- Hold back and slow down payment for services rendered…suppliers must be paid every 2 weeks – many medicare/government insurances would hold payments at least 6 weeks thus making pharmacies finance the whole scheme, and their was no mechanism to force payment.See how many pharmacies failed within 2 years of the start of medicare prescriptions.

- Reimburse for many medicines below acquisition cost and it was fill all precriptions or none. So again, medciare was stealing from the pharmacies not just their product but their service and overhead as well…

- Subsidizing mail order facilities which work on a PBM or kickback model – hence in effect the government was overpaying for drugs on purpose so they could not only get the rebates to respend on other things but could claim they need more money to fund next years benefits.

- strong arm drug makers into changing their
business models and rebate/discount programs. Sounds nice for those who need prescription medicines but who loses out? Stock holders, bond holders, pensioners, bond holders. From where is the burden shifted? research dollars, tax revenue, employment, advertising expenditures etc.

Its all just burden shifting or burden abandonment if you ask me…

What makes an X-ray or MRI or lazer surgery work? The skill of the operator and Doctors, Pharmacists and Nurses are not all created equal and do not have equal skills.Moreover there are limited numbers of these people and supply is rather in-elastic.

State funding of healthcare does not guarantee everyone good healthcare, it merely substitutes random lots for meritocracy as a way of deciding who gets the care or at least the best care.

It is not far off that the choice of treatments and whether to treat will be based upon genetic tests (see the guidelines for the use of the medicine Tegretol for example). That means with govt healthcare there will be a database with all your genetic info stored therein and treatment decisions will be prioritized by likelihood of success.

Consider this scenario – government and taxpayers not wanting to spend money limiting access to treatments – drug companies and hospitals not wanting to risk their success percentage advocating treatments only in those with a high likelihood of good outcomes – limited numbers of highly skilled people in each field and unlimited numbers of people wishing to access the treatments.