Chasing long tails in medicine

Economics is defined as the study of the optimal allocation of scarce resources. There is a mindset that when discussions of healthcare intersect with those of economics, there is a tendency to imply that health care should be viewed as something very different where if the laws of economics are somehow applicable, they should be applied differently. However, scarcity matters is all realms, every in healthcare.

Forgetting this tends to lead to decisions where resources are misallocated in healthcare, the logic being that money should not be an object when dealing with someone's, anyone's health. This aspiration is hard to argue against, but it is an aspirational statement, not a practical statement. We do not have infinite resources to invest in anything and acting as though we do or should leads to harm.

Once you get people to accept this as a concept, you still run into problems in translating this into action. Those who operate in healthcare are, with the exception of being monetarily numerate, and otherwise relatively enumerate. Expensive, wasteful, and even dangerous interventions are routinely lobbied for based upon anecdote and anxiety. Interventions found to be statistically justified in selected high risk populations are then advocated for in a more general population.

I view this as a long tail problem. Investing modest resources in a given problem may yield substantial results. Doubling the investment may result in additional incremental improvements, but nothing as substantial as the initial investment. Additional investments run into the law of diminishing returns. However, notable cases highlight that the work is incomplete, and serve as blanket justification for investment of additional resources to bring us closer to perfection.

Chasing long tails is baked into medicine at all levels. Physicians use this to justify more expensive and intrusive approaches to diseases and risk of disease. Regulatory entities use anecdotes to drive increasingly onerous regulatory burdens, all on the basis of safety and quality. The problem is that we apply this logic with tunnel vision and are influenced by the myth that scarcity concerns should not enter into health care discussions.

All roads lead to the original sin of healthcare delivery in the US, that being third party payers. All of this would have never happened if we did not raise an entire generation of physicians and patients within the health insurance bubble. Insulating patients from actual costs allowed us to chase long tails for decades without appreciating the waste. It will be painful for virtually everyone to stop this.