Today’s NY Times has a terrific op-ed by Rita Redberg MD, a Professor of Medicine at the University of California in San Francisco, that clearly describes the massive waste that occurs in Medicare (and the rest of health care) from incentives for care services that have no basis in evidence. The article provides concrete examples of blatantly unnecessary or incorrect services that have become commonplace and immensely costly, without clinical benefit.
Dr. Redberg has an interesting bio. A Cardiologist, she is Chief Editor of Archives of Internal Medicine. Even more provocative, she “has spearheaded the journal’s new focus on health care reform and “less is more”, which highlights areas of health care with no known benefit and definite risks.”
Please read today’s piece and then rebroadcast to your professional network. In it, Dr. Redberg has encapsulated the core of America’s health care cost crisis. Appreciating this reality is the predicate to changing health care and its threat to the larger American economy.
Care And Cost 
A 89 year old non symptomatic woman in Vermont whom I know was recently told she needed a colonoscopy and had the procedure. Pointless.
OK, Dr. Redberg points out what pretty much any practicing primary care physician knows and lives every day. She might have wanted to add that patients routinely come in with an entire list of tests and services that they want ordered and then become quite upset if the doctor can’t come up with the approriate ICD code to justify payment from either their commercial payer or Medicare. When was the last time a week didn’t go by without having to field an angry phone call about lab tests done as part of a physical that were not covered by a health plan? When was the last time you discussed the lack of evidence supporting PSA use and a patient actually declined the test? When was the last time you had to figure out what your patient heard from Dr. Oz and how to explain that particular test or diet or nutritional supplement? When was the last time you explained to an asymptomatic 40 y.o. male who works out four days per week that a cardiac stress test is not indicated to screeen him for cardiovascular disease? When was the last time you had to review several pages of reports generated from unecessary imaging tests done in a mobile unit in the patient’s office building’s parking lot? I agree Medicare should not pay for unecessary care, but right now the burden of restricting any access to tests or procedures falls heavily on primary care physicians. We live in a medical society where my encouraging medical management over cardiac stents can end-up as a posting on a physician review website as “Don’t see this doctor if you have heart problems!” or as one of those nerve-racking letters of intent.