2. The uneven delivery of health care, which varies from hospital to hospital, region to region.
3. The money spent on ineffective care, using resources for the sake of those resources' continuing existence.*
4. The general unsustainability of expenditures.
5. The holes in our systems of preventive care*, care for immigrants, and care for non-English speakers.
6. The overabundance of specialists.*
7. The philosophical and ethical failures of the current medico-industrial establishment.
8. It all costs too much & we can't afford it (repetition of 4. for emphasis)
9. Other countries do it better.
10. If we give veterans, the old, and the poor evidence-based medicine (or at least we're starting to try) why can't we do it for everybody?×
At the Health Care Blog, George Lundberg picks the following sources of savings, where comparative effectiveness research can help save money while guiding us to the most effective treatment. His confidence that screening mammography doesn't improve mortality seems misplaced (the data isn't clear, and the studies are difficult), and his jab at oncologists is impolitic, but otherwise this is a worthwhile list.
- Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.
- The same for invasive angioplasty and stenting (currently around 1,000,000 procedures per year) saving tens of billions of dollars annually.
- Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions saved here.
- Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions saved.
- CAT scans and MRIs are impressive art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by some capitated or packaged method that is use-neutral. More billions saved.
- We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.
- Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.
devotee of the Kabbalah
who set out to cure the Chlamydia
that is ravaging the koala.
"All my creatures are precious,"
said the Maker of all people,
"but don't forget your esoterica
in the pocket of the marsupials."