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When Less Is More In Health Care

03/18/2010 05:12 am ET | Updated May 25, 2011
  • D. Brad Wright Assistant Professor in the Department of Health Management and Policy at the University of Iowa

I cite heavily here from Ceci Connolly's excellent piece in the Washington Post that takes a look at just how much waste there is in the U.S. health care system, and argues that rationing--done right--would actually result in a redistribution of resources that would be a win-win for everyone.

How can this be? Surely, if we take a finite amount of resources and redirect from some in order that others might benefit, that will involve losers and winners, right? Not exactly. You see, the reason why this would work out well is that the country generally has two groups of people: those who get less care than they need and those who get more care than they need. If you balance those groups out, it should be possible to give everyone the care they need. Notice that I said need and not want.

While overtreatment is obviously not a good idea from an efficiency standpoint, the folks being overtreated shouldn't be too quick to defend their right to hold on to all that medical care either, because many studies have shown that overtreatment poses its own risks to health and life. Just think of it like this: Every medical intervention comes with some risk of adverse outcome, no matter how slight. Thus, for every intervention received over and above what is necessary, the risk of an adverse outcome grows in a cumulative fashion. Soon, enough slight risks have been pooled together that something bad happening becomes a very distinct possibility.

Connolly's article cites a finding from the New England Healthcare Institute that determined that "as much as $850 Billion spent on medical care each year 'can be eliminated without reducing the quality of care.'" It'd be bad enough if we just took all that money, put it in a pile, and set it afire, but like I said, it's not that it's just harmlessly wasteful. We're putting ourselves at increased risk through our unquenchable desire for more and more care.

Of course, none of this is to preclude those with the means to pay for it themselves from getting whatever care they desire. This is a discussion about how to spend money that's been pooled--whether through taxation and public spending or insurance premiums and claims. As the American Enterprise Institute's Joseph Antos puts it "If they want to spend their money on [unnecessary care], that's fine. If they want to spend our money on [unnecessary care], we ought to think about it."

Emory Medical School's Dr. Arthur Kellerman sums it up: "In the United States today, we give you all the care you can afford, whether or not you need it, as opposed to all the care you need, whether or not you can afford it." How right he is.
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