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Comment by caturopath | Hacker News Reader

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.

> 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.

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.

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.

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