It is customary for friends of liberty to denounce the New York Times for its left‐wing bias. But it would be a mistake to write off the Grey Lady completely. In fact, with two recent articles on health care, the Times seems to be building the case that our obsession with expanding health coverage is, well, unhealthy.
Yesterday, the Times ran an essay titled, “What’s Making Us Sick Is an Epidemic of Diagnoses,” by three researchers with the VA Outcomes Group in Vermont: Drs. H. Gilbert Welch, Lisa Schwartz and Steven Woloshin. What the authors call “an epidemic of diagnoses” is another way of saying we consume too much medical care. The authors write:
[T]he real problem with the epidemic of diagnoses is that it leads to an epidemic of treatments. Not all treatments have important benefits, but almost all can have harms.
What is behind this epidemic?
More diagnoses mean more money for drug manufacturers, hospitals, physicians and disease advocacy groups. Researchers, and even the disease‐based organization[s] of the National Institutes of Health, secure their stature (and financing) by promoting the detection of “their” disease. Medico‐legal concerns also drive the epidemic. While failing to make a diagnosis can result in lawsuits, there are no corresponding penalties for overdiagnosis. Thus, the path of least resistance for clinicians is to diagnose liberally — even when we wonder if doing so really helps our patients.
In other words, providers over‐diagnose (and are over‐paid) because there is insufficient restraint placed on excessive diagnosis and treatment.
Why is there insufficient restraint in health care but not in other areas? Because government has worked diligently to create tax breaks and subsidies that remove consumers’ natural incentives to curb their consumption. (And yet Republicans and Democrats alike continue to push for even less restraint.)
The authors do offer one mild proposal to address this epidemic:
People need to think hard about the benefits and risks of increased diagnosis…Perhaps someone should start monitoring a new health metric: the proportion of the population not requiring medical care. And the National Institutes of Health could propose a new goal for medical researchers: reduce the need for medical services, not increase it.
The way we usually get people to think about costs and benefits is to let them own the money involved. That’s a prescription for less government.
Today, the invaluable Gina Kolata reports on researchers’ efforts to identify the factors that contribute to a long life. Though there are lots of questions to be answered, Kolata writes:
Year after year, in study after study, says Richard Hodes, director of the National Institute on Aging, education “keeps coming up.” And, health economists say, those factors that are popularly believed to be crucial — money and health insurance, for example, pale in comparison.
Kolata goes on to quote James Smith, a health economist with the RAND Corporation, as saying that health insurance “is vastly overrated in the policy debate.”
Health insurance doesn’t seem to extend longevity. Too much health care can be dangerous. And patients don’t examine the costs and benefits of health care as they should.
It looks like health policy wonks on both the right and the left need to renew their subscriptions to the Times.