Wintercow’s post today brought this IOM poster to mind from Ezra Klein:
Hmm, it’s intriguing that best practices in health care would have so much to mimic from other (competitive!) industries. There are good arguments a la Robin Hanson for cutting health spending in half, but they’re orthogonal to the boots-on-the-ground efficiencies that competition in health care provision could bring. If Robin is right, iatrogenic risks quickly converge with the benefits of the marginal treatment, and so most health care beyond the basics is a costly signal of loyalty and compassion***. Therefore health spending could be massively cut with only small marginal effects on health outcomes (as seen in the RAND HIE and contemporary regional variation in Medicare spending with little change in outcomes).
This is a cursory blog post on a much broader topic, but at least the IOM recognizes that health care has something to learn from competitive sectors for those services that are indeed useful.
***Of course we could argue about clinical trials and the cost effectiveness literature that seeks to tease out which procedures objectively work how well for what price, but the aggregate net benefits of medical interventions are still important to examine: interventions in a controlled lab setting might prove effective, yet still be ‘nightmares of iatrogeny’ (copyright pending on that phrase ) in real practice thanks to medical errors and unaccounted drug/device/morbidity interactions. That’s at least one of the hypotheses we have for the gap between the aggregate uselessness of the marginal health dollar vs. the often favorable results of specific clinical trials.