http://www.youtube.com/watch?v=7i8b7YwMWhs

at 0.50

It’s not like this is new evidence, either. Though it has arguably reached critical mass recently, it’s been around for years. I’ve had personal conversations with federal policymakers acknowledging that public health policy on both the federal and the state level is not evidence-based.

There is an enormous investment in the status quo; there is tremendous money being made in treatment, and we have not yet figured out any systematic ways to capture significant rents from public health and prevention (which isn’t to say we couldn’t, but it’s not obvious how we could, which creates significant friction to disrupting the revenue streams available in the present arrangements).

This goes through all levels of our health care delivery and financing arrangements. Why do we continue to rely so heavily on technical innovation, when there is little doubt that we have all the technology that we need — and then some — to reduce mortality and human suffering significantly, but our translational system is piss poor, frankly. Moreover, there is good evidence that such investments in technical innovation are a significant factor in our hyperinflationary health care costs (estimates go as high as 40%) and actually drive disparities, in addition to subsidizing expensive, inefficient speciality care while disincentivizing primary care, the latter of which is, based on the evidence, far more likely to improve population health in the long run.

The significant rents available in the status quo is a major reason the U.S. health care nonsystem is so screwed up. Don’t interpret this as a diatribe against market forces — I’[m acknowledging just how powerful they are. If we can find ways of harnessing that in ways that we have reason to believe will significantly improve health and reduce human suffering, I’m all for it. But it’s hard to pretend we’ve really tried to do that thus far; nor is it easy to imagine why private firms would suddenly up and assume the significant transactional costs attendant to switching regimes.

JMO.