Remember: medicine is magic

Healthcare is not just another business, and what we buy when we buy it is not just another set of services.  Medicine is magic.

This is clearly true, even though free market types (I'm one) want to see it as amenable to normal laws of supply and demand. It’s not that those laws don’t apply to it. They clearly do. It’s just that there are other drives on healthcare consumption far beyond (or beneath) those laws that make it hard to analogize from other businesses.

All these people screaming at healthcare meetings show that. Agree or disagree with their position, they are not just dupes of sinister manipulators. There's more to it than that.  They have visceral reactions to what is being proposed. It doesn’t even matter if they’ve understood the proposed changes—arguably, almost none of us understand any of the plan, we just decide by who is proposing it whether we think it's good or bad—but it’s clear that they are driven to respond, in a way they would not be on other subjects.

There have always been doctors, and they have always supplied a service to meet a demand. This is true, even though until about 1910 or so, physicians killed more people than they helped. Before the mid-19th century, all they could really do was bleed you, blister you, make you throw up, or give you diarrhea. And, aside from bone-setting and a few crude surgical techniques that probably still killed you as often as they helped you, that was about all they could do for you. None of those "treatments" did a damn bit of good, but they often weakened you or dehydrated you, so you died sooner. And when physicians put you into a hospital, all that did was put you in close contact with people who had diseases even worse than yours.

But people kept paying for medical services, and the wealthy paid more and got physicians with elaborate degrees from Oxford or Paris who knew nothing whatsoever about the human body. So the wealthy died more often from overexcited physician interventions.  And, what’s more, every physician was positive that what he was doing was beneficial.  People wanted to be treated, so physicians existed, were trained, had certifications, etc., showing that economics is often the achievement of irrational goals through rational means.

So there is an emotional substructure to these debates that needs to be recognized. You can talk comparative effectiveness, you can talk procedures that have no positive outcome, you can talk overused imaging equipment...all of it essential to maneuver to improvements in healthcare provision, but it won’t go anywhere unless you realize that healthcare is still, at its root, magic, and doctors are magicians. It just so happens that their magic both works (a topic for another post) and costs an incredible amount of money.