Whereas, our single clearest data point regarding the marginal value of this spending, the US-funded RAND health insurance experiment,
where from 1974 to 1982, 7700 subjects were randomly assigned to 3 to 5
years of free or not free medicine, found no significant evidence of a
substantial health effect of more medicine, confirming the usual results of continuing aggregate health–medicine correlation studies,
We the undersigned petition the US to
publicly conduct a similar experiment again soon, this time with at
least ten thousand subjects treated for at least ten years, which
should be feasible for a half billion dollars, or one part in forty
thousand of annual medical spending. Whatever other purposes such an
experiment pursues, it should try to make clear the aggregate health
effects of variations in aggregate medical spending, variations induced
by feasible regimes of quality control, including free patient choice
induced by a varying aggregate price.
Here is the link. I doubt if upping the number of subjects will much change the results. As long as we are playing mad scientist, I would prefer some disaggregated tests, namely:
1. How much better off are the poor uninsured if they get health insurance? (Financially much better off but in health terms only slightly better off is my current guess, and yes there is already some evidence here.)
2. How much less healthy would the well-insured be if they had to consume thirty percent less health care?
3. How much healthier would we be if we retargeted expenditures to some commonly recommended areas, such as pre-natal care and prescription drugs?
And my favorite is:
4. How much would health care cost if we simply banned all health insurance and modified forms thereof?
Except possibly for #1, these are not easy experiments to run, and yes computational modeling would beg the relevant questions. But I think #3 — or even the thought thereof — poses the biggest problem for Robin’s worldview that medicine doesn’t do us much good. Robin is a real world innovator, a hands-on, duct tape kind of guy, so he can’t retreat into the claim that we cannot possibly parse current expenditures more effectively. Lots of health care does lots of good, and from there we can pick up the ball and run with it.
For more on Robin’s revisionist health care views just scroll through the last week’s entries on his blog.