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Health Care, Costs, and Progress

This article caught my eye:

"Patients interview you," said Dr. Cadeddu, a urologist at the University of Texas Southwestern Medical Center at Dallas. "They say: 'Do you use the robot? O.K., well, thank you.' " And they leave.

On one level, robot-assisted surgery makes sense. A robot's slender arms can reach places human hands cannot, and robot-assisted surgery is spreading to other areas of medicine.

But robot-assisted prostate surgery costs more -- about $1,500 to $2,000 more per patient. And it is not clear whether its outcomes are better, worse or the same. . . .

It is also not known whether robot-assisted prostate surgery gives better, worse or equivalent long-term cancer control than the traditional methods, either with a four-inch incision or with smaller incisions and a laparoscope. And researchers know of no large studies planned or under way.

The reason why I found this story interesting is because of the problem it presents for nationalizing health care.  Given such studies, it seems likely that a government panel would refuse to fund the robotic surgery.  The trouble is that, it is entirely possible that in five years, given continued funding, practice, experimentation, and technical development, that could change.  And it's probably that the cost of robotic surgery has come down over time. Would a technocrat, looking at this study conclude that it's best to save money by not funding such (potential) innovation?  After all, it is possible that, in this case, there will be no further progress or cost savings.  When there's one big, unified system, there's much less room for innovation.  Sometimes, the civil servants guess which technology is the way of the future, and then we're stuck with it, whether it works or not.  The less unified the system, the more room there is for trial and error, argument, innovation, and competition, for both trying new things, and for deserting failed experiments.  This is the sense in which it's proper to say that the market is more efficient than the alternatives.  It is terribly inefficient in the narrow sense, since so many experiments fail.  But the pace of innovation is usually much more rapid. 

Categories > Health Care

Discussions - 5 Comments

I think you are basically right, given your "nationalized health" premise. I just don't see it as necessarily a bad thing. (Like everything else it depends -- especially on the systematic collection of outcomes information.) But without restraining some "innovation" (bad innovation?) and duplication, I don't see how to get hold of inexorably rising costs.

Yes. Very few medical innovations have occurred in countries which have completely obliterated their medical private sector with a national health plan. Moreover, those same plans also have no monetary incentives whatsoever for such innovation.

Do you read European newspapers, Richard? Ever? And I'm not talking about the few select articles your right-wing buddies send you. Have you ever picked one up (or looked at one online) and just browsed through the medical section? If not, you should. I think it would do you a lot of good.

Please, Matt, enlighten us. Point us to a study like this one--http://www.ncpa.org/sub/dpd/index.php?Article_ID=18714--except showing the opposite.

Also, you might want to check out this link from the New York Times--http://www.nytimes.com/2006/10/05/business/05scene.html

Okay, Morty.

Here and here.

I can use google too.

But my point isn't who is better and who is worse. My point is that to read Richard's post one would think that nationalization of a health care system automatically results in less innovation and the complete demise of the private medical sector. Neither of those presumed consequences are certain.

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