I suggest the common issue (between health care and foreign aid) is that of agents, who benefit from the current status quo, and provide arguments and generate memes to sustain the status quo. I don’t mean to say that the agents are generally doing this wilfully, almost no Doctor believes that “most health care is useless but I will continue the scam to maintain my income/status”, just like no aid worker believes what they are doing is useless. But human nature is very good at hiding motives and clothing them in altruistic seeming morality, even to yourself, sort of the reverse of the Smithian invisible hand/selfish baker.
Another way to look at this is incentives: which option has the better pay off (at the margin) for a doctor or aid worker; either convincing people that a given proposed treatment is effective (generating more income for the agent) or the alternative of creating more effective/efficient treatments (generating less income for the agent)?
I suggest the common issue (between health care and foreign aid) is that of agents, who benefit from the current status quo, and provide arguments and generate memes to sustain the status quo. I don’t mean to say that the agents are generally doing this wilfully, almost no Doctor believes that “most health care is useless but I will continue the scam to maintain my income/status”, just like no aid worker believes what they are doing is useless. But human nature is very good at hiding motives and clothing them in altruistic seeming morality, even to yourself, sort of the reverse of the Smithian invisible hand/selfish baker.
Another way to look at this is incentives: which option has the better pay off (at the margin) for a doctor or aid worker; either convincing people that a given proposed treatment is effective (generating more income for the agent) or the alternative of creating more effective/efficient treatments (generating less income for the agent)?