The nation’s 47 million uninsured are not the only reason that health care has become a big issue in the presidential campaigns. Besides leaving many uncovered, the U.S. also has trouble controlling the spending habits of a health care colossus that is on track to consume 20 cents of every dollar by 2015, a tripling from 1970 levels. Even back in 2005, the health expenditures for each U.S. citizen exceeded the entire per capita incomes of Chile or Venezuela.

The spending binge is rooted in the nation’s technophilia: medical technology accounts for as much as half the growth in health care spending. Although this trend has benefited everyone—witness the near halving of cardiac arrest deaths from 1980 to 2000—not all those added dollars have been as well spent as drug and device manufacturers would have us believe. Our love affair with next-generation imaging machines, implantable devices and the like has blinded us to the reality that scant evidence often exists for whether something novel works any better than existing equipment, procedures or chemicals.

The recently published book Overtreated by New America Foundation Fellow Shannon Brownlee documents how surgical operations to relieve back pain, elective angioplasties that dilate partially obstructed coronary arteries, and superfluous computed tomography contribute to the $400 billion to $700 billion in medical care (out of a $2-trillion health care economy) that does not better our health. In 2005 the state of Ohio had more MRI scanners than did all of Canada, leading physicians in Toledo to joke about why cars passing by city hospitals don’t swerve out of control because of strong magnetic fields. Yet studies have shown that imaging techniques such as MRI have not improved diagnosis as much as doctors and patients think they have.

Brownlee’s book does not even touch on some ultrahigh tech, such as the University of Texas M. D. Anderson Cancer Center’s $125-million proton-beam facility, replete with a physics-grade particle accelerator, that zaps tumors. Questions remain, however, about whether proton beams are more effective than another form of radiotherapy that M. D. Anderson already offers.

One solution, advocated by Brownlee and some other health policy analysts, is a rejuvenation of the Agency for Healthcare Research and Quality (AHRQ)—or the creation of an organization like it—that would compare different treatments (a mission not within the Food and Drug Administration’s purview). It would be entrusted with comparing the benefits and risks of drugs, procedures and medical devices, while gauging any benefits against costs. The same Newt Gingrich–led Congress that eliminated the Office of Technology Assessment in 1995 almost did away with the AHRQ, which barely survived with diminished funding and powers: it now serves only as an information clearinghouse, not an organization that makes recommendations on Medicare reimbursement decisions.

Several Democratic candidates, including Senators Hillary Clinton and Barack Obama, have endorsed the need for institutes that would lay the foundation for “evidence-based” medicine. For a revitalized AHRQ or a clone thereof to work as it should will require that a new president follow through with adequate funding, an assurance that Medicare (and, as a consequence, other insurers) will consider seriously its findings and, perhaps most important, a Federal Reserve–like independence from the momentary whims of the political establishment. The original impetus to dismantle the AHRQ came after a group of outraged back surgeons objected to the agency’s recommendation that surgery should not be tried before drugs and physical therapy. A watchdog that helps to ensure we pay only for what works, notwithstanding the entreaties of drug companies and equipment manufacturers to do the opposite, will provide a powerful brake on the spiraling costs already choking our medical system.

4 Comments

1. 1. rroto1 12:59 AM 1/28/08

   The government is paying for a large chunk for the medical treatment in the US. It should take the lead by getting out of the medical business. This will drive the cost down.
   The government and other third party payers could take a large chuck out of the medical cost by eliminating medical fraud, increasing the number of medical doctors and eliminating the pseudo-professions. We are paying tons of money for the placebo effect. Pseudo science and its followers the psychologists, herbalists, chiropractors and other hucksters should be banned. What I find really offensive is that non-medical bureaucrats want to tell the medical profession to do.

   Reply | Report Abuse | Link to this

2. 2. John_Toradze 07:19 AM 1/31/08

   Inadvertent duplicate post. (I think they happen from using the back button on my browser.)

   
   
   --
   Edited by John_Toradze at 01/31/2008 11:42 AM

   Reply | Report Abuse | Link to this

3. 3. John_Toradze 07:24 AM 1/31/08

   Physician income has risen out of proportion to other professions, without any real increase in relative education or value. This has been fueled by insurance, which clipped the connection between the consumer and payment. Technologies are expensive, yes, but most of them are minor compared to personnel costs. Our economy is hitting the wall on health care. Something will give. Already, physicians incomes have topped out. But either they have to drop, or they must not keep pace with inflation until similarly educated and valuable professions, like engineers catch up. We will need to triage people, and should be investing our medical care dollars in prevention and with an eye to the probability of society recouping its investment in each patient. The young should get the extraordinary measures, not the old. (And I am old.)

   Reply | Report Abuse | Link to this

4. 4. nucmedtech 03:11 AM 3/8/08

   I am an imaging technologist, and while I agree that there are some areas of overuse in imaging, I think that overall, medical imaging keeps patients from having to have more expensive invasive procedures, multiple biopsies, etc. I also feel that medical imaging allows us to follow patients more closely, and thereby stay ahead of diseases like cancer and other progressive disease processes. By periodically scanning patients in a manner appropriate their disease, we can address problems before they become life threatening, and even more expensive than any imaging procedure would be.
   
   Imaging and technology are being unfairly blamed for our rising healthcare costs. Our healthcare costs are rising because everyone because the focus is on money and not on patient care, life quality, and overall outcomes. Everyone is so worried about how much a scan costs, but what they don't look at is what we would have to do if the scan weren't available.

   Reply | Report Abuse | Link to this