"Where in some areas, such as maternal-fetal health, the European national health model is far superior in keeping mothers and babies alive,"

Hmmmmm.

If I'm not mistaken, there is no difference between US and European systems in these sorts of measurements of public health if you compared the INSURED populations of each.

Of course, in Europe, 100% of the citizens are insured, while in the US, the number is 85%. That 15% uninsured lowers the US averages down to the bottom of the list of the developed country.

For example, I remember reading someplace that for males in the US who are without heaith insurance for most or all of their life, their life expectancy averages 62 years. If you do the math, you find that life expectancy in the US is the same or higher than in Europe, IF you compare insured to insured.

So, the systems themselves perform the same, as long as a person can access them.

"where do you draw a line of innovative medicine vs established good practice?"

Well, I think that for well known conditions and diseases, protocols are established by consensus, even if there's not a governing body with the authority to establish specific protocols.

It's when diseases and conditions are *not* well known that it makes sense to let the doctors loose, rely on their training and creativity. Since I don't know how authoritarian the systems in other nations are (that's an entirely different question than how their insurance payment schemes work) I dont know if the creativity of the doctors in other countries has been "bred" out of them, so to speak.

And your last question is by far the most pertinent as we move forward towards universal care in the US. Since Biden is likely to win, that means that it's most likely that Medicare 4 All is dead, and the ACA will be invigorated. This will not result in our cost of care dropping very much, but the good news is that the ACA does not create any sort of authority over protocols, leaving our doctors to freely do what they are well-trained to do.