Newsweek's Begley: Bring On the Rationing

"Rationing is already here," done by insurance companies, so why not "start rationing useless interventions right out of medical practice?" asks Newsweek's Sharon Begley in a September 2 "Web exclusive" entitled "Health-Care Rationing: Bring It On."

Begley made clear that her complaint is with how patients under the current health care structure can easily order up expensive tests (MRIs, CAT scans, etc.) that she argues are often times wasteful or unnecessarily adminstered (emphasis mine):

[L]et's figure out what treatments and diagnostic tests make a difference to people's health and longevity, and which are insanely overused to no good end. The latter is what we need to ration, restricting their use to the patients and conditions where they can make a difference or abandoning them altogether.

Begley continued with criticism that practically hinted that a government middleman would be better able to "ration" health care efficiently (emphasis mine):

There is a raging debate about why CT and other scans are overused, and a new study in the open-access journal BMC Health Services Research provides some clues, at least in one European country where overuse is a problem much as it is in the U.S. For the study, Kristin Lysdahl and Bjørn Hofmann of the University of Oslo polled 374 radiologists for their views on the causes of the increasing use of radiological imaging. Their top five answers, in order: new radiological technology (my translation: "Ooh, a new toy, let's use it"); patients' increased demands for certain knowledge about their own health (to which I must add that patients seem to have no clue that CT scans do not necessarily tell a doctor anything they can't figure out by other means, or anything that will alter the course of treatment); physicians' lower tolerance for uncertainty (a.k.a. "Let's be sure we cover our backsides so we don't miss something and get sued"); expanded clinical indications for radiology; and increased availability of radiological equipment and personnel ("We have it, so let's use it"). Note that the list does not include "it improves patient care" as a reason for the increased use of CTs.

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The list of overused medical treatments is as long as your arm, and in each case the consequences are felt not only in our collective wallet but in our health. Overuse of antibiotics? Not only does it breed resistant bacteria, but it can camouflage a deadly brain infection in children. How about giving patients beta-blockers in the hours right after a heart attack? Also useless, found a 2005 study, but commonly done. Spinal-fusion surgery? Arthroscopic surgery for osteoarthritis of the knee? Pointless, and pointless.

At the risk of being a broken record, as my mother used to say, we are already rationing, on the basis of ability to pay. How about we start rationing useless interventions right out of medical practice?