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The absurdity is painful. That in a wealthy nation people can be unable to access medicine because the system for deciding who will pay how much for it is unavailable. Absolutely grotesque.

The hack isn't the problem. The system that privileges access to medicine is.

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I'm not sure this is the message of this story. There are tons of computer systems involved under single-payer systems.

Polish person here, this is very true. Our prescription system is extremely centralized, there's no such thing as a paper prescription any more. When a doctor gives you a prescription, you get a four-digit code. The prescription can be redeemed at any farmacy by giving them the code and your national identification (PESEL) number. If this system goes down, there's no access to prescription medication, to anybody, anywhere in the country, period. Even an emergency government authorization to use paper prescriptions wouldn't help here, as a lot of people are on "long-term" prescriptions. They go to a specialist once a year or so, get a prescription for a year's worth of drugs, and then go to the farmacy every month to get their monthly refill. There's no way we have enough doctors to get all the long-term prescriptions correctly and quickly re-issued on paper when the need arises.

This is true re electronic prescriptions. It’s an awesome system that works like a charm.

However, paper prescriptions still exist and can be used in a pinch. I had a doctor write one out for me a few months ago. He did not have access to a computer but had a pad and his stamp on him.

Keep in mind that this electronic system came online a few years ago. Most doctors have issued paper prescriptions longer than electronic prescriptions.

It’s a bit dramatic to say that there is no way to get them to do it again if the need arose.

Sounds like the real crisis is that it costs a tiny bit more money doing it the old fashioned way.

I hope I did not give an indication that it costs more money doing it the pen-and-paper way. There is no cost involved to the patient. Is not know about the doctor but I presume it’s free issuing a prescription either way.

> There's no way we have enough doctors to get all the long-term prescriptions correctly and quickly re-issued on paper when the need arises.

In the US, prescriptions with refills have a label on the bottle indicating how many refills left. I imagine in a recognized crisis, you would be able to get those refilled with little trouble, maybe even if it said zero refills as long as it was a drug typically used long term and not a drug commonly abused.

> label on the bottle

We don't do that. You just get a box and that's it.

You could print a label that is stickied onto the "retail" box.

This is usually the case in the UK, at least at major pharmacy chains. It’s definitely convenient (similar to the US-style bottles) for traveling to easily indicate that any medicines you have are on prescription in your name.

But none relating to payment or ability to pay. In the UK, medications are dispensed without checking whether a person is eligible for free prescriptions. Anyone can collect a prescription medication without paying by claiming an exemption (e.g. being on low income, pregnant, etc.) without proof. The pharmacist can also waive the £9 fee for a prescription. There's never a situation where not being able to figure out the paperwork prevents medicine being available.

The prescription system itself could be compromised, in which case everyone in society would face the same issue (which would be mediated by the fact that paper prescriptions are still produced, and a pharmacist can telephone a prescribing surgery). Only a supply chain attack would really cripple the system.

Presumably even in a single-payer system, you still need just as good of an accounting of costs and care provided. The data needs are all still there, just fewer parties are transacting.

Absolutely. But in the UK, Ireland, Germany, New Zealand, etc... nobody would be refused their medicine because the payment system didn't work. Even if the computers didn't work.

In the USA, people can and do die because there's a financial barrier to accessing medicine. Not so in countries that care about people.

> But in …Germany…etc... nobody would be refused their medicine because the payment system didn't work. Even if the computers didn't work.

If the computers didn’t work, it would be incredibly painful in Germany because most pharmacies don’t regularly stock most prescription drugs. They’re often ordered from central warehouses on demand - i.e. if you walk in with a prescription for Xanax in the morning, you’ll typically need to come back in the afternoon to pick it up.

That ordering process is entirely digital. If you suddenly switched to paper forms, phone calls, and faxes, it’d be a nightmare.

I have never experienced that problem. I've had my prescriptions filled without having to wait for stock dozens of times in Berlin.

It's not really a "problem" because you can usually get them the same day, but I can assure you that it's a thing, especially if you take controlled medications like Methylphenidate.

An even more fun quirk is that because different pharmacies seem to use different distributors, you'll sometimes have to hop around until you find one whose distributor has whatever your medication is in stock. I once had to go to four different pharmacies in Mitte before I found one that could order Zolpidem.

Methylphenidate is exactly what I take - strange and interesting that we have opposite experiences, but in Xberg I never had a problem

I agree that the hack is the problem, but a single-payer system would mean the moving parts of the distributed system are less complex which means it's easier to manage. Just having fewer corporations involved means fewer boundaries between systems which means it's less likely to break.

One the primary goals of any - and indeed every - medical system is to ration resources. Which is to say to privilege access to medicine. When we talk about medical care access, we tend to talk around this, but it's a needed part of any system. Any system that doesn't do this quickly learns, institutionally, that without some limiting mechanisms in place the system will be overwhelmed and its resources exhausted.

Obviously some approaches and systems work better than others and are more tolerant to some kinds of faults. Unfortunately, none of this gets away from the absurd, insulting, and grotesque reality that care has to rationed somehow.

I guess increasing supply isn't profitable enough compared to artificial scarcity.

Every healthcare system I've ever encountered, read about, or heard about has some kind of rationing. This is apparently independent of questions of profit or non-profit, private or public. Socialized, not-profit-driven healthcare systems also have to ration resources somehow.

It's certainly a constraint of any medical system but not a goal, primary or otherwise. The goal of socialised medicine is to provide medical care equitably to everyone who needs it - to assign that as a right. Care only has to be rationed to the extent that resources are constrained below what is required to meet the need. And all of that is orthogonal to a system like that in the US, where care is a luxury not a right.

How do you define "need"? We certainly should do better at improving access to affordable care and eliminating inefficiencies. But need for healthcare is essentially infinite for patients with serious chronic conditions or near end of life. And as the population becomes older and more obese that will be an increasingly larger share. We just don't have the resources to pay for everything regardless of where the bill goes. Care rationing in most developed countries will only get stricter.

The absurdity of people defending possibly the worst system of rationing healthcare on the planet will never grow stale.

I suppose straight up denying healthcare based on class would be worse. But such a system would actually afford its customers the dignity of honesty.

I'm sorry, I can see I have been unclear. I am in no way defending the worst system of rationing healthcare on the planet. It's awful, horribly, abominable, and must be changed to include some basic fucking humanity.

I'm saying that rationing is inevitable and our thinking about health care systems needs to account for that.

> I'm saying that rationing is inevitable and our thinking about health care systems needs to account for that.

I understand there are utopian arguments for healthcare, but where is the demand to respond to them?

I am in no way condemning the individual response to this I'm just earnestly curious where this impulse comes from.

Because, arguably, vast majority of people - in other words, public opinion, or vast majority of voters - don't understand that healthcare has to ration scarce resources too. Healthcare being a right is a nice, feel-good slogan, but does little to address resource scarcity or system inefficiency.

Dismissing basic, reasonable expectations as "feel good slogans" is a smarmy tactic to distract from wealth hoarding.

The sky is the limit with what humans can do, but under late stage capitalism, it boils down to the preferences of those who control the system, and nothing more.

https://nymag.com/intelligencer/2022/03/how-asset-managers-h...

Healthcare rationing has historically been even more severe under non-capitalist systems.

Which would be a poor comparison in this context given what the linked article spells out:

We already have a centrally planned economy, but it's only for the wealthy.

> Healthcare being a right is a nice, feel-good slogan, but does little to address resource scarcity or system inefficiency.

I don't think these are contradictory concepts, nor does this do much to justify the objectively atrocious method we currently use to ration healthcare. Every dime of profit could have gone to healthcare—that's not rationing, that's just unnecessary and easily preventable cruelty.

> One the primary goals of any - and indeed every - medical system is to ration resources.

We can fix this. Essentially, every smoker, every alcoholic, and every obese human immediately goes to the back of the line.

No need for this convoluted bullshit of a system.

Firstly, that is still a convoluted bullshit system for rationing healthcare. Logically you'd have to assign some sort of worthiness score to every activity that matters then track everyone to figure out their score and stop them lying to get to the front of the queue. Even if you literally only mean these 3 things, you'd have to track smoking and alcohol consumption. I doubt that'd be enough to effectively ration healthcare though, since the resource demand is practically infinite.

Secondly, you're inviting some really complex moral and political arguments. There have been worse ideas than linking healthcare to a political assessment of lifestyle, but I suspect it'd be up there in the same orbit as communism, genocide and slavery. It is hard to see it ending well once the politicians start to disagree on the healthiness of people's lifestyles.

I dunno, in some ghoulish sense it might be the next logical thing for the US to try. Why stop at merely bad ideas?

The Affordable Care Act (Obamacare) does allow health plans to charge higher premiums to smokers. Implementation varies by state. I'm sure that a lot of plan members just lie to avoid the surcharge.

https://www.kff.org/faqs/faqs-health-insurance-marketplace-a...

That doesn't put smokers at the back of any queues. They still get resources roughly in line with the amount of money that they have.

Perhaps it's possible for the public to outbid the parasite's owners and pay the ransomware group to just shred the entire operation. As companies become ever more virtual, the corporate death penalty ala Fight Club or Mr. Robot seems ever more plausible.

They will be pack if you pay. The only safe payment is in fbi tracked money. then track the guilty down and put them in prison (or what ever reform program). If the country they live in won't give them up that is an act of war and send NATO in.

In practice, cyber attacks dont seem to trigger even discussion of article 5. It will be interesting to see if we reach a state where they do

There was a discussion of including cyber attacks as military action before 2020 among NATO leadership, iirc.

Wasn't a hot news item some 4+ years back that US decided to include cyberattacks on the list of acts that potentially warrant nuclear retaliation?

You might think about geopolitics a bit too much if you reach for article 5 because of cyber crime, maybe a bit too much wargaming in your head, things are kind of tense these days and I dont think invading a country would be an appropriate or mature response.

This is a war, just a cyber war.. these groups are russian backed.

Something between John Oliver burning $15M in medical debt and Tyler Durden with vans full of nitroglycerin.

Every nation does this? When I lived in a universal healthcare system I had to show my healthcare card to get medicine. Prescriptions were transmitted electronically.

None of this is unique to the US.

Having to show identity documentation doesn't rely on a payment processor. Prescriptions in the UK (and other places - Germany for example) are electronic by default but can be made out on paper and verified without a computer.

It's not showing an identity document, it's "our systems aren't up so I can't fill your prescription".

Same in Ireland. My doctor can send it electronically to a pharmacy but I can take my paperwork to any pharmacy to get it filled.

In germany I get a piece of paper and bring it to a pharmacy most of the time... It has worked when my phone was out of charge, when the pharmacy had Internet problems, etc.

How many countries allow a single company to monopolise it?

Are you suggesting that single payer systems have multiple, redundant IT systems in place with different vendors?

I mean, even on a good day, the people who need drugs can't necessarily access them. Can't wait for the system to come back up so I can find out another important medication isn't covered.

That sounds like it is still part of the system that privileges access. In a sane world, you have the option of paying the seller for the thing you want, then they give it to you.

That is a big part of what makes this crazy. People are in an insane system where they can't pay for drugs. Then the system goes down and they really get into trouble.

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