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Say there is an experimental therapy that costs $100K but saves life in only 10% of the patients. Should medical insurance deny spending that money based on probability? How about 50% but costs $1 million? It is their decision... even if the doctor has some (major) influence. If they deny it, you should darn well blame them.

What most countries with public health care systems do is they set a limit in how much they will pay per year of life. If you have a 50% chance of living 6 months longer, and it costs $1m, then it is $1m*/(0.5y*50%)=$4m per life year, and they will say no. People don’t always like it, but it makes sense. It makes sense in any insurance scheme that there is some cap on the liability.

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