Most people don't have 10 million dollar hospital bills. That's how insurance works: everyone pays in case something happens to them, and the people who have expensive treatments are subsidized by those who don't.

Insurance is more effective at dispersing that cost when the pool is larger, so the most effective scenario would be for everyone to pay in via taxes and simply… be covered.

Edit: I don't understand the point you're trying to make with your edit.

Rather, were services purchased really worth 10 million dollars?

How much of that are salaries for underperforming, bloated structures in charge of "management" and billing?

Canadians spend 220k (in 2013) per person per lifetime. It's very unlikely you can shrink 10 million dollar bill to anywhere close to that.

[1]https://www.theglobeandmail.com/life/health-and-fitness/heal...

What makes Americans that much more expensive than Canadians?

It's mostly end of life care (relative to other countries).

So during your life - broken bones etc - roughly equal.

But if you are stuck in ICU for a year when 75+ - that's uniquely American and incredibly expensive.

"Numerous articles on EOL costs show that a large proportion of Medicare expenditures occur during the last 6 months of life.1-9 This phenomenon has continued for many years as the number of Medicare decedents has increased with the aging American population. Medicare expenditures for EOL have increased dramatically from 1983 to 2016, primarily because of the increase in the number of decedents. Other articles compare EOL expenditures in the United States to other countries10,11 or focus on Medicare expenditures for specific diseases.12-14 A recent development in the literature challenges the idea that EOL costs are responsible for a high percentage of health-care costs.15

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/

I am aware that EOL care is a large part of the costs of our system. However, one thing I have not heard is any definitive evidence that that is materially different in the US vs. e.g. Canada or the UK.

This study suggests that your interpretation is not correct: https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0174 Mean end of life spending is only marginally higher in the U.S. than in other countries.

I thought something like 25% of medicare spending was in last year of life spending.

I've also heard that something like 5% of folks generate 50% of costs.

So the argument has been that because in the US total expenditure can go so high (ie, we will easily spend $10M on one person where other countries won't) that you end up with a serious spike as a result of last year of life and extraordinary effort costs.

Other countries have less variance (including income inequality)

Yep, I'm aware of the argument, and I think you've stated it correctly. But the data I was able to find does not seem to support it.

From the study (~1980 data) [1]: Cost of care in the last year of life in USA varied from study to study, between US$40,000 to US$95,776.

Extrapolated cost for Canada: 6,758.2

[1]https://www.longwoods.com/content/20878/healthcare-quarterly...

That number is the total cost for all people who died in Canada, extrapolated from Saskatchewan data, in millions of dollars. 6.7B dollars, that is. Considering something like 300k people die in Canada each year, that's around 20k per capita. (This is seriously mixing units because the population of Canada has increased a lot since the study you cited.)

In any case, it's not the correct number. Quebec data from the study I cited showed 60k per capita on hospital alone, with incomplete data to characterize the remainder of the costs.

> At what cost to others?

Assuming nothing else changes, it'll about double the cost of what people pay now for private insurance (in terms of taxes).

However, there's no reason to assume nothing else changes. The US spends an atrocious amount on the overhead of bookkeeping our "free-market" semi-adversarial healthcare system. Estimates over the past 22 years range from 13 to 25% of the cost is raw administration. Assume most of that cost goes away (let's say 90%, which seems fair) and you're left with Americans paying about $250-400 a month more on average in taxes for healthcare than what is paid now.

Since it's taxes, the progressive tax rate would kick in and this would translate overall to most Americans paying almost nothing more, the middle class getting squeezed (this could be ameliorated with laws, but if nothing else changes the middle class gets squeezed), and the wealthy and super-wealthy shouldering the bulk of the cost.

I think a piece that you're missing here is that health problems get drastically worse, and more expensive to fix, when they're not addressed.

Problems are often not addressed in a reasonable time frame because many people don't have access to reasonable health care. Even they they do, they may be hesitate to use it. Anecdotally, last time I went for a preventative check, I was given an FAQ sheet when I signed in reminding me that if I ask about anything specific, or diagnostic, that is not preventative (as if I'm supposed to understand the difference), then it would have to be billed separately and may-or-may-not be covered by my insurance. That was almost enough for me to not ask my doctor questions while I was at the office.

I would imagine that more widely addressing issues early on before they become expensive would remove another large portion of overall US healthcare costs.

Not everyone is going to have a 10 million dollar hospital bill. That's the entire point of insurance, and also the point of having a national plan: you generally aren't going to know if you're going to have a lifetime expense of 10K or 10M. So you need to aggregate that across the entire population.

Other countries seem to manage it.

Why? Works ok in Australia.