Breast Cancer: a Hansonian Tale

Health care is set up to serve insurance companies rather than patients. There is no incentive to make patients healthy. The incentive is to perform procedures that will be reimbursed by third party payers. Health care providers receive no economic benefit from determining whether their procedures benefit patients, so it should come as no surprise that medical services don't correlate to health outcomes.

Shamus, it should surprise you that people choose to pay for something that gives them little or no value.

Robin, I think they 'choose' to pay for it in the same sense as they choose to pay for farm subsidies or other corporate welfare schemes (scams). Asymmetric information, and asymmetric ability to influence the politicians.

Arnold, do you have any evidence that "groups of people who receive more medical services do not show better health outcomes than comparable groups receiving fewer services"? I know that this is what Robin claims, yet he has never been able to point me to a single study that would strongly confirm this claim. The only experimental study he uses, the Rand study from the 70's, is severely flawed, and essentially useless in this context, although it does provide arguments against subsidized health insurance. Robin also mentions some correlational studies but in our discussions he never linked to them. Is there a single correlational study that has satisfactorily removed confounding variables?

And why are there studies claiming a 3 to 5 year gain in life-expectancy from access to medical care?

There is no doubt that some medical interventions, mainly traditional ones, make patients worse off in terms of survival or comfort but claiming that *all* medicine is on average useless or harmful goes very strongly against what I know about it.

Actually, Robin has a whole paper that lists studies that support his position. Look up "Robin Hanson show care"

fascinating.

there's a ph.d. for someone who can find all the effects of hormone replacement therapy; e.g. higher incidence of estrogen-positive breast cancer, lower incidence of leukemia, lower incidence of osteoporosis, higher incidence of stroke, etc.

then come up with a way to explain all the changes in probabilities to a woman with IQ=100 with little-to-no medical training so that she can make an informed choice.

what would dr. kling's decision matrix look like for this decision?

or, there's nationalized medicine.

Health insurance coverage may provide a hedonic value unrelated to actual outcomes. Knowing that you are covered and will be cared for in the event of a medical emergency may provide value.

Robin Hanson argues that this suggests that medical services are as likely to make you worse as make you better. The women who used to receive hormone therapy and subsequently got breast cancer might agree.

‘A standard puzzle in health care economics is that groups of people who receive more medical services do not show better health outcomes than comparable groups receiving fewer services.’

Would this be because the people who receive less medical services are healthier? Healthier people are less likely to seek health insurance.