> The total health care
> spending in the US is warped by the extreme costs of high-end care
> that's simply not available in Canada.
Every efficacious treatment, therapy or drug that is available in the United States is available in Canada. Extreme costs (in a distrubitional sense) characterize spending for health care in all nations.
> I think, for the purposes of
> this thread, it's important to keep your eye on my claim: that for the
> same dollars, (average) individual Canadians could (probably) do better
> in the US.
This is only true in a rather simplistic and uninteresting way (and even then it may just barely true). Let's look at this in several ways.
Your argument is really wrong on its face (comparing 42% of Canadian taxes to private insurance premiums) in that anyone in the United States already pays a portion of their income into taxes for health care. So the real comparison is between the taxes and individual private contributions between countries. So then we are into important distributional issues which I have little interest in "average" positions. Note though, Canadians may pay a higher percent in taxes but they pay privately as well.
The most important to make, althogh it does not follow conventional arguments, is what private insurance gives you in the U.S. is different than what social insurance gives you in Canada. This is true in the narrow sense that the benefits are different within public plans in Canada and private/public plans in the US. But more importantly, social insurance provides social benefits not captured in private insurance. Some examples include a greater concern with the health and well-being of other people in society (public health, occupational safety, wage security, commitment to practical education, personal well-being, etc.). Comparing one's (presumably equal but that begs a whole lot of distributional questions itself) slice of social insurance to comparable public insurance completely ignores one of the fundamental powers of social insurance. Do you think the people in Canada are really more concerned with others welfare or is it that social insurance in part creates/reinforces that concern?
But even if you wish to exclude the central power of social insurance (what the heck, ignoring it passes for informed debate in the US), your argument is pretty weak. First, you are selecting a rather narrow example to make a point (and then calling it AVERAGE!!!). A wealthy and healthy person may be able to craft a better private deal in an individual year--but that is true for being uninsured as well. Both public and private insurance is about the redistribution of well to sick--but it is something we fundamentally agree is OK because we may be the one who is sick.
Public insurance also adds redistribution rooted in the tax system. It then takes on the progressivity/regressivity of the tax system. I don't know a lot of details about Canadian taxation but there probably exists rich people who would benefit from private insurance vs. public. This is nowhere near "average".
Internationally speaking neither country is particularly great in health care delivery and both are probably relatively inefficient. It is just that the U.S. is by far the worst in the world at health care administration (that is, the "load" added by administering health plans and profiteering). Because of this excess administration their are a whole lot of people who get far less care even at the same dollars (their are a myriad of other reasons the care is not the same as well).
All in all, I would "ballpark" estimate that at least 90% of the Canadian population materially benefit from public health insurance over U.S. style insurance. Its just that the 10% who don't are generally the richest (and healthiest) and they make a lot of spurious arguments to mask their interests.
Jim
"It's easier to figure out what we want than to determine what we want is the right thing."
-Nancy Folbre