"Overtreated" Says Too Much Healthcare Is Bad For Us

The general theme of the book “Overtreated,” the New York Times’ pick for best economics book of the year, is that we can cut a significant percentage of our health care costs—”between one fifth and one third,” says the author—and not have any impact on our level of health. As a nation, we tend to err on the side of too much treatment, exposing ourselves to unnecessary risks and racking up fees on procedures we could do without. And since doctors depend on a piecemeal approach to earning income, while at the same time dealing with significant financial risks from malpractice suits, they tend to push for more treatment, not less (they need to earn a living while also protecting themselves from accusations of doing too little).

One reason the Times selected the book is that, unlike so many “problem” books, it provides a series of possible solutions at the end.

It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now. Research has shown that patients frequently decide against marginal care when they know the true risks and benefits. Malpractice laws would also need to be changed so doctors were not sued by patients who later changed their minds.

Other solutions would be more difficult—because medical evidence is often murky, because hospitals and insurers would fight to keep their revenues and because most Americans think it’s the other guy who’s getting unnecessary treatment. These are the reasons that presidential candidates don’t focus on wasteful treatment.

But models for reform are out there. Hospitals that don’t use the fee-for-service model, like those run by the Veterans Health Administration, are already getting better results for less money. They closely track their performance—that is, the health of their patients—and motivate employees to improve it.

“No. 1 Book, and It Offers Solutions” [New York Times]

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  1. num1skeptic says:

    well obviously this author knows everything.

  2. smitty1123 says:

    I takes something like a bone sticking out of my skin before I’ll even think about going to the doctor.

  3. I wonder if this is like the anti-bacterial soap discussion: you’re not supposed to use it because it creates super-powered mutant bacteria.

    The whole system is a helluva sanity test: drug companies creating “syndromes” to sell their medicine, news casts scaring the spit out of the average consumer, elitist doctors treating you and then sending you home with a “good luck.”

    I think my Prozac’s wearing off…

  4. char says:

    @num1skeptic: Not sure exactly how the authors knowledge of “everything” has any application.

    Unless this is reverse sarcasm meant to mock those who will inevitably call out the author for some pointless reason.

    God internet, you confuse me :(

  5. Amelie says:

    I’m sure the 45 million people without health care are really keen to pick up that book. If costs are cut, the insurers and doctors will pocket the savings, rather than make health care available to all.

  6. hubris says:

    I have to be on my death bed before I’ll go to the doctor. I was raised to think, and very much believe, that millions of years of evolution have given us a hell of a machine meant to last a long time. Sure, medicine is incredible, and has lengthened human lifespan significantly and not to be discounted. However, the kneejerk “oh god, my kid has the sniffles, time to go to the ER” or “oh no, I have a papercut, better throw some antibiotic cream on so my immune system doesn’t have to do any work” are what’s making us sicker as a nation.

    If more people “sucked it up” we’d be in a much better position.

  7. hubris says:

    @zouxou: No one’s saying anything about genuine, necessary healthcare. Of course everyone should be insured and covered. But having coverage doesn’t mean you should use it every time you get a headache.

  8. DrGirlfriend says:

    ” (they need to earn a living while also protecting themselves from accusations of doing too little).”

    I think this is a valid point. I’d probably read this book just to get a better handle on this guy’s argument before saying anything one way or another, but I do agree that it’s not just patients who are in a tricky situation in this country. Doctors walk a really fine line as well. To wit, the growing decrease of doctors going into OB/GYN specialites, due to ever-increasing malpractice insurance premiums in that particular area.

  9. mamacat49 says:

    “because most Americans think it’s the other guy who’s getting unnecessary treatment”>>> and that’s the real issue. No one wants to be the guy NOT getting the blood test, or the x-ray or the crazy $$$MRI if it might do some good. Most of what I do(Radiology) is totally unnecessary and negative, but patients want us to do something (anything!) just so they feel like they “got their money’s worth.” Until patients stop demanding treatment, and the lawyers are sitting outside of the hospital doors just waiting for the one poor sap who feels “mistreated,” it will only get worse.

  10. Xerloq says:

    @mamacat49: It’s not just patients demanding unnecessary treatments – it’s doctors prescribing unnecessary ones, as well. My kid occasionally gets the sniffles which have thus far synched with a few of his well-baby visits. Each time the doctor prescribed Zithromax – even if he suspected it was a virus – just in case. Breeding super-bacteria indeed.

    Patients need to treat their insurance benefits as if it were their own money. It’s too easy to forget the multi-hundred dollar premium (matched threefold by your employer) and think your paying only $10 or $20 bucks a visit. Any time we see the doctor, we ask, is there a cheaper alternative that would give the same results?

    Go get an MSA. It’ll help you avoid over-treatment.

