Wednesday, April 02, 2008


Modern medicine is one of the things I've recently changed my mind about. I'm not especially interested in the subject; whenever Obama and Clinton start agonising over the difference between their plans my jaw immediately starts to slacken. So, bear that in mind I say that this podcast in incredibly interesting. Seriously. You should listen to it.

Better health outcomes correlate with loads of things, like higher income, higher status and a bunch of other things that I forget now. The one thing that they don't correlate with is medical care. More specifically, in a huge experiment done in America, a few thousand people were given free medical care while another group had to pay out of pocket. The people getting free care consumed 40% more care (and not for trivial stuff) but ended up no healthier than the people consuming much less care.

There's a lot to say about licensing and I don't feel like being thorough right now, but here are some points to get started

  • The default should be doing nothing. Overcoming this default should involve more than the fact that licensing is so deeply entrenched, or seems to make sense.
  • Licensing acts to restrict entry which not only drives up prices and results in the bizarre norm that many doctors get used to working a million hours a week, it affects the average quality of care provided. We could improve the quality of doctors by purging the worst 5% or 10% currently practising, should we do this? Would it be better to license the top 5% of medical losers? What calculations have been done that show that the current number of doctors provides the optimal average healthcare? Considering my doubts about healthcare in general I doubt that this has been done.
  • It isn't true that people choose their doctors now based on the fact that they're licensed. People ask friends shuttle between different doctors etc. If you stopped requiring licenses, most people would still prefer that they went to medical school. The effect would take place at the margin.
  • Excellent results for just about all products have emerged through processes that are thoroughly repressed in the case of medicine, licensing being one of the ways that is used to enforce conformity and suppress innovation.
  • Over regulated medicine encourages and legitimises quack medicine. This post is still one of my favourites; I hope you'll excuse me I borrow liberally from it.

    The bizarre thing is the way this all works. Government regulation limits the availability of decent medical care and makes it expensive. As a result, alternative remedies (of the sort that the regulations are there to stop) become very popular and because they are so popular the government subsidises it! As the Jamie Whyte article points out, the government doesn?t think the remedies actually work. So where have all the high minded ideals that result in the regulations on regular medicine gone?


Tracy said...

How do they know that high medical prices cause people to seek alternative remedies?

It could be, but perhaps it could be from a distrust of doctors, medical science, etc.? Perhaps it's the sense of control that alternative remedies give to people? Or the holistic/spiritual component?

In general I think that the licensing of the medical profession should be rethought. I doubt the current balance of health professionals is optimum. In Canada, private doctors are not allowed at all. It seems ridiculous as there is such a shortage of doctors that a friend of mine who has been having severe stomach cramps for 3 months won't be able to see a specialist for a year. So she's going to fly back to Iran in May just to see a doctor!

mutt said...

I didn't say this expicitly, but I also mean high opportunity cost, which there is in Canada. In Canada, the cost of care for her is essentially infinite, so she's going back to iran (really expensive, but at least possible). put 1000 people in her shoes and some chunk will do what she does, some chunk will wait, some chunk will just get better and one chunk will go for quack care out of desperation.

this last section can act to legitimise the option.

So you're right, but I just guessed... If you make one thing really hard, you'll increase demand for other things, and quack medicince just is one of those other things.

some people just really believe in it.