As per usual, Robin Hanson's claims that we should cut the provision of medicine in half are, shall we say, a bit strong, but it is true that we've got enormous amounts of waste, and it's undoubtedly true that we should vastly enhance the amount of money we spend studying the effectiveness of treatments.
David Cutler's riposte, by contrast, seems quite on-point. Policy should focus on separating good care from bad care. There's no reason to go at this with a meat cleaver (unless you're Robin Hanson, and have made a career out of, um, "viewquakes," which sort of require you to make Shocking! Claims!) Also, if you are going to cut care, you'll want to do it on the supply side (i.e, with trained professionals helping decide where to slash spending), because all the available evidence shows that patients do not, themselves, know which care to cut, and when faced with higher medical bills, will just cut care indiscriminately.
Lastly, Hanson mentions that medicine is often used to "show that we care," which does not actually increase anyone's health. But medicine is also used to comfort. Take a patient with heart palpitations. Odds are they're just benign skipped beats. A doctor may even know those odds. But when your heart jumps, it's scary. So the doctor runs the set of tests that distinguish them from deadly arrhythmias. These tests are, in Hanson's telling, wasted medicine, as they do nothing to improve biological function and are very costly. But the assurances they offer do much to improve quality of life, which is, along with extending the length of life, rather the point of medicine.
There will always be some level of "wasted" medicine that isn't, at the moment of prescription, sure to be waste (i.e, a diagnostic that could find a deadly disease, but doesn't), and some amount of medicine that's used to calm fearful patients. Neither of those show up on yearly physicals, but nor are they necessarily wasted dollars if your metric is improving patients' quality of life.
