Wherein Kevin Drum Discovers Different Individuals Have Different Preferences

From Kevin Drum today on health care:

But here's the tidbit that caught my eye:

A fascinating series of pilot programs, including for prostate cancer, has shown that when patients have clinical information about treatments, they often choose a less invasive one. Some come to see that the risks and side effects of more invasive care are not worth the small "” or nonexistent "” benefits. "We want the thing that makes us better," says Dr. Peter B. Bach, a pulmonary specialist at Memorial Sloan-Kettering Cancer Center, "not the thing that is niftier."

When I read about healthcare, pretty much the only thing I hear is that everyone wants infinite amounts of it.  And they always want the latest and greatest stuff.

Not me.  My motto is, "That healthcare is best that cares the least."  Or something like that.  Basically, I prefer to get the minimum reasonable amount of healthcare possible, and I have a strong preference for the simplest, oldest, best-known treatments.  I'm not exactly a fanatic about this, but generally speaking I think that most new treatments turn out not to be nearly as effective as we think, and the more time you spend around hospitals the better your chances of catastrophe.

Wow, that's amazing!  Its almost as if we shouldn't have one bureaucracy in Washington making health care decisions for everyone!  In fact, there are several things in here that tend to challenge leftish assumptions:

  1. Contrary to leftish assumptions, individuals do seem to be grown up enough to make health care tradeoffs for themselves
  2. Individuals seem to want to make different cost-benefit-treatment trade offs from each other, belying the notion there is some universal optimum that bureaucrats in Washington are capable of achieving
  3. Allowing individuals to actually shop and make price-benefit decisions in health care might actually reduce costs and improve satisfaction (though absolutely no one in DC seems to be proposing a plan along these lines)

Unfortunately, Drum seems to take none of these lessons from his own post.  Here is the conclusion he draws:

But maybe the difference is just information: I read an awful lot about this stuff, and it's convinced me that there dangers to overtreatment just as there are dangers to undertreatment.  Leonhardt's "fascinating series of pilot programs" suggests that with better information, more people might agree.

Creepily, he seems to conclude from all this that if we can just "educate" the public more, they will be more likely to accept the one-size-fits-all treatment constraints to be implemented by Washington.

PS: I am generally with Drum on doing the absolute minimum for run of the mill health problems I encounter.  If I have a cold, for example, I don't start dosing myself with every over the counter drug I can find.  And our family tries very hard not to use antibiotics unless the condition is really serious.

But my sense is that my attitude will change a lot if the "C" word ever comes into play.  Cancers are much more solveable early than late, and my tendency would be to hit the crap out of it early with  as much of the arsenal as I could.  I don't know what Drum's personal medical history is, but my sense is that it is unwise to extrapolate linearly one's treatment preferences from colds to cancer.


  1. Dr. T:

    One of the subjects emphasized during medical school and residency training is giving proper explanations of treatment options to patients and their loved ones. Doctors know that differing patient situations, needs, and personalities affect what is optimal. For example, some patients are totally freaked out by the idea that cancer is growing in their bodies. They want that cancer cut out, even if the risk of surgical removal is greater than zapping the cancer with radiation or chemotherapy. Other patients greatly fear surgery and would prefer chemotherapy even if the cure rate is lower.

    Some conditions can be treated successfully in a hospital in a week, but would take four weeks to treat as an outpatient. A single Mom might choose the outpatient option because she can still care for her kids. A scientist who is the keynote speaker at a meeting in three weeks would prefer the hospital option so he'll be cured before the talk.

    Does anyone believe that the federal government's further involvment with health care will allow us such diverse choices?

  2. SuperMike:

    I think even reasonably hardcore top-down guys imagine that people have different preferences. What I think they seek is a world in which everyone has the exact same "menu" of health options, regardless of the ability to pay. Unfortunately, that translates into "regardless of cost", and we're back to considering how it's to be rationed, if not by price.

  3. Not Sure:

    "But maybe the difference is just information: I read an awful lot about this stuff, and it’s convinced me that there dangers to overtreatment just as there are dangers to undertreatment."

    Translated into plain english:

    "I'm intelligent enough to make informed decisions regarding my own health care needs but other individuals aren't, so it'll be necessary to have Smart People in government available and ready to make those choices for them."

    Or something like that.

  4. Jeff:

    I don't think Kevin is saying individuals make rational choices when given more or better information.

    I read it as smart, rational people (who all happen to agree with me...) make good choices when properly informed. Dumb, irrational people (everyone who disagrees with me...) make bad choices, government should force the dumb people to allow all us smart, informed people to make their choices for them.

  5. stan:


    But remember, Kevin wants the smart, informed civil servants to make these choices (with appropriate input from powerful politicians and their friends) because Kevin really, really cares about dumb, irrational people. As opposed to those mean-spirited, hate-filled, racist, sexist, exploitative homophobes who disagree with Kevin.

    Look at how well that type compassion has worked for children in inner city schools. Or black workers in South Africa after American companies all left the country. Or the peasants in South Vietnam. Or the malaria sufferers in the third world. Or the unemployed teenagers whose jobs were eliminated because of higher minimum wages.

    "What the world needs now is love, sweet love ...."

    With compassion like that, we could strive to reach the heights scaled by the likes of Michigan, California, France.... maybe we could even make it "back to the USSR."

  6. Mesa Econoguy:

    But maybe the difference is just information: I read an awful lot about this stuff...
    -Mr. Dumb

    Apparently he doesn’t, which means Kevin Dumb is a liar, or he hasn’t processed the information correctly. Since he doesn't understand utility curves or economics, I find it more than a stretch that he understands such a complex topic as healthcare, much less healthcare economics.

    This is why we can’t have stupid, economic illiterates like Kevin Dumb making policy.

    Unfortunately, there are a whole bunch of Mr. Dumb’s friends in power making larger mistakes and evaluations right now.