Do everything you can, doctor

During a conversation last night with a Scottish friend, it came up that he cannot recall ever having had a blood test.

This may be the primary argument against preventative medicine saving money. Yes, you save a little when you catch conditions early. But think how much money you save by never giving healthy young people tons of blood tests and other largely unnecessary diagnostic procedures.

And how much good do the broad-spectrum general blood tests do people our age? I've had conditions caught very early by blood tests. Luckily this has allowed me, in consultation with my doctor, to . . . wait for symptoms to appear.

Moreover, overall, it's not clear that the health benefits of catching things early through comprehensive screeening outweigh the health costs of superfluous treatment of conditions that weren't bothering the patient all that much. I'm more than fine with spending a great deal of money on screening if it improves peoples' health, but it's not clear to me that this is the case.

Why does American medicine do so many blood tests, X-Rays, EKGs, and so forth? You can't blame it all on lawsuits; my doctor didn't test me for hyperthyroidism because she was afraid of the malpractice suit that would result from my losing too much weight and getting heart palpitations. Nor can you blame it on money; my doctor doesn't profit from giving me blood tests that all come back normal. And I don't think the lack of rational rationing can be the culprit either. To the extent that insurance companies have bad incentives, it should be to do too little, not too much. They should have incentives to ration this sort of thing, but they don't.

I suspect the ultimate cause is the medical culture, which will make this sort of thing very hard to eradicate in either a single-payer or a private system.