Robin Hanson cites three studies, the Rand Health insurance experiment, the Oregon Health Insurance Experiment, and the more recent Karnataka Hospital Insurance Experiment.
In each experiment, the impact of free health insurance on health was minimal. Hanson takes this as evidence that, on the margin, healthcare doesn’t work. But I feel like there’s an obvious alternative explanation that I’m genuinely not sure why I haven’t seen people talk about.
In each of these studies, people were only offered free health insurance. They weren’t forced to seek more care. And it’s sensible to think that, if you have an important medical condition, you’ll seek healthcare even if you lack insurance. Most emergency rooms in fact have a policy that they’ll take anyone regardless of ability to pay. So, at least in America, it doesn’t seem like ability to pay is a huge determinant of whether people receive life-saving healthcare.
Instead, it seems like the main result of these studies is that excess healthcare—the type of healthcare people consume if they feel like “I might as well because it’s free”—is not helpful. But that’s a different conclusion than “on the margin, healthcare does not help”. I mean, I guess it depends on which margin we’re talking about. Cutting back on, say, emergency services that people will use regardless of whether they have insurance, seems like it would probably lead to worse outcomes. Am I misunderstanding something?
No, except that the India study would indicate otherwise, and fits your hypothesis of a less steep increase, with most of it being costs not visits, and the dutch epidemiological study with alternative-medicine GP study showcases decreased mortality with seeking less healthcare (marginally if you consider a homeopathic GP to still be a “real doctor”, significantly if you don’t)
<someone on /r/ssc mentioned an indian study that did find better mortality outcomes for 2 diseases but failed to report total mortality, still, goes against this claim>
But overall, as stated in the article, I agree there’s some marginal form of healthcare that is useful, I give emergency rooms as prime examples, I would go to an emergency room in a heartbeat in a situation that actually required one. I actually think it’s much bigger than ER. It’s just that, statistically speaking, we are likely overconsuming healthcare to our detriment in terms of time and money, and potentially even health outcomes.
Robin Hanson cites three studies, the Rand Health insurance experiment, the Oregon Health Insurance Experiment, and the more recent Karnataka Hospital Insurance Experiment.
In each experiment, the impact of free health insurance on health was minimal. Hanson takes this as evidence that, on the margin, healthcare doesn’t work. But I feel like there’s an obvious alternative explanation that I’m genuinely not sure why I haven’t seen people talk about.
In each of these studies, people were only offered free health insurance. They weren’t forced to seek more care. And it’s sensible to think that, if you have an important medical condition, you’ll seek healthcare even if you lack insurance. Most emergency rooms in fact have a policy that they’ll take anyone regardless of ability to pay. So, at least in America, it doesn’t seem like ability to pay is a huge determinant of whether people receive life-saving healthcare.
Instead, it seems like the main result of these studies is that excess healthcare—the type of healthcare people consume if they feel like “I might as well because it’s free”—is not helpful. But that’s a different conclusion than “on the margin, healthcare does not help”. I mean, I guess it depends on which margin we’re talking about. Cutting back on, say, emergency services that people will use regardless of whether they have insurance, seems like it would probably lead to worse outcomes. Am I misunderstanding something?
No, except that the India study would indicate otherwise, and fits your hypothesis of a less steep increase, with most of it being costs not visits, and the dutch epidemiological study with alternative-medicine GP study showcases decreased mortality with seeking less healthcare (marginally if you consider a homeopathic GP to still be a “real doctor”, significantly if you don’t)
<someone on /r/ssc mentioned an indian study that did find better mortality outcomes for 2 diseases but failed to report total mortality, still, goes against this claim>
But overall, as stated in the article, I agree there’s some marginal form of healthcare that is useful, I give emergency rooms as prime examples, I would go to an emergency room in a heartbeat in a situation that actually required one. I actually think it’s much bigger than ER. It’s just that, statistically speaking, we are likely overconsuming healthcare to our detriment in terms of time and money, and potentially even health outcomes.