising or expected?

No, I'm not surprised. I don't know a lot of detail about successful european economies, but I could venture a guess: It's my strong belief that our manufacturing sector, the backbone of the middle cl, has been systematically destroyed by the cost of health care. Our citizens are poorly educated, poorly nourished, and over-medicated. Our doctors and government oversight agencies have become corrupted by the mive amounts of money and revolving doors of the pharmaceutical and insurance industries and their lobbies. How to fix it? I haven't got a clue. We can start by educating ourselves, exercise, take medication as a last resort, and demand our government agencies do their jobs, nothing more, nothing less.