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The "trying multiple approaches" point he makes at the end exists in America, to an extent. It's called federalism. There can be substantial, though not absolut

The "trying multiple approaches" point he makes at the end exists in America, to an extent. It's called federalism. There can be substantial, though not absolute, differences between the laws of the states. Different states value different things, so some will try things before the nation as a whole is ready. If they work, the nation can look to their experiences and try to implement a nationwide plan that has all of those benefits and avoids any pitfalls they experienced. Examples: women's suffrage, universal healthcare, medicinal marijuana even though it's federally illegal, physician-assisted suicide for terminal patients, probably tons more.

izendejas 17y ago
Agreed. The key is to improve the data collection process. To be more scientific, per se, in how we approach state-wide and national problem-solving. To treat other states as controls, etc. What we have now is people citing different stats from oft sketchy sources, to say the least, when they mean they're relying on "the numbers."
isleyaardvark 17y ago
Massachusetts is a relevant example, they passed a state-wide health care reform bill in 2006.
jacoblyles 17y ago
One problem with this system in practice is that the federal government is already so expansive in terms of regulation and tax burden that there is not very much room left for states to experiment in. California and Texas are very different states by some measures, but there are no states without Social Security, No Child Left Behind, the FDA, the War on Drugs or the Patriot Act, all things that I would prefer to do without.
- diN0bot 17y ago
  i'm curious about your qualms with the FDA and what you'd like to replace it with.
  - jacoblyles 17y ago
    FDA liberalization is not exactly a fringe position among economists. The basic argument is that the FDA may kill more people than it saves and may hamper medical innovation in the long run. It's hard to measure counterfactuals, but you can measure the costs of FDA regulation which are huge, about 80% of the cost of a new drug. So the benefits of the FDA would also have to be huge to justify its existence. The arguments are out there if you are curious. You can find people that argue the position better than I can on a Hacker News comment thread.
yummyfajitas 17y ago
We don't need to do this only within the states, we can also just do systematic experiments. Once upon a time, we wanted to determine how much health insurance affected health. So we (and by "we", I mean the RAND corporation) created several different health insurance plans, and randomly assigned people to different plans. From this, we determined that very high deductible insurance lowers costs by 30% (relative to full coverage), but health is unaffected. We have not performed a single experiment since then.

izendejas 17y ago

Agreed. The key is to improve the data collection process. To be more scientific, per se, in how we approach state-wide and national problem-solving. To treat other states as controls, etc. What we have now is people citing different stats from oft sketchy sources, to say the least, when they mean they're relying on "the numbers."

isleyaardvark 17y ago

Massachusetts is a relevant example, they passed a state-wide health care reform bill in 2006.

jacoblyles 17y ago

One problem with this system in practice is that the federal government is already so expansive in terms of regulation and tax burden that there is not very much room left for states to experiment in. California and Texas are very different states by some measures, but there are no states without Social Security, No Child Left Behind, the FDA, the War on Drugs or the Patriot Act, all things that I would prefer to do without.

diN0bot 17y ago
i'm curious about your qualms with the FDA and what you'd like to replace it with.
- jacoblyles 17y ago
  FDA liberalization is not exactly a fringe position among economists. The basic argument is that the FDA may kill more people than it saves and may hamper medical innovation in the long run. It's hard to measure counterfactuals, but you can measure the costs of FDA regulation which are huge, about 80% of the cost of a new drug. So the benefits of the FDA would also have to be huge to justify its existence. The arguments are out there if you are curious. You can find people that argue the position better than I can on a Hacker News comment thread.

yummyfajitas 17y ago

We don't need to do this only within the states, we can also just do systematic experiments. Once upon a time, we wanted to determine how much health insurance affected health. So we (and by "we", I mean the RAND corporation) created several different health insurance plans, and randomly assigned people to different plans. From this, we determined that very high deductible insurance lowers costs by 30% (relative to full coverage), but health is unaffected. We have not performed a single experiment since then.