[coredog64]

What you're missing is that those countries can (and do) use market mechanisms.

I have direct experience with the French system, so I'll use that as an example. When you go to the doctor for an outpatient visit, you pay the whole bill right then and there. Your insurance company will then reimburse you for some significant percentage of the "reasonable and customary" cost of that visit. Do you need a shot as part of that visit? Guess what -- you have to go next door to the pharmacist and buy the dose. The doctor will then administer it.

Inpatient is different (fully covered and no billing) and indigent patients are given a special card that directs the doctor to bill insurance directly.

We could do that here in the US without universal health care and it would make a significant dent in our spend without a corresponding decrease in outcomes.