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Shannon Brownlee, Overtreated: Why Too Much

care delivery that has something in common with

Medicine Is Making Us Sicker and Poorer (New York:

this paper, see John Hammergren, Skin in the Game

Bloomsbury, 2007).

(Hoboken, NJ: Wiley, 2008). The business perspec-

tive also can be found in an interview with author

6.  See, for example, Alex Berenson and Reed

Clayton Christensen in the article by Mark D.

Abelson, "Weighing the Costs of a CT Scan's Look

Smith, "Disruptive Innovation: Can Health Care

inside the Heart," New York Times, June 29, 2008,

Learn from Other Industries? A Conversation with

www.nytimes.com/2008/06/29/business/29scan.h

Clayton M. Christenson," Health Affairs 26, no. 3

tml.

(2007): w288­95, http://content.healthaffairs.org/

cgi/content/abstract/hlthaff.26.3.w288v1.

7. See U.S. Congressional Budget Office, "Evidence

on the Costs and Benefits of Health Information

15. See, generally, Ronald H. Coase, "The Nature

Technology," May 2008, www.cbo.gov/ftpdocs/

of the Firm," Economica, New Series 4, no. 16

91xx/doc9168/05-20-HealthIT.pdf.

(November 1937): 386­405.

8. For more on the role of innovation and third-

16. For a case that the Veterans Administration

party payments in the rise in health care spending,

follows superior practices, see Phillip Longman,

see Arnold Kling, Crisis of Abundance: Rethinking How

Best Care Anywhere (Sausalito, CA: PoliPointPress,

We Pay for Health Care (Washington: Cato Institute,

2007). A broader argument for integrated delivery

2006).

systems can be found in Brownlee.

9. For more on the dire impact of rising medical

17. Lisa Girion, "Kaiser Permanente Gets Perfect

spending on Medicare and the overall budget out-

Four-Star Rating on HMO Score Card," Los Angeles

look, see the U.S. Congressional Budget Office,

Times, November 21, 2008, www.latimes.com/

"The Long-Term Outlook for Health Care Spend-

news/science/la-fi-hmos21-2008nov21,0,504

ing," November 2007, www.cbo.gov/ftpdocs/87xx

8504.story.

/doc8758/11-13-LT-Health.pdf.

18. For more on the potential of markets to

10. See Atul Gawande, "The Way We Age Now,"

improve efficiency in health care, see Michael F.

New Yorker, April 30, 2007.

Cannon and Michael D. Tanner, Healthy Compe-

tition: What's Holding Back Health Care and How to Free

11. Jeff Goldsmith, "Hospital/Physician Relation-

It, 2nd ed. (Washington: Cato Institute, 2007).

ships: A Constraint to Health Reform," Health

Affairs 12, no. 3 (1993): 160­69, http://content.

19. Substituting institutional licensure for individ-

healthaffairs.org/cgi/reprint/12/3/160.pdf.

ual licensure has been suggested before. See Paul

Peterson and Joan S. Guy, "Should Institutional

12. See, generally, Paul Starr, The Social Transforma-

Licensure Replace Individual Licensure?" American

tion of American Medicine (Basic Books, 1982 [actual-

Journal of Nursing 74, no. 3 (1974): 444­47, www.

ly published in January 1983]).

jstor.org/pss/3469623.

13. See Atul Gawande, "The Score: How Child-

20. See Shirley Svorny, "Medical Licensing: an

birth Went Industrial," New Yorker, October 9,

Obstacle to Affordable, Quality Care," Cato Institute

2006; "The Way We Age Now," New Yorker, April

Policy Analysis no. 621, September 17, 2008.

30, 2007; and "The Checklist," New Yorker, De-

cember 10, 2007.

21. Ibid., pp. 7­8.

14. For a "business process" perspective on health

22. Ibid.

9