If a $100 million RAND experiment, Mk II, found that cutting health care expenditures by 30% had negligible health effects, this would suggest a great way to improve our knowledge of medicine: cut Medicare, Medicaid, and the tax subsidies to employer insurance and raise $500 billion to do truly gargantuan experiments and isolate helpful and harmful components of medicine.

In your original post, correct me if I’m wrong, you seemed frustrated with the state of healthcare in the United States and concluded that we must be performing many procedures which have net benefit zero.

All that I am saying, is why don’t we try to find out which procedures have net benefit zero, or are harmful, and which are helpful.

Your original post spoke to the problem of bad information being used to make medical decisions. Why don’t we try to improve our knowledge of medicine before we create a new system?

I am not so sure the problem is the system for choosing medicine, but rather the apparent holes in our knowledge regarding what helps and what hurts.

Shouldn’t information on individual medicines allow for the configuration of an optimal system for choosing medicine.

I think this is a great idea…. unfortunately, you are going to need a MUCH larger sample size. Any time you start looking at individual medicines, you are going to need a large population of people that actually received the medicine… your group of 10-20 thousand people will not have enough people receiving any one particular medicine to make the determination of “which medicine is good enough”… especially if you are going to account for multiple testing.

I’ll quote from the ‘Variety’ review
http://www.variety.com/review/VE1117933678.html?categoryid=31&cs=1

Quotes:

“Sicko,” an affecting and entertaining dissection of the American health care industry, showing how it benefits the few at the expense of the many.

Employing his trademark personal narration and David vs. Goliath approach, Moore enlivens what is, in essence, a depressing subject by wrapping it in irony and injecting levity wherever possible: a graph shows America’s position in global health care as No. 38 — just above Slovenia — and is followed by film footage of primitive operating conditions; and he offers a long list of health conditions that can deny a person insurance coverage, with the list scrolling into deep space accompanied by the “Stars Wars” theme.

Pic explores why American health care came to be exploited for profit in the private sector rather than being a government-paid, free-to-consumers service as are education, libraries, fire and police.

Pic starts by sketching a gamut of health-care horror stories from average Americans: those who can’t afford insurance, those who are denied coverage for various, often ludicrous reasons, and those who believe themselves well-protected, but find that the moment they avail themselves of medical services their insurance provider uses obscure technical reasons to refuse coverage, retroactively deny claims and cancel insurance, or raise rates so astronomically that the patient is forced into the ranks of the nearly 50 million uninsured.

The congressional testimony of a former Humana medical director provides a devastatingly direct description of what she calls “the dirty work of managed care.” Constantly told that she was not denying care to patients, rather simply denying them Humana’s coverage, her career advanced as she saved her corporation money.
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Sounds like a film worth seeing.

BillK

Tyler Cowen responded to my petition saying he would like to see “How much healthier would we be if we retargeted expenditures to some commonly recommended areas, such as pre-natal care and prescription drugs?”

A new experiment could include several such systems for choosing which medicine is good enough to give patients, and see which regime actually works best.

“Whatever other purposes such an experiment pursues, it should try to make clear the aggregate health effects of variations in aggregate medical spending, variations induced by feasible regimes of quality control, including free patient choice induced by a varying aggregate price.”

I think I understand the first part about aggregate spending: if we spend X% more on medicine, how much better health to do we get? But what about “variations induced by feasible regimes of quality control”? This seems to have something to do with the distinction between medicine as practiced in theory (in controlled studies, say) versus how it is practiced in the field. But the verb “induced” is tripping me up. And the last part: are we asking that the study specifically charge subjects different amounts and see how much medicine they are willing to buy? Why do we want to know that; is the point to distinguish whether medicine that people are willing to pay (more) for produces more health than “extra” medicine that comes cheap or free?

Overall I could benefit from some expansion of the logic behind how one might wish to see such a study constructed. I can see that it is not a trivial matter.

Do snakeoil products really have a negative impact on outcomes? Are they any less popular in Europe?