Discover more from Overcoming Bias
The RAND experiment showed that people with more generous health insurance consumed a lot more health care than those with less generous insurance, but didn’t have much (or maybe anything) in the way of better health outcomes. The natural interpretation of this is that everyone, including those with less generous insurance, chooses to get all of the high-value treatments, and that the extra treatments consumed only by those with more generous insurance aren’t worth much.* If this was true, then Robin’s suggestion to radically cut health care would follow directly; it would be the low-value marginal treatments that would get cut while the high-value infra-marginal treatments would remain. This would also be consistent with the evidence that it is damaging to one’s health to have no insurance at all (everyone in the RAND experiment had insurance of some kind), as people with no insurance would be missing out on (at least some of) the high-value infra-marginal treatments along with the low-value marginal ones.
The problem is that some of the other evidence from the RAND study is not really consistent with this story. It seems that the marginal care consumed only by people with more generous insurance is not just low-value stuff. The marginal treatments consumed only by those with more generous insurance, in the opinion of expert doctors, looks a lot like the infra-marginal treatments consumed by everybody. But if that’s true, doesn’t it have to mean that all health care is of little value? If the marginal care looks just like the infra-marginal care, and the marginal care is of little value, then doesn’t the infra-marginal care have to be of little value too? I don’t think anybody seriously believes that, which makes me think that there is something wrong with the studies that say that the marginal care is just like the infra-marginal care. Does anyone have any other ideas?
*I ignore here the possibility that these marginal treatments provide little improvement in health as measured by the study, but provide substantial quality-of-life benefits. I also ignore the possibility that things have changed in a fundamental way since the RAND study was done many years ago; a possibility that Robin has recognized and responded to with a call that the RAND experiment be repeated.
Does Healthcare Do Any Good At All?
Many of us have a chance to test our beliefs about healthcare.
Give up your health insurance and stop seeing doctors. You can save a significant amount of money that way just in copayments alone. And you can perhaps go to your employer and ask how much of a raise they'd give you in exchange for no health benefits. Something like 48 million americans spent some time uninsured last year, up from 46 million the year before. You could join them. If you're sure that health care does no good, it would be the right thing to do.
Then there's Alan Yeung's split:
"A better starting point would be to divide healthcare into public health, primary healthcare, emergency healthcare (accidents, injuries, etc.), care of chronic diseases (into which one should include old age), and care of major non-chronic conditions (heart disease, cancer, etc.)."
If you could get public health benefits and insurance just for emergency health care, and leave the rest....
The healthcare system of a nation doesn't have a whole lot of effect on the life expectancy of the population.http://www.nationalcenter.o..."More robust statistical analysis confirms that health care spending is not related to life expectancy. Studies of multiple countries using regression analysis found no significant relationship between life expectancy and the number of physicians and hospital beds per 100,000 population or health care expenditures as a percentage of GDP. Rather, life expectancy was associated with factors such as sanitation, clean water, income, and literacy rate.8"