Comment by tptacek

No, we don't agree. I think there are different values implicated in our system, in a system like the UK NHS, and a system like Australia's (for the record: I'd take Australia's over ours).

The UK does a good job of hiding economic concerns from its users, at a cost in availability of services, especially high-end and experimental interventions. The UK makes these rationing decisions knowing that some people are going to be denied life-saving care, but in exchange for that everybody else in the system will get predictable access to their care.

The American system does a good job of getting services delivered to customers; it does a better job of that than the NHS does, if you measure in interventions performed; it does such a better job at that that it's a real problem in our system: we overprescribe and overdeliver interventions that drive costs and decrease certainty as payers work out which things to cover and which not. The flip side of that is that everyone in that system can tell themselves that the system is doing what it can to gate delivery on whether care is truly needed and will be effective, and that it's not categorically denying care because of top-down mandates.

Neither set of values is totally benign. You can prefer one or the other.

I can go all 12 rounds on this topic, but if I keep writing about this I'm not going to write the work thing I'm supposed to write, so I'll leave it there.