This editorial will appear in Monday’s print edition.
An Associated Press series published in this newspaper points to a problem that doesn’t sound like a problem: Too much medical care. The usual complaint is too little.
But as the AP reports, unnecessary treatment can actually threaten patients’ health. Paradoxically, it also threatens access to treatment, because it drives up costs and makes it that much more expensive to extend coverage to the uninsured.
If the new Democratic health reforms can’t rein in overtreatment – which means discouraging excessive procedures, prescriptions and diagnostic imaging – the attempt to provide medical insurance to all Americans medical insurance will sooner or later collapse under the weight of unsustainable costs.
Perhaps the AP’s most glaring example of unnecessary care is redundant or unneeded X-rays.
Of most concern is the overuse of CT scans, which create extremely detailed images of the body’s interior. In doing so, though, they administer radiation doses that can be hundreds of times greater than a traditional chest X-ray – heightening the risk of cancer.
Most of the time, presumably, the image is worth the radiation exposure.
But with many patients, no one seems to be tracking the overall dose from multiple CT scans. And doctors sometimes appear to be substituting imaging technologies for their own trained judgment – which can be considerably more trustworthy than a snapshot of the innards.
Some also use technology to preemptively defend themselves against potential malpractice lawsuits. Responding to a Consumer Reports survey in 2007, 60 percent of the doctors acknowledged ordering tests of one kind or another to keep the plaintiffs attorneys at bay. Sixty-six percent said they’d given in to a patient’s insistence on an unneeded test.
American health care is full of such perverse incentives to provide unneeded care. Medical journalist Shannon Brownlee flushed them all out in her 2007 book, “Overtreated: Too Much Medicine Making Us Sicker and Poorer.”
The culprits include just about everyone: Insurers – including Medicare – pay doctors far more to do surgery and high-tech procedures. Hospitals invest fortunes in high-tech equipment and expansions to lure the super-specialists who bring in the revenues. Pharmaceutical ads encourage people to pester their doctors for costly prescriptions.
The result is a voracious medical infrastructure that must sell procedures and tests, sometimes regardless of need. Studies have demonstrated that communities that see the most procedures aren’t healthier for it – they simply have more specialists and hospitals trying to stay in business.
By some estimates, a fifth to a third of all dollars spent on treatment in this country buys nothing in the way of better health. Some of those wasted dollars actually buy more sickness. This must change if the American health care system is going to be cured.