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]