Not only that, but that they can look very clearly at cost vs benefit. With a citizen, who is unlikely to move anywhere else, you can look at lifetime care costs and reduced earning ability (at least in the average case), and say outright that it is sensible to pay $100,000 to save many times that on a lifetime of ineffective care and reduced potential. You can also look at the public health impacts - treating one patient might reduce the risk of wider infection in society, which can also be placed in the cost-benefit analysis.

This is more difficult with American states (because people move between them much more- the payment comes from one state, but the benefit is spread out), and more difficult for insurers (because they are subject to much greater short term pressures, and can't look at wider benefits).

From the article:

“If it is cost-effective from a societal standpoint, it is not necessarily going to be cost-effective from a health plan standpoint,” said Dan Mendelson, chief executive of Avalere Health, a health care consulting company.

But we would need to reward provider networks for keeping people healthy, not just treating them when sick.

Simple: make it federal. Scale it up until you get controlled borders.

As a healthy Veteran, I can say I'm glad I haven't had to dip into my benefits...

Instead of rolling your eyes, work on a solution ;-)

..and that pharamceutical companies aren't run by complete monsters.

Pharmaceutical companies have a long history of despicable behavior.

"Pfizer Bribed Nigerian Officials in Fatal Drug Trial, Ex-Employee Claims" (http://www.cbsnews.com/news/pfizer-bribed-nigerian-officials...)

I know we have a broad range of vaccines against once common ailments, and anti-bacterial agents but I don't think we've ever had good viral 'cures' so its not as if cures are being held back. I think the fundamental research just isn't there.

This sword cuts both ways. Implicit in your response is that it's the potential income from American medical spending that's driving the investment in research: even if (or maybe because?) the income from other nations that structure health care expenses is used more wisely, it's not sufficient incentive to induce such research.

Well, the UK has DEATH PANELS (as some people call them) which is probably the National Institute for Health and Care Excellence (they had a name change which makes the acronym a bit weird, but their still called NICE).

So if a medication can't show efficacy and is very expensive it's not going to get NHS funding.

We used to allow people to spend their own money if they wanted to on medication. We still do - IVF has limited provision as one example - but there was a spate of drug companies releasing very expensive and not very efficacious meds. When they got turned down for NHS funding those companies paid money to patient groups to campaign for changes in the decision. (Pretty fucking sleazy - using the desperation of dying people to promote your ineffective medication) The government at the time decided to change the rules around a small number of medications. You would be able to buy those yourself, but you would then have to pay for the rest of your care too. I'm not convinced that was the right decision.

Even though there is a big upfront cost (in the US), isn't the treatment with this drug a lot less expensive than not treating someone with Hep C? So shouldn't the overall costs go down?