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As we've been talking about the need for comparative effectiveness review over the past few days, I've been remiss in not linking to Shannon Brownlee's excellent Washington Monthly article detailing how the orthopedic industry partnered with Gingrich's Republicans to neuter the Agency for Health Care Policy and Research, a government group that had the potential to act as a comparative effectiveness review board. The whole article is great, and I urge you to read the whole thing. But I'm going to quote these three paragraphs as one of the clearest explanations of what's wrong with our health care delivery -- as distinct from insurance -- system:
Last year, we spent more than $16 billion on back surgeries, and, in the past decade, surgeons have been performing spinal fusions at a furious rate, even though there still has never been a rigorous, independently funded clinical trial showing that going under the knife is superior to cheaper, less invasive remedies. At the same time, the nation's total health care bill continues to skyrocket, propelled in no small measure by procedures that are equally as questionable as spinal fusion. In 2000, America spent $1.3 trillion, a figure that nearly doubled to an estimated $2.1 trillion by 2006. In the view of Peter Orzag, head of the Congressional Budget Office, this has put the U.S. on "an unsustainable fiscal path."Of course, some of our money is going toward new treatments and tests that help Americans live longer and healthier lives. However, as much as 30 cents on every health care dollar is spent on unnecessary care—or "overtreatment," in medicalspeak. That may sound odd after all we've heard from people like Michael Moore about how everybody from your hospital to your insurer is getting rich by denying you care you need. Yet both problems exist simultaneously. All too often, patients don't get necessary medical treatment. At the same time, we risk being given stuff that not only doesn't improve our health but which may actually harm us. One estimate suggests that as many as 30,000 Medicare recipients die prematurely each year from unnecessary care.This overtreatment is due in part to an excess supply of medical resources-hospital beds, intensive care units, specialists, CT scanners—in many parts of the country. But it is also the result of our national failure to fund the research that could show what works in medicine, what doesn't, and for which patients—and then to train doctors to understand that research and use it. Our current fee-for-service payment system, which pays hospitals and doctors for each hospitalization, office visit, procedure, test, and surgery performed, simply gives providers an incentive to adopt anything that's well reimbursed, regardless of whether it actually helps patients. Medicare pays for practically anything that physicians deem "medically necessary," much of which, from spinal fusion to a fancy new imaging scan for Alzheimer's, remains unproven by anything resembling good scientific evidence.But we've still got the best health care waiting rooms in the world!