  11. Vicky says:

    I always think so much money and frustration could be saved if I didn’t have to go to the doctor in the first place – it doesn’t even require a reduction in care. Prime example: birth control pills. I’ve been taking them for 14 years now, amounting to about 13 too many visits to a doctor to get my prescription refilled.

  12. Chrome says:

    Working in a hospital in a primary care position, I frequently see doctors practicing “shotgun medicine.” The theory behind it is throw enough tests/medications at an illness and you’re bound to find/treat something. I don’t know the author or their credentials, but from he title alone, sounds like someone finally “got it.”

  13. Curiosity says:

    Brownlee is not the only person who actually applies economics to healthcare (unlike political candidates … Note [pewforum.org] and [www.health08.org])

    For the ideas in the book (for free) via podcast I would (and have) listened to:

    Arnold Kling on the Economics of Health Care and the Crisis of Abundance [www.econtalk.org]

    And perhaps more interesting:
    Hanson on Health
    [www.econtalk.org]

  14. Curiosity says:

    Also people should note Hason’s Blog As well as the Rand experiment at
    [www.overcomingbias.com]

    “The bottom line is that thousands of people randomly given free medicine in the late 1970s consumed 30-40% more medical services, paid one more “restricted activity day” per year to deal with the medical system, but were not noticeably healthier! So unless the marginal value of medicine has changed in the last thirty years, if you would not pay for medicine out of your own pocket, then don’t bother to go when others offer to pay; on average such medicine is as likely to hurt as to help.” states Hason from the 1983 New England Journal of Medicine – The Effect of Coinsurance on the Health of Adults [www.rand.org]

  15. kittenfoo says:

    back when i was gainfully employed with a company that had insurance benefits, this time of year, every year, you would see families scrambling to the eye doctor so they could get their “free” glasses or contact lenses. which weren’t really “free” of course.

    yes, there are definitely overusers out there. one of my former in-laws enjoyed poor health all her life, and her biggest hobby is going to the doctor so she’ll have lots of new horrific medical details to share with anyone who’ll listen.

    then there are the 45 million uninsured. i’m one of them. i basically don’t get medical care, except for the services of an ADD-addled general practitioner who’s so batty he doesn’t remember one patient from the next, so you just have to “remind” him that he promised to prescribe you (fill in the blank): birth control, vicodin, valium, whatever. i have no faith in doctors any more. None.

  16. bohemian says:

    There are two things going on at the same time. People not getting needed healthcare and people getting not needed healthcare. It depends on the condition and the doctor.

    I had a doctor try to convince me to get a cat-scan of my head because my allergies were driving me crazy in May when everything blooms. It would have been $900 and about $200 out of my pocket. He provided no compelling signs that merited getting said cat scan when I asked him. Nothing I had pointed to a possible sinus issue and I get allergy issues every year at the same time, I just need a new prescription. Conveniently this private specialty clinic had just bought a brand new state of the art cat-scan machine for their office.

    I had the same thing with a podiatrist. He diagnosed a heel deformity and told me my only option was to have major orthopedic surgery where they saw off your heel, take a chunk out and put you in a cast. I would be off my feet for a month while this heals and he mentioned no other options or what the risks involved were. I went home and did some research. As long as I mostly wear open back shoes it won’t be an issue or a risk to further damage.

    Change what kind of shoes you wear.
    OR
    $20,000 orthopedic surgery and a month of being laid up.

    Yet I can’t get my health insurance to cover two rather basic medications I need to keep me able to function on a daily basis.

  17. BlondeGrlz says:

    @Vicky: My doctor’s office just opened a nurse-run drop in clinic wher they’ll refill birth control, check your kids sniffles, do a pregnancy test, and other stuff you don’t really need a doctor for. But military-run healthcare has always been hit or miss as far as quality.

  18. Amy Alkon says:

    @omerhi:

    I have to be on my death bed before I’ll go to the doctor. I was raised to think, and very much believe, that millions of years of evolution have given us a hell of a machine meant to last a long time.

    Do you think people lived to be 85 during the Pleistocene? Not going to the doctor is idiotic.There are cancers people get if they live long enough, to name one example, and they needn’t be deadly — providing treatment comes in time.

    I suggest approaching doctors’ recommendations with skepticism, but the average person (who has no experience reading studies, and even somebody like me, who reads studies for work) is going to have a hard time understanding what is good data and bad.

    To name two examples where the public has been sold a bill of goods, there is indeed danger from silicone breast implants (see the work of UCLA’s Sander Greenland) and the connection between passive smoking and cancer has been fudged. (See the work of Carl V. Phillips and James E. Enstrom.)

  19. Gopher bond says:

    I’m so thankful I live in a small town with a doctor and dentist who take cash payments for minor health care. The costs are trivial when done outside the system. They probably don’t report the transactions since I think it’s against the law, but I don’t blame them for it. I don’t have healthcare but I can easily afford the preventative upkeep.

