Health Care: What Is It Good For?

A lot less than you probably think, says economist Robin Hanson.

While we are thinking about Hillary Clinton's latest plan that promises to get more health care to more Americans, let's ask: What's so damn great about health care anyway?

Here's part of what Hanson's saying, over at Cato Unbound:

Our main problem in health policy is a huge overemphasis on medicine. The U.S. spends one sixth of national income on medicine, more than on all manufacturing. But health policy experts know that we see at best only weak aggregate relations between health and medicine, in contrast to apparently strong aggregate relations between health and many other factors, such as exercise, diet, sleep, smoking, pollution, climate, and social status. Cutting half of medical spending would seem to cost little in health, and yet would free up vast resources for other health and utility gains. To their shame, health experts have not said this loudly and clearly enough.

Non-health-policy experts are probably shocked to hear my claims. Most students in my eight years of teaching health economics have simply not believed me, even after a semester of reviewing the evidence. Heroic medicine is just too central to our culture, a culture where economists like me have far less authority than doctors. Worse, even most standard textbooks in health economics fail to make the point clearly….

So I want to say loudly and clearly what has yet to be said loudly and clearly enough: In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. (At least they do not in studies with enough good controls.) It has long been nearly a consensus among those who have reviewed the relevant studies that differences in aggregate medical spending show little relation to differences in health, compared to other factors like exercise or diet. I not only want to make this point clearly; I want to dare other health policy experts to either publicly agree or disagree with this claim and its apparent policy implications.

The most important such policy implication is: we should be spending less on medicine as a nation–perhaps even half as much.

How should we cut medical spending? There are many possibilities, and I may prefer some possibilities to others. But I do not want such preferences to distract from the main point: most any way to implement such a cut would likely give big gains.

After giving detailed accounts of many of the studies and data that support his controversial contention–read the whole thing–Hanson knows you are wondering: Why is almost everyone so mistaken on such a vital matter?

If you wonder how the usual medical literature could give such a misleading impression of aggregate medical effects on health, I will point to funding and publication selection biases, statistical tests ignoring data mining, leaky placebo effects, differences between lab and field environments, and the fact that most treatments today have no studies. If you wonder how medicine could suffer so much more from such problems than other subjects, I'll point you to my forthcoming Medical Hypotheses article, wherein I suggest humans long ago evolved a tendency to use medicine to "show that we care," rather than just to get healthy.

Back in 2000, before I was familiar with Hanson's arguments, I made a similar point in comedic form over at Suck.com