Health care cost control requires saying no to patients


Let’s face it, the best way to cut health costs is to say “no.”

That means denying unnecessary tests that most patients in the United States are accustomed to having.

The New York Times‘ David Leonhardt has the best take on this issue that I’ve read. He acknowledges the difficulty of telling the American public “no,” and cites examples ranging from the breast cancer screening controversy to the managed care backlash in the 1990’s:

This try-anything-and-everything instinct is ingrained in our culture, and it has some big benefits. But it also has big downsides, including the side effects and risks that come with unnecessary treatment. Consider that a recent study found that 15,000 people were projected to die eventually from the radiation they received from CT scans given in just a single year — and that there was “significant overuse” of such scans.

The economic arguments against overtesting simply won’t resonate with patients. Despite the dire forecasts of bankruptcy and Medicare insolvency, “the try-anything crowd occupies the moral high ground … Compared with an anecdote about a cancer patient looking for hope, the economic arguments are soulless.”

He proposes capitalizing on the uniquely American traits of free choice and more control instead. Give patients and doctors the necessary effectiveness data to make their own decisions on whether to undergo a test. Some studies even suggest that patients would err on the side of not testing once all the risks and benefits are known.

As for doctors, the malpractice system shouldn’t punish them for a shared decision that holds back testing, yet results in a poor outcome. Instead of advocating for malpractice caps, I agree with shielding doctors who follow clinical guidelines from liability.

Leonhardt says it will be very difficult to say “no” to the American “yes “culture. But if we can empower patients by providing the information to make their own informed decisions, perhaps we may not need to.


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