I am busy juggling a few writing projects so in this post, I'm going to give you three dots. You connect them ...
1) David Leonhardt's New York Times column (which I'm assuming many of our readers saw yesterday so not going into detail here) asks, "How can we learn to say no?" in a nation that has a pervasive belief that more care is better care. He argues that the basic task is an educational one: unnecessary care can cause pain and even death. Comparative effectiveness, better decision-making information and tools for patients, and new payment incentives are all cornerstones not only of a lower cost health care system but of better quality care.
2) Lots of coverage of the new JAMA study on unnecessary complex spine surgery. My favorite was by my friend Joanne Silberner at NPR. Despite the mounting evidence that it really doesn't work all that well for most patients AND it has more risks, including life-threatening risks, the surgery is becoming wildly more common. Medicare pays. Surgeons make more money from the fusion procedure. As do the manufacturers of the screws and devices used in those operations. Her story dovetails nicely with Leonhardt's -- here we have the evidence for "no." But we don't have the patient education, nor the payment incentives.
3) Merrill Goozner on his Gooznews blog writes that it's not just what we know and don't know, or why we do things that are not cost effective -- or not effective, period. It's also what we pay for drugs, devices and procedures. The equivalent, he says, of those $600 hammers on the Pentagon's shopping list. He writes:
It's time for health care writers to focus on the prices paid for individual items that go into the nation's skyrocketing health care tab. Remember the "wasteful defense spending" stories like the $600 hammer that appeared a few decades ago? One didn't have to convince Americans that defense spending was bad to get the public outraged about such obvious ripoffs. Health care is an analagous situation. One can spend years trying to convince physicians and patients that this new procedure, test, drug or device that might save or improve their lives really isn't necessary. Or you can spend a half hour showing them that its price is just too damn high. There's an awful lot of $600 hammer health care stories out there for enterprising reporters willing to look.
(By the way, Merrill is contributing to The Fiscal Times, and he's worth reading.)