Imagine if we let doctors do medicine instead of letting profiteering beancounters optimize for number go up.

I can see why some things landed here. Medicine is expensive. Desperate people are more susceptible to fraud. Yet things are improving: someone like me would be long dead a generation ago.

We should look at these challenges holistically and think about better fiscal/social engineering of our marketplaces. Alvin Roth's book, "Who Gets What and Why", is a good introduction to identifying market failures and thinking about how to address them.

We do let them do that if you are willing to pay them for it. The fact is that if you "let doctors do medicine" without any cost benefit analysis, then you really aren't going to like the cost.

Step therapy is required in countries with universal healthcare, too.

It can actually be harder to get access to new therapies in countries with universal healthcare because they’re more uniform and strict in what they allow.

For a relatable example: The UK just raised the age of eligibility for COVID vaccines all the way up to 75 years old: https://www.mirror.co.uk/news/health/covid-russian-roulette-... Contrast this with the US where COVID vaccine coverage is a basic expectation of health insurance for all ages. And that’s for a simple, cheap medicine without step therapy! It doesn’t matter if your doctor thinks you need it, the rules are set from the top.