Medicine • Philosophy
I was recently involved in a Twitter tiff triggered by the following Mayo clinic announcement:
#Energytherapies offer support in healing for #cancersurvivors #LivingWithCancer http://t.co/AUyX8cLj4w pic.twitter.com/0N30G7VL65
— Mayo Clinic (@MayoClinic) June 7, 2015
Readers were promptly outraged:Continue reading “Is medicine a scientific enterprise?”
Two thoughtful healthcare analysts (a physician and an economist) wonder about health care quality:
@ethanjweiss I agree. If nobody can assess quality or productivity in any way,* that’s a deep problem, isn’t it?
— Austin Frakt (@afrakt) May 26, 2015
They are not alone. Even though the Institute of Medicine’s 2001 epic poem mobilized legions of missionaries of quality, it is far from obvious that we have clarity about the overall aim of the crusade.
Our eyes may have been opened to the sins of medical errors, the shame of healthcare disparities, the wastefulness of therapeutic inefficiencies, and the guilt of runaway costs, but if quality care is in fact the goal, and not a pretext for bureaucratic do-goodism, agreement on its meaning seems to be of the essence lest the campaign to “cross the chasm” turn instead into a crossing of the Styx.Continue reading “Three questions for the Missionaries of Quality”
[Shortly after its initial posting on this site, this article was also cross-posted on the website the Ludwig von Mises Institute under the title “The Mayo Clinic and the Free Market.” I have made some very minor edits since then. MA. April 18, 2015.]
Neoclassical economists such as Kenneth Arrow and Joseph Stiglitz tell us that the health care market is imperfect (or “Pareto inefficient”), meaning that the allocation of services is not optimal from the standpoint of social welfare. They point to information asymmetry as an important cause of this imperfection: patients cannot distinguish on their own the physician from the charlatan, the surgeon from the butcher, the remedy from the snake oil, the hospital from the coop. This may lead to moral hazard where the party with the most knowledge can provide inferior service with impunity.
To provide the necessary counterbalance for this “knowledge gap,” experts must be in charge of social institutions that tell patients where to go, who to see, how to be treated, and how much it should cost. This has been a principal and virtually unchallenged argument underpinning health care legislation in the last 100 years. In a famous paper he wrote on the subject in 1963, Arrow declared that “It is the general social consensus, clearly, that the laissez-faire solution for medicine is intolerable.”
But for those who wonder how intolerable the “laissez-faire solution” really is, a short booklet published in 1926 may prove instructive. Continue reading ““Intolerable” laissez-faire in medicine: the early years of the Mayo Clinic”
