I'm not sure how implementing a system like Germany or Japan wouldn't impact those things at all. Why aren't Germany or Japan equal to the USA in 5-year cancer survival rates? Their systems optimize for different priorities, and those involve trade-offs.

So no, it obviously doesn't go without saying. If we want to cut overall health system costs or improve access then we might have to accept some reduction in service quality, at least for the most expensive stuff.

Perhaps because the US is the home of a number of prestigious colleges and to be with your peers you have to relocate there? You act like the broken healthcare system is the only possible explanation for cases where the US provides better care, but I'm yet to see that proven. Intuitively it doesn't track because many of the issues with the system don't pertain to things like intensive cancer care but to simple things that are of the exact same quality in countries with better systems, such as insulin where the only difference in the US is the price.

Not to mention, your comparison on cancer survival rates is flawed. The US system drives many people with cancer to be completely unable to afford treatment, which I doubt you've factored into your survival rate number.

Well now you're just making things up. It's not my cancer survival rate number, it's the number published by the CONCORD programme in the London School of Hygiene & Tropical Medicine. If you had bothered to read the article I linked above then you wouldn't need to doubt because you would know exactly what they factored in.

I did check it, it does not appear to mention this factor at all. I would assume then that they are focusing only on individuals who were able to actually get treatment, since this seems to be the survival rate among patients in treatment.