This is always what amuses me from my European perspective. Large parts of the insurance systems where created for ensuring workers are healthy and productive. And it is an understanding that bad care causes permanent reduction in work output.

It's part of the "if you are successful it is because you worked hard and deserved what you get" and the "if you are a failure, it is because you are stupid and lazy".

There are no unfortunates in the USA, there are only losers and winners.

If more welfare spending creates more wealth, then wouldn’t you expect the median Western European to be wealthier than the median American? Yet the opposite is true. How do you reconcile this?

First we talk about Healthcare Spending. The US spends the most and get the worst outcomes in G7. Also you have universal health insurance for Elder People (Medicare). It just doesn't make any sense to have perfectly capable workers to loose their ability to work because they couldn't get a treatment for 10.000$ in real cost (not the marked up price for Uninsured people, because the insurance companies want a rebate from the sticker price)

Also if you look at GDP measured in PPP the US doesn't really have an advantage. In other measurements as HDI they trail even behind