  20. Curiosity says:

    @testsicles:
    It is actually not outside the law, of course unless they don’t pay the IRS.

  21. clevershark says:

    Overspending on treatment seems like a natural side effect of profit-based health care, where you’re a customer as well as a patient and your health care provider is, by extension, also a salesman.

  22. bohemian says:

    Something that other countries do that could help cut down on health care costs is to change the way we distribute drugs.

    The drug companies resist allowing things like some of the newer allergy drugs to go OTC for various reasons. There have been similar debates over oral contraceptives, statin drugs, certain NSAIDS and the like.

    In some other countries they allow pharmacists to prescribe certain drugs the people take long term or have lower risk factors. I can’t even imagine how many hundreds of dollars I have wasted having to go see a doctor for no reason other than to get another allergy script because my current one was only for a year or I moved and now need a new script. I am so glad Zyrtec is going OTC, they need to make Allegra OTC because it is already a generic.

  23. TMurphy says:

    I would like to see malpractice worked out so doctors don’t have to be so paranoid about everything. With enough slack there, we should be able to then add legislation increasing the penalties for wasteful treatment. I’m sure a more federalized healthcare system would allow defrauding the government to be brought up as a charge. I don’t want to force a shortage of doctors, but I don’t want a family to be unable to afford their child’s wheelchair or physical therapy because the insurance company can’t cover them because they’ve been paying for millions of unnecessary prescriptions (or rather they can’t afford it because they won’t have enough profits for the CEO to buy a new yacht).

  24. Techguy1138 says:

    It seems much of this boils down to patient education.

    Being healthy requires quite a bit of knowledge and effort. Public schooling needs to concentrate on issues like how to treat minor wounds,basic first aid, and when to go to a doctor.

    Some things are necessary like seeing an eye doctor yearly,seeing a dentist,getting a physical or getting prescriptions refilled.

    Some things are not, like going to the ER because you are achy.

    Doctors also need to take the time to do research themselves. Most doctors only think about their patients when they are right in front of them. They see what you have look up something while the nurse is with you and give you a prescription.

    Time also needs to be taken to educate patients. It’s always up to the patients to decide on the best care, doctors only give advice.

    Educated patients and active doctors would increase the quality of health and life for many. To bad that doesn’t pay.

  25. PracticalMagic says:

    I have really good insurance. But my doctor complains to me (I’m female) that I go to the doctor about as well as a male. I don’t like going, and I don’t believe in being over medicated, or taking even aspirin unless I absolutely need to. I get my physical once a year, and everything is always fine. So why waste my ins. payments, and co-pays? Let some other hypochrondriac pay for his/her niceties in life.

  26. emt888 says:

    I am a graduate student at a fairly large university and I have the student insurance. This means that I have to go to the student health center for treatment. I am in good health, but earlier this year I could feel myself getting a sinus infection (I get 1 every 1-2 years). I thought I would pop into the health center and maybe (if needed) get an antibiotic for the infection. Instead, the doc wanted me to get sinus x-rays to make sure it was an infection, which would have cost me $200. He also wanted to put me on high blood pressure medicine since my BP that day was “borderline.” I explained to him that I was in the middle of mid-terms and my mom had recently died, so I was just stressed out and didn’t need long-term medication. After mentioning that my mom had died, the doc also wanted to put me on depression medications! He never did a depression assessment and he had talked to me for all of about 3 minutes. I walked out with no medications and finally used a neti pot to help with my sinuses.

  27. kimsama says:

    The big problem with this argument comes from the fact that if the author had done any research at all, they’d have discovered that countries with people who run to the doctor for everything, like Japan, have people who are ridic healthy and live forever. When I was there, people largely credited their health as a whole to the fact that people went to the doctor everything — colds, flus, coughs, etc — and so the doctor could help them catch problems early and could help them make preventative changes.

    Let’s face it, this is not the problem with healthcare in America. The problem is that many people wait, or are forced by lack of insurance to wait, until their conditions are expensive and hard to treat. And insurance companies bargain the fuck out of rates and leave the uninsured to make up for the lost $.

  28. SaraAB87 says:

    I don’t like going to the doctor either. Heck those offices will make you MORE sick rather than help you heal the illness that you originally came there for.

    My blood pressure is VERY normal at home, in fact its probably lower than the average blood pressure if I take it on any given day. It goes up when I go to the doctor because I am so sick of going there that I get nervous that they are going to find something wrong with me or make me go back again just to get my pressure checked. There are things such as home blood pressure monitors and the ones at the stores, you don’t need to go to the doctor to get your pressure checked.

    I have to be on my death bed to go to the emergency room (unfortunately I have had to go twice in my life for this exact reason), and even if you get put in the hospital, you should crawl out of there as soon as possible for fear of coming out of there with more illnesses than what you came in with.

