And besides, returning to your hypothetical open-heart surgery prescription, even if you were to shop around for the best possible price on such surgery, the price still will not be cheap, because it's a complicated procedure with a long recovery time. Open-heart surgery, we can say, is inherently Serious. Yes, techniques have improved, but it's always risky, as well as expensive.
It's hard to see, for example, open-heart surgery ever being seen as "Routine," because even if the operation could be performed entirely by robots, the mere fact that the surgery involves opening someone's chest makes it complicated, subject to medical Murphy's Law.
And yet more heart treatment has become Routine--because it has evolved into new forms. The need for open-heart surgery has been obviated in many cases, by newer procedures based on newer technologies--angioplasties and stents, for example. And these newer procedures come pretty darn close to Routine.
Two summers ago, former President Bill Clinton, who has had open heart surgery, was hospitalized within chest pains; after a couple stents were implanted, he was released the next morning. Now that's the power of Routine Medicine. Clinton's life was immediately better, and compared to major surgery, whatever was spent on him during that less-than-a-day stay was a bargain.
Down the road somewhere, as those sorts of heart procedures become even more routine, perhaps they, too, could be performed at retail clinics, just as with, say, the Lasik eye procedure. Indeed, some kinds of surgery, aka laparoscopic or minimally invasive surgery , are becoming more Routine as more and more patients receive them on an out-patient basis, This is the process of "Routinization" occurring--that is, as the procedure gets easier to do--often with the aid of technology, such as cameras, lasers, and even robots. The more Routine a treatment is, the cheaper it will be. And, by the way, the treatment will likely be better, as medical science works out the kinks over a "scaleable"population. Our cell phones, for example are better because they have produced in the billions.
Once again, we see the pattern: Serious Medicine is inherently the costly preserve of doctors, medical suites, and hospitals. And that's why it stays expensive, as argued here . Routine Medicine, based on equalling out of Arrow's information asymmetry, is out in the market, hopefully, and so it becomes cheaper and better.
And of course, statin drugs, such as Lipitor and Crestor, are cheaper still. They have saved millions from costly heart procedures--and even more costly death. And as statins can be mass produced and as they go generic, the cost of those life-saving pills will eventually fall down to aspirin-like levels. You can get those Routine Medicines at any pharmacy. And that's a good thing.
So if your doctor says you need open heart surgery, you have a Serious problem. But if he says you need to go a blood-thinning statin, you have a Routine problem.
Routine is good. As Whitehead reminded us, we live by Routine. And, as the Manhattan Institute's Howard reminds us, Routine is cheaper.