D is based on a serious misunderstanding of how private health insurance works.
NHS:
The only limiting factor chosen by the NHS (undertaken by the NICE commitee) is to determine which specific investigations and treatments are ‘worth’ funding.
For treatments, they use a value function called a “Quality Adjusted Life-Year” (QALY), and compare that to the cost of the treatment. At the time of writing, it’s automatically approved if the cost is shown to be under £10,000 per QALY gained, more efficacious at the same price than an already-approved equivalent, or cheaper at the same efficacy.
If it’s more expensive then it goes through a slower and more in-depth process to allow public and private argument about both the price and efficacy.
Thus an investigation or treatment that is extremely expensive but is proven to offer extraordinary results will be funded, while one that works but not very well or that is cheap but ineffective are denied.
All approved treatments are approved for everyone.
In the NHS, denials are only ever of specific treatments, and never specific individuals.
In the NHS, doctors are legally required to make decisions based on the needs of the patient regardless of monetary cost. If a treatment is ‘on the list’ and medically indicated, it is provided.
In the NHS, the cost of treating any individual person is considered irrelevant, and in most cases the doctor does not even have any knowledge of the cost.
The systematic pressure on treatment manufacturers is thus to be more effective than existing treatments, to charge less than competitors for similar efficacy, to charge £9,999 per QALY, or to be really efficacious so that NICE will choose their product. Thus the NHS often gets really, really good prices!
The pressure on the doctors and hospitals is to give you the best treatment on the menu, because it reflects badly on them if people die too often.
You could view this as the NHS giving all doctors and patients a menu.
Private Health Insurance:
Private health insurance also decides which investigations and treatments that they will fund and under which circumstances. This part is almost exactly the same—in some cases they even follow the NICE decisions, as it’s a convenient way of avoiding appearing to decide.
The difference is that private health insurance also denies health care to individuals, by stating that the insurance will not pay for treatment of specific ailments (eg pre-existing conditions or effects caused by ‘dangerous’ activities), by refusing to cover those individuals at all, or by setting premiums outside their ability to pay (effectively the same as denial, but easier to square in their own minds).
So you, personally, may not even be permitted all the approved treatments. Or indeed, any treatments at all.
The systematic pressure is for all providers to charge as much as possible and for the insurers themselves to pass the amortised cost onto their customers and eject any customer deemed likely to want expensive payouts.
This is still a menu, except now there’s a bouncer on the door who can decide not to let you in, and the waiter can decide to rip out some of the pages of your particular menu.
Pure Private Health:
You can have anything you can pay for, regardless of efficacy.
The systematic pressure on all providers is to charge the entire wealth of all patients—a sane individual is unlikely to refuse to pay if they or their loved one would otherwise die.
This is a personal chef who takes your wallet.
Note that all other schemes automatically have this as the ultimate backstop, unless explicitly prohibited by law. (eg laws regarding claims of efficacy, licencing of practitioners etc.)
Summary:
Both the NHS and private health insurance systems limit the available treatments, the difference between them is that private health insurance futher limits which of the ‘master list’ of treatments are available to individual people.
A purely private health system does not limit the treatments, but does apply extreme limits to individual people, and is always available regardless of other systems.
D is based on a serious misunderstanding of how private health insurance works.
NHS:
The only limiting factor chosen by the NHS (undertaken by the NICE commitee) is to determine which specific investigations and treatments are ‘worth’ funding.
For treatments, they use a value function called a “Quality Adjusted Life-Year” (QALY), and compare that to the cost of the treatment. At the time of writing, it’s automatically approved if the cost is shown to be under £10,000 per QALY gained, more efficacious at the same price than an already-approved equivalent, or cheaper at the same efficacy.
If it’s more expensive then it goes through a slower and more in-depth process to allow public and private argument about both the price and efficacy.
Thus an investigation or treatment that is extremely expensive but is proven to offer extraordinary results will be funded, while one that works but not very well or that is cheap but ineffective are denied.
All approved treatments are approved for everyone.
In the NHS, denials are only ever of specific treatments, and never specific individuals.
In the NHS, doctors are legally required to make decisions based on the needs of the patient regardless of monetary cost. If a treatment is ‘on the list’ and medically indicated, it is provided.
In the NHS, the cost of treating any individual person is considered irrelevant, and in most cases the doctor does not even have any knowledge of the cost.
The systematic pressure on treatment manufacturers is thus to be more effective than existing treatments, to charge less than competitors for similar efficacy, to charge £9,999 per QALY, or to be really efficacious so that NICE will choose their product. Thus the NHS often gets really, really good prices!
The pressure on the doctors and hospitals is to give you the best treatment on the menu, because it reflects badly on them if people die too often.
You could view this as the NHS giving all doctors and patients a menu.
Private Health Insurance:
Private health insurance also decides which investigations and treatments that they will fund and under which circumstances. This part is almost exactly the same—in some cases they even follow the NICE decisions, as it’s a convenient way of avoiding appearing to decide.
The difference is that private health insurance also denies health care to individuals, by stating that the insurance will not pay for treatment of specific ailments (eg pre-existing conditions or effects caused by ‘dangerous’ activities), by refusing to cover those individuals at all, or by setting premiums outside their ability to pay (effectively the same as denial, but easier to square in their own minds).
So you, personally, may not even be permitted all the approved treatments. Or indeed, any treatments at all.
The systematic pressure is for all providers to charge as much as possible and for the insurers themselves to pass the amortised cost onto their customers and eject any customer deemed likely to want expensive payouts.
This is still a menu, except now there’s a bouncer on the door who can decide not to let you in, and the waiter can decide to rip out some of the pages of your particular menu.
Pure Private Health:
You can have anything you can pay for, regardless of efficacy.
The systematic pressure on all providers is to charge the entire wealth of all patients—a sane individual is unlikely to refuse to pay if they or their loved one would otherwise die.
This is a personal chef who takes your wallet.
Note that all other schemes automatically have this as the ultimate backstop, unless explicitly prohibited by law. (eg laws regarding claims of efficacy, licencing of practitioners etc.)
Summary:
Both the NHS and private health insurance systems limit the available treatments, the difference between them is that private health insurance futher limits which of the ‘master list’ of treatments are available to individual people.
A purely private health system does not limit the treatments, but does apply extreme limits to individual people, and is always available regardless of other systems.
I think the USA antipathy to a general health service likely stems from this irrational argument:
This is of course backed up and encouraged by the insurance and private health providers who benefit greatly from the excessive fees they can charge.