How Contrarian is the Hansonian View of Medicine?
By Bryan Caplan
To be honest, when Robin Hanson first told me his views on health care, I thought he was a lone nut. A brilliant lone nut, but a lone nut nonetheless. Still, my conversations with Robin inspired me to grill every health expert I came across, and with time I came to realize the Shocking Truth: Robin’s views on the health benefits of medicine were quite mainstream. Robin’s unique contribution was not in his beliefs, but in the fact that he thought that his beliefs mattered for health policy.
Don’t believe me? Here’s Dr. Mainstream, David Cutler of Harvard, responding to Robin on Cato Unbound:
If one takes the 25 percent of care that needn’t be provided and 10 percent in unnecessary administrative expense, that’s 35 percent of the nation’s medical bill that could be eliminated without loss. Allow for further savings from information technology, reduced errors, investment in disease management, or generation of comparative effectiveness information, and the savings could approach 50 percent. The potential savings are as high as Hanson guesses.
As a sociological observation, I am surprised by Hanson’s argument that this hasn’t been much noted. The work of the Dartmouth team has received enormous media attention, including front page coverage in the New York Times, for example. My book suggests large possible savings as well. And the knowledge that non-medical factors are important for health has been amply documented in many contexts. If Hanson wants to add his agreement to this array of research, I’m all for it. [emphasis added]
Thus, Cutler’s response to Robin practically amounts to “Oh, everyone knows this stuff already.” But if that’s true, why aren’t there any presidential candidates eager to shout: “We need to drastically cut health care spending; half of it doesn’t do any good anyway”? The answer’s obvious: Their candidacies would go down in flames. Almost everyone who has looked at the data knows this stuff. But experts are tiny minority – and only a tiny minority of this tiny minority is eager to emphasize lessons that the world doesn’t want to hear.