This morning I went to the Stockholm Stadsmuseum where they had, among other things, an unremarkable little diorama showing pre-modern health care as practiced in Sweden. Lot pre-modern health care elsewhere in Europe it involved a lot of bloodletting and other bogus practices based on a completely wrongheaded understanding of how disease works.
This is all pretty well-known as a matter of history and science. But it occurred to me that it’s perhaps something worth thinking about in the context of modern health care debates. After all what typically happens when the technology for doing something doesn’t exist is that it just doesn’t get done. People started buying radios when people learned to build radios that worked. Why were all these people buying health care services that didn’t improve health? And what would a health reform debate in 1500 look like? On the one hand, I guess you’d have liberals saying it was really unfair that poor people couldn’t get health care and advocated for taxes and a regulated list of covered services to which everyone was entitled. And on the other hand you’d have free market economists saying that this interference in the market was a terrible idea, was going to lead to rationing, would stifle innovation, etc. Somewhere you’d have a 16th century Shannon Brownlee protesting that actually the doctors were just killing people with their leeches, but nobody would listen to her.
Now obviously modern medicine’s not the same as that. But whatever elements of human psychology—some combination of wishful thinking plus Robin Hanson’s point that we spend on health care for relatives not only because we care but also to show we care—created a viable market in non-cures are still with us. And that’s got to be an important factor in why it’s hard to design satisfactory health care systems. It’s noteworthy when you compare what different countries do that there’s enormous diversity in policy while the diversity in actual outcomes is hard to find and hard to measure.