Thanks for the detailed reply.

Regarding arguments that the allocation of medical resources, particularly in the U.S. are wasteful and harmful in many cases - I agree in general, though the specifics are messy, and I don't find Robin's posts on the matter very well argued*. I'm most interested in this bit:

This is statisticians and efficiency experts and so on trying to apply standard industrial techniques to medicine and getting pushback that looks ludicrous to me. For example, human diagnosticians perform at the level or worse than simple algorithms (I'm talking linear regressions, here, not even neural networks or decision trees or so on), and this has been known in the efficiency literature for well over fifty years

Particularly since your initial claim that had me raising eyebrows was that MetaMed failed because they have great diagnostics, but medicine doesn't want good diagnostics.

Edit: *In the RAND post he argues that lower co-pays in a well insured population resulted in no marginal benefit of health (I'm unconvinced by this but I'd rather not go there), therefore the fact that most studies show a positive effect of medicine is a sham. I'm not sure if he thinks that statins and insulin are a scam but this is a bold and unjustified conclusion. The RAND experiment is not equipped to evaluate the overall healthcare effects of medicine, and that was not its main purpose - it was for examining healthcare utilization. The specific health effects of common interventions are known by studying them directly, and getting patients to follow the treatment protocols that get those results is, as far as I know, an unsolved problem.