Comment by mindslight
3 days ago
I don't agree with this dichotomy. It asserts a monolithic top-down perspective, making it completely inapplicable to the dynamic I described in my last paragraph. It's "universal care" only in the sense that its universe has been defined to exclude most patient agency. Divergence from other possible patient-desired choices then tends to get rationalized away.
For example, perhaps having a follow up after 6 months only increases the expected value of the outcome by 0.1% and then multiplied/integrated by expected lifetime earnings it's not worth the economic cost of the system paying for that earlier follow up. But being my life, I should be able to spend my resources (including my time, which this current top-down model certainly doesn't account for) to achieve an outcome with much more utility to me personally than simply how much income (/taxes) I'm expected to produce.
It sounds like you’re talking about what you want, and I’m talking about how I think things are. I don’t see a wealthy country being able to do anything other than some form of universal care with heavy government involvement in the industry to make it happen. There’s nothing preventing it in terms of economics or technology, I just don’t think people will accept it.
Most of these systems do allow that sort of patient agency for those who can afford it, though. Maybe you had a weird specialist who didn’t want to see you earlier, but there are plenty of doctors who will go beyond your insurance coverage in exchange for cash.