The number of positive results found by the RAND experiment is completely in line with what you'd expect from false positives from multiple comparisons, particularly given that these results were all found in non-preregistered segments.
nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury you won't get a timeout to make choices about which emergency room offers the best bang for the buck.
The vast majority of medicine is not emergency medicine. This idea that patients are unable to price shop and compare providers is completely debunked. India's free market health system represents 1/6 of the world and Indians do this every day.
Like any sane person I want to minimize the overall cost of healthcare, but I also want to minimize avoidable suffering.
As RAND and Oregon show, free and reduced cost healthcare do not minimize avoidable suffering (at least suffering caused by medical conditions) any better than high marginal cost plans.
This isn't just a matter of altruism or anxiety about high healthcare costs; if you have a maximally efficient healthcare delivery system then it's likely to fail in the event of a black swan public health crisis because all the gains from efficiency have already been booked for profit.
Can you provide an argument why a more efficient medical system - specifically one where patients don't visit the doctor for frivolous/moral hazard reasons - would be somehow susceptible to black swan events?
The vast majority of emergency medicine is not emergency medicine, but emergencies are among the most likely things to have a catastrophic impact at the individual level. I cannot possibly treat the entire complexity of healthcare in a single comment and neither can you. That's why I'm offering a limited specific counterexample to your general argument, to point out the existence of fundamental economic problems in healthcare that are often buried by economic jargon which misrepresents the behavior of the healthcare market.
As RAND and Oregon show, free and reduced cost healthcare do not minimize avoidable suffering (at least suffering caused by medical conditions) any better than high marginal cost plans.
Unless you're poor or chronically sick. You have made it abundantly clear time and again on HN that you do not believe in altruism but think that all economic decisions should be made on the basis of self-interest; I think that approach is bunk and so we are not going to agree on a common goal any time soon.
Can you provide an argument why a more efficient medical system - specifically one where patients don't visit the doctor for frivolous/moral hazard reasons - would be somehow susceptible to black swan events?
If you're maximally efficient there's nothing to cut when the shit hits the fan. I think critical systems should include some excess carrying capacity (ie waste) because it's faster to reallocate resources internally than to get additional resources under time pressure.
As a simple example (from which I am not attempting to generalize to the secotr as a whole and which I am not going to get into any nitpicky arguments about), there's a good argument that we have a bit of a doctor shortage these days: https://www.quora.com/Why-dont-we-train-more-doctors
It would be rather inefficient to have a public health system with too many doctors and nurse practitioners. They wouldn't be as busy and wouldn't make as much money as they could at equilibrium, and you can easily imagine various second-order effects of such an inefficiency, and the fact of a cumulative social cost.
But if there is a public-health crisis, would you rather meet it with too many doctors or too few?
The vast majority of emergency medicine is not emergency medicine, but emergencies are among the most likely things to have a catastrophic impact at the individual level.
And this is handled by the high copay, high cap model proposed by RAND, Singapore and myself. You still have not identified any "fundamental economic problems" or misrepresentations of the behavior of the healthcare market.
Unless you're poor or chronically sick.
False - the group studied in the Oregon experiment was poor. Oregon explicitly studied a medicaid expansion. RAND included poor folks too - in fact, one conclusion you can data mine from RAND (if you are so inclined) is that low cost medical care increased certain health problems for poor folks.
(Of course, that result is just as shaky as all the other data mined results.)
You have made it abundantly clear time and again on HN that you do not believe in altruism...
When did I make this clear? Are you confusing my opposition to harmful or wasteful altruism as opposition to all altruism? You are confusing my criticism of bad implementations with opposition to solving the problem.
Concretely: I have no major objection to effective altruism - perhaps something like Singapore's model. I object to wasteful feel-good measures that don't have any measurable benefits, like Obamacare's medicaid expansion.
As for things like maintaining an excess supply of medical pros to handle crises, if that's necessary I don't think it should be provided via random inefficiency. It should be explicitly planned in.
I just can't be bothered to go around this today since we're not going to agree anyway. On altruism, I was thinking of a specific comment you made a while back about being rationally focused on your interests, reproductive ability and descendants (qua biology rather than social attitude, but I think it's consistent with your expressed libertarian viewpoint. I don't remember enough to successfully look it up right now.
I think this encapsulates a key difference in our worldview:
As for things like maintaining an excess supply of medical pros to handle crises, if that's necessary I don't think it should be provided via random inefficiency. It should be explicitly planned in.
I used to think that, but now I favor a little general random inefficiency because we don't know what we don't know. My inclinations are utilitarian, but sadly my ability to predict the future is limited so I systematically distrust my own utility calculus.
Altruism in that comment actually referred to the willingness of an individual to sacrifice personal reward for the cause of white power. I said that I'm not altruistic and am happy to make choices that harm white power in return for personal gain.
Also I'm not a libertarian, I'm closer to neoreactionary than to any other identifiable ideology.
nor are competing therapies or competing providers of the same therapy offering a commodity product that can be freely selected between, just as if you suffer a catastrophic injury you won't get a timeout to make choices about which emergency room offers the best bang for the buck.
The vast majority of medicine is not emergency medicine. This idea that patients are unable to price shop and compare providers is completely debunked. India's free market health system represents 1/6 of the world and Indians do this every day.
Like any sane person I want to minimize the overall cost of healthcare, but I also want to minimize avoidable suffering.
As RAND and Oregon show, free and reduced cost healthcare do not minimize avoidable suffering (at least suffering caused by medical conditions) any better than high marginal cost plans.
This isn't just a matter of altruism or anxiety about high healthcare costs; if you have a maximally efficient healthcare delivery system then it's likely to fail in the event of a black swan public health crisis because all the gains from efficiency have already been booked for profit.
Can you provide an argument why a more efficient medical system - specifically one where patients don't visit the doctor for frivolous/moral hazard reasons - would be somehow susceptible to black swan events?