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.