This weekend, I met with Adam and John and we recorded some educational videos for SM (coming soon). It reminded me about the evidence base of many therapies.
Dr. John took to task the Watchman device. We discussed IVC filters. A half dozen chemotherapy drugs came up. Paxlovid, removing the primary tumor in metastatic disease, cancer screening, bone marrow transplant for myeloma, MRIs for dubious purposes, etc. etc. A laundry list of things that don’t work.
Our conversation reminded me of the core challenge in health care. We have some interventions of indisputable benefit, some that are preference sensitive and an ocean of things that don’t work or have harms exceeding benefits— and our system pays for everything, all the same. If anything, the last category puts food on the table.
Different people can agree or disagree on whether health care is a human right— that society should be taxed to pay for. But no one can possibly think people have a right to health care that doesn’t work. No one can possibly believe that we should tax people to pay for IVC filters and watchman’s that do more harm than good. Yet that is precisely what we are doing.
It is clear that federal and state governments are not capable of paying for things that work, let alone prioritizing high value medical services. It is clear that doctors can’t do it either. Patients are often confused about what to believe. Vendors only care about their sales. Hospital administrators are trying to put the profit in non profit.
In such an environment, where we cannot stop interventions that don’t work, where spotting real scientists from snake oil salesmen is a game of Where’s Waldo, the best thing we can do is to stop subsidizing health care.
Health care, as it is practiced in 2026 America, is not a human right. It’s a tax penality on our ignorance and wishful thinking.