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Comment by ejstronge | Hacker News Reader

> That’s ridiculous because in a single per system the government stands in front anyways. > There are plenty of drugs in Europe doctor might want to prescribe but the government says “nope, not going to pay for it”

Not only does this happen with the current system, it’s worse, because there aren’t always explicit instructions about what will be covered - so your care depends on whether your doctor is willing to beg the insurer to provide a drug to you

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One major difference is that most people, at some financial burden, can choose to change insurance providers whereas in many countries with universal systems (single-payer or otherwise) the government guidelines for what the national service or insurance providers must pay for or not tends to be more consistent across the board.

For instance, this is a struggle for people in many European countries who would benefit from access to specific psychiatric prescriptions which are either not prescribed except after trying various cheaper options or are not even approved because of the potential cost to the government, while the same drug is often available in the US (ranging from $10-hundreds a month, as is typical in the US). Public healthcare in at least California sounds more comparable to the universal single-payer systems I’ve seen in its relative inflexibility.

No system would be perfect, but by cutting out most of the administrative overhead more gets to be spent on actual care. And by having everyone getting the same or similar coverage decisions it could easier to sort out. Also another benefit of single payer is that all or at least most out outcomes can be collected and compared to the treatments. This should enable improved outcomes and cut through the B$ we have here where 70,000 people can die needless from Vioxx before it even got a review. https://www.jci.org/articles/view/38430#:~:text=Some%20consi....

Insurance companies can always hike premiums to compensate though. State run system could/would be a lot stricter with their funding and have less wiggle room.

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