Congratulations to fellow Slug Shannon Brownlee, who's book Overtreated got named "Economics Book of the Year" by The New York Times' David Leonhardt. Overtreated runs through a topic many of you will be familiar with: The excessive quantity of medical services we're prescribed, the weak evidence that more is better in health care, and the need to cut volume and generate stronger data on comparative effectiveness. It's got lots of scary stories and arresting statistics. It is, in sum, totally convincing, and a surprisingly good read. But it's tough. I had lunch with Brownlee a week or two ago, and she wanted to know what the likelihood was that the next round of health reform would do anything to cut care volume. That, in her estimation, is what's needed: In health care, supply is creating its own demand, and so reducing supply -- fewer specialists, CT scanners, etc -- is the first step towards a better, leaner, cheaper system. But reducing volume is political anathema. Pick your favorite slur levied against reform -- "waiting lines," rationing," socialized medicine" -- and what it is, at base, is a reference to a dystopic future in which volume is somewhat more controlled than it is now, and 92-year-olds don't get greenlighted for heart transplants (true story, at least according to a friend at a party the other night, which is the only type of information I really trust). Even HMOs* -- so hated by the public, but basically effective at controlling costs without harming health -- are basically volume-cutting organizations. My overarching theory of reform tends to be that you sell a system that offers health security, full coverage, and a better affordability. Along the way, you integrate it, so more insurance is offered through structures vulnerable to regulation (like federal health markets). And then, with most health care flowing from one place, you can begin experimenting with soft ways to cut volume, like smart cost sharing. But anyone looking for rationing or real cost control in the first round of reform will be sorely disappointed. *Remember not to confuse HMOs with managed care. They're different, but have, sadly, been conflated in the conversation.
