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I think the US system allows the public to dump blame for high costs on insurance executives who are (as we see now) pressured into approving treatments. The UK system seems healthier, in that there’s less anger around healthcare and most people support stuff like QALY-based decisions because the fact that it’s “our” money is more obvious, such that even the median person understands it.
I'm not sure how well the QALY stuff works in practice. I heard stuff about the public being able to pressure the NHS into funding treatments that didn't pass QALY tests. Puberty blockers were also funded by the NHS at some point. Though, I think this treatment seems to be around £1000/year so maybe if your QALY bar is £20,000/QALY then you can make the numbers work if you are able to find some marginal net improvement across the cohort. But I'm very suspicious of these mental health treatments. What if some dude claims if he spends £1000/year on good quality alcohol that passes the QALY bar? At what point does it morph between healthcare and funding utility monster lifestyle choices?
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