[ExI] How to get a healthy country

J. Andrew Rogers andrew at ceruleansystems.com
Wed Oct 17 06:27:35 UTC 2007

On Oct 16, 2007, at 10:14 PM, Stathis Papaioannou wrote:

> It's not clear what you are referring to here. Would you say that it
> easier to detect and treat lung cancer or emphysema than try to  
> reduce the rate of smoking in a country, for example?

Lifestyle modification is not preventative medicine in the sense that  
it is usually used when discussing policy.  Yes, you could  
hypothetically legislate all junk food out of the country and mandate  
regular exercise, but would that be preventative medicine?  Note that  
this is one of the other reasons some people cast a jaundiced eye on  
expansive mandatory universal preventative medicine -- it is easy to  
imagine something like this happening because there is precedent  
under similar auspices.

Preventative medicine usually refers to regular checkups,  
diagnostics, vaccinations, etc.  Some of these, like certain  
vaccines, have an unambiguous net medical benefit.  But for many  
other types of common preventative medicine the total cost to society  
of universal access significantly exceeds the total cost of not doing  
it at all.  Now, as a wealthy society we have the luxury of  
individually engaging in economically dubious preventative medicine  
and we engage in it prodigiously, but if you make it mandatory and  
universal would it be just to make everyone pay for an economically  
foolish expenditure?

The real tradeoff is this:  we can spend lots and lots of money on  
extensive universal preventative care, or we can spend a lot less  
money on very basic preventative care and spend the balance on very  
advanced diagnostics (like all those MRIs) and treatments.  In terms  
of health outcomes, the latter choice is better.  But people really  
like their preventative care even if the benefit is dubious, so it is  
politically potent, never mind the problem of incentives.

The reason this is such a hard issue is that no one wants to make  
tradeoffs.  Are you willing to reduce your own average healthcare  
outcome in order to help ensure equality of access?  Since no one is  
suggesting massively increasing healthcare spending (and independent  
of the question of systemic inefficiency), this is the question that  
needs to be answered.  If it would be detrimental to the healthcare  
outcomes of the majority of people, would it even be just?  I am okay  
with people proposing the universal healthcare, but let's not pretend  
that it does not have some serious downsides with real consequences  
for average people.


J. Andrew Rogers

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