Journalist Brownlee blames America’s sky-high healthcare costs on expensive treatments imposed by doctors on patients all too ready to accept or even demand them.
At a time when presidential candidates are asked how they plan to pay for universal healthcare coverage, the author provides reams of data to back up her contention that the real issue is the “dysfunctional, unfair and spectacularly expensive system” we’re already paying for. Unnecessary care is rampant, she concludes. Doctors are coaxed, conditioned or warned that they must prescribe drugs or tests, refer to specialists, put patients in the hospital, operate. If this excessively aggressive approach involves a new drug, device or machine, so much the better: Medicare or another insurer will pay generously for high-ticket items, but not for prevention and advice. Some patients benefit; many do not. Medicare patients living in high-cost, high-care regions are no healthier than their peers in lower-cost, less-care regions. For this conclusion, as for others in the book, Brownlee relies on data from the Dartmouth Atlas of Health Care, an annual compendium that tallies who gets what procedure for what ailment in each region of the country. Overtreatment is a national problem, the author states. Precipitating factors include aggressive physicians; litigious patients ready to sue over any omission; and hospital administrators adding (and filling) surgical wings or ICUs to pay for emergency departments that operate at a loss. Also contributing to the mess are direct advertising to consumers and control of clinical trials by Big Pharma, insufficiently monitored by weak federal agencies charged with regulation and with reviewing the evidence of what works. What to do? Brownlee points to the Veterans Health Administration, which rose from rock bottom in the mid-1990s to become a model health-care provider. Other institutions could achieve similar results, she believes, by implementing a strategy of “CARE”: coordination, accountability, electronic medical records and evidence.
A bombshell of a book: must reading for consumers, their political representatives and all those White House contenders.
