...Shannon Brownlee's Overtreated provides a welcome antidote to the narrow view that simply finding enough money to buy health insurance for all the uninsured would solve our health-care crisis. She reminds us that entrepreneurial medicine often drives physicians and other providers to do too much to patients, which can be bad for their health as well as for everyone's wallet. Doctors order costly imaging studies like MRIs and CAT scans when a careful history and physical exam would do. They administer courses of toxic chemotherapy (which account for over half the revenues of many oncology practices) to dying cancer patients in the absence of evidence that it will help. They manage heart disease with invasive procedures when much simpler regimens would work as well.

As Brownlee points out, the culprit here is not just the for-profit free-for-all that American medicine has become. Patients often demand the fanciest technology for its own sake, and physicians sometimes prefer to provide the newest and most complex treatments because they want to do everything possible for their patients. But these desires alone cannot explain the irrational technological exuberance of U.S. health care. Physicians in other advanced nations want to be on the cutting edge, too, and patients everywhere want the best care available. What is distinctive about our system is that it provides economic incentives that encourage doing the most expensive thing all the time to everyone who can pay for it or have it paid for. In most settings, there is little pressure to consider costs, and much reason for physicians, patients, and other decision-makers to maximize expenditures. In the effort to prevent unnecessary expenses, we have introduced new layers of care deniers, who sometimes deny coverage even for appropriate services. And so the world's most expensive health-care system paradoxically provides a great deal of medical care that isn't needed, while people who lack coverage cannot get even the most basic services. Overtreated is a must-read for all those (and there are many) whose main concept of "fixing the health-care system" is buying Blue Shield or Medicare for everyone. ...

For the complete article, please follow this link. Shannon Brownlee is a Fellow with New America Foundation.

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