This editorial will appear in tomorrow’s print edition.
When the doctors who make their money from delivering medical procedures say they’re delivering too many of them, it’s time to listen.
Last week, nine medical specialty groups announced an initiative against unnecessary care – for example, MRIs for ordinary backaches, EKGs when the patient has no signs of heart trouble, brain scans for common headaches and antibiotics for virus infections.
These are serious people. They include, among others, the boards of the American Academy of Family Physicians, the American College of Cardiology and the American College of Physicians.
The problem they’re addressing is just as serious. The United States spends more than $2 trillion a year on health care, with costs rapidly rising. Medicare is busting the federal budget; state governments – including Washington’s – are staggering under the weight of their own health insurance costs.
Corporations and privately insured individuals are likewise burdened. Economists are predicting that America will be spending a fifth of its gross domestic product on health care by 2020.
Yet all this spending doesn’t translate into better health. America’s vital indicators lag far behind many countries that spend far less.
A big part of the problem is that much of the treasure this country dumps into clinics, hospitals and pharmacies is simply wasted. People who study the issue commonly estimate that at least 20 percent and as much as 30 percent of the country’s medical spending is unwarranted.
A recent study in the Journal of the American Medical Association, “Eliminating Waste in U.S. Health Care,” focused on six problem areas. The authors found that the cost of overtreatment – such as unnecessary surgery or unwanted end-of-life care – ran from $158 billion to $226 billion in 2011.
Another problem, lack of transparent or competitive pricing, produces bizarrely inflated bills. One notable observation: “U.S. prices for diagnostic procedures such as MRI and CT scans are several times more than identical procedures in other countries.”
The Choosing Wisely campaign launched last week aims to educate both doctors and the public about what treatments might not be necessary, depending on the circumstances and the individual patient.
Physicians, in theory, control most of the spending; if they don’t order a procedure or a hospital admission, it doesn’t happen. In some cases, they aren’t up to date on what heals and what doesn’t. Some – let’s be honest – will do procedures in iffy cases because it pads their incomes.
But patients who pressure their doctors for excess care are also a big factor in overspending. So are the courts; most doctors say they order unnecessary tests for fear of malpractice accusations and lawsuits.
What’s needed is a culture change. The prospect of saving hundreds of billions of dollars a year should be a powerful incentive to sign up with the specialists’ Choosing Wisely initiative.