Most pharmaceuticals involve high upfront costs, to discover and test the drug, and very low marginal costs.  Another pill can be printed almost for free.

That cost structure favors health systems, such as that of Britain, that try to pay lower for services.  They can end up getting a relatively good deal from price discrimination.  After all, they can be served at low marginal cost, at least for those ttreatments.

Now imagine a biomedical future where many more treatments are based on the sequencing of your individual genome, and then the development of specific treatments personalized to you.  Obviously it will depend on developments, but very likely those remedies will have relatively high marginal costs.

In that setting the British approach to health care procurement and pricing will work less well.  It is the well-capitalized, “overspending” systems, such as the United States, that will have an easier time making the adjustment.

“The rising relative advantage of well-capitalized health care systems” is a neglected trend, because it makes a lot of earlier elite pronouncements about health care economics look a bit off.