This is nonsense. Someone has to decide if a procedure is worth the cost. If it's not the patient (who isn't paying) and it's not an insurer (though who wants that?), it's the government.

Deciding a procedure isn't appropriate or worth the cost is rationing. In a bureaucratic system, you have bureaucrats deciding what procedures are for whom and when.

No it isn't.

> Someone has to decide if a procedure is worth the cost. If it's not the patient (who isn't paying)

In Belgium, it is the doctor together with the patient. If a procedure is medically justified, cost doesn't factor into the equation.

> In a bureaucratic system, you have bureaucrats deciding what procedures are for whom and when.

That is simply false.

Of course it does. There are rules saying what procedures are urgent, which ones are legitimate, and which treatments are covered and at what prices. The government doesn't write a blank check for doctors and patients to fill out.

[1] http://www.mloz.be/nl/art/dure-geneesmiddelen-structurele-ma...

In northern Italy I have seen two "simple" (easily removed surgically) cancer cases going through all diagnostic steps in less than 2 months (including ultrasound, biopsies, CT scans), followed by surgery and/or radiotherapy, all at absolutely zero cost for the patient.

If you need heart surgery (valve replacement, coronary stents, stuff like that), your GP can get you an ambulance straight to the ICU, and you can stay there for free until everything is ready for surgery, maybe in a couple days.

Surgical operations are split into 2 groups - planned and unplanned. In planned enter people that could wait a bit.

If there is good medical reason that you cannot wait you get the treatment on the spot.

You only have real waiting lists for transplants.

And in what way is that not a waiting list?

It is best for both the purse of the system and the patient if needed but not urgent stuff is done at time convenient to all parties. This way everybody could be prepared. The hoapitals will stock the right amount of supplies, the bloodbanks will know how much and what kind of blood is needed in advance and so on. The patient will make sure all mission critical projects are taken care of for the rehabilitation time etc.

The most convenient time for me for my knee surgery was yesterday the most convenient time for the hospital was in 4-6 month. Guess who's convenience was taken into consideration.

Its always me-me-me. Screw everybody else's needs. If i cant get get what i the second i ask for it then the system muat be horrible.

Would you be able to cut the waiting time in this country by paying more? What would be the waiting time without paying extra (which I'm sure the insurance company would not approve) in the US?

4-6 months worth of other patients with similar needs?

And while I guess knee surgery is technically 'elective' as in I could elect to not be able to carry heavy things and have trouble getting up stairs, I'm not quite sure I'd use that term.

As for using the term "elective", I would use that term, given it has a specific definition: https://en.wikipedia.org/wiki/Elective_surgery

> Elective surgery or elective procedure (from the Latin eligere, meaning to choose) is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patient's life, but does not need to be performed immediately.

Call it what you want, but that is literally rationing a scarce resources

On the other hand the people that need lets say hip replacement will get it. The system have enough capacity and budget to serve their medical needs. But it works better if the people are properly spaced.

So (excepting some triage) they put people on a _list_ of people that need hip replacements and make them _wait_ until they get to the front of the list before they get their surgery.

Waiting lists are just a stupid argument, because the US has them too.

We fare badly in particular on getting access to a primary care doctor quickly (or other general care, if you Google articles). We have the highest percentage response for the question "Went to ER for condition that could have been treated by regular doctor if available" of the countries surveyed. And we have the highest response for people unable to get medical care due to cost.

When it comes to specialists and elective surgery, we definitely have much less issues with waiting lists there. IMHO general health care is much more important; this is another indicator of the perverse incentives of the current US health care structure.

Look at Canada, where this stuff is happening in spades. I'm living it.

It's a tried and tested technique. Take a well working system which doesn't generate profits, push to reduce costs, entirely destroying the service then point it out and say "See? It doesn't work. Better privatize it!"

The reason for the waitlists in Canada are complex, but cost control is one of the reasons.