  29. Catperson says:

    @emt888: This reminds me of the time I went in to my doctor because I wanted to start exercising and modifying my diet for weight loss and you always hear that you should see a doctor before starting any weight loss program. I left his office with a prescriptions Synthroid and Xenical to help me lose weight and a prescription for Wellbutrin because I said I was tired a lot. I’m sure I was just tired because I had been eating poorly, and I was fat for the same reason. I just wanted to make sure I was in good enough health to start exercising and eating a low calorie diet, but this this guy loaded me up with pills. I used them for a week until I realized that I didn’t have to take them just because the doctor said so and I never went back to him.

  30. nevergod says:

    i hate going to the doctor, and personally, have only really been 3 times in my life after the age of 13.

    once for a sprained wrist, once becuase i got an infection in my finger from a lobster trap, and once for a physical before college.

    people these days RUN to the doctor for anything and they load people up with pills. People are loosing the immunities that we built up over the years as kids playing in the dirt and not worrying every time a kid eats some dirt or something. i’ve never been sick in my life and i certainly wouldn’t run to the doctor everytime i caught something or wanted to diet, let your body do its thing. drugs only make us weaker in most cases, obviously there are exceptions for things like cancer and MS and the like but i find it hard to even take asprin for headaches.

    proper diet and exercise and a well lived life will cure you!

  31. Rusted says:

    @nevergod:Uh yeah, who needs yearly check ups? So what if a spot on the skin turns into an oozing sore. I’ll never get (name your favorite type) cancer, ever!

    Guess I was a wuss for getting an hyphema looked after.

  32. Curiosity says:

    @kimsama:

    Have you read the book? In fact most economists actually use data from other nations – including Japan.

    Irrespective of what the people whom you associated with credited their health care to, I would be interested in some scientific study that doesn’t rely on personal testimony but on scientific method, screening for biases, and statistical methods that supports your point.

    You know something less mumbo jumbo than “Bob said it was true therefore it must be.” Moreover I encourage you to apply this method to the book.

  33. ceejeemcbeegee is not here says:

    @omerhi: I don’t know… I’ve watched countless family members die from treatable conditions because they were busy “sucking it up.”

    Please don’t confuse common sense with outright stubbornness.

  34. ceejeemcbeegee is not here says:

    Here’s what I don’t get: If I’m paying my premiums every month out of my pocket, why shouldn’t I go to the doctor every time I feel like it? I still have to write my 20% check, no one else’s “tax dollars” are being used here, so why not utilize the services I pay for?

  35. Heartnrizingson says:

    If we research our “illnesses” and understand what is going on in our bodies when we have them, we could make choices that would solve a hug chunk on the problem. The conventional doctors are to be used as a resorce, not as an overseer of our health and wellness. That is our job. With all the information out there we have no excuse for not getting what we need to stay or get healthy. If your doctor is a drug pusher or knows better than you whats best for you and will not work with you, get a new doctor!

  36. RvLeshrac says:

    @ceejeemcbeegee:

    This is where the crux of the problem lies. In the US, we go to the doctor because we’re paying for it no matter what. We take the treatment because it is often less expensive than risking missing work/etc. Doctors prescribe treatments that are ineffective or just ‘too much’ for the symptoms because their income depends on it.

    In countries with a NHS, they go to the doctor just as (or more) often, the difference being that the doctor doesn’t prescribe useless or worthless treatments – they don’t have any financial incentive to give you *MORE* than the necessary treatment, and it actually wastes time they need to spend helping those who are actually ill and need more care.

    Ironically, of course, this is the polar opposite of what the anti-national-health-care twats want you to believe.

  37. Xerloq says:

    @ceejeemcbeegee: The issue is that your company is probably matching two to three times your premium, and (depending how the plan is structured) they pay each time you visit the doctor. The more you go, the more it costs the company and your insurance plan. They don’t care, though, because next year they raise your premiums to make up the differences. You don’t care, because you feel a sense of entitlement because ‘you paid for it.’

    Theoretically, visiting the doctor less frequently would eventually result in health care costs decreasing.

    I still advise, get an MSA.

  38. bustit22 says:

    @RvLeshrac:
    There is no incentive for a doctor to give you more than the necessary treatment in a national health care system? WRONG!

    In a national healthcare system like Canada’s, doctors still make more money by providing more services.

    For all those people who hate it when an insurance company gets to decide who gets treated and who does, move to Canada, when it’s the GOVERNMENT who decides who gets treatment who doesn’t.

  39. kimsama says:

    @Curiosity: Well, lovely. I guess I should have mentioned I was in Japan because I was in university there, and I took multiple courses on the sociology, history, psychology, and culture of Japan. That included research on the history of health care in Japan. My colloquial observations are merely a confirmation of the dominant view of healthcare in Japan.

    P.S. No one is named “Bob” in Japan, so there! : P