Yesterday's NY Times published an article about access to cancer-treating drugs in Britain's National Health Service (NHS) that really lays bare the challenges faced by public health insurance systems. The article tells of Brits with cancer who are denied access to certain pharmaceutical treatments by the NHS because they are too expensive.
But it doesn't stop there. The NHS funds a set level of care for all Brits, although effective standards can vary by region based on waiting times, etc. The article described how the NHS threatened to withhold payment for any other treatment if the patient purchased the drug of her choice on the open market.
Why? The argument is that the NHS functions by providing equal care to all, period. Apparently that means choosing a particular cost structure for the average Brit and sticking with it --- even though benefits and the valuation of those benefits could vary across individuals, as do income, wealth, and education. It is the latter point that presumably riles up the NHS; folks with more money or knowledge may demand more health care.