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.