Health Reform – Haste Makes Waste, Less is More, That’s It,  More or Less

Less is more.

Popular aphorism, attributed to the poet Robert Browning (I812-1889), to architect Ludwig van der Rohe (1886-1969), and to series in Archives of Internal Medicine inspired by Institute of Medicine (2010 to present)

We spent about $2.8 trillion on health care last year, and system wastes $700 billion.

Ekekial J. Emanuel, MD, former chief medical advisor to President Obama and now vice-provost at University of Pennsylvania,  “Opinionator: We Can Be Healthy and Rich,” New York Times, February 2, 2013

February 4, 2013 – I love it how health policy types toss off subjective figures liked “$700 billion “ in waste as if it were gospel and not their opinion.  The more prevalent opinion among them is that 30% to 40% of health dollars are wasted, more or less

Says who? Says the Dartmouth Institute of Health Policy.  Says CMS bureaucrats and advisors.   Says academic researchers at Mt. Sinai School of Medicine and U. Of California (Physicians’ Persistent “overuse” of Care Continues,” Cheryl Clare, Healthleaders media,  February 1, 2013), and says the Institute of Medicine who inspired a series of “Less is More” artlcles in the Archives of Internal Medicine.

Examples usually given are these:  PSA screening for prostate cancer in men over 75,  cervical screening for cervical cancer in women over 65, EKGs and CBCs in general physical exams, mammagrams in women over 74, imaging for back pain, antibiotics for URIs,  overuse of medications among the elderly.

What we need , say they,  are more databases or hospital claims data to spot the overuse and overusers of “inappropriate care."

Well, maybe.   But patients want doctors to so “something,” “anything” to show their concern during an office visit.  There are demands that doctors do something in the 10 minutes allotted to them by health plans and Medicare to see enough patients to meet their bottom lines.  And there is a place for routine exams in an aging populations,  particularly in those with vague complaints.  And policy wonks and academic researchers tend to forget there is something called “defensive medicine,” and lack of tort reform, which is constantly on physicians minds and pocketbooks,  should they be called to the stand for not doing something that could have been done.

Tweet:  Critics argue if physicians did fewer routine tests, they could save the system 30%, more of